What is Zoloft?
Zoloft is a brand name for prescription medication sold under the generic name Sertraline. Zoloft is an oral tablet and a typically prescribed medication for depression, panic, anxiety and obsessive-compulsive disorders. Zoloft is classified as a specific type of antidepressant called a Selective Serotonin Reuptake Inhibitor (SSRI) [1, 2, 3, 4]. The active substance contained in Zoloft is the ingredient Sertraline. Sertraline is what causes Zoloft to act as an antidepressant [2, 4].
What does Zoloft do?
Zoloft is prescribed for a long list of mental health problems, including obsessive-compulsive disorder (OCD), major depressive disorder, panic disorder, social anxiety disorder, post-traumatic stress disorder (PTSD), and premenstrual dysphoric disorder. It’s often prescribed alone or with other drugs and therapies [1].
Zoloft is also prescribed for children aged 6–17 years to treat OCD [4]. The drug’s effects are achieved by increasing the level of serotonin – a neurotransmitter distributed throughout the brain that maintains stability and reduces the symptoms of OCD and depression [5].
What is the Menstrual Cycle?
The Menstrual Cycle is the normal monthly cycle in women with a uterus and ovaries. It is a complex feedback system of hormones, primarily including estrogen and progesterone, preparing someone for pregnancy every month. The cycle lasts approximately 28 days, and heavy bleeding typically lasts 4-5 days [6].
Every month, the uterus thickens its lining so that, if fertilization happens, it will be ready to care for a fertilized egg. At the same time, one of the ovaries creates an egg (which is released – or ovulates – from its follicle). When this does not result in either a pregnancy or a miscarriage, the levels of estrogen and progesterone drop, the thickening is no longer needed, and the thick lining and some blood are shed, leaving what’s medically known as a menstrual flow but also as a period [7, 6].
What Causes the Menstrual Cycle?
Hormonal changes dominate the cycle. Luteinizing hormone-releasing hormone (LH-RH) is produced in the neurons of the brain in a pulsatile manner at set times. This release causes the secretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) by the pituitary gland then induces the ovarian synthesis of estradiol (a form of the estrogen family). FSH allows it to activate LH [8].
Rising estrogen levels thicken the uterine lining (endometrium), in case an egg is fertilized. If the egg is not fertilized, the lining is shed along with estrogen and progesterone in the second half of the cycle, resulting in menstruation [7, 6].
A peak LH concentration induces ovulation, the release of an egg from the ovaries, but this process is also triggered by appropriate progesterone levels: progesterone produced after ovulation by a temporary endocrine structure (the corpus luteum of the ovaries) acts through negative feedback mechanisms at the hypothalamic level and helps to regulate the cycle [8].
Does Zoloft affect the Menstrual Cycle?
Zoloft, also known as sertraline, is part of the class of selective serotonin reuptake inhibitors (SSRIs) that are widely used to treat depression, anxiety and other conditions, such as a disorder called premenstrual dysphoric disorder (PMDD).
Zoloft may affect the menstrual cycle in some women, though the evidence is mixed. Zoloft seems to affect menstrual cycling around PMDD.
PMDD is the severe subtype of PMS; it is defined by negative mood symptoms that are markedly exacerbated in the luteal (premenstrual) phase of the cycle, occurring in 5-8% of women of reproductive age. Sertraline was approved by the US FDA for the treatment of PMDD, and there are reports of clinical response to therapy within a few days of initiation of the treatment [9].
One study focused attention specifically on the incidence rate of antidepressant-related menstruation disorders and found that the incidence of menstrual disorders was much higher in the antidepressant group (24.6%) than in the control group (12.2%). The proportion of antidepressants causing menstrual disorders was highest for paroxetine, venlafaxine, Sertraline and their combined use with mirtazapine [10].
Another study portrayed that sertraline increased significantly the pregnanolone serum levels and the pregnanolone: progesterone in the luteal phase of women with PMDD, which may indicate that Sertraline can increase the levels of neuroactive steroids that modulate the activity of GABA at the GABA-A receptor in humans, which in turn may influence the menstrual cycle [11].
Side effects of Zoloft on Menstrual Periods
There is no specific information which associates the impact of Zoloft on the human menstrual cycle and there is no available literature linking these two factors together, but there are other factors which have similar aspects, which discuss a possible relationship between Zoloft and Menstrual periods.
In one study of the SSRI fluoxetine (Prozac is also an SSRI), 15% of women taking a high dose switched to having longer cycles, compared with 6% of women taking a lower dose and 3% of women taking a placebo [12] — but this study did not concern Zoloft in particular, and the effects of different SSRIs can exhibit different effects.
Moreover, some psychotropic drugs impact the Menstrual Cycle and can reduce pregnancy potential.
Generally, SSRIs can manifest sexual side effects, which might ultimately affect the Menstrual Cycle – decreased sex drive and trouble reaching orgasm [2], but these side effects were not directly linked to the Menstrual Cycle.
Conclusion
In conclusion, while some SSRIs are linked to menstrual cycle change in a small number of studies, the link between Zoloft and Menstrual Cycle change is tenuous. Therefore, more research must be conducted to provide more promising information.