Premenstrual Dysphoric Disorder (PMDD) is a cyclical mood disorder tied to the menstrual cycle, characterized by severe emotional and physical symptoms that significantly disrupt daily life. While the exact cause is unknown, experts believe it stems from an abnormal brain reaction to normal hormonal changes, particularly involving serotonin. Effective treatment often involves a combination of medication, therapy, and lifestyle adjustments tailored to the individual's needs. A doctor's treatment plan depends on the severity of symptoms, whether contraception is desired, and individual patient responses.
First-line medications for PMDD
For most people with severe PMDD, a doctor will first prescribe either a Selective Serotonin Reuptake Inhibitor (SSRI) or a specific type of hormonal contraceptive. These are considered the standard first-line options due to their proven effectiveness in treating PMDD symptoms.
Selective Serotonin Reuptake Inhibitors (SSRIs)
SSRIs are antidepressant medications that work by increasing serotonin levels in the brain, which can stabilize mood. They are a particularly effective treatment for PMDD's emotional symptoms like irritability, mood swings, and anxiety.
FDA-approved SSRIs for PMDD include:
- Fluoxetine (Sarafem)
- Sertraline (Zoloft)
- Paroxetine (Paxil)
Other SSRIs sometimes used off-label include:
- Citalopram (Celexa)
- Escitalopram (Lexapro)
SSRIs can be prescribed in different ways for PMDD:
- Continuous dosing: Taken every day throughout the entire menstrual cycle. This may be more effective for those with persistent or severe depressive symptoms.
- Luteal-phase dosing: Taken only during the two weeks leading up to menstruation and stopped when the period begins. This approach may minimize side effects, as PMDD symptoms are typically limited to this phase.
Hormonal birth control pills
Some oral contraceptives can provide relief by suppressing ovulation and stabilizing hormone levels. For women who also want contraception, this can be an ideal solution. The specific combination pill containing drospirenone and ethinyl estradiol (Yaz) is FDA-approved for treating PMDD. It often uses a cycle designed to minimize hormonal fluctuations. However, hormonal treatments' effectiveness can vary, and some individuals may experience worsened mood.
Second and third-line treatment options
If first-line therapies are ineffective or contraindicated, doctors may consider other options.
- Gonadotropin-releasing hormone (GnRH) agonists: For the most severe and treatment-resistant cases, GnRH agonists like leuprolide may be used to temporarily suppress the menstrual cycle, inducing a reversible menopause. Due to potential side effects like bone density loss and menopausal symptoms, this is typically a short-term, last-resort option.
- Anxiolytics: Medications such as buspirone or benzodiazepines like alprazolam may be prescribed for severe anxiety. However, routine use of benzodiazepines is discouraged due to the risk of dependence and inconsistent efficacy.
- Diuretics: For women with significant bloating and fluid retention, a diuretic like spironolactone may be used, often during the luteal phase.
- Nonsteroidal Anti-inflammatory Drugs (NSAIDs): Over-the-counter NSAIDs like ibuprofen or naproxen can effectively manage the physical symptoms of PMDD, such as headaches, joint pain, and cramping.
Non-pharmacological approaches to support medication
Medication is often most effective when combined with lifestyle and psychological support. A doctor may recommend:
- Cognitive Behavioral Therapy (CBT): This form of therapy can help manage emotional symptoms and develop coping strategies for dealing with PMDD's impact on daily life.
- Dietary changes: Reducing caffeine, alcohol, and salty foods can help with anxiety, irritability, and bloating. Consuming complex carbohydrates may also stabilize mood.
- Regular exercise: Aerobic activity has been shown to improve mood and energy levels.
- Nutritional supplements: Though evidence is limited, some studies suggest that calcium may help with physical and emotional symptoms, and vitamin B6 might also offer benefits. Consulting a doctor before starting supplements is recommended.
Comparison of common PMDD medications
| Treatment Category | Examples | Dosing Schedule | Primary Target Symptoms | FDA Approval for PMDD | Potential Side Effects |
|---|---|---|---|---|---|
| SSRIs | Sertraline, Fluoxetine, Paroxetine | Continuous or Luteal Phase | Mood swings, irritability, depression, anxiety | Yes (specific drugs) | Nausea, sexual dysfunction, headache, insomnia |
| Hormonal Contraceptives | Drospirenone/ethinyl estradiol (Yaz) | Continuous Cycle | Emotional and physical symptoms | Yes (Yaz) | Blood clots, irregular bleeding, breast pain |
| GnRH Agonists | Leuprolide (Depot) | Monthly injections | Ovulation-related symptoms | No, used off-label for PMDD | Menopausal symptoms, bone density loss |
Finding the right treatment with your doctor
Because treatment for PMDD is highly personalized, working closely with a healthcare provider is essential. Keeping a detailed symptom diary for a few cycles can help accurately pinpoint the cyclical nature and severity of symptoms. When discussing treatment options, it is important to communicate all your symptoms and any previous attempts at managing them. Your doctor will help you weigh the pros and cons of different medications based on their potential effectiveness for your specific symptoms, side effect profiles, and any other health conditions. Finding the right solution may take time and collaboration.
Conclusion
Understanding what medications a doctor will prescribe for PMDD empowers patients to take an active role in their treatment. SSRIs are the leading choice for managing emotional symptoms and can be taken daily or intermittently. For those seeking contraception, specific oral contraceptives like Yaz are FDA-approved and may effectively address both physical and emotional symptoms. In severe cases, other hormonal treatments or anxiolytics may be considered. Ultimately, the most successful treatment for PMDD combines medication with non-pharmacological support and is developed through a close partnership with a healthcare provider.
For more detailed, peer-reviewed information on PMDD diagnosis and treatment, visit the International Association for Premenstrual Disorders (IAPMD) website.
