Explore Your PMDD Treatment Options
From abdominal bloating to anxiety and depression, the symptoms of PMDD are often severe. Do you know your PMDD treatment options?
By Krisha McCoy
Medically Reviewed by Lindsey Marcellin, MD, MPH
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Premenstrual dysphoric disorder, or PMDD, is a severe form of PMS. In fact, the symptoms of PMDD — which may include feelings of profound sadness, suicidal thoughts, anxiety, extreme irritability, and mood swings — are usually so severe they require treatment.
Some women also seek treatment for PMS, though it’s not as crucial, says Rebecca Kolp, MD, an obstetrician and gynecologist in the department of obstetrics and gynecology at Massachusetts General Hospital in Boston. "Whereas with PMDD, if you truly fit the diagnostic criteria, you probably should be treated."
6 Ways to Treat PMDD
Once you are diagnosed with PMDD, your doctor will help guide you through your treatment options. These will depend on which symptoms you are experiencing, and how severe they are.
PMDD treatment options include:
- Antidepressants.Dr. Kolp says that the most common PMDD treatment is a type of antidepressant medication called selective serotonin reuptake inhibitors (SSRIs), which work on a brain chemical called serotonin that is thought to be involved in PMDD. The U.S. Food and Drug Administration (FDA) has approved Zoloft (sertraline), Sarafem (fluoxetine), and Paxil CR (paroxetine HCl) for the treatment of PMDD. Kolp says that most women with PMDD take these medications daily, but some only need to take them during the luteal phase (second half) of their menstrual cycle.
- Birth control pills.Some women find that taking birth control pills, such as drospirenone and ethinyl estradiol (YAZ), can help relieve their PMDD symptoms. "The thinking is that [the birth control pill] affects the hormonal causes of PMDD, if there are any," says Kolp.
- Psychotherapy and counseling.In some cases, individual or group counseling sessions may help women manage their PMDD symptoms. Kolp says that counseling may be especially helpful for women with PMDD who also have underlying depression. "It never hurts to consider [counseling] as additional therapy," she says.
- Lifestyle changes.Kolp says that exercise and taking vitamins or supplements like vitamin B6, magnesium, and calcium may help women with PMDD. But these treatments are usually not used as a first line treatment, since PMDD symptoms are usually too severe to be managed with lifestyle changes alone.
- Surgical removal of the ovaries (oophorectomy).In very rare cases of severe PMDD, surgical ovarian removal, or oophorectomy, may be considered. Ovary removal has been shown to relieve PMDD symptoms, but it also causes you to stop ovulating and become menopausal. "The problem with something like that is that you're trading the symptoms of PMDD for all the symptoms of menopause," says Kolp. She says that women can manage menopausal symptoms with hormone replacement therapy, but that may put you at higher risk of serious conditions, including breast cancer and stroke. What's more, when premenopausal women have their ovaries removed, their lowered estrogen levels put them at increased risk of cardiovascular disease and osteoporosis. "[Ovary removal] would really be a last resort for [PMDD treatment]," says Kolp.
- GnRH agonists.Medications called gonadotropin-releasing hormone (GnRH) agonists are another PMDD treatment used only in women with severe symptoms. GnRH agonists interfere with certain hormone levels to inhibit ovulation, creating a temporary menopause-like state. Because GnRH agonists can lead to hot flashes, muscle pain, vaginal dryness, headaches, irritability, and health conditions such as osteoporosis, they should not be taken for more than six months.
If you have PMDD, discuss the benefits and risks of your treatment options with your doctor. PMDD is different in every woman, and no single treatment works for everyone. If a particular treatment isn't working for you, ask your doctor if there are others you can try.
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