What treatments truly work for my PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a severe and often debilitating condition that affects a significant number of women in the days leading up to their menstrual period. Unlike typical premenstrual syndrome (PMS), PMDD is characterized by extreme mood shifts, intense irritability or anger, profound sadness or despair, anxiety, and a range of physical symptoms that significantly disrupt daily life, relationships, and work. These symptoms typically begin in the luteal phase of the menstrual cycle (after ovulation and before menstruation) and resolve shortly after menstruation begins.

Living with PMDD can feel isolating and overwhelming, but it is a recognized medical condition with effective treatment options. Understanding what is covered in PMDD treatment is the first step toward finding relief and reclaiming your life. A multi-faceted approach, often combining several strategies, tends to yield the best results.

The Foundation of Treatment: Lifestyle Adjustments

Before diving into pharmacological interventions, it is crucial to recognize the power of lifestyle adjustments. While these may not be sufficient on their own for severe PMDD, they form a vital foundation that can enhance the effectiveness of other treatments and improve overall well-being.

• Dietary Changes: What you eat can profoundly impact your mood and physical symptoms. Focusing on a balanced diet rich in complex carbohydrates, lean proteins, fruits, and vegetables can help stabilize blood sugar levels, which in turn can reduce mood swings and cravings. Limiting intake of refined sugars, excessive caffeine, alcohol, and high-sodium foods is often recommended. Caffeine and alcohol can exacerbate anxiety and sleep disturbances, common in PMDD (Queensland Health, n.d.).

• Regular Exercise: Physical activity is a natural mood booster and stress reliever. Engaging in at least 30 minutes of moderate aerobic exercise most days of the week, such as brisk walking, cycling, or swimming, can increase serotonin levels in the brain, helping to alleviate depressive symptoms and improve sleep quality (Queensland Health, n.d.).

• Stress Management Techniques: Stress can significantly worsen PMDD symptoms. Incorporating stress-reducing practices into your daily routine is essential. Mindfulness, meditation, deep breathing exercises, and yoga can help to calm the nervous system, reduce anxiety, and improve emotional regulation (Mind, n.d.).

• Quality Sleep: Prioritizing consistent and adequate sleep is fundamental. Sleep disturbances are a common PMDD symptom, and poor sleep can intensify mood swings, fatigue, and irritability. Establishing a regular sleep schedule and creating a calming bedtime routine can make a significant difference.

First-Line Medical Therapies: Targeting Neurotransmitters and Hormones

For many women with PMDD, lifestyle changes alone are not enough to manage the severity of their symptoms. Medical interventions, particularly those targeting serotonin pathways or hormone regulation, are often necessary and highly effective.

• Selective Serotonin Reuptake Inhibitors (SSRIs): SSRIs are considered the gold standard and first-line pharmacological treatment for PMDD (American Academy of Family Physicians, 2016). These antidepressants work by increasing the availability of serotonin in the brain, a neurotransmitter crucial for mood regulation. Unlike treating major depressive disorder, SSRIs for PMDD often show a rapid onset of action and can be effective at lower doses. They can be prescribed to be taken continuously throughout the month or intermittently, only during the luteal phase (the 1-2 weeks before menstruation) (Mayo Clinic, 2018; Talkiatry, 2024). Common SSRIs used include fluoxetine, sertraline, paroxetine, and escitalopram.

• Hormonal Contraceptives: Certain types of hormonal birth control, specifically combined oral contraceptive pills that suppress ovulation, can be effective in managing PMDD symptoms by stabilizing hormone levels. The pill known as Yaz (drospirenone and ethinyl estradiol) is FDA-approved specifically for PMDD, and some extended-cycle or continuous regimens (with no or fewer hormone-free intervals) may also offer relief by minimizing hormonal fluctuations (Clue, n.d.; WebMD, n.d.).

• Gonadotropin Releasing Hormone (GnRH) Agonists: For very severe and treatment-resistant cases, GnRH agonists may be considered. These medications temporarily induce a reversible, menopause-like state by suppressing ovarian hormone production and ovulation. This essentially eliminates the hormonal fluctuations that trigger PMDD symptoms. Due to potential side effects like bone density loss, GnRH agonists are often used for short periods or combined with "add-back" hormone therapy (estrogen and progesterone) to mitigate these effects (Chelsea and Westminster Hospital NHS Foundation Trust, n.d.). This treatment is usually reserved for severe cases after other options have been explored.

Therapeutic and Complementary Approaches

Beyond medication, several therapeutic and complementary approaches can provide significant support for managing PMDD symptoms.

• Cognitive Behavioral Therapy (CBT): CBT is a highly effective talk therapy that helps individuals identify and challenge negative thought patterns and behaviors that contribute to emotional distress. For PMDD, CBT can provide coping mechanisms for intense mood swings, anxiety, and anger, teaching strategies to reframe distorted thoughts and improve emotional regulation (Click2Pro, n.d.; Belle Health, n.d.). It can be a standalone treatment or used in conjunction with medication.

• Nutritional Supplements: While more research is always beneficial, some supplements have shown promise in alleviating PMDD symptoms for certain individuals. These include:

  • Calcium: Studies suggest that calcium supplementation (1,000-1,200 mg daily) may improve mood and physical symptoms (American Academy of Family Physicians, 2016).

  • Magnesium: This essential mineral plays a role in numerous bodily functions, including nerve and muscle function, and some women find it helpful for reducing anxiety and cramps.

  • Vitamin B6: Involved in neurotransmitter production, Vitamin B6 may help with mood regulation.

• Acupuncture: Some women report symptom relief through acupuncture, an ancient Chinese practice involving the insertion of thin needles into specific points on the body. While more research is needed, it is thought to influence pain perception and overall well-being (AANMC, n.d.).

• Herbal Remedies: Certain herbal remedies, such as chasteberry (Vitex agnus castus), evening primrose oil, and St. John's Wort, are sometimes used for PMDD symptoms. However, scientific evidence for their effectiveness varies, and it is crucial to consult a healthcare provider before using them, as they can interact with medications (AANMC, n.d.; Mayo Clinic, 2018).

Collaborating with Your Healthcare Team

The most effective PMDD treatment plan is highly individualized. It is crucial to work closely with a knowledgeable healthcare provider, ideally one experienced in women's health or reproductive psychiatry.

• Symptom Tracking: Keeping a detailed record of your symptoms, their severity, and their timing in relation to your menstrual cycle is invaluable. This information helps your doctor accurately diagnose PMDD and tailor a treatment plan. Many apps are available for this purpose such as HEALCYCLE.

• Open Communication: Be open and honest with your doctor about all your symptoms, your daily struggles, and any other health conditions you have. This holistic picture is essential for integrated care.

• Patience and Persistence: Finding the right treatment or combination of treatments for PMDD can take time and adjustment. It is a process of trial and error, and patience is key. Do not get discouraged if the first approach doesn't offer complete relief.

Related Articles

For more in-depth information and support on managing PMDD and understanding your hormonal health, explore these related articles on HealCycle:

• Do PMDD symptoms get worse during perimenopause?: This article explores how hormonal fluctuations during perimenopause can impact and potentially intensify PMDD symptoms, offering insights into managing symptoms during this life stage.

• What role does the luteal phase play in PMDD?: Gain a deeper understanding of the luteal phase and its critical role in the manifestation of PMDD symptoms, which is essential for timing treatments.

• Does PMS Cause Insomnia?: While focusing on PMS, this article explains how hormonal shifts can disrupt sleep, a common and often debilitating symptom in PMDD.

These resources aim to further empower you with knowledge on your journey to managing PMDD effectively.

Conclusion

PMDD is a complex condition, but a range of effective treatments is available to help manage its challenging symptoms. From fundamental lifestyle adjustments and targeted medications like SSRIs and hormonal contraceptives to supportive therapies like CBT and certain supplements, a personalized and comprehensive approach can lead to significant relief and a much-improved quality of life. Remember, seeking professional help, maintaining open communication with your healthcare team, and being patient with the process are key steps toward finding the right treatment path for you. You deserve to feel stable and well throughout your entire cycle.

Disclaimer:

The information provided in this blog post is for informational purposes only and does not constitute medical advice. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your qualified healthcare provider with any questions you may have regarding a medical condition or before starting any new treatment or making any changes to existing medical care.

References

American Academy of Family Physicians. (2016). Premenstrual syndrome and premenstrual dysphoric disorder. American Family Physician.

American Association of Naturopathic Medical Colleges (AANMC). (n.d.). Premenstrual dysphoric disorder (PMDD) natural treatments. AANMC.

Belle Health. (n.d.). Cognitive behavioral therapy (CBT) for PMDD. Belle Health.

Chelsea and Westminster Hospital NHS Foundation Trust. (n.d.). Gonadotropin releasing hormone agonists for PMS. Chelsea and Westminster Hospital NHS Foundation Trust.

Click2Pro. (n.d.). Managing premenstrual dysphoric disorder (PMDD) through therapy. Click2Pro.

Clue. (n.d.). Hormonal birth control for PMDD and PMS: Does it help?. Clue app.

Johns Hopkins Medicine. (n.d.). Premenstrual dysphoric disorder (PMDD). Johns Hopkins Medicine.

Mayo Clinic. (2018, April 7). Premenstrual syndrome (PMS) - Diagnosis & treatment. Mayo Clinic.

Mind. (n.d.). Self-care for premenstrual dysphoric disorder (PMDD). Mind.

Queensland Health. (n.d.). Beyond bloating and mood swings: your guide to premenstrual dysphoric disorder (PMDD) and why it's more than just premenstrual syndrome (PMS). Queensland Health.

Talkiatry. (2024, March 23). PMDD and antidepressants medications: A psychiatrist explains. Talkiatry.

WebMD. (n.d.). The pill: How can it help with PMS?. WebMD.