Premenstrual Dysphoric Disorder (PMDD) Treatment Options
For women who suffer with a severe form of premenstrual syndrome (PMS) known as premenstrual dysphoric disorder (PMDD), it’s important to know the available treatment options, both conventional and alternative. Awareness of a variety of treatment approaches gives women an opportunity to make an informed decision.
Approximately 3 to 8 percent of menstruating women experience PMDD, which is characterized by physical and psychological symptoms that occur during the days before the menstrual period. To get a diagnosis of PMDD, women must have five or more of the following symptoms: anxiety, bloating, breast tenderness, fatigue, food cravings, frequent crying, headache, irritability, joint pain, mood swings, panic attacks, sleep problems, and trouble focusing.
Symptoms of PMDD can be severe and debilitating and interfere with a woman’s ability to perform everyday functions. In fact, research shows that women who suffer with PMDD are significantly more likely to have suicidal ideation (thoughts of suicide), to attempt suicide, and to make suicide plans. This fact is just one of several reasons why it is important for patients and healthcare professionals to make every attempt to find effective treatments for this condition.
New PMDD treatment review
A new review of PMDD treatment options was undertaken by a team at the University of Texas Southwestern Medical Center and published in the Journal of Psychiatric Practice. The authors looked at evidence and treatment guidelines for pharmaceutical, psychiatric, and natural treatment options.
Overall they reported that:
- A review of 34 randomized trials that included nearly 4,400 women suggested that selective serotonin reuptake inhibitors (SSRIs; e.g., escitalopram, fluoxetine, sertraline) appear to be a “first-line” treatment for PMDD. However, they also pointed out that more research is needed to determine the best treatment schedules that take into account the drugs’ side effects during different phases of a woman’s menstrual cycle.
- Second-line options may include some antidepressants and anti-anxiety drugs, such as alprazolam, which may be helpful during the luteal phase (the time after ovulation and before the period begins). The authors noted that there’s insufficient data on these drugs and PMDD to offer specific advice.
- Women with PMDD who need birth control may consider taking pills that contain drosperinone and ethinyl estradiol
- A third-line treatment option includes anovulatory treatments, which suppress the pituitary gland and estrogen and progesterone production. This places women in a state of medical menopause. Drugs for this purpose include Lupron, Prostap, and Zoladex, all of which are associated with significant side effects.
Other treatment options for PMDD
Several natural and alternative treatments should be considered as well. These could be used along with conventional options or alone.
Calcium and other nutritional supplements. A Canadian team reviewed available randomized clinical trials to determine the effectiveness of 62 herbs, vitamins, and minerals in the treatment of PMS and/or PMDD. They discovered evidence to support the use of calcium (you may experience relief from PMDD symptoms when consuming 1,200 milligrams of dietary and supplemental calcium daily), and some suggestion that vitamin B6 and chasteberry may be helpful, as well as ginkgo, magnesium pyrrolidone, saffron, St. John’s wort, soy, and vitamin E.
Chasteberry. Concerning chasteberry in particular, at least two studies have examined its effectiveness compared with fluoxetine in PMDD. In one study, 57.9 percent of 20 women who took chasteberry (20-40 mg/day) experienced clinical improvements compared with 68.4 percent of the 21 women who took fluoxetine (20-40 mg/day). The investigators found that chasteberry may be more effective in managing physical symptoms while fluoxetine may be better for psychological symptoms.
In the second study, which involved 57 women with PMDD, the investigators found that while both products yielded significant improvements, fluoxetine outperformed chasteberry on all symptoms.
Lifestyle habits that may prove helpful include regular exercise, reduced use or elimination of caffeine, and small, frequent meals that focus on healthful carbohydrates, the latter of which may help reduce mood swing severity.
Acupuncture could be another treatment option for PMDD. A 2013 study explored this option and was published in Acupuncture in Medicine. In the single-blind, randomized clinical trial involving 30 women with PMDD, the authors found that compared with sham acupuncture, real acupuncture performed twice a week for two menstrual cycles resulted in a significant improvement in anxiety and depression. The investigators concluded that “acupuncture could be another treatment option for PMDD patients.”
Women who suffer with PMDD have a variety of treatment options from which to choose. To experience significant relief, it may be necessary and advisable to adopt more than one treatment option. However, always consult a knowledgeable healthcare provider before beginning any type of treatment.
Atmaca M et al. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Human Psychopharmacology 2003; 18: 191-95
Carvalho F et al. Effects of acupuncture on the symptoms of anxiety and depression caused by premenstrual dysphoric disorder. Acupuncture Medicine 2013 Dec; 31(4): 358-63
Ciotta L et al. Psychic aspects of the premenstrual dysphoric disorders. New therapeutic strategies: our experience with Vitex agnus cstus. Minerva Ginecol 2011; 63:237-45
Maharaj S, Trenino K. A comprehensive review of treatment options for premenstrual syndrome and premenstrual dysphoric disorder. Journal of Psychiatric Practice 2015 Sep; 21(5): 334-50
Pilver CE et al. Premenstrual dysphoric disorder as a correlate of suicidal ideation, plans, and attempts among a nationally representative sample. Social Psychiatry and Psychiatric Epidemiology 2013 Mar; 48(3): 437-46
Whelan AM et al. Herbs, vitamins and minerals in the treatment of premenstrual syndrome: a systematic review. Canadian Journal of Clinical Pharmacology 2009 Fall; 16(3): e407-29