PMDD: What is it and How Can it be Treated?

Oct 12

By Grace Fox

Overview

Many women struggle with the emotional ups and downs of PMS, but for some, these changes in mood are more extreme. PMDD, or Premenstrual Dysphoric Disorder, is a disorder that can cause both mental and physical symptoms in the week or two prior to menstruation. These symptoms can include a depressed mood, anger, crying spells, insomnia, paranoia, difficulty concentrating, and agitation (1). The physical symptoms can include vision changes, fluid retention, gastrointestinal issues, dizziness, and headaches (1). This is not a complete list, however, and many women experience only a few of the issues, but still to such a degree that it impacts their daily functioning.

The cause of PMDD is not known, but doctors believe that it may be an abnormal response to hormonal changes that occur during a woman’s cycle as she approaches menstruation. PMDD can be diagnosed by the patient reporting several months worth of these symptoms that cannot be solely explained by another health issue, such as hyperthyroidism. It is a chronic condition, but the symptoms of it can be alleviated by lifestyle changes and certain medications.

If you believe that you may be experiencing issues that go beyond typical PMS, either physical or mental, it is always a good idea to track symptoms by writing them down. You can also prep for a doctor’s appointment by writing down a list of questions and concerns so that you don’t forget anything or become too overwhelmed to advocate for yourself during the appointment.

Lifestyle Changes

Preplanning- Although all of the treatments and lifestyle changes below can help with the symptoms of PMDD, a great way to decrease its impact on a person’s life is by being aware of symptoms and when they are most likely to come up. Scheduling social activities, meal prep, schoolwork, and other adjustable activities on days when someone may not be experiencing PMDD symptoms can help make the hardest days of the month easier.

Changes in Diet- According to John Hopkins, increasing protein and carbs, and decreasing sugar, salt, caffeine, and alcohol can help alleviate symptoms (1).

Certain Vitamins and Supplements- Hopkins also lists “vitamin B6, calcium, and magnesium” as potentially helpful (1).

Regular Exercise- Exercise is something many major health organizations list as important in the management of PMDD, and it is essential for the maintenance of overall health. Physical activity can also be incredibly helpful for emotional regulation.

Stress Management- Stress management can mean different things for different people, but activities may include meditation, yoga, and engaging with hobbies.

Layered Clothing- Having layers to take on and off can help with hot flashes, which is one of the symptoms of PMDD.

Available Treatments

Antidepressants

SSRIs, or selective serotonin reuptake inhibitors, are typically taken every day, but some women take them during the week or two stretch prior to their period to treat PMDD. According to Harvard’s Medical School, SSRIs that have been reportedly effective include “sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), or fluoxetine (Prozac)” (2). SNRIs, including venlafaxine (Effexor), may also be effective (2). Although both types of medication can have side effects that can impact a person’s quality of life, a doctor may prescribe them when the benefits outweigh the potential downsides.

Hormonal Birth Control

Yaz, a combined hormonal contraceptive (CHC) pill, is the only birth control pill that is approved by the FDA as a treatment for PMDD (3). Although research suggests that CHC pills with a specific dosage of hormones are more effective, other monophasic CHC pills may also be effective in the treatment of PMDD. They are simply not as well studied as the 20 mcg ethinyl estradiol/3mg drospirenone dosage (4). It is important to note that progesterone-only birth control, or the mini pill, can negatively affect mood, so it may not be the best option for someone with PMDD.

Over the Counter Medications

Over the counter medications can be used to address certain physical symptoms, such as diarrhea, constipation, nausea, and back pain. Although you don’t need a prescription to get them, they can be helpful in making symptoms manageable.