Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS) that significantly disrupts daily life, often causing extreme emotional and physical symptoms. While PMS is common, PMDD affects about 3–8% of women and people assigned female at birth, with symptoms so severe they can impair personal, social, and professional functioning.
Your body gives signals—this ring helps you decode them
What Causes PMDD?
The exact cause of PMDD is still unclear, but it’s believed to be related to hormonal changes during the menstrual cycle, particularly sensitivity to fluctuating levels of estrogen and progesterone.
This hormonal sensitivity affects neurotransmitters like serotonin, which regulates mood, appetite, and sleep, contributing to the intense emotional and physical symptoms experienced by individuals with PMDD.
Feeling cloudy? Shine light on symptoms with our PMDD tracker!
Symptoms of PMDD
PMDD symptoms usually begin 7–10 days before menstruation and subside shortly after the period starts. The symptoms include both physical and emotional manifestations:
Emotional and Behavioral Symptoms:
Severe mood swings
Irritability or anger
Anxiety and tension
Depression or feelings of hopelessness
Difficulty concentrating
Decreased interest in activities
Physical Symptoms:
Fatigue
Breast tenderness
Bloating and weight gain
Headaches
Joint or muscle pain
The severity of these symptoms can lead to significant impairments in day-to-day functioning, including relationships and work productivity.
PMDD Treatment Options
1. Antidepressants (SSRIs and SNRIs):
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), are the first-line treatment for PMDD. These medications regulate serotonin levels in the brain, helping to alleviate mood swings, depression, and irritability. SSRIs can be taken continuously or intermittently (only during the luteal phase of the menstrual cycle). Studies have shown SSRIs are highly effective in reducing PMDD symptoms within the first few days of use.
Serotonin-norepinephrine reuptake inhibitors (SNRIs), like venlafaxine (Effexor), are also used, especially when PMDD is associated with significant physical symptoms such as fatigue or chronic pain.
2. Hormonal Treatments:
Hormonal treatments aim to suppress ovulation, which can stabilize the hormonal fluctuations that trigger PMDD symptoms:
Oral contraceptives: Birth control pills containing drospirenone and ethinyl estradiol are commonly prescribed. They reduce hormone fluctuations and have been shown to improve mood symptoms in many PMDD sufferers. Extended-cycle regimens (fewer hormone-free days) are particularly effective.
Gonadotropin-releasing hormone (GnRH) agonists: These medications induce a temporary, reversible menopause by suppressing ovarian hormone production. They are typically considered a second-line treatment when SSRIs and oral contraceptives are ineffective.
3. Lifestyle and Dietary Changes:
While medication is often necessary, lifestyle modifications can help manage symptoms. Regular exercise, yoga, and meditation improve mood and reduce stress, while cutting back on caffeine, sugar, alcohol, and salty foods may reduce bloating and irritability.
4. Nutritional Supplements:
Research suggests that certain supplements may alleviate PMDD symptoms:
Calcium: Daily calcium intake of 1,200 mg has been shown to reduce symptoms of PMDD.
Vitamin B6: Some evidence suggests that 50–100 mg of vitamin B6 per day can improve mood symptoms, but more research is needed.
Magnesium: This supplement may help reduce bloating, mood swings, and breast tenderness.
5. Cognitive Behavioral Therapy (CBT):
CBT is a type of therapy that helps individuals identify and modify negative thought patterns and behaviors. It has been found to be effective in managing the emotional symptoms of PMDD, particularly when used in conjunction with medication.
6. Herbal Remedies Chasteberry:
(Vitex agnus-castus) is an herbal remedy that may help reduce symptoms such as irritability, mood swings, and breast tenderness. However, the evidence is mixed, and more research is needed to confirm its efficacy. Always consult a healthcare provider before starting any herbal treatment.
Surgical Treatment
A hysterectomy, which involves removing the ovaries and uterus, is considered a last resort for PMDD when other treatments fail to provide relief. By removing the ovaries, the source of hormonal fluctuations is eliminated, effectively stopping the menstrual cycle and alleviating PMDD symptoms.
However, this procedure is irreversible and requires careful consideration, as it induces menopause, which comes with its own set of health challenges, including the need for hormone replacement therapy (HRT) to mitigate menopausal symptoms like hot flashes, bone loss, and cardiovascular risks.
Alternative Treatments with Promising Evidence
While not first-line options, some treatments show promise for managing PMDD symptoms and may be considered for individuals who don’t respond well to standard treatments:
5α-reductase inhibitors: These medications, typically used to treat conditions like prostate enlargement, may help some individuals by blocking the conversion of testosterone into dihydrotestosterone (DHT), although more research is needed.
Continuous estradiol plus progestogen: Hormone therapy with continuous estradiol combined with progestogen may stabilize hormone levels and provide symptom relief in some women.
Vitex Agnus-Castus (Chasteberry): This herbal remedy has been studied for its potential to reduce irritability, mood swings, and other PMDD symptoms. However, its effectiveness varies, and it should be used under medical supervision.
Treatments with Limited Evidence
Some treatments have shown mixed results or have not been thoroughly studied for PMDD but may offer relief for some individuals:
Supplements: While calcium, magnesium, and vitamin B6 show some benefit, other supplements like evening primrose oil and omega-3 fatty acids lack consistent evidence supporting their efficacy.
Micronized progesterone: This natural form of progesterone is sometimes used in hormone therapy, but its effectiveness in treating PMDD is limited, and it may not provide significant relief for all patients.
Progestin-only contraceptives: These contraceptives, including intrauterine devices (IUDs) that do not suppress ovulation, have limited evidence for their use in treating PMDD. Some individuals report worsening symptoms with progestin-only medications.
PMDD Management: A Holistic Approach
Given the complexity of PMDD, most individuals benefit from a combination of treatments tailored to their specific symptoms. In many cases, an integrated approach combining medication, lifestyle changes, and emotional support provides the most relief.
Working with a healthcare provider to develop a personalized treatment plan is crucial for managing this condition effectively.
Community Feedback and Personal Experiences
“Citalopram has been really helpful for me so far. I tried a different pill, but it made my symptoms worse. My doctor, who knows a lot about PMDD, said to increase the dose if my symptoms get worse in the two weeks leading up to my period. It feels like a lot of trial and error. I’m also taking multivitamins that contain magnesium, which I’ve heard can help.”
“Oxeloacetate is the only thing that’s made a difference for me.”
“I’ve tried a lot of different treatments: various pills, Mirena, antidepressants, loads of HRT, and Prostap injections to induce chemical menopause. Prostap was the only thing that really helped because it stopped my cycle. The other treatments either didn’t work or had unbearable side effects. Now, at 53 and nearly menopausal, I’m unmedicated. If I had been younger when PMDD started (I was 45), I’m sure I would have opted for an oophorectomy and hysterectomy, especially since I’m also intolerant to progesterone.”
“SRI’s, Mirena Coil, next stop either prostap injections for chemical menopause or hysterectomy for the real deal”
“Lots of birth control in the past, been off for about 2 years now. Currently on prozac, lamictal, and medical cannabis & mushrooms for PMDD treatment. Yoga/exercise, woman’s health specialists, selfcare, therapy and eating right too!”
Your body gives signals—this ring helps you decode them
Conclusion
PMDD is a debilitating condition that significantly impacts the lives of those affected. However, with the right combination of treatments, many individuals find relief from the emotional and physical symptoms that accompany this disorder.
First-line treatments like SSRIs and hormonal therapies are often highly effective, while lifestyle changes and alternative therapies may further enhance symptom management.
Community support and personalized treatment plans, developed in collaboration with healthcare providers, are essential for navigating the challenges of PMDD and improving quality of life.
For anyone struggling with PMDD, it’s important to remember that help is available, and treatment options exist to alleviate symptoms. If you suspect you may have PMDD, consult with a healthcare provider to explore the best course of action for your specific needs.
