treatment options
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There is no single option that works for all people living with PMDD. It's best to work with your health care and support team to find the best treatment option for you. Many people find the combination of several treatment options what helps the most.
There are several treatment options currently prescribed to manage the symptoms of PMDD. Some have been shown to be effective and some are not. Some may decrease symptoms or greatly improve them, while others may have no effect or may worsen symptoms over time. These options are listed in order of first-line treatment options to the most invasive. Always check with your medical team before stopping or starting any medication or treatment.
The following treatment options have been evaluated for PMDD. Treatment guidelines for PME are currently under development and will be published when available.
Changes in lifestyle
Diet and Nutrition
complementary alternative medicine
oral contraceptives
SSRI
mood stabilizers
GnRH agonists
Oophorectomy / Hysterectomy
Changes in lifestyle
Lifestyle changes are the first line of defense to help minimize the symptoms of PMDD. Getting enough sleep and exercise while consuming a diet rich in protein, complex carbohydrates, fruits, and vegetables are the foundation of any treatment plan. While maintaining a healthy diet and getting enough exercise can be challenging during the luteal phase, reducing stress and getting enough sleep can be vital to surviving a cycle.
Several studies show that women, in general, need more sleep than men. For women, reduced sleep was associated with a significantly increased risk of heart disease and diabetes, as well as more stress, depression, anxiety and anger. While racing thoughts and anxiety (two common symptoms of PMDD) can easily contribute to poor sleep, aerobic exercise has been shown to improve sleep quality and help women fall asleep faster.
For women with mild symptoms, these interventions should be tried before pharmacological treatment. Although strong evidence is lacking, doctors generally recommend that patients with PMS or PMDD reduce or eliminate their intake of caffeine, alcohol, nicotine, sugar, and sodium.
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Diet and Nutrition
Anyone will benefit from a complete and nutritious diet. Those with PMDD will benefit even more. Studies show a strong correlation between what we eat and emotional well-being. A common symptom of PMDD is an intense desire to eat during the luteal phase, specifically high-carbohydrate foods, and with good reason. Carbohydrates influence the production of serotonin, which directly and indirectly controls mood, sexual desire and function, appetite, sleep, memory, body temperature, and social behavior. Although serotonin is produced in the brain, approximately 90% of our serotonin supply is found in the digestive tract and blood platelets. The connection between mood and food is clear.
The pathway from carbs to serotonin looks like this: carbs > insulin > tryptophan > serotonin. While high-protein foods like chicken and beef contain a large amount of tryptophan, a small amount of this necessary nutrient cannot be efficiently absorbed by the brain. When a carbohydrate-rich meal is consumed, the resulting insulin helps deliver more tryptophan to the brain and increases serotonin levels.
However, it is important to choose the right type of carbohydrate, as choosing the wrong type can make symptoms worse. Carb-rich foods will have the opposite effect and will deplete serotonin. While intense cravings may want the opposite, choosing whole grains will achieve the desired boost. Ultimately, a diet rich in whole grains, fruits, vegetables, and calcium will benefit you the most.
In addition to a well-balanced diet, studies show great benefit from adding the following supplements:
Vitamin B6, up to 100 mg per day
Vitamin E, up to 600 IU per day
Calcium carbonate, 1,200 to 1,600 mg per day
Magnesium, up to 500 mg per day
Tryptophan, up to 6 g per day
A recent study reviewed the efficacy and safety data for herbal supplements marketed for women. The author concluded that two herbal products, evening primrose oil and chaste tree berry, have been effective in treating breast tenderness and engorgement that often accompany PMS. There is no definitive evidence that these herbal supplements have a positive effect on the emotional symptoms of PMDD.
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Free alternative medicine (CAM)
Acupuncture has been shown to have positive effects on physical pain and emotional symptoms, such as dysphoria and anxiety.
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Oral Contraceptives (OCP / Birth Control Pills / The Pill)
Oral contraceptives are also a first-line treatment option for PMDD. "The pill" contains two forms of female hormones including ethinyl estradiol (estrogen) and drospirenone (progestin/synthetic progesterone). Some pills may contain only progestin. When taken daily, these hormones travel through the bloodstream to the pituitary gland to prevent the release of LH and FSH, which in turn prevents the growth of an egg during ovulation.
These medications can relieve symptoms by regulating the fluctuation of hormones throughout a woman's menstrual cycle. Although, according to the American Academy of Family Physicians, ACOs are not reported to be consistently effective in treating PMDD.
OCs may not be enough if mood symptoms are prominent, and in some patients, these drugs can worsen dysphoria (a known side effect of some birth control pills) in many women with and without PMDD. Increased symptoms appear to be especially prevalent in women with PMDD of the progesterone-sensitive type. Recent studies point to a direct link between the female hormone progesterone and PMDD. All OCPs contain progesterone and can make symptoms worse.
In randomized controlled trials, the only birth control pills that have shown improvement in PMDD symptoms are pills that consist of a combination of ethinylestradiol and drospirenone (such as Yaz, Ocella, and Beyaz). These pills have been shown to offer relief from both physical and psychological symptoms of PMDD with improvement in health-related quality of life. For women who choose the birth control pill, Yaz is the only contraceptive method approved by the FDA to treat PMDD.
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SSRI
Several members of the selective serotonin reuptake inhibitor (SSRI) class of drugs have been approved by the FDA to treat PMDD symptoms of anxiety and depression. These medications work by regulating levels of the neurotransmitter serotonin in the brain and are often considered a first-line treatment for this disorder. SSRIs that have been shown to be effective in treating PMDD include:
fluoxetine (Prozac, Sarafem)
sertraline (Zoloft)
Paroxetine (Paxil)
citalopram (Celexa)
Up to 70% of women report symptom relief when treated with SSRI medications. Side effects can occur in up to 15% of women and include nausea, anxiety, and headache. SSRI medications to treat PMDD may be prescribed to be taken continuously or only during the 14-day luteal phase (second half) of the menstrual cycle. Other types of antidepressants (tricyclic antidepressants and monoamine oxidase inhibitors) and lithium (Lithobid) have not been shown to be effective in treating PMDD. Finding the correct dose is key to the effectiveness of SSRIs. This form of treatment has been shown to improve irritability, depressed mood, dysphoria, bloating, breast tenderness, changes in appetite, and psychosocial function. Studies show that most SSRI treatment trials are short-term,
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mood stabilizers
Women with PMDD are often misdiagnosed as having bipolar disorder (rapid cycling or otherwise) due to the cyclical nature of both disorders. Because of this tragic mix-up, women are often prescribed medications to treat bipolar disorder called mood stabilizers. These medications include:
quetiapine (Seroquel)
lithium
carbamazepine (Tegretol)
divalproex (Epival)
lamotrigine (Lamictal)
gabapentin (Neurontin)
topiramate (Topamax)
The last three listed above are classified as "anticonvulsants" and are generally used "off-label" alone or in addition to other medications. These medications are classified as antipsychotic medications and have potential risks when used long-term and/or incorrectly in the wrong amounts or for the wrong disorders. In summary, mood stabilizers are neither approved nor appropriate for the treatment of PMDD.
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Chemical menopause (GnRH agonists)
Gonadotropin-releasing hormone analogs (GnRH analogs or GnRH agonists) have also been used to treat PMDD. These medications inhibit the production of estrogen by the ovaries by inhibiting the secretion of regulatory hormones from the pituitary gland. As a result, menstrual periods stop, mimicking menopause. Nasal and injectable forms of GnRH agonists are available. Examples of GnRH agonists include:
leuprolide (Lupron)
Nafarelin (Synarel)
and goserelin (Zoladex)
Side effects of GnRH agonist drugs are the result of a lack of estrogen and include hot flashes, vaginal dryness, irregular vaginal bleeding, mood swings, fatigue, and loss of bone density (osteoporosis). Adding small amounts of estrogen and progesterone can help avoid or minimize many of the troublesome side effects of estrogen deficiency and help preserve bone density. PMDD can be driven by low levels of progesterone or estrogen, so some experimentation may be required to discover the appropriate level of these hormones.
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Surgical menopause (THBSO)
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Small studies reported relief from PMDD when hysterectomy and bilateral oophorectomy were performed. Hysterectomy with oophorectomy should be considered a treatment option of last resort for women with severe PMDD who have not responded to standard treatments. In a 1990 study, fourteen women with severe and debilitating PMDD volunteered for a study of hysterectomy, oophorectomy, and continuous estrogen replacement therapy. They had all completed their families and had not benefited from previous medical treatments. Six months after surgery, the PMDD symptom record revealed that all women had complete relief of symptoms. Six months after the operation, the women showed a dramatic improvement in mood, general affect, well-being, life satisfaction, and overall quality of life.
Fountain: iapmd.org