While premenstrual syndrome (PMS) is a mild hormonal condition with symptoms that almost 90 percent of women experience at some point throughout their life, premenstrual dysphoric disorder (PMDD) is a serious mental health condition that affects less than 10 percent of women and causes severe psychological complications. Women with PMDD suffer functional impairments that may affect their professional and personal lives and they may be at an increased risk for panic attacks and suicidal thoughts.
Fortunately, help is available. Many different types of PMDD treatment include behavioral therapy and medication. Treatment options for PMDD may consist of lifestyle and dietary changes. Natural treatment options, like aerobic exercise and meditation, can be great options for women who do not want to take or do not respond well to hormone therapy or psychiatric medication.
Therapy Options for PMDD
Research found that cognitive therapy may be an effective treatment for PMS and PMDD. In cognitive therapy, people work with a therapist to identify distorted thoughts that affect mood and behavior. For women with severe PMS or PMDD, cognitive therapy can help them track changes associated with the onset of their periods and address them proactively.
The best option for PMDD or PMS therapy may be one or more behavioral interventions. Behavioral or lifestyle modifications can be particularly effective for women with severe premenstrual symptoms. Evidence-based approaches include:
- Taking calcium or chasteberry supplements
- Engaging in aerobic and nonaerobic exercise
- Practicing relaxation techniques or meditation
- Increasing consumption of complex carbohydrates
- Reducing consumption of refined sugar and artificial sweeteners
Research varies on the efficacy of vitamins, minerals and herbs for treating PMDD. There is some support for the use of vitamin B6, vitamin E and magnesium, but it is less reliable than the evidence for calcium and chasteberry. Exercise may improve a wide range of mood and anxiety symptoms and is an excellent complement to therapy and medication.
Medications for PMDD
There are options for people seeking effective PMDD medication, including some that don’t work for any other mental health condition. Selective serotonin reuptake inhibitors (SSRIs) and oral contraceptives are the most commonly used medications to treat PMDD.
Since the effects of PMDD link to hormonal change, birth control for PMDD is a practical option for many women. Research has not yet established which birth control pill works best for PMDD. Individual factors have a significant impact on how women respond to different oral contraceptives.
Research supports the use of drospirenone and ethinyl estradiol to treat PMDD. However, this formulation is also known to trigger or worsen negative mood symptoms in some women. A recent review found that formulations using a different progestogen, such as levonorgestrel or desogestrel, are also useful in reducing PMDD symptoms.
It depends on the hormones of the woman to determine which of these medicines has the fewest side effects and is best for controlling PMDD or PMS symptoms. Depression and mood instability are potential side effects of any birth control pill, so women who want to use them to treat PMDD should only do so when prescribed by a trusted physician.
Antidepressants like selective serotonin reuptake inhibitors (SSRIs) may be a treatment option for both conditions. Around 60 to 70 percent of women who take them for either PMDD or MDD experience an improvement in mood symptoms. A meta-analysis found that SSRIs reduced both physical and behavioral symptoms of PMDD.
Studies show that SSRIs may be a potential medication for PMDD. Another study showed that when women used Prozac for PMDD, their symptoms were reduced during an 18-month course of treatment and that when the women stopped taking it experienced a worsening of symptoms. Sarafem (fluoxetine) contains the active ingredient Prozac, and it is a comparable choice to treat PMDD.
While SSRIs are generally the preferred psychiatric medications for PMDD, research suggests there isn’t a single antidepressant that’s best for PMDD. Researchers report that clomipramine, a tricyclic antidepressant, and venlafaxine (Effexor), a serotonin-norepinephrine reuptake inhibitor (SNRI), are also useful for treating PMDD.
Treating PMDD and Co-Occurring Conditions
Women with PMDD may have a history of other mood disorders. Anywhere from 18 to 69 percent of women with PMDD have had a depressive disorder. Anxiety disorders are also common comorbid disorders for women with premenstrual dysphoric disorder:
- About 25 percent of women with PMDD also have panic disorder.
- Nearly 20 percent of women with PMDD also have a social anxiety disorder.
- From 4 to 38 percent of women with PMDD have a generalized anxiety disorder.
- Approximately 12 percent of women with PMDD have obsessive-compulsive disorder.
Fortunately, all of these conditions respond particularly well to shared interventions including:
- Lifestyle modifications like exercise and relaxation techniques
- SSRIs and other antidepressants
- Psychotherapy, especially cognitive behavioral treatment (CBT)
It is possible to treat these disorders simultaneously in a way that does not interfere with the recovery process for any single disorder. They may rely on the same cognitive distortions, which CBT can help address. As women address social fears and self-deprecating thoughts in therapy, they may experience improvements in mood as well as reduced anxiety levels.
PMDD and Substance Abuse Treatment
For women with a substance use disorder and PMDD, groups such as Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), can help them overcome addiction. However, they are often not enough. PMDD may require medication monitoring by a physician, as well as complementary individual therapy and lifestyle modifications.
Fortunately, many addiction treatment providers now understand the importance of providing integrated treatment for co-occurring substance use and mental health disorders. When all providers coordinate their services, they can work with clients to build upon progress in any area of treatment and to prevent changes in one condition from triggering a recurrence of symptoms in the other.
The Recovery Village provides integrated treatment for people with co-occurring disorders. If you or someone you know is struggling with a substance use or co-occurring disorder like PMDD, call and speak with a representative to learn more about which treatment program could work for you.