The Best Treatment Options for PMDD

Premenstrual Dysphoric Disorder (PMDD) is a cyclical, hormone-based mood disorder that affects women during the luteal (premenstrual) phase of their menstrual cycle. Symptoms can include irritability, sadness, anxiety, depression, brain fog, irrational outbursts of anger, suicidal ideation, bloating, breast tenderness, joint or muscle pain, food cravings.
PMDD is a severe form of premenstrual syndrome that affects about 5.5% (1 in 20!) of women and AFAB (Assigned Female At Birth) individuals of reproductive age.
Treatment options for PMDD include lifestyle changes, medication, psychotherapy, hormone-based treatments, and surgery.

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In this blog post, I’ll talk you through the best treatments for PMDD according to the UK National Guidelines. So if you have PMDD or know someone who does, please give it a read or share!

This post does NOT contain medical/health advice. All the information provided is for general informational and educational purposes only and is not a substitute for professional advice. Please consult with your medical professional before making any decisions about your health.

What is PMDD caused by?

Unfortunately, the factors that cause PMDD are not currently known. It is known that individuals with PMDD have a greater sensitivity to the normal hormone fluctuations (oestrogen and progesterone) that occur during the luteal phase of the menstrual cycle. This sensitivity leads to alterations of the brain chemicals that control mood and sense of well-being.

There may also be a genetic component: some researchers at the National Institutes of Health (NIH) have found that women with PMDD have an altered gene complex that processes the body’s response to hormones and stressors. 

Other factors can also trigger and/or amplify PMDD symptoms:

• unhealthy lifestyle (poor diet, lack of exercise, lack of sleep, stress, alcohol and caffeine abuse)
• stressful or traumatic events.

PMDD can best be managed through a combination of medical and psychological treatment, as well as lifestyle changes aimed at reducing stress levels. PMDD will, most likely, require ongoing therapy with your mental health professional to help you with tackling life challenges that may contribute to PMDD symptoms.

What are the best treatment options for PMDD?

Here comes the tricky bit: there isn’t a single line of treatments for PMDD. Different options work on some women and not on others. Sometimes you find relief from a combination of two or more of those recommended treatments.

The current treatment options for PMDD are taken from the Guidelines on Premenstrual Syndrome developed in the UK by the National Association for Premenstrual Syndrome (NAPS). These provide different levels of treatment based on the severity of the disorder:

• lifestyle changes: regular exercise, healthy diet, yoga, meditation, etc.
• counselling and psychotherapy
• vitamins and supplements
• oral contraceptives and antidepressants (SSRI Selective Serotonin Reuptake Inhibitor)
• hormonal therapies: GnRH antagonists (Gonadotrophin Releasing Hormone) with hormone replacement therapy
• surgery of hysterectomy and ovariectomy.

1. Lifestyle Changes

The first step in managing PMDD is usually making some lifestyle changes. This may include:

Regular exercise

This can be an effective way to help manage PMDD. Exercise helps reduce stress, which has been linked to PMDD symptoms. Additionally, regular exercise can help improve your mood and energy levels.

Healthy diet

Eating balanced meals with plenty of fruit and vegetables can help to reduce symptoms such as bloating, tiredness, and cravings.
Eating a healthy diet is also important, as PMDD can be triggered by deficiencies in certain vitamins or minerals. It’s important to be mindful of what you are eating and make sure you’re getting the right amount of vitamins and minerals.

Caffeine can also worsen PMDD symptoms such as irritability, anxiety, and insomnia, while alcohol has been linked to worsening PMDD-related depression. Taking steps to limit the amount of caffeine and alcohol you consume is a key part of PMDD management.
Read also the benefits of quitting coffee on women’s health.

Lastly, remember to DRINK! Increasing your water consumption is important, as dehydration can also worsen PMDD symptoms.

Yoga or meditation

Yoga and meditation are two holistic approaches that can be extremely helpful in managing PMDD symptoms. Both of these activities have been linked to improved mood and reduced stress levels and can help PMDD sufferers find relief.

Getting enough sleep

Getting enough sleep is essential for PMDD sufferers to manage their symptoms. Research indicates that PMDD can be worsened by sleep problems, such as insomnia or difficulty falling asleep. It’s important to establish a good sleep routine and stick to it as much as possible.

These lifestyle changes can help you to better manage your symptoms. However, if these measures are not enough, there are other PMDD treatment options available.

2. Counselling / Psychotherapy

If lifestyle changes don’t help, counselling or psychotherapy may be recommended. This type of therapy can help you understand PMDD and how it affects your life, as well as the impact PMDD has on your relationships with family and friends.

Counselling or psychotherapy can be offered by a GP, a healthcare professional specialising in mental health problems (e.g., a psychologist), or a counsellor that patients can see privately. The National Institute for Health and Clinical Excellence (NICE) recommends cognitive behavioural therapy (CBT) for PMDD.

CBT is a talking treatment that can help you manage your problems by changing the way you think and behave. It has been shown to reduce symptoms of PMS in some women. There are no specific studies on how effective CBT is for PMDD, but it has been found to be helpful for severe PMS in general, and it is worth considering it in conjunction with lifestyle changes and other PMDD treatments.

3. Vitamins and Supplements

Alongside lifestyle changes and counselling (or psychotherapy), your doctor may recommend taking vitamins or supplements. This usually includes a vitamin B12 supplement and omega-three fatty acids.

Vitamin B12 is essential for a healthy nervous system, and many people with PMDD are low in this vitamin. Taking a B12 supplement may help to improve your mood.

Omega-three fatty acids are also thought to be helpful for PMDD as they can help to reduce inflammation. Some women find that taking an omega-three supplement reduces their PMDD symptoms.

In addition to those, the following vitamins are recommended to relieve PMDD symptoms:

Vitamin B6 – max 50mg/day (with GP supervision)

Magnesium 250mg/day

Calcium 1g/day + Vitamin D 10mcg/day, especially for migraine.

4. Complementary Therapies (CAM)

Complementary therapies are also recommended for PMDD. These may include acupuncture or herbal medicine. Whilst there are no specific PMDD-specific studies, it is thought that these treatments can help PMS symptoms.

Acupuncture

Acupuncture is a type of traditional Chinese medicine where thin needles are inserted into the body at certain points to relieve pain and improve health. PMDD can cause mental illness, which is one of the conditions that acupuncture has been shown to help with. Acupuncture may be recommended if you have PMDD, as it has been shown to reduce PMDD symptoms.

Herbal Medicine

The traditional herbal medicine includes the use of various plant extracts, leaves, roots, spices, flowers, berries or other parts of a plant for medicinal purposes. Whilst there are no PMDD-specific studies, it is thought that herbal medicine can help PMDD symptoms.

These are the most common herbal medicine used in the treatment of PMDD:

• Agnus Castus (or chaste berry or vitex berry) 20-40mg/day.
  Agnus castus is a herb derived from the fruit of a shrub native to Europe. It is believed to act as a nerve tonic and can help to reduce PMDD symptoms such as irritability and depression.
• Red Clover Isoflavones 40-80mg/day
  Red clover isoflavones are a type of supplement derived from the red clover plant and are thought to be beneficial for PMDD. Red clover isoflavones may also help to regulate hormones, which can help PMDD sufferers.
• St John’s Worth
  St John’s Worth (SJW) is a herbal supplement that is commonly used to treat PMDD. Studies have found that taking SJW may help to regulate hormones and increase serotonin levels in the brain. It has been shown to be effective in reducing PMDD symptoms, so it is worth considering if other PMDD treatments have not been successful.

WARNING: Herbal medicine is not a substitute for professional medical advice. It should only ever be used under the guidance of an experienced and qualified healthcare practitioner who can advise on potential interactions with other medications and potential side effects.

5. Medical Treatments

Oral Contraceptives

There are mainly two types of pills: the combined pill and the mini pill.

The combined pill contains both the hormones estrogen (ethynyl estradiol) and progesterone (drospirenone). This is prescribed by your doctor and used as a first-line treatment for moderate to severe PMS/PMDD.
It works by helping to regulate hormone levels and balance out excess oestrogen in the body.

Drospirenone is a synthetic form of the hormone progesterone and can help treat PMDD symptoms such as depression, irritability, anxiety, bloating and food cravings by balancing out high levels of oestrogen in the body. It also helps to reduce fluid retention.

Oral contraceptives that contain drospirenone are only available on prescription. They include Yaz, Yasmin and Beyaz. Your doctor will be able to tell you if these pills could help your PMDD symptoms.

The mini pill, also known as progestin-only oral contraceptives, is a PMDD treatment option that can help to regulate hormone levels. Unlike the combined pill, it only contains one type of hormone: progestin.

Antidepressants (SSRI Selective Serotonin Reuptake Inhibitor)

If lifestyle changes, counselling or psychotherapy don’t work for PMS/PMDD symptoms, antidepressants may also be recommended. Antidepressants are thought to help PMDD by increasing the levels of serotonin in your brain, which can affect mood and energy. They are considered one of the first-line options in the management of PMDD.

Antidepressants that may help PMS/PMDD symptoms include SSRIs (Selective Serotonin Reuptake Inhibitors) such as escitalopram or fluoxetine, citalopram, sertraline and paroxetine. Your doctor will be able to tell you if these pills could help with your PMDD symptoms.

Please remember that antidepressants can have side effects such as nausea, weight gain or loss of appetite.

6. Hormonal Treatments

GnRH Agonists (Gonadotrophin Releasing Hormone) with hormone replacement therapy

GnRH agonists (or analogs) are a type of medication that can be used to treat PMS/PMDD symptoms. They prevent oestrogen release in your body, stopping menstrual periods and mimicking menopause (that’s why it is also called chemical menopause). The medicine is injected and is usually taken every four weeks.

This treatment is usually combined with hormone replacement therapy (HRT) to prevent (or reduce) bone density loss. HRT involves taking hormones your body doesn’t produce or isn’t producing in the right amounts. Combined oestrogen and progesterone HRT can be used to treat PMS/PMDD symptoms such as depression, anxiety, irritability and bloating.

7. Surgical Treatments

Surgery to remove the ovaries (ovariectomy) and uterus (hysterectomy) may be recommended if PMDD symptoms aren’t improved by any of the above treatments. Surgery should be considered a last-resort treatment option in cases of severe PMDD.
This is a type of treatment called ovarian suppression therapy (also known as surgical menopause). If you have this surgery, your periods will stop completely as there won’t be any functional tissue left in your ovaries.

Surgery isn’t always available on the NHS in all parts of the UK, so you might have to pay for this type of PMDD treatment privately.

Frequently Asked Questions – FAQs

Conclusion

If you or someone close to you experiences PMDD, don’t lose hope. There are treatments available that can make a huge difference. Be sure to consult with a medical professional to figure out what might work best in your unique case. Sometimes it takes a little trial and error to find the right solution, but it’s worth it when the quality of life improves as a result.

Share this post with anyone who might need it- because knowledge is power when it comes to taking care of our bodies and minds. 💖

Sources

[1] NAPS UK, PMS Guidelines

[2] IAPMD website https://iapmd.org/treatment-options

[3] IAPMD Evidence-Based Management of Premenstrual Disorders (PMDs)