Premenstrual Dysphoric Disorder (PMDD) Treatment Options That Experts Recommend

Doctors and therapists discuss the treatment options available for PMDD.

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When we think of a premenstrual disorder, it’s often about premenstrual syndrome, commonly known as PMS. However, that’s just one of the premenstrual disorders that can bring painful physical symptoms and poor mental health. There’s also premenstrual dysphoric disorder (PMDD), which is “essentially a severe, disabling extension of PMS, but it’s important to note that the emotional and psychological symptoms tend to be the most prominent.” says Dr. Meghan McGrattan, MD, an OB/GYN and a gynecologic surgeon. 

Like PMS and many other gynecological health conditions, there’s no clear cause or treatment plan for PMDD. Instead, PMDD treatment can involve a mix of oral contraceptives, therapy, and other approaches, depending on what works for the individual. Read on to learn about common PMDD symptoms, how it’s diagnosed, and the best treatment options available according to doctors and therapists.

What are PMDD symptoms? 

PMDD causes physical and mental symptoms that disrupt daily life. According to The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), diagnosis requires at least five symptoms (one from each category below) in the week before a period, with symptoms improving after a few days of menstruation. 

First category of PMDD symptoms

• Marked affective lability, such as mood swings, sudden sadness, and increased sensitivity to rejection
• Marked irritability or anger or increased interpersonal conflicts
• Markedly depressed mood, feelings of hopelessness, or self-deprecating thoughts
• Marked anxiety, tension, or feelings of being keyed up or on edge

Second category of PMDD symptoms

• Decreased interest in usual activities
• Subjective difficulty in concentration
• Lethargy, easy fatigability, or marked lack of energy
• Marked change in appetite, such as overeating or having specific food cravings 
• Hypersomnia or insomnia
• A sense of being overwhelmed or out of control
• Physical symptoms such as breast tenderness or swelling, joint or muscle pain, weight gain, or bloating 

How is PMDD diagnosed?

According to Dr. Kecia Gaither, MD, an OB/GYN and director of perinatal services and maternal-fetal medicine at NYC Health + Hospitals, a healthcare provider can diagnose a person with PMDD by reviewing their symptoms and determining if they appear in tandem with the menstrual cycle. Medical professionals should consult the DSM-5 to determine applicable symptoms and timings of the depressive disorder. People living with PMDD can run the risk of being misdiagnosed with a mood disorder. 

PMDD treatment options

As mentioned above, treatment options for PMDD can include everything from birth control to medication. The disorder’s severe symptoms can be challenging to manage and might require trying a mix of techniques. Here are the treatment options for PMDD: 

1. Medication 

Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat PMDD. “These are the first-line medications for PMDD and work by modulating serotonin levels, which are thought to be responsible for the mood-related symptoms,” says Dr. McGrattan. “Unlike when SSRIs are used for depression when used for PMDD, they often work within one or two cycles.” Doctors commonly prescribe fluoxetine or sertraline for treating PMDD. 

Dr. McGrattan and Charlie Health Group Facilitator Bree Williams, LPCA, both note that while some people living with PMDD choose to take SSRIs continuously, others might only use them during the luteal phase, the two weeks before they menstruate.

A person living with PMDD might also benefit from hormonal medications, including combined oral contraceptives. “The theory behind the use of hormonal medications in the treatment of PMDD is that by stabilizing the hormonal fluctuations of the menstrual cycle, the trigger for PMDD symptoms may be reduced,” explains Dr. McGrattan.

A doctor might also prescribe gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide, for severe PMDD cases in which other treatment methods have failed. Dr. McGrattan explains that “they essentially induce a temporary menopause by shutting down ovarian hormone production.” 

Dr. McGrattan notes that it can be incredibly frustrating for individuals treating PMDD, as one approach doesn’t work for everyone. “There’s a lot of trial and error in finding the right approach, and even within these broad treatment categories, responses can vary significantly,” she says. 

“For example, among the SSRIs, some people do great on fluoxetine, but sertraline does nothing for them. Others might feel significantly better with luteal-phase SSRI dosing, while some need continuous use to get relief. The same goes for hormonal treatments — one birth control pill can be life-changing for someone, while another makes symptoms worse.”

2. Lifestyle changes

Experts also recommend that individuals living with PMDD introduce a series of lifestyle changes. Diet-wise, Williams recommends reducing your intake of things such as caffeine, sugar, and processed foods, along with alcohol and nicotine, which can worsen symptoms like mood swings. Williams and Dr. Gaither suggest trying mindfulness techniques, such as yoga, meditation, and progressive muscle relaxation. 

The experts also recommend that individuals ensure they get enough sleep and exercise and set boundaries when they need rest. Plus, Dr. Gaither notes it can also be helpful for people living with PMDD to keep a journal of symptoms to identify triggers and patterns.

Regardless of the treatment option a person pursues, Dr. McGrattan reiterates that “patience and persistence are key. If one treatment doesn’t work, that doesn’t mean the next won’t. Sometimes, it takes a few tries to find the right mix of strategies, and I always tell my patients that just because the first option didn’t work doesn’t mean they’re out of options.”

3. Therapy

Therapy is another option for managing PMDD symptoms. “Cognitive behavioral therapy (CBT) has also been shown to be effective in treating PMDD, either as a primary method of treatment for milder disease or as an adjunct to pharmacologic strategies for more severe symptoms,” says Dr. McGrattan. 

CBT can help people identify and change negative thought patterns, develop coping strategies for PMDD symptoms, and improve emotional regulation during their cycle.

How Charlie Health can help 

If you or a loved one is struggling with premenstrual dysphoric disorder (PMDD), Charlie Health may be able to help. Our virtual Intensive Outpatient Program (IOP) provides more than once-weekly mental health treatment for people who are dealing with serious mental health conditions, including PMDD, severe depression, and other conditions. 
We incorporate evidence-based treatments into individual counseling, family therapy, and group sessions. Additionally, we provide medication management when needed. With this kind of well-rounded treatment, managing PMDD is possible. Fill out the form below or give us a call to start today.