Most of us are all too familiar with the anxiety, headaches, breast tenderness, mood swings, and other uncomfortable symptoms that accompany premenstrual syndrome or PMS. But what if those symptoms were way more extreme than your standard bout of PMS? That's what it's like to have premenstrual dysphoric disorder, or PMDD.
The Mayo Clinic describes PMDD as a severe and sometimes disabling extension of premenstrual syndrome. "Although regular PMS and PMDD both have physical and emotional symptoms, PMDD causes extreme mood shifts that can disrupt your work and damage your relationships," The Mayo Clinic explains.
If you're experiencing PMDD, you may have standard PMS symptoms along with additional symptoms like extreme anxiety, extreme moodiness, feelings of hopelessness, anger, and irritability. Fortunately, some treatments may help.
"Women shouldn't be afraid to seek treatment for PMDD," says Aimee Eyvazzadeh, who is an OB-GYN and reproductive endocrinologist. "The best first step is to make sure you're meeting with a doctor that is experienced and comfortable treating women with PMDD. The next step is to meet with your doctor to review your symptoms in detail so they can do blood work to make sure that issues like hypothyroidism aren't missed."
Here are several physician-recommended treatments that may be helpful for people with PMDD.
Meet the Expert
- Aimee Eyvazzadeh is an OB-GYN and reproductive endocrinologist.
- Lucky Sekhon is a reproductive endocrinologist, infertility specialist, and board-certified OB-GYN.
- Heather Irobunda is a New York City-based OB-GYN.
- Linda Burke-Galloway is a board-certified OB-GYN.
- Felice Gersh is an OB-GYN, founder and director of the Integrative Medical Group of Irvine, and the author of PCOS SOS Fertility Fast Track.
Change Your Diet
"There is a well-established connection between mood and food," explains Lucky Sekhon, who is a reproductive endocrinologist, infertility specialist, and board-certified OB-GYN. "Many women with PMDD crave carbohydrates in the week leading up to their period—carbohydrates increase insulin levels which in turn increase tryptophan which converts to serotonin."
Serotonin, she explains, is a "feel-good" neurotransmitter chemical that indirectly controls mood, appetite, sleep, social behavior, and more. If you're going to eat carbohydrates to help your PMDD symptoms, Sekhon stresses the importance of choosing whole grains and avoiding sugar and other processed carbohydrates. Too much sugar can actually have the opposite effect and reduce serotonin.
Sekhon also suggests taking a multivitamin because studies have shown that vitamin B6, vitamin E, vitamin D, and magnesium may improve mood among women with PMDD.
Try Taking Birth Control Pills
Birth control pills can treat symptoms of PMDD. According to OB-GYN Heather Irobunda, birth control pills can alleviate PMDD symptoms because they suppress ovulation, which keeps hormone levels more stable. "The less these hormone levels fluctuate," she says of estrogen and progesterone, "the less one will experience PMDD symptoms."
Try Taking an Antidepressant
Research shows that selective serotonin reuptake inhibitors (SSRIs) and other antidepressants may reduce premenstrual dysphoric disorder symptoms, including behavioral changes and mood disturbances. Some people take SSRIs every day to control their PMDD symptoms. In contrast, others only take the medication between the day they ovulate and start their period, typically about two weeks. Your gynecologist can help guide you toward a regimen they believe will most effectively control your individual symptoms.
"Most people report a noticeable change as soon as their first menstrual cycle after getting started on these medications," Irobunda says.
The most extensively studied and commonly prescribed SSRIs include sertraline, citalopram, escitalopram, and fluoxetine, says OB-GYN Linda Burke-Galloway. These are fairly fast-acting, and some people find relief within the first cycle after starting the medication. "The most significant side effect of SSRIs is sexual dysfunction," Burke-Galloway adds.
Behavioral therapy is another recommended treatment for premenstrual dysphoric disorder. One major benefit of therapy is that it can easily be coupled with other treatment forms on this list.
"This treatment option is sometimes beneficial in identifying triggers, such as external factors like work-related stress, that may worsen PMDD symptoms," Irobunda says. "Patients can then practice techniques to better cope with these triggers."
A review of scientific studies found that acupuncture and herbal medicine may reduce PMDD symptoms, in some cases by 50 percent or more. This is particularly promising given that these treatments are safe and were associated with no adverse outcomes.
Acupuncture may be beneficial for the feelings of anxiety and dysphoria that are associated with PMDD.
Try a Yoga Flow
There isn't a ton of research on yoga and PMDD, but some research is promising. In one study in Taiwan, yoga was associated with increased physical function and decreased menstrual pain, breast tenderness, abdominal swelling, cramps, and cold sweats. The researchers suggest that women should be educated on the potential benefits of yoga and other forms of exercise in decreasing premenstrual dysphoric disorder (PMDD) symptoms.
"There is some data that fasting during the luteal phase of the menstrual cycle can help to increase the proper function of the autonomic nervous system, increasing the calming parasympathetic part and decreasing the sympathetic, stress component," says OB-GYN Felice Gersh, who is founder and director of the Integrative Medical Group of Irvine and the author of PCOS SOS Fertility Fast Track.
Try Light Therapy
Gersh suggests that light therapy can help with PMDD symptoms like depression and sleep problems. Her tip? Try incorporating bright light in the morning and middle of the day.
Address Your Circadian Rhythm
Taking magnesium and eating a large breakfast can help set the circadian rhythm, which can be dysregulated in women with PMDD, Gersh says.
Having surgery to remove your ovaries is among the more extreme treatments for PMDD but may bring relief. "In women who may need a hysterectomy and their ovaries removed for heavy periods or other gynecological problems, many with PMDD note relief of their symptoms," Sekhon explains. "This makes sense as we know there is a definite link between PMDD and the hormonal fluctuations from the ovaries as they go through an ovulation cycle."
Taking medication to induce temporary menopause is another treatment that falls along the more extreme or aggressive side of the spectrum. "It is often given with small amounts of estrogen and progesterone to prevent hot flashes and other annoying side effects, and to prevent any adverse effects on bone density," Sekhon says.
Change Your Lifestyle
Exercise, breathing exercises, prioritizing sleep, and other lifestyle changes may help with the anxiety and depression brought on by PMDD.