Because the causes of premenstrual dysphoric disorder (PMDD) are not well understood, treatment usually focuses on alleviating symptoms.
Initially treatment may concentrate on conservative measures, such as stress reduction techniques, exercise, and dietary measures, such as eliminating caffeine, alcohol and sodium from the diet.
Supplementation with evening primrose oil (a source of gamma linolenic acid, or GLA) has been reported to alleviate PMDD symptoms, however currently published medical studies do not support this claim.
Vitamin and mineral supplementation may be recommended. A handful of well-designed studies point to supplementation with calcium, vitamin B6, magnesium and vitamin E as being potentially helpful in the treatment of PMDD symptoms.
Medications which may be helpful in ameliorating PMDD symptoms include ibuprofen (painful menstruation, headache), bromocriptine (breast pain and swelling), spironolactone (bloating and weight gain), naltrexone (irritability, anxiety, depression) and atenolol (irritability).
Antidepressants belonging to the class called selective serotonin reuptake inhibitors (SSRIs) have been shown to be extremely effective and are considered to be the first-line treatment for PMDD. In a meta-analysis of 15 randomized clinical trials, SSRIs were seven times more effective than placebo. In addition, the women obtained relief from both physical and behavioral symptoms of PMDD. Sarafem (fluoextine), Zoloft (sertraline) and Paxil (paroxetine) are the three SSRIs which are currently FDA-approved for the treatment of PMDD.
Studies show that about 25% of women will experience an improvement in their symptoms when given a monophasic oral contraceptive, while 50% experience show no change and 25% experience a worsening of symptoms.
Estrogen patches may help some women. However side effects like nausea, breast tenderness and weight gain may preclude its use in some women.
If other treatments do not work, your doctor may opt to halt ovulation by using a synthetic androgen called danazol or through use of a gonadotropin-releasing hormone (GnRH) agonist like leuprolide.
Although the latter two treatments are highly effective, they are also expensive and not without risk. The both bring the same symptoms and risks as menopause such as hot flashes, vaginal dryness, osteoporosis and heart disease.
Removal of the ovaries is a treatment of last resort and is considered only if all other treatments have failed.
Sources:
Jacobson, James L. and Alan M. Jacobson. Psychiatric Secrets. 2nd ed. Philadelphia: Hanley & Belfus, 2001. Katz, Vern L. et. al. Comprehensive Gynecology. 5th ed. Philadelphia: Mosby Elsevier, 2007.
