Get Relief for Your Severe PMS/PMDD Symptoms

Almost all women experience some premenstrual symptoms in the week or two before their period. But in about 40% of women, the symptoms are significant enough to make the diagnosis of Premenstrual Syndrome or Premenstrual Dysphoria Disorder.

There are several treatment options for PMS/PMDD. The type of treatment that is right for you depends on upon the severity of your symptoms. If you have only mild PMS you may feel better just with lifestyle changes but if you have severe PMS or PMDD you may need other medications or treatments.

First Line Treatment Options

All women can benefit from the following recommendations but women with a diagnosis of PMS/PMDD should follow these basic lifestyle changes:

  • Decrease alcohol consumption
  • Decrease caffeine intake
  • Eliminate high glycemic carbohydrate foods (white bread, white rice, pasta, sweets)      
  • Eat low glycemic complex carbohydrates (whole grains, brown rice, wheat pasta, fruit)
  • Daily exercise

If lifestyle changes are not adequate in relieving your symptoms you may want to try other treatment options before consulting with your healthcare provider to discuss pharmacologic therapy. There are many alternative therapies that claim to be beneficial

The following is a list of complementary and alternative medical therapies that clinical research has shown may have some benefit.

  • Cognitive behavioral treatment  (counseling)
  • Reflexology
  • Calcium carbonate 1200 mg daily
  • Chaste berry fruit (Vitex agnus castus) 20 mg daily

    What If First-Line Treatments Don’t Help?

    If you have severe PMS or your mild PMS symptoms are not improved after trying some of these first-line treatment options, you may need to start or add other medications. These medications work by affecting your hormone levels and/or your brain chemicals that are responsible for the symptoms of PMS.

    Combined oral contraceptives

    • The pill suppresses your ovulation. This is thought to help “balance” the hormone changes in the luteal or premenstrual phase.
    • May work best if symptoms are mostly physical.
    • May be best for women with mild to moderate symptoms.

    Continuous or luteal phase serotonin reuptake inhibitors (SSRIs)

    • The hormone changes that occur in the luteal or premenstrual phase can decrease the function of your neurotransmitter serotonin. This can cause symptoms like depression, anxiety and irritability.
    • Can be taken just during the luteal phase from cycle day 14 until your period starts
    • Gives relief of symptoms within 1-2 days
    • Start at lower doses and can be increased if needed
    • May be best for women with mostly mood-related symptoms or severe PMS/PMDD

    Estradiol patches and oral progestin or Mirena

    • Second line of hormonal treatment if the birth control pill doesn’t work

    GnRH analogs and add-back hormone replacement therapy

    • The third line of hormonal treatment.
    • GnRH is an injectable hormone that suppresses ovulation.
    • Causes a temporary “menopause-like” state
    • Hormone replacement therapy is given to prevent bone loss and some menopause symptoms

    Total Abdominal Hysterectomy with hormone replacement therapy including testosterone

    • This is the last resort option
    • Can be considered if all other treatment options have failed in women with severe PMS/PMDD
    • Once your uterus and ovaries have been removed you will no longer be able to get pregnant

    The overall goal of treatment is to get you feeling better with as little intervention as possible. Don’t be frustrated if first-line treatment doesn’t help. It often takes a combination of lifestyle modifications and medications to help relieve your PMS symptoms. Remember that an integrative approach is most successful to quiet the PMS/PMDD monster.

    Johnson S. Premenstrual Syndrome,Premenstrual Dysphoric Disorder, and Beyond.Obstetrics and Gynecology 2004;104: 845-859

    American Congress of Obstetricians and Gynecologist Practice Bulletin Number 15. Premenstrual Syndrome. April 2000;accessed 05/29/15

    Royal College of Obstetricians and Gynecologists Green-top Guideline Number 48. Management of Premenstrual Syndrome. December 2007

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