Most physicians will recommend that women first modify their lifestyle, such as changing their diet and increasing exercise, before they prescribe drugs for PMDD. For women who need more help than lifestyle changes offer, however, there are plenty of treatment options

Nondrug Treatments

In general, nondrug treatments can improve the patient’s coping strategies or affect brain chemistry. For example, light therapy seems to increase serotonin activity, which is implicated in depression and PMDD. Some nondrug treatments for PMDD include:

• Relaxation therapy: Some research shows relaxation techniques, which help decrease heart rate, blood pressure, and slow breathing, are helpful in reducing the physical symptoms of PMDD.

• Light therapy:At least one study has demonstrated that thirty minutes of bright light reduces emotional and physical premenstrual symptoms.

• Cognitive-behavioral treatment: This treatment teaches patients to recognize, examine, and replace negative thought patterns with positive ones and can help reduce PMDD-related anger and negative emotions. Some research supports the positive effects of cognitive therapy on PMS symptoms.

• Sleep deprivation: Total sleep deprivation for one night is therapy used to treat depression, providing short-term help to as many as 50 percent of depressed patients. Researchers don’t know why manipulating the sleep cycle improves mood, but it may have to do with disturbances in the dream sleep cycle, which are common in depressed patients. Research now suggests this type of treatment may be just as effective for PMDD patients. Sleep deprivation therapy only provides short-term benefits, but studies now suggest the resultant mood improvements can be maintained by daily light therapy or certain drugs.

Vitamins, Supplements, and Diet

Diet changes and dietary supplements have been shown improve many physical and some mood symptoms in PMDD PMS patients. Vitamin B6, magnesium, calcium, and evening oil have been studied as possible PMS and PMDD treatments. While data supporting vitamin B6 is limited and of poor quality, doses may be helpful in reducing symptoms. Calcium supplements in the luteal phase of the premenstrual cycle can reduce and pain, improve mood, and reduce food cravings; and a daily milligram dose of magnesium has been shown to reduce Evening primrose oil is often recommended by alternative practitioners and is popular in Europe and Australia to treat tenderness; however, clinical studies have not shown it to effective PMS remedy.

Diet and dietary supplements are also thought to be helpful improving some of the symptoms of PMDD. One recent nonrandomized trial found that a low-fat vegetarian diet reduced PMS symptoms, but there is insufficient data on dietary supplements to recommend them as a treatment.

Hormones

Hormone treatments include progesterone, birth control pills, and drugs used to suppress the ovarian cycle. The theory is that women can’t experience PMDD if they’re not ovulating. Some common hormone treatments include:

• Progesterone:A number of studies have found that progesterone is no better than a placebo in treating PMS, while data on synthetic progesterone-like drugs, such as dydrogesterone, are conflicting.

• GnRH analogues:Drugs such as Lupron and Synarel manipulate ovulation by shutting down the ovaries. They are commonly used in infertility treatments and more recently save the eggs of women undergoing chemotherapy. Clinical trials have shown they have a beneficial effect on PMS symptoms, but because there is a high risk of osteoporosis if they are used for more than six months, GnRH analogues aren’t appropriate as a long-term therapy.

• Danazol: Used to suppress the ovarian cycle, this drug reduces premenstrual symptoms, but it has its own set adverse effects, including weight gain, hot flashes, mood instability, vaginal dryness, and an intensification of masculine characteristics, which limit its use as a PMDD drug.

• Birth control pills:Oral contraceptives seem to alleviate the physical symptoms of PMDD, such as breast tenderness and bloating, but do not affect psychological symptoms.

In some women, the side effects of oral contraceptives worsen or mimic PMDD symptoms. In 2006, the FDA approved a new oral contraceptive that may have some significant benefits for PMDD. The birth control pill, called YAZ, has more days of active hormones than other low-dose contraceptives, which means that women experience fewer hormone fluctuations and fewer symptoms. With typical lowdose oral contraceptives, women take hormones for twenty-one days and then a placebo pill for seven days. In contrast, women on YAZ go off hormones for four days only. In a clinical study, 450 women with PMDD took either YAZ or a placebo pill. The results were significant: 48 percent of the women taking YAZ reported significant improvement in their PMDD symptoms, compared with 36 percent of women taking a placebo pill. However, YAZ contains a progestin called drospirenone, which may increase potassium levels and can lead to serious problems for women with kidney, liver, or adrenal disease.

Diuretics and NSAIDs

Diuretics and nonsteroidal anti-inflammatory drugs come both prescription and over-the-counter versions. NSAIDs are in reducing inflammation, while diuretics, such as spironolactone, reduce swelling, bloating, and weight gain.

SSRIs

Selective serotogenic reuptake inhibitors are becoming the drug of choice for PMDD. Several research trials have shown that SSRIs are both effective and have minimal side effects. A common SSRI is fluoxetine (sold under the brand name Sarafem or Prozac). Fluoxetine has been shown to reduce tension, irritability, and depression but is not as effective on physical symptoms. Its most common side effect is sexual dysfunction, such as decreased libido and the inability to orgasm. Sertaline, another SSRI, reduces both behavioral and physical symptoms, according to two randomized controlled trials. Paroxetine-controlled release has also proven effective when given during the luteal phase.

Surgical Options

Surgery is a treatment of last resort for PMDD because it ends a woman’s fertility, and it cues the onset of menopause, which has its own set of physical symptoms. However, a hysterectomy (the surgical removal of the uterus), along with the removal of the ovaries (known as a bilateral oophorectomy) cures PMDD, while a hysterectomy alone can reduce symptoms.