It is important to rule out any underlying disorders including low progesterone or thyroid issues. Simple blood tests can rule out hormone imbalances and deficiencies or thyroid disorders.
Oral contraceptives are also a first-line treatment option for PMDD. "The Pill" contains two forms of female hormones that include ethynyl estradiol (estrogen) and drospirenone (progestin/synthetic progesterone). Some pills may contain only progestin. When taken daily, these hormones travel through the bloodstream to the pituitary gland to prevent the release of LH and FSH which in turn prevents the growth of an egg at ovulation.3,4
These medications can offer symptom relief by regulating the fluctuation of hormones throughout a woman's menstrual cycle. Although, according to the American Academy of Family Physicians OCPs are not reported to be consistently effective in the treatment of PMDD.
OCPs may not suffice if mood symptoms are prominent and, in some patients, these drugs may worsen dysphoria (a known side effect of some birth control pills) in many women with and without PMDD.The increase in symptoms seems to be especially prevalent in women with progesterone-sensitive type PMDD. Recent studies point to a direct link between the female hormone progesterone and PMDD. All OCPs contain progesterone and may make symptoms worse.5
In randomized controlled trials, the only birth control pills that have shown improvement in PMDD symptoms are pills that consisted of a combination of ethynyl estradiol and drospirenone (like Yaz, Ocella, and Beyaz). These pills have been shown to offer relief from both physical and psychological PMDD symptoms with improvement in health-related quality of life. For women who choose the Pill for contraception, Yaz is the only birth control FDA-approved to treat PMDD.6,7
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It is recommended before starting or stopping any type of medication for the treatment of PMDD, to have baseline progesterone levels tested over a full menstrual cycle. A single hormone test is not sufficient in diagnosing a true progesterone deficiency as hormones naturally fluctuate throughout a monthly cycle.21,
Should progesterone levels prove to be too low, supplementing progesterone may be beneficial in relieving symptoms. For those without low progesterone, adding more of this hormone may increase the severity of symptoms including depression, rage, and anxiety. The only way to know if your PMDD is caused by a progesterone intolerance or sensitivity is by trying it. If symptoms worsen and continue to worsen after two months of therapy, progesterone therapy should be stopped.
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There is no single option that works for all women with PMDD. You will want to work with your health care and support team to find the best treatment option for you.
Many women find it is a combination of several treatment options that help the most.
There are several options for treatment that are currently prescribed to manage symptoms of PMDD. Some have been proven to be effective and others have not. Some may lessen symptoms in the short term and others may have no effect or worsen symptoms over time. Always consult with your medical team before stopping or starting any medications or treatments.