Dysphoric Disorder (PMDD)
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- What is PMDD?
- Symptoms of PMDD
- Causes of PMDD
- Prevention of PMDD
- Risk factors for PMDD
- Complications of PMDD
- When to see a doctor about PMDD
- Diagnosis of PMDD
- Conventional treatment of PMDD
- Alternative/complementary treatment of PMDD
- Living with PMDD
- Caring for someone with PMDD
Conventional treatment of pre-menstrual dysphoric disorder (PMDD)
The conventional (western) medical approach to treating PMDD is through a combination of the following treatments:
Hormone therapy
These are used to regulate hormones by preventing ovulation and prevent or ease PMDD symptoms:
- Contraceptive pill - usually contains both eostrogen and progesterone in specific ratios, but there are also contraceptive pills that contain only one or the other hormone only. There are many variations of the Pill, with different amounts of each of the hormones eostrogen and progesterone. Today, most doctors prescribe a particular contraceptive pill called Yasmin® with a special combination of hormones (drosperinone/ethinyl estradiol), as research has shown it can greatly assist in reducing the symptoms of PMDD by suppressing ovulation, reducing fluid retention and countering the effects of testosterone
- Danazol - this medication reduces the output of both follicle-stimulating hormone (FSH) and luteinising hormone (LH) and eostrogen, so it stops the menstrual cycle, which may help with some women's PMDD symptoms. If the menstrual cycle is ceased, then PMDD symptoms are also not going to occur. While Danazol is effective at reducing symptoms of PMDD, it is only prescribed as a medication of extreme last resort, when other options are not viable, as it has really severe side effects (acne, cramps, depression, flushing, increased HDL ("bad") cholesterol levels, increased male characteristics, reduced breast size, weight gain) and also cannot be prescribed for longer than six months
- GnRH agonists - Gonadotropin releasing hormone agonists (GnRH) are a type of medication that suppresses ovulation by stopping the production of estrogen and progesterone. The GnRH agonists are effective at reducing symptoms of PMDD, but they are only prescribed as a medication of last resort, when other options are not viable, as they have severe menopause-like side effects (in particular, hot flushes and night sweating) and they also cannot be prescribed for longer than six months
- Bromocriptine - this drug selectively targets one of the abnormal hormones, but is not used very much these days as it can cause a worse imbalance of the hormones
These drugs all have side effects, some of which are pretty severe and cause many women to stop taking them, simply because they cannot tolerate the side effects at all. These medications just treat the symptoms and not the actual cause of the PMDD, so they do not really provide a major benefit for PMDD long-term, which is the reason why many doctors these days are more inclined to suggest an alternative/complementary approach to treating PMDD and only suggest medication as a last resort.
The contraceptive pill for example, should not be taken by women who smoke, who have had any type of blood clots or who have had any type of eostrogen female cancers. The other medications also have their own set of side effects and the risks should be discussed with your doctor.
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Medications
The following medications are prescribed, either on their own or in a combination advised by your doctor, depending on symptoms:
- Fluid retention relief - to relieve symptoms associated with
bloating in the breasts, abdomen and the whole body
- Diuretics - both over-the-counter and prescription are used to relieve the fluid retention and breast tenderness symptoms associated with PMDD by blocking the function of the hormone aldosterone. Examples are: Aldactone (not to be taken at night as they can cause disrupted sleep when they wake you with the need to urinate often)
- Prostaglandin inhibitors - to
relieve inflammation
- COX-2 Inhibitors - these medications are used to relieve menstrual cramping and premenstrual symptoms. Examples are: Celebrex (other Cox-2 inhibitors have been taken off the market due to significant side effects, including heart attack, stroke and possible death)
- Analgesics - to
relieve pain and/or inflammation
- Naproxen, ibuprofen, or mefenamic acid - these are non-steroidal anti-inflammatory medications which relieve premenstrual pain and reduce menstrual pain and bleeding. They work to reduce inflammation by reducing prostaglandin production. Examples are: Advil, Naprogesic, Nurofen, Ponstan
- Anti-depressants - these are recommended to be used just in the two weeks prior to menstruation, during PMDD (or sometimes all month for some women) to reduce symptoms associated with depression. Today, there are a number of anti-depressant medications which are specifically tailored to be used for PMDD
- Benzodiazepines - are only recommended to be used for a few days prior to menstruation for anxiety symptoms, when other treatments have been ineffective. These medications depress the central nervous system, but they lose their effectiveness over time and can be very addictive. Examples are: Xanax
- SSRIs - these medications work by helping the brain retain more serotonin, the neurotransmitter responsible for regulating mood and which may be low in women with PMDD. These medications help to relieve depression, anxiety, irritability, aggression, and many physical symptoms of PMDD. Examples are: Prozac, Sarafem, Paxil, Zoloft, Luvox, Celex
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