In an evidence-based review published in 2012, Laura Wakil, Samantha Meltzer-Brody, and Susan Girdler present a thorough review of premenstrual dysphoric disorder (PMDD), reviewing its diagnosis and treatment options. The information provided is clear and provides an excellent framework for understanding PMDD. In addition, this article includes a section on the association between PMS/PMDD and a history of sexual or physical trauma, an important topic that other reviews have typically not included.
Although published 9 years ago, there are not many reviews on PMDD out there, and this is a good one. With regard to treatment and diagnosis, little has changed over the last decade. PMDD is now classified as a mental illness in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5); however, the diagnostic criteria we have used are basically the same.
Although many women with PMDD are treated with hormonal contraceptives, the data supporting their efficacy has been mixed. The only oral contraceptive FDA-approved for the treatment of severe premenstrual symptoms is a combination of drospirenone and ethinyl estradiol (marketed as Yaz or Yasmin).
In contrast, there is ample information to support the use of serotonin reuptake inhibitors.
In terms of treating women with PMDD, one of the greatest frustrations is that there are so few effective treatments available. Many women with PMDD cannot tolerate or do not respond to serotonin reuptake inhibitors. In those patients, we might consider using an oral contraceptive. However, hormonal interventions are not an option or do not work, what’s next?
The last treatment approved by the FDA for the treatment of severe premenstrual symptoms or PMDD was Yaz in 2006. In the 15 years since that approval, we have seen some novel treatments (see below); however, none of these have come to market. Given that PMDD affects about 3% of — or about 3.7 million — American women during their reproductive years, there is a clear need for the development of additional modalities of treatment for PMDD.
To supplement this review, I would add the following posts on new treatments for PMDD:
- A Novel Treatment for PMDD: Ulipristal Acetate, a Progesterone Receptor Modulator
- Ovarian Suppression for PMDD: New Study Suggests Long-Term Effectiveness and Tolerability
- Allopregnanolone Sparks Interest as New PMDD Treatment
- Internet-Based Cognitive-Behavioural Therapy for Women with PMDD
- Preliminary Data Supporting the Use of Mindfulness-Based Cognitive Therapy for Premenstrual Symptoms
Another good review is from Drs. Edwin Raffi and Marlene Freeman from our Center, published in 2017; this review provides a more in-depth look at the underlying causes of premenstrual symptoms.
Ruta Nonacs, MD PhD
Wakil L, Metlzer-Brody S, and Girdler S. Premenstrual dysphoric disorder: How to alleviate her suffering. Current Psychiatry. 2012 April;11(4):22-41.
A printable and downloadable PDF of this article can be found HERE.