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Premenstrual Dysphoric Disorder (PMDD) (cont.)

Medication

Antidepressants

The selective serotonin reuptake inhibitor (SSRI) (antidepressant medications) commonly used to treat depression are the most common medical treatment for PMDD. Up to 75% of women will have reduction in symptoms when treated with SSRI medications. Side effects can include nausea, anxiety, and headache, although more serious side effects are possible. SSRI medications to treat PMDD may be prescribed to be taken continuously or only during the 14-day luteal phase (second half) of the menstrual cycle. Examples are fluoxetine (Prozac, Sarafem), sertraline (Zoloft), paroxetine (Paxil), and citalopram (Celexa).

Other Medication

Other medical treatments that have been used in PMDD are drugs that interrupt ovulation. These can include oral contraceptive pills (OCPs, birth control pills) as well as Gonadotropin-releasing hormone analogs (GnRH analogs or GnRH agonists), which stop menstrual periods by inhibiting the secretion of ovarian regulatory hormones from the pituitary gland. Examples of GnRH agonists include leuprolide (Lupron), nafarelin (Synarel), and goserelin (Zoladex). The side effects of GnRH agonist drugs can be unpleasant and mimic menopausal symptoms (hot flashes, vaginal dryness, irregular vaginal bleeding, mood changes, fatigue, and loss of bone density). Treatment with small amounts of estrogen and progesterone along with the GnRH analog medications can help reduce the side effects and preserve bone density.

Danazol (Danocrine)

Danazol (Danocrine) is a drug that has sometimes been used to treat PMDD when other treatments have failed. Danazol promotes high androgen (male hormone) and low estrogen levels. It is not a first-line treatment because it has a number of significant side effects. A majority of women taking this medication develop side effects from the drug, including weight gain, edema, decreased breast size, acne, oily skin, hirsutism (male pattern hair growth), deepening of the voice, headache, hot flashes, changes in libido, and mood changes.

Next Steps

If a woman's symptoms persist despite therapy for PMDD, a health care practitioner may suggest a different medication or treatment. It is important to follow the health care practitioner's suggestions for treatment and follow-up visits.

Follow-up

Follow-up visits will be necessary to monitor the woman's response to treatment and its possible side effects. The health care practitioner's will make recommendations regarding the frequency of follow-up visits.

Prevention

Since PMDD is likely the result of a complex hormonal interaction and its cause is poorly understood, there is no known way to prevent PMDD from occurring.

Outlook

If untreated, PMDD can significantly interfere with a woman's quality of life and her ability to function at work, school, or home. However, PMDD is a treatable condition, with most women reporting a reduction in symptoms with adequate medical treatment. In addition, a number of different therapies are available should a given treatment be ineffective for an individual woman.

Medically reviewed by Steven Nelson, MD; Board Certified Obstetrics and Gynecology

REFERENCE: Medscape Reference; "Premenstrual Dysphoric Disorder."


Medically Reviewed by a Doctor on 9/11/2014

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