Over the years, many treatments have been used for premenstrual symptoms, for premenstrual syndrome (PMS), and most recently for premenstrual dysphoric disorder (PMDD). Until recently, few of these treatments were evaluated in carefully designed research studies and even fewer were shown to be effective. There are now four prescription drugs that have been approved by the U.S. Food and Drug Administration (FDA) for treating the condition. These FDA-approved medications are fluoxetine (Sarafem), paroxetine controlled-release (Paxil CR), and sertraline (Zoloft), together with drospirenone/ethinyl estradiol oral contraceptive (YAZ). Nonetheless, many treatments of less well established value remain in widespread use and some women find them to be quite satisfactory. Unfortunately, promise of "cures," often costly, are sometimes made for treatments that have not been subjected to well-designed confirmatory research. When we discuss treatments for PMDD here, we'll base our comments on the best available research data, the opinions of experienced clinicians, and a generous sprinkling of common sense.

There are 3 broad approaches to treating PMDD. While most experts recommend a combination of all 3, there have been no scientific studies to determine if combination treatment is really the best approach. It is likely that the best approach or combination of approaches will vary from woman to woman based on things like symptom severity and which symptoms are most troublesome.

Here are the 3 approaches with some examples of each:

1. Medications - including antidepressants, antianxiety drugs, analgesics, hormones and diuretics.
2. Psychobehavioral - including exercise and psychotherapies (cognitive-behavioral, coping skills training, relaxation).
3. Nutritional - including diet modification, vitamins, minerals and herbal preparations.

Hear from an expert - Dr. Jean Endicott

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