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frequently asked questions about treatment of pmdd













What is the best medication?

While there is no single medication that stands out above all others for treating PMDD, the class of drugs known as SSRIs (selective serotonin reuptake inhibitors) are the preferred treatments. Among them, fluoxetine (Sarafem), paroxetine controlled-release (Paxil CR), and sertraline (Zoloft) have been approved by the FDA for treating PMDD, but other drugs in this class also appear to be effective. For women who choose to use an oral contraceptive, a drospirenone/ethinyl estradiol product (YAZ) is also FDA-approved for PMDD. There is no "best" medication for everyone. The decision should be made between you and your clinician, based on your needs and your medical history.

Do medications help get a person's life back in order?

While medications may greatly relieve symptoms of PMDD, they may not be "cure-alls." Sometimes improvement is not complete and even if it is, problems that were caused by PMDD may continue to exist. Psychotherapy and other forms of counseling can be helpful in dealing with those difficulties.

Do medications cure PMDD?

No, but medications can be effective in controlling symptoms of PMDD. If a woman has benefited from a PMDD medication and stops taking it, the symptoms of PMDD are likely to return. In this sense, the medicine has not cured the condition but rather has effectively controlled it. Control rather than cure with medicines is actually quite common in medicine - diabetes is controlled, high blood pressure is controlled, heart failure is controlled and so on.

What if a medication doesn't work or I can't tolerate it?

Don't despair. This doesn't mean that you will have the same problem with another medicine. Before switching it is important to be sure that the dose and the length of the treatment have been adequate. The good news is that quite a few medicines can benefit PMDD. You may need to be patient until the one that suits you best is found.

Do I have to take PMDD medication every day?

Not necessarily. If symptoms are quite severe or if the PMDD medicine is also being used to treat another condition, daily dosing may be indicated. Under certain circumstances, intermittent dosing of an SSRI (taking it daily only during the second half of the cycle) may be just as effective. Sertraline (Zoloft), fluoxetine (Sarafem), and paroxetine controlled release (Paxil CR) are FDA-approved for continuous and intermittent use. You and your doctor should discuss the best approach for you.

How long do I need to take medicine?

If you benefit from a PMDD medication and tolerate it well, don't be in a rush to stop it. PMDD tends to be a chronic recurrent condition, so symptoms are likely to return if you stop treatment. Periodically, attempts can be made to lower the dose gradually and see if the medicine is still necessary. Some women prefer to continue treatment until they reach menopause, at which time medicine can be stopped without concern of relapse.

How quickly do medications work?

Generally, drugs like the SSRIs (selective serotonin reuptake inhibitors) work during the first month of treatment. If dose adjustments are necessary it may take 2 or 3 menstrual cycles to get a full response.

What will the doctor need to know?

A doctor treating you with medication for PMDD should want to know your complete medical and psychiatric history, all medications you are taking (including herbal and other over-the-counter products), your diet, and your occupation and activities. Even if you are not sure whether certain facts are important, mention them and let your doctor decide how important they are to your treatment.

Are any laboratory tests required?

Although no specific laboratory tests are required before starting most PMDD medications (there may be exceptions), there could be some tests your doctor will want because of your overall state of health.

How do medications work?

Because the exact cause of PMDD is not known, it is difficult to explain why certain medications help. A brain neurotransmitter chemical known as serotonin is thought to play a major role, especially because the most effective medications for treating PMDD (SSRIs such as Sarafem, Paxil CR, Zoloft and others) act fairly specifically on serotonin. It is believed that such medications restore the brain's balance of serotonin.

Are medications addictive?

In general, PMDD medications are not addictive. Some of the antianxiety drugs (Xanax, Ativan, Klonopin and others) have been abused and their use requires close medical supervision. Most people who use these drugs, however, use them in the prescribed amounts and do not have problems with them. It is important to realize that physical dependence (not addiction) is common with regular use of benzodiazepines (the above antianxiety drugs). If they are stopped too rapidly, unpleasant physical withdrawal symptoms can occur. Following a discontinuation program recommended by your doctor can help you avoid these problems. The SSRIs (selective serotonin reuptake inhibitors) are not addictive and have not been abused. However, if some SSRIs are stopped abruptly people may experience unpleasant but not dangerous withdrawal effects.

How should I store medication?

Medication should be stored in its original prescription container away from direct sunlight and sources of heat and moisture. The bathroom medicine cabinet is not a good storage area. Some people find it easier to remember their doses if they put a week's supply in a plastic pill box divided into 7 daily compartments. Since all medication is potentially poisonous, it should be kept away from children.

What if I am running out of medication?

If you are getting close to running out, contact your doctor for another prescription. Plan ahead so you don't miss any doses. If you plan to discontinue treatment, a gradual decrease in the dose of most medicines makes it easier for your body to adjust.

What if I have side effects?

All medicines can cause side effects. Many side effects disappear over time or if they persist are easily tolerated. Some side effects, however, can be more troublesome and occasionally dangerous. Your doctor can provide information about any concerns you have. Sometimes lowering the dose, adding a counteractive medicine or switching to another medication may be necessary. Sexual side effects sometimes occur and should be discussed, even if the doctor hasn't asked specifically about them.

Are medications risky during pregnancy or breast-feeding?

This is a complicated question to answer because there are differences among medications. Pregnancy is an effective way of relieving PMDD; therefore, it should not be necessary to take PMDD medication while pregnant. Most medications do appear in breast milk but the amount getting into an infant is very, very low. Nonetheless, it is best to discuss with your doctor the risks and benefits of taking medications during pregnancy and while breast-feeding.

Can I take other medicines with a PMDD medication?

Before taking another medication with your PMDD medicine or before adding a PMDD medication to other medicines you are taking, be sure to discuss this with your doctor. Sometimes one medicine will raise or lower the blood level of another or interact in other ways that could cause problems. There can also be other types of interactions that can be troublesome and occasionally even dangerous. Don't forget to mention non-prescription drugs, herbal products and other dietary supplements that you have been taking when you talk with your doctor.

Can I exercise while taking a PMDD medicine?

By all means. Regular exercise has many health benefits and may even be helpful for PMDD. Your age and whether you have other health problems may enter into decisions about exercise. When in doubt, ask your doctor.

Are PMDD medications safe if I have another medical problem?

This is best discussed with your doctor who can help determine if any medical condition you have might be a problem.

Can I get good PMDD treatment at a health food store?

If you truly have PMDD, prescription medication offers you a much better chance of a good response than do nutritional supplements or herbs. Remember that good treatment depends on correct diagnosis and health food stores are not in the business of making medical diagnoses. You can click back to the section on nutritional approaches for more detail.

Isn't progesterone the best treatment for PMDD?

No, progesterone is actually not the best treatment for PMDD or PMS despite all the publicity and extravagant claims. A recent review (British Medical Journal, October 6, 2001) of all the well designed research studies concluded, "there is no published evidence to support the use of either progesterone or progestogens in the management of premenstrual syndrome." However, if progesterone has worked for you or for someone you know, we won't argue with success, but we don't recommend it as a treatment.

Is medicine always necessary to treat PMDD?

Not necessarily. But keep in mind that PMDD is a severe form of PMS and non-medication treatments such as exercise, nutrition, and psychotherapies are far less likely to be effective in the absence of medication.

Why not just cut out my ovaries?

While surgical removal of the ovaries will relieve PMDD, there are many possible surgical, medical and psychological complications that could occur. It is considered a treatment of last resort for only the most severe forms of PMDD.

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frequently asked questions about treatment of pmdd