The exact cause of PMDD is currently unknown. Ovarian hormone levels during the menstrual cycle do not differ between individuals with PMDD the general population.[4]
First line treatment for PMDD is with selective serotonin reuptake inhibitors (SSRIs), which can be administered continuously throughout the menstrual cycle or intermittently, with treatment only during the symptomatic phase (approximately 14 days per cycle).[9] Hormonal therapy with oral contraceptives that contain drospirenone have demonstrated efficiency in reducing PMDD symptoms as well
As per common lore, women with PMDD experience mental illness symptoms limited solely to the last two weeks of their menstrual cycles and the distressing symptoms are relieved by the arrival of menstruation.
Mildly interesting factoids
- PMDD is essentially the only condition that I'm aware of (other than premature ejaculation) where antidepressants can be taken as needed instead of daily. It's commonly accepted practice to allow/advise women to only take their SSRIs at a set interval prior to the anticipation of luteal phase mood symptoms. Which is totally against common tenets of SSRI use for other conditions like depression, where it's commonly held that it takes at least a week to have any clinical effect and in many cases as long as 4 weeks.
- The side effect of inability to orgasm in men while on antidepressants is taken advantage of for men with premature ejaculation. SSRIs are specifically prescribed first line solely to decrease sensation and make them last longer.
- Essentially all birth control pills contain the same type of estrogen, although at slightly different doses. The difference between the Coke and Pepsi brands of birth control pills is the progesterone type and dose. Essentially all birth control pills containing both are considered non-inferior to each other because trials are never done head-to-head, but against placebo. Thus doctors literally recommend brands with absolutely zero critical thought.
- The progesterone Drosperinone claimed to help with PMS is a relatively new hormone brought to market over a decade ago. It is purported to have side benefits for women such as better acne control, but was also initially reported to cause more blood clots than traditional birth control pills. There was controversy whether the increased thrombotic events were actually specific to the new chemical or if it was simply overreporting of bad outcomes because of a new drug on the market compared to old hat.
