Treatment:

A healthy lifestyle is the first step to managing PMDD.

• Eat a balanced diet (with more whole grains, vegetables, fruit, and little or no salt, sugar, alcohol, and caffeine)
• Get regular aerobic exercise throughout the month to redue the severity of PMS symptoms
• Try changing your sleep habits before taking drugs for insomnia (See also: Sleeping difficulty)

Keep a diary or calendar to record:

• The type of symptoms you are having
• How severe they are
• How long they last

Antidepressants may be helpful.

The first option is usually an antidepressant known as a selective serotonin-reuptake inhibitor (SSRI). You can take SSRIs in the second part of your cycle up until your period starts, or for the whole month. Ask your doctor.

Cognitive behavioral therapy (CBT) may be used either with or instead of antidepressants. During CBT, you have about 10 visits with a mental health professional over several weeks.

Other treatments that may help include:

• Birth control pills may decrease or increase PMS symptoms, including depression
• Diuretics may be useful for women who gain a lot of weight from fluid retention
• Nutritional supplements -- such as vitamin B6, calcium, and magnesium -- may be recommended
• Other medicines (such as Depo-Lupron) suppress the ovaries and ovulation
• Pain relievers such as aspirin or ibuprofen may be prescribed for headache, backache, menstrual cramping and breast tenderness

Expectations (prognosis):

After proper diagnosis and treatment, most women with PMDD find that their symptoms go away or drop to tolerable levels.

Complications:

PMDD symptoms may be severe enough to interfere with a woman's daily life. Women with depression may have worse symptoms during the second half of their cycle and may need changes in their medication.

As many as 10% of women who report PMS symptoms, especially those with PMDD, have had suicidal thoughts. Suicide in women with depression is much more likely to occur during the second half of the menstrual cycle.

PMDD may be associated with eating disorders and smoking.

Calling your health care provider:

Call 911 or a local crisis line immediately if you are having suicidal thoughts.

Call for an appointment with your health care provider if:

• Symptoms do not improve with self-treatment
• Symptoms interfere with your daily life