From the FDA Drug Label
Drospirenone and ethinyl estradiol tablets may also be taken to treat premenstrual dysphoric disorder (PMDD) if you choose to use the Pill for birth control. Two multicenter, double-blind, randomized, placebo-controlled studies were conducted to evaluate the effectiveness of drospirenone and ethinyl estradiol tablets in treating the symptoms of PMDD. Women aged 18–42 who met DSM-IV criteria for PMDD, confirmed by prospective daily ratings of their symptoms, were enrolled In both trials, women who received drospirenone and ethinyl estradiol tablets had statistically significantly greater improvement in their Daily Record of Severity of Problems scores.
The best treatment for Premenstrual Dysphoric Disorder (PMDD), according to the provided drug labels, is drospirenone and ethinyl estradiol tablets. This treatment has been shown to be effective in two clinical trials, with women receiving the treatment experiencing a statistically significant improvement in their symptoms. However, it is essential to note that this treatment should only be used for PMDD if the patient has already decided to use oral contraceptives for birth control and has been diagnosed with PMDD by a healthcare provider 1.
From the Research
The most effective treatment for Premenstrual Dysphoric Disorder (PMDD) is a combination of medication, specifically selective serotonin reuptake inhibitors (SSRIs), and lifestyle changes, as evidenced by the most recent and highest quality study 2. For medication, SSRIs such as fluoxetine, sertraline, or paroxetine are commonly prescribed, usually starting at a low dose (e.g., 10-20mg for fluoxetine) and increasing if needed. These can be taken daily or only during the luteal phase (2 weeks before menstruation). Hormonal treatments, such as birth control pills containing drospirenone, are another option. Lifestyle changes are crucial and include:
- Regular exercise (30 minutes of moderate activity most days)
- Stress reduction techniques like meditation or yoga
- Balanced diet rich in complex carbohydrates and lean proteins
- Limiting caffeine, alcohol, and salt intake
- Ensuring adequate sleep (7-9 hours nightly) Supplements like calcium and vitamin B6 may also help alleviate symptoms. These treatments work by regulating neurotransmitters and hormones that are thought to be imbalanced in PMDD, as supported by studies 3, 4, 5, 6. It's essential to track symptoms for at least two menstrual cycles to confirm PMDD and monitor treatment effectiveness, and to consult a healthcare provider to determine the best individualized treatment plan. The most recent study 2 provides moderate-certainty evidence that SSRIs reduce premenstrual symptoms in women with PMS and PMDD, and are more effective when taken continuously compared to luteal phase administration. However, SSRI treatment also increases the risk of adverse events, with the most common being nausea, asthenia, and somnolence. Therefore, the best approach is to use SSRIs as the first-line treatment, while also incorporating lifestyle changes and considering hormonal treatments, under the guidance of a healthcare provider, to minimize adverse effects and maximize treatment effectiveness.