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.
Treatment of PMDD in a 40-year-old female:
- Drospirenone and ethinyl estradiol tablets can be used to treat PMDD in women who choose to use the Pill for birth control and have been diagnosed with PMDD by their healthcare provider.
- The patient should take one pill every day at the same time, in the order directed on the package.
- It is essential to follow the directions for taking the birth control pills to minimize the chance of getting pregnant.
- The healthcare provider should be consulted before starting drospirenone and ethinyl estradiol tablets, especially if the patient is currently on daily, long-term treatment for a chronic condition or taking strong CYP3A4 inhibitors 1.
From the Research
Treating Premenstrual Dysphoric Disorder (PMDD) in a 40-year-old female typically involves a combination of medication, lifestyle changes, and psychological support, with a focus on selective serotonin reuptake inhibitors (SSRIs) or novel formulations like selective progesterone receptor modulators (SPRMs) as first-line treatments. The most recent and highest quality study 2 suggests that SPRMs, such as ulipristal acetate, may offer a new and effective approach to managing PMDD symptoms with minimal side effects.
Medication Options
- Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine (20mg daily), sertraline (50-150mg daily), or escitalopram (10-20mg daily) can be taken continuously or only during the luteal phase (2 weeks before menstruation) 3, 4, 5.
- Selective progesterone receptor modulators (SPRMs) like ulipristal acetate have shown promise in reducing PMDD symptoms with negligible side effects 2.
- Hormonal treatments like combined oral contraceptives containing drospirenone (such as Yaz or Yasmin) can help regulate hormonal fluctuations 6.
Lifestyle Modifications
- Regular exercise (30 minutes daily) can help reduce symptoms.
- Stress reduction techniques (meditation, yoga) are beneficial.
- Limiting caffeine, alcohol, and salt intake, and maintaining regular sleep patterns can also help manage symptoms.
Additional Support
- Cognitive behavioral therapy specifically targeting PMDD symptoms can provide additional benefit.
- Since the patient is 40, perimenopause considerations should be discussed, as hormonal fluctuations may worsen symptoms.
- Treatment should be individualized based on symptom severity, with medication adjustments as needed over 2-3 menstrual cycles to achieve optimal relief.