From the Research
Histamine and estrogen play crucial roles in Premenstrual Dysphoric Disorder (PMDD), with estrogen influencing histamine activity and release, and histamine levels fluctuating throughout the menstrual cycle, peaking during the luteal phase when PMDD symptoms are most severe. The relationship between histamine and estrogen is complex, with estrogen affecting mast cell degranulation and histamine release, as well as regulating histamine receptors in the brain 1. For women with PMDD, managing symptoms often involves addressing both histamine and estrogen fluctuations.
Some key points to consider in managing PMDD symptoms include:
- Antihistamines like cetirizine (10mg daily) or loratadine (10mg daily) may help manage symptoms, particularly during the luteal phase (7-14 days before menstruation) 2.
- Stabilizing estrogen fluctuations through hormonal contraceptives like combined oral contraceptives with drospirenone (such as Yaz or Yasmin) can help manage PMDD symptoms 3.
- Low-dose SSRIs like fluoxetine (20mg daily) or sertraline (50-100mg daily) are also effective, either continuously or only during the luteal phase, as they have been shown to reduce premenstrual symptoms in women with PMDD 1, 4.
- The choice between continuous and intermittent dosing regimens for SSRIs may depend on individual patient response, with continuous dosing regimens potentially being more effective for some women 4.
It's essential to note that while these treatments can help manage PMDD symptoms, the underlying pathophysiology of the disorder is not fully understood and is likely multifactorial, involving the interplay of hormonal, neurochemical, and environmental factors 5. Therefore, treatment should be tailored to the individual patient's needs and symptoms, and may involve a combination of pharmacological and non-pharmacological approaches. The most recent and highest quality evidence suggests that SSRIs, particularly when administered continuously, are effective in reducing premenstrual symptoms in women with PMDD 1.