PMDD Treatment

Written and Fact-Checked by: Jenna Carberg

PMDD Treatment at a Glance

Premenstrual dysphoric disorder (PMDD) is treatable, and most people have more than one option. Here is how the main treatments compare, based on the American College of Obstetricians and Gynecologists (ACOG) guidance as summarized in published reviews and the underlying research:

Treatment How strong the evidence is Best for
SSRI antidepressants First-line; strong recommendation, moderate-quality evidence Most people with PMDD
Birth control pill with drospirenone (Yaz) FDA-approved for PMDD; evidence limited to short trials People who also want contraception
Cognitive behavioral therapy (CBT) Small-to-medium benefit; effects lasted at follow-up Alone or alongside medication
GnRH agonists with add-back hormones Effective; conditional recommendation Severe PMDD that has not responded to other treatment
Surgery (removing the ovaries and uterus) Last resort; no randomized trials Severe, disabling PMDD after other options
Calcium, exercise, acupuncture Low-quality evidence, low risk Add-ons, not replacements

SSRIs: The First-Line Treatment

Selective serotonin reuptake inhibitors (SSRIs) are the most studied and most effective medications for PMDD. A Cochrane review of 31 randomized trials found SSRIs reduce premenstrual symptoms, whether taken every day or only in the second half of the cycle.

They Work Faster for PMDD

In depression, SSRIs usually take weeks to work. In PMDD, symptoms often improve within days. That is what makes it possible to take them only when you need them.

Every Day or Just Before Your Period

  • Continuous dosing: the medication is taken every day of the month.
  • Luteal-phase dosing: the medication is taken from about two weeks before your expected period until your period starts.

The Cochrane review found no clear difference in effectiveness between the two, though few trials compared them directly. Intermittent dosing can mean less medication overall; continuous dosing is simpler if your cycle is irregular.

FDA-Approved SSRIs for PMDD

  • Fluoxetine (sold for PMDD as Sarafem; the same drug as Prozac): 20 mg a day, every day or starting 14 days before your expected period through the first full day of bleeding.
  • Sertraline (Zoloft): starting at 50 mg a day, taken continuously or only in the luteal phase.
  • Paroxetine controlled-release (Paxil CR): starting at 12.5 mg a day, continuously or in the luteal phase.

Other SSRIs are also used for PMDD, but these carry a specific FDA indication.

Side Effects

Side effects are common and increase with dose. In the Cochrane review, nausea affected about 1 in 7 people and low energy about 1 in 9. SSRIs carry an FDA boxed warning about increased suicidal thoughts in children, teens and young adults, so any new or worsening thoughts should be reported to your prescriber right away.

Birth Control Pills for PMDD

  • Yaz (drospirenone 3 mg with ethinyl estradiol 20 mcg) is the only birth control pill FDA-approved to treat PMDD symptoms, and only for people who also want an oral contraceptive. It is not approved for ordinary PMS.
  • A Cochrane review found it may help PMDD, but the placebo effect was also large, the trials lasted only three cycles, and it is not known whether it works better than other pills.
  • It can cause nausea, bleeding between periods and breast pain.
  • Like all combined pills, it carries a boxed warning: people over 35 who smoke should not use it.

Other birth control pills have not been shown to treat PMDD, and some people find their mood worsens on hormonal contraception, so it is worth tracking symptoms after starting one.

Therapy for PMDD

Cognitive behavioral therapy (CBT) helps people manage the thoughts, reactions and conflicts that intensify during the premenstrual weeks, and plan around their cycle. A meta-analysis found CBT’s effect was small to medium, similar to antidepressants in size, and unlike medication, its benefits held up at follow-up. It can be used alone or together with medication.

Find a therapist who treats reproductive mood disorders

Treatments for Severe PMDD

GnRH Agonists

Gonadotropin-releasing hormone (GnRH) agonists, such as leuprolide, temporarily switch off the ovaries’ monthly cycle, which removes the hormonal trigger. A meta-analysis found them effective, and adding back low doses of estrogen and progesterone to prevent menopause-like side effects did not reduce the benefit. They are generally reserved for PMDD that has not responded to SSRIs or other treatments.

Surgery

Removing both ovaries (and usually the uterus) is a last-resort option for severe, disabling PMDD, including cases with suicidal thoughts, typically after a successful trial of GnRH agonists shows that stopping the cycle helps. In one small surgical series, most women reported their cyclical symptoms resolved, but that study had no comparison group, and surgery causes immediate menopause, usually requiring hormone replacement.

Supplements, Lifestyle and Natural Remedies

Many people search for a natural cure. None has been shown to cure PMDD, but a few options have some evidence for easing symptoms:

  • Calcium (1,200 mg a day): in one large trial in women with moderate to severe PMS, symptoms dropped 48% with calcium compared with 30% with placebo. It has not been tested specifically in PMDD.
  • Vitamin B6: may help, but most studies were low quality.
  • Chasteberry (Vitex agnus-castus): studies look positive, but they are at high risk of bias, so no firm conclusion is possible.
  • Regular moderate exercise and acupuncture: low-quality evidence, but low risk.

These are reasonable to try alongside proven treatment, not instead of it, especially if PMDD brings severe depression or suicidal thoughts.

What About Pepcid and Allegra?

A regimen of famotidine (Pepcid) with an antihistamine such as fexofenadine (Allegra) or cetirizine (Zyrtec) has spread widely on social media as a PMDD treatment. No clinical trials have tested it. A search of the medical research literature found no studies of this combination for PMDD, and clinicians and pharmacists have cautioned that antihistamines have not been studied for PMDD and that over-the-counter does not automatically mean safe for long-term use.

Some people report it helps them, and that experience is real to them, but there is no evidence it works better than a placebo. If you want to try it, talk to a pharmacist or doctor first, and do not let it delay treatments with proven benefit.

How to Get Started

  1. Track your symptoms daily for two cycles, using the free tracker from the International Association for Premenstrual Disorders (IAPMD), to confirm the pattern.
  2. Book an appointment with a gynecologist, primary care doctor or psychiatrist, and bring your tracking.
  3. Ask about an SSRI, including whether luteal-phase dosing makes sense for you.
  4. Consider therapy, especially CBT, alongside or instead of medication.
  5. Plan ahead for pregnancy. A history of PMDD is linked to a higher risk of postpartum depression, so tell your ob-gyn.

If PMDD brings thoughts of ending your life, call or text 988 for the Suicide and Crisis Lifeline, free and available 24 hours a day, even if you expect the thoughts to pass when your period starts.

Frequently Asked Questions

What is the best treatment for PMDD?

SSRI antidepressants are the first-line treatment with the strongest evidence. The best choice for you depends on your symptoms, whether you want contraception, and how you respond.

Can I take an SSRI only before my period?

Yes. Because SSRIs work quickly in PMDD, many people take them only from about two weeks before their period until it starts. Research found this works about as well as daily dosing.

Is Prozac used for PMDD?

Yes. Fluoxetine, the drug in Prozac, is FDA-approved for PMDD under the brand name Sarafem, at 20 mg a day, either daily or in the two weeks before a period.

What birth control is best for PMDD?

Yaz (drospirenone with ethinyl estradiol) is the only pill FDA-approved for PMDD symptoms, for people who also want contraception. Evidence for other pills is unclear.

Does Pepcid and Allegra work for PMDD?

There is no clinical evidence. No trials have tested famotidine with antihistamines for PMDD.

Can PMDD be cured naturally?

No natural remedy has been shown to cure PMDD. Calcium, vitamin B6, chasteberry, exercise and acupuncture may help some symptoms, but the evidence is weak.

What if nothing works?

For severe PMDD that does not respond to SSRIs and other options, GnRH agonists that pause the menstrual cycle are effective, and surgery is a last resort. A specialist in reproductive psychiatry or gynecology can help.

PostpartumDepression.org Team
Written by:

Jenna Carberg was diagnosed with postpartum depression following the birth of her daughter in 2016. It was a healthy birth but in the following days, Jenna's mood changed quickly. Doctors suggested that it might be the "baby blues", but her husband Chris suggested she seek a second opinion. Jenna was diagnosed with postpartum depression and began a journey that lasted 9 long months with significant ups and downs. Jenna's mental health care and her experiences became a passion for her to share with the world. She and her husband Chris founded PostpartumDepression.org as a support website designed to help women suffering in silence and their loved ones.

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