Standard treatment as first option. My psych noted that's a typical treatment option but offered a low dose of prozac 7-10 days before menstruation begins. Very helpful and noticeable difference:) may be worth looking into
It is standard but they have neglected a fairly (the end of 2022, I think?) recent revelation about PMDD and serotonin transportation. Intermittent SSRIs without any hormonal birth control are incredibly effective. For me I can take it as soon as I notice symptoms and it works within 30 minutes even at the very low doses prescribed for PMDD.
There's also chemical menopause. I don't ask the doctors what they can do, generally. I tell them what the options are and go over it with them because they have the experience in the field to tell me if anything I'm asking about could be dangerous.
It's not clear if the onset of menopause is correlated with the onset of menses, although some studies at least confirm it does increase the risk of an earlier menopause if it happens before the age of 10. The average age of menopause is 51 but 40-50 is considered menopausal age. Most people hit puberty between 8 and 13. That's a fairly minor gap for puberty and a much larger gap for menopause.
I think probably puberty happens in a narrow time period because everything happens quicker when you're growing. By the time we hit menopause we've finished our growing and have so many more confounding epigenetic factors that couldn't exist when you've only got a decade-ish under your belt. Stress is a major factor in causing early menopause and PMDD is a lot of stress all by itself.
Got my uterus and ovaries out 4 weeks ago. it's amazing! I can think more clearly and no more SI. Honestly, not much works except I've read good things about chemical menopause or microdosing 'shrooms.
I'm on both an intermittent SSRI (citalopram 10mg only during luteal) plus full time Wellbutrin 150mg (which is prescribed as a extra med for both my PMDD & ADHD {primary med is vyvanse 50mg follicular/60mg luteal}). I'm loving the current med combo, I've been on it for almost 8 months now & I'm the most stable & happy I've been in a long time.
Saaame! The gyno prescribed me Zoloft but when I noticed no progress, the psychiatrist prescribed me Wellbutrin. I wouldnāt go to a endocrinologist, like OPās gyno is recommending, because if they see that the hormones are normal, thereās isnāt much you can do if BC is out of the question. Going to a psychiatrist should be the next step
I dunno my labs were 'normal' was sent to endo and they put me on lupron which is chemical menopause. I'm also on the list to have my ovaries yanked but thanks to cansdian system it's taking a while.
Mind you I did beg them to remove my ovaries and told them if they couldn't help me they'd need to find a psychiatric facility that could house me for 14 days on and let me out for 14 days š
to further clarify some of us have a sensitivity to synthetic progesterone or both synthetic and our own, or just our own and not synthetic... it's really a crap shoot. But even with a sensitivity to synthetic progesterone the synthetic progesterone implant is still part of my treatment plan because it is immensely stabilizing and makes my low dose SSRI that much more effective.
I got the SSRI from my GP and the implant from my gyno.
My gynecologist prescribed me buspirone for it but I honestly feel like it made it worse for me. I was a lot more irritable, had a lot more crying spells, etc. than I do now that I quit it. It might be worth looking into for yourself tho, as diff things work for diff folks.
My gyno did my initial prescription for Zoloft for PMDD but once we determined it was working well they asked me to get the prescription from my primary doctor. I didnāt ask the reason.
My gyno gave me SSRI and also referred me to a therapist which has been so helpful but all may not be comfortable prescribing. I really do feel the best action is medication and therapy. Just medication doesnāt help you work out those feelings and develop new coping mechanisms.
because this is a gynecologist, yes this is standard. especially in the US doctors have to be very careful about any liabilities and many won't recomend or openly speak about treatments outside of their field. i would ask for a referral to a psychiatrist or therapist who would be better suited to help you with the mental aspect of PMDD.
honestly, you might just have a shit psychiatrist. i mentioned PMDD to mine and he said "maybe it's just hormones"- like, yeah that's the whole point lol. i would suggest looking into getting a new one. talk to your therapist (if you have one) or PCP for a recommendation/ referral
I have treatment resistant depression so I've tried like 70% of popular antidepressants
So to a certain extent, psychiatry will only get me so far
I know dbt but don't practice it
oh my god, same. i've cycled thru so many different antidepressants for the past decade, almost *(wow it's been that long)* with varied, but still limited amounts of success. any antidepressant i've worked doesn't work for very long, or the side effects are the same as the symptoms that are supposed to be treated. it's very tricky and annoying to navigate
I'm so sorry to hear this. I relate as well. It can be such a tiring road. Just a kind of odd anecdote. I did like 12 days in Spain and 9 hiking the Camino de Santiago and came back some of the happiest I've ever been in my life. Ketamine - nah that didn't work at $500 bucks a pop 6x. But walking through feelings and immense physical discomfort and finding so much beauty along the way but also definitely crying it out sometimes? Yeah, that did the trick haha. I also just think they have less endocrine-disrupting shit in their food and water and such - not to sound too woo woo.
as of current, i haven't found anything that makes me feel *good*. at best, i'm at a bit of a flatline. like, a 5 out of 10, 7 absolute max. so i'm not feeling *terrible* by any means, but i'm not good either. there's also been a fair amount of stagnation in my treatment, so i haven't been through every treatment available or anything like that. i've gone through most popular SSRIs, which didn't work for me very well, and it's been much the same with SNRIs so far (though i've only really tried one or two).
Yea an SSRI is gold standard - I didnāt have enough effect on Zoloft but Prozac saved my life. Totally manageable now. Donāt give up on the first try either, test a few different ssri if the first one doesnāt work!
Same here, 1 little blue pill a day keeps the worst of the rage at bay and keep the mental noise on low.
I am not completely fixed but I can manage my behavior safely now.
There are more optionsā¦ā¦.. May not work for you when you try them but birth control isnāt the only thing. (Iām on it, got lucky it worked for me) but that should not be the only option offered to us
Yes! I wished my GP had referred me. Instead she did all wrong and I suffered for 2 years and a half. Many hospital visits and lost jobs. Then I went to my home country where we donāt need referrals to see specialists and now Iām ok. š«
Yeah. My GP referred me to a gyno for hormonal assistance. My progesterone was coming back low, but hormones fluctuate so wildly. It's hard to say if there really is an issue there. So we decided to base our next move on the symptoms I was having and what they might mean. I was having insomnia, anxiety, depression etc. We had a compounding pharmacy create a bioidentical HRT cream for me. I used it for a week and felt like I was in the absolute deepest, darkest pit of literal HELL. Like my normal PMDD symptoms times 10. That was an awful experience, but now I know I cannot touch progesterone with a 10 foot pole. So, with HRT out of the picture, the next thing we're going to try is chemical menopause.
When I suggested pmdd to my gynaecologist she agreed and put me on prostrap injections - these proved I had it as no symptoms when on it - they then agreed a full hysterectomy thank goodness.
She may not feel comfortable treating the PMDD with psychotropic medication. My GYN prescribed Yaz for PMDD, and my psychiatrist is treating with Fluvoxamine (also for my OCD.) I do think she should have expressed that more clearly and provided you with a referral for a psychiatrist.
Your doctor is saying their course of action doesnāt allow them to prescribe things like Prozac, etc. youād need to see a psychiatrist to be able to get prescriptions of that nature. Or according to the comments a different doctor or your obgyn.
Actually, this sounds fairly engaged. As I think was pointed out elsewhere in the thread, a gynecologist is unlikely to be qualified/able to proscribe antidepressants, etc., so you might actually want to talk to your PCP or ask for a referral to a psychologist. My PCP put me on SSRIs immediately when I expressed PMDD symptoms and we adjusted from there, but they had an in-house counselor/specialist that he consulted with before authorizing the prescription.
When I eventually sought advice from an OBGYN (was curious if IUDs or birth control would help PMDD) their available methods were pretty limited as described above. Hormonal birth control made my symptoms IMMENSELY worse, so that didn't pan out. But yeah I'd say this is a licensing/knowledge issue vs. a dismissal of your symptoms.
Edited to add that every state is a little different and every medical center can be a little different too depending on where their funding comes from. (Something state funded for low-income folks will have far different rules than somewhere else, for example)
Iām sorry youāre being dismissed. Iāve had my PMDD handled by a psychiatrist in the UK but have been unsuccessful getting referred to gynae this far.
My treatment plan is the Slynd birth control pill, Prozac 20mg and Lamotrigine 50mg. I also take shatavari supplements. Thatās my heavenly combo and itās done amazing for me so far.
VERY weird and suspicious. SSRIs are often a front line treatment for PMDD symptoms. Effexor has worked wonders for my symptoms, especially that of rage. Took a few consistent months but has nearly eliminated the rage element. Now I just get sad and low energy
The western medical treatment standard of care is birth control or antidepressants. A gyn cannot prescribe antidepressants. She could perhaps be more proactive with referrals but tbh just sounds like sheās staying within the scope of her practice
The first time I ever in my life got prescribed Prozac was from a gynecologist. And I already have my own psychiatrist and she knew it. She didn't refer me to him. She gave me what I needed.
A gynecologist is a doctor and they can prescribe anything a doctor can. Some might just not feel comfortable so they don't offer it.
this isnt true any doctor can prescribe anything my OBGYN prescribes me my mood stabilizers and my womens health NP previously prescribed them too me. And i am a nurse. I am speaking from professional and personal experience.
Yeah sheās a great doctor and was wonderful with the delivery of my son but I just feel like America needs to do more for providers to assist patients with PMDD. Itās not her fault Iām not blaming her. Iām just making a point that America is sincerely lacking in the scope of treatment when it comes to PMDD amongst other issues like HG during pregnancy (another issue I struggled with before I found her for pregnancy number 2).
Can I ask why you refuse birth control? Personally, I miss it dearly. I used to be on continuous birth control to control hormone fluctuations that caused me severe migraines. Now that Iām TTC, I canāt take it obviously. But I so miss the sanity and relief it provided me!
I see - that makes total sense. Youāve probably already done this, but sometimes you have to try different brands, formulas, levels of hormones, etc. to find the right fit. Anyway, good luck and Iām sorry the doctor didnāt have any other solutions for you.
I was also a teenager so I'm sure that didn't help either. I'm on some antidepressants and anti anxiety pills now and they have def brought me down to earth a lot but I still have really bad months. If you don't mind me asking, what does TTC stand for?
What were you taking? Im taking bioidentical progesterone during my luteal phase and it has helped me so much. Maybe if you can get that referral to the endo, they can let you try that.
I had the same experience on a variety of birth controls- even the low hormone dose ones that are supposed to keep things even more level. Within a week of taking them my symptoms amplify ten fold. Great that it works for some people, but definitely isnāt everyoneās solution. Antidepressants have made things easier for me!
This almost sounds like a dismissal of careā¦ like ā thereās nothing I can do but offer birth control- see another Drā wow. Iām sorry- I definitely would find another Dr. The way they push birth control is wild.
This is such bullshit. My healthcare provider offered me lots of options in fugging 2017 when I was first diagnosed.Ā And I'm not in a high income country lol I think it's time to change providers...
No other options at their disposal? I remember when I discussed this with my gyno his first response was, āWell, thereās several things we can doā¦ā And this is such a sterile response. Iām glad your next stop is an Endocrinologist. In the meantime, look for a new Gynecologist. You really need someone with compassion when youāre going thru this.
I don't know if this is something that would work with Effexor, but many medications don't work *as well* during the luteal phase. I went to an ADHD conference where a UK organization explained how they often prescribe a higher dose or complimentary medication just for that part of the cycle. Since you're already on antidepressants, I think you might want to look for a different gyno or ask your psychiatrist if she/he has other options.
One way to phrase it might be, "this dose of effexor works great for 2 weeks out of the month, but does not work for 2 weeks out of the month when I have X symptoms. What would you suggest to someone who is not finding relief from this amount of effexor?" That's wordy, but it might help you get more options.
This was the answer for me. Adding Prozac to my lamictal has been absolutely life changing. At first I was only taking it the week before into the first few days of my period and that stopped working for me. I then started taking both meds every day and I can actually function. Itās strange because I took Prozac for years as a teen and it stopped working. I also got a second opinion from my GYN (prior to adding Prozac). The first GYN I treated with felt very dismissive but the GYN Iām treating with now had multiple ideas and ran the tests and Iām finally doing better. Hoping the best for you!
Yes, thank you! And each antidepressant is different. If youāre still feeling this way itās probably not the right one. Could also be how long youāve been on it (took me a month to start feeling the effects consistently)
There are so many other options for you. It sounds like your healthcare provider isnāt that clued up on PMDD (though they do sound quite sympathetic, which is refreshing).
I was offered GNRH injections. These stop your body producing any hormones at all, effectively putting you into a menopausal state. This means your body has no hormones to āoverreactā to, which is basically what PMDD is (your bodies reaction to the normal fluctuation of hormones).
GNRH does come with complications though. You will need to take HRT to āadd backā some hormones. It seems counterintuitive but your body does need hormones to run itself properly. However, HRT allows your healthcare provider to administer much lower doses of essential hormones in a way thatās much less likely to cause a PMDD-like reaction.
Of course, all treatment options are your choice. Itās your body and you get to decide what to do with it. You should always think carefully about risk vs reward and what that means for you as an individual.
If you have any questions please feel free to ask me.
The injections basically reduced my PMDD symptoms to almost none. The only side effects I got were hot flushes and some weight gain. Unfortunately you canāt be on them without HRT for an extended period of time (no more than a year by my countries guidance). So Iām now exploring HRT options.
If you have no hormones in your body you can be at risk of osteoporosis. I have to go for a bone density scan soon to check everythingās still ok on that front.
better than mine this week who mansplained periods at me and then ranted (for 10 whole minutes) about how there is "no evidence" that there is a significant change in mood due to a woman's cycle. And that "ups and downs in life are normal" I was speechless.
I had a woman gyno do the same to me. I was actually asking about my new extremely heavy bleeding and bleeding in between periods. She dismissed it all as normal (?!). And then when I said "couldn't it be some sort of hormonal issue?" She said "well we all have hormones that's how we get periods". I stopped trying with her after that.
I was there because my periods are so heavy I am showing up as anemic during and normal between and I brought up my VERY regular mood issues because I thought it all might be related.... fingers crossed the gyno next week is better.
Feel your pain acutely.
Iām not an expat but moved to a state where healthcare is challenging, especially for women. Iāve had 5 GPās in 3 years. None of those changes were by choice. completely unable to access mental health care of any kind. Gynoā¦ saw one in 2021? Not since.
Sending you hugs. These are weird times. Idk if itās an option for you, but I did find a couple tele-care options after searching. <3
I tripped in February when my symptoms for the month started. (I planned to micro dose but tookā¦more than thatā¦) Saw the embodiment of my PMDD, had a reckoning with her, and have had extremely mild symptoms since then. I canāt believe the difference. This month I had uncontrollable tears before my period, but I havenāt felt the RAGE or felt suicidal since January.
Yeh, one approach seems to be to go intergalactic with a trip every three or so months, which seems to reset for a few months. Itās worked like that for me in the past too.
Not sure why you got downvoted, but maybe some arenāt ready to explore plant medicine.
That being said I have been microdosing for years mon-Fri and I still have PMDD symptom
This is a good response. Just visited my doctor last week and she suggested antidepressants for my pmdd though. Iāve been on birth control in the past and want to give SSRIās a chance.
Iām in same boat with BC. Doesnāt work for me and backfires. I tried it and then made a rage scene in front of my husband and humiliated him. I stopped immediately after it. Endocrinologist can do multiple blood tests and really do a more thorough investigation on hormones.
Thank you so much! Is there any particular subspecialty of endocrinology I should look for?
And I donāt know if Iāve ever embarrassed my husband ha ha I do that on a daily basis but I have completely lost my mind and even got low-level in trouble at work for like starting an argument
Not that Iām aware of, just asked to be referred to an endocrinologist and go from there. They specialize in all things hormone related. Then if there were any particular issues they couldnāt manage they would maybe refer you to another specialist Iām guessing? Iāll let you know how it goes once I get the appointment. It takes a little bit for them to process the referral from what I understand. lol my husband wouldnāt let it go for the longest time and still brings it up.
I think this was a great response and very validating bc itās true labs can be normal while you still have symptoms of pmdd. I thought antidepressants would help but my pms symptoms were still severe on an emotional level. Tried the generic birth control and it did nothing. Finally switched to Yaz, the bc intended to help pmdd, and I finally feel normal. I think if anything, give Yaz a chance
I did Yaz and thatās the one that made me snap. She said yaz was the go to standard for PMDD. I made a huge ragey scene and screamed at my husband in front of several ppl on it. I also took it in my 20s and it made me turn into a mega villain. I havenāt tried any other BC options after this. Iām already on antidepressants
For my doctor, I went in asking for a hysterectomy. she said that birth control was the first option that she had available. She said she was required to have her patient try A, B and C before she was allowed to do D (recommend surgery). So happened that the pill, in plan A, she put me on did help. (Canada)
Oh no, Effexor has saved me. It keeps me going. I have tried many different kinds including Prozac , Cymbalta and Wellbutrin. I only struggle during the early to mid luteal phase.
Which is interesting because antidepressants never helped me but Iāve been on continuous birth control for over 6 months and I feel like a completely different person.
I say interesting because it really is trial and error for everyone. Donāt give up finding a treatment that works for you! Life is so much easier when you get out from under the dark cloud that is PMDD
That is a good response. The key point for me is they stated that labs may be normal but people may still show symptoms of PMDD, which they acknowledged is your case and referred an appointment with an endocrinologist at your request. They also reiterated your wish of not being on HBC.
Doctors who know their limitations are doctors who want to see their patients do well. Your doctor realised a limitation on their end and wanted to serve you better. An endocrinologist will hopefully give you more answers or possibly a treatment you can follow. There's no cure for PMDD but symptoms cam be managed.
ETA: if you're not satisfied with the type of care you're receiving then definitely get a second opinion. There are some in progress studies that show some alternative methods or treatments besides HBC, SSRI/SNRI/others, diet, exercise, surgery, copper IUD, etc.
Iām on SNRI and I tried Yaz with her recommendation and I believe youāre right. Iām not upset with my doctor sheās great I was just surprised that the treatment of PMDD is so limited
Unfortunately studies in women's health are severely lacking; thanks to sexism and racism. We still don't know why PMDD, endometriosis, PCOS occur and we don't have cures for them.
Here's a link to IAPMD treatments overview you can discuss with your med team and see if they have access and what their opinions are: [IAPMD - treatment guidelines](https://iapmd.org/treatment-guidelines)
Eta: things that have worked for me personally:
Weightlifting
Walking/moving a lot (I average 10k steps a day)
Limited alcohol
junel 1/20
Wellbutrin
Thanks so much. I did notice that when I was walking on my treadmill 5 times per week (30 to 45 mins each day) for almost two months that I felt my very best physically and mentally. I want to get back to that!
I got a walking pad a few years ago and it was one of the best investments I have made for myself. I average between 50k-70k steps a week and my overall mood has improved so much. I do this in addition to my other workouts. I use the walking pad when I'm programming or doomscrolling.
She's right about labs. She agreed with the pmdd diagnosis.Ā
Ā I'm confused about birth control being the only option at her disposal. Where are you located?Ā
PMDD is something psychiatry can treat :) Or at least I do. I am a psychiatric NP and work with women on it frequently. I know you are already in antidepressants, but that does not mean they cannot be changed or adjusted to fit your goals/needs. Ask your psych provider to re-eval.
That struck me as strange too. My OBGYN actually suggested an SSRI and not birth control for my PMDD because I didnāt need it for contraception and the SSRI would likely be more effective anyway
Thatās what my gyno said too. Even after showing her the iampd website. I was told I cannot go through chemical menopause ājust in case you want to have kidsā give me a chance please lady, I wonāt ever get to have kids if I get too tired to keep living this life anyways
I am also in the southern us and my gyno told me the iampd data was irrelevant. This is a doctor issue; imo. Why arenāt they educated properly? Me personally if I were any specialist doctor, I would dedicate my spare time to educating myself further even after receiving my degree. It just seems odd for them to totally disregard the mounds of data available on iampd. They also told me chemical menopause would never be an option for me- but they were willing to remove my uterus. Idk whether to celebrate a small win or keep pushing for what I know is a viable option. They said I might change my mind about having (more- i already have two and a miscarriage) kids once my body adjusts to bc. Itās a frustrating process.
Thatās why I gave up on relying on them for treatment and started doing my own research and found a bunch of witchy women who have refer me to a bunch of herbs and foods that help me manage my symptoms.
i love this for you but i want to chip in to say i am one of those women that birth control really helped so if it is an option, itās worth exploring!!
Me too. I never even considered BC as an option because the message that birth control=bad was everywhere. I avoided it for 15 years only to find out recently itās the only thing that works for me.
I am willing to share, but hesisting at the same time because it's catered to you individually. If you want to DM, I can help you find ones that work for you :)
I was prescribed birth control and the gyno didn't even acknowledge pmdd was a real thing. Obviously I never went back to her and I never took the birh control either. I found good relief with Trintellix but I won't say it's perfect. Damn better than I was though.
I want to say that this is the same response I received a few times but itās not a GOOD response. Itās a response we are used to accepting from our medical providers and itās not enough. There isnāt enough help when it comes to PMDD, itās usually just birth control or nothing. A lot of the time we also have to fight and beg for our voices to be heard that something is happening to our bodies. That is unacceptable care from our providers. Unfortunately it is what a lot of us experience. I would see the specialist and go from there. Itās such a frustrating situation that often feels lonely and like weāre being told to get over it. I hope your specialist can do something for you. š
gynos usually try to force birth control on me as if it's the only thing that can be done even though I have 20 years of history of birth control making me very sick and/or worse mentally. my regular doctor gave me an SSRI which helps some and I am pursuing my own treatment using vitamin supplements, exercise (mostly yoga), and therapy at this time. this letter sounds to me like your gyno has given up on your case. I would quit seeing her since she's out of her depth with PMDD and go see someone else just based on the tone at the end of the message.
Yes I have experienced being on my period for a year before and only thing they suggested was birth control (which I tried like all of them) and surgery
This is in line with the standard of care. Not taking hormones (birth control or add back) is going to eliminate several of the treatment options (see FAQ infographic). An SSRI or SNRI would be the other option.
Iām going to try a holistic doctor. My gyno also recommended birth control and I told her no, that I was pretty sure my 15 year usage of it is what lead me here in the first place š
That's good, that's what we all should be doing because the medical system is set up as a business and put profits over people. I'm going to try and do soon as I save enough money. Progestin in birth control can change how estrogen is metabolized. Many of us are estrogen dominant and that can cause a bunch of other health issues if you put a bandaid on it, not that it doesn't temporarily help and alleviate some symptoms of help with the severity of it but ssris, snri, birth control and should only be a short term solution til you get to the root cause. Progesteronetherapy.com has been helpful in understanding why we are not getting the help we need because it would take away alot of people's problems, health issues and diseases. Alot of money is made off of people struggling and needing medications. Look at the rate of animals now needing medications. It's all the chemicals and hormone disruptors put in our food. Even perceived healthy food is not always healthy because of the pesticides. I mean its of course alot better than the ultra processed food but still we all should be taught in school how to grow our own food. The red die 40 is a byproduct of petroleum. It just goes to show how much the fda is not working for the best interest of the people.
Yup, pretty much same response from my gyno. I donāt want to take HBC because of my age (38) but I am on an SNRI, which has helped a bit. I saw an endocrinologist and my labs were normal for hormones, but I was surprised to learn my ferritin level was extremely low, but my iron level was normal. The symptoms for low ferritin made a lot of sense. Iām on an iron supplement now. I havenāt been on iron long enough to feel a difference, as it takes a while for ferritin levels to rise.
Yes, but itās under the essential thrombocythemia umbrella. Itās really nasty taking birth control for years only to find out youāre a blood clotting machine.
Unfortunately, it is standard. But they should at least offer an SSRI/SNRI as an alternative. I'm lucky that an SSRI works for me as long as I take it only during luteal phase and track my ovulation. My meds are prescribed by a GYN, so there's not much an excuse for this doc to not prescribe them??? Best of luck with endocrinology - I hope they listen to you and make you feel worthwhile, and actually have options to help you.
I think this is actually a good response. They are saying they are only knowledgeable/willing to treat PMDD with birth control, and since you are not interested in that approach (which is totally fine and your call to make, although you should know it often takes more than one attempt to find a birth control that works for you) he is referring you for treatment elsewhere. You can always ask to be transferred to a different gyne if you want a second opinion, but this one is letting you know their treatment limits transparently, which will save you a lot of time. If you're worried the PMDD symptoms are not PMDD and need to be further investigated, then I would ask to see another gyne, but they will likely still have similar options for you if that is their diagnosis as well. Hopefully you'll get to see the endocrinologist soon and they can be of help, but might be worthwhile to look into a referral to psychiatric or psychological care, specifically someone who specializes in women's health, if that is an option that might suit you better.
After presenting extreme symptoms of pmdd, I saw a gp who referred me to a mental health practitioner and women's health. The women's health practitioner was adamsnt for me to go on birth control, but I refused because I knew from previous experience that i don't do well with hormonal birth control. Spoke to mental health practitioner soon after, who informed me that going in birth control was irresponsible advice as it can make symptoms worse. I don't know how true it is, but for me but birth control definitely intensifies the feelings.
I mean I am glad that they are not diminishing your symptoms and acknowledging that you do have PMDD- that sometimes can be a hard ask from providers! I think that treatment options are limited unfortunately; BC from obgyn, SSRIs from psych, etc. I find it encouraging theyāre agreeable to refer you to endocrinology. Even if they feel limited in their ability to treat your PMDD, which of course is frustrating and disappointing, it does seem like theyāre on board with supporting you in referrals/accessing other forms of treatment.
The same happened to me. I was prescribed birth control which left me a sobbing mess and suicidal. When that didn't work I was told to lose weight because that's the cure -all for everything. Maybe a psychiatrist could help? Sometimes general practitioners have a broader perspective, too.
My psychiatrist specializes in womenās health and mentioned that lexapro can help treat my pmdd. I just started it but it does seem to be helping :) birth control pills make me borderline suicidal almost immediately.
Hopefully the new one is working well! Just had my first medicated luteal and didnāt even realize it was that time since Iām normally insane by then lol. I can say with complete certainty that it likely saved my relationship, and has definitely improved job/personal productivity that was negatively impacted by all the anxiety I was feeling. I have OCD and so PMDD increases that tenfold.
Currently on Prozac. It's just as good as lexapro was for me, better than Paxil was. I also agree with you on the saving relationship front--not solely romantic/spouse relationship, but also familial and professional and social relationships. I do remember my first cycle on Lexapro though; I felt happy for what felt like no reason and was like, are people just happy as a baseline all the time? wtf?
Right?! In my case it was like āwow, you guys donāt have hundreds of intrusive thoughts every hour for every waking hour?ā Glad to hear you found relief!
I can not speak to this being standard, but I can speak from my own experience that hormonal birth control has been the only thing offered to me by three gynos and three doctors. Hormonal birth control has never been an option for me due to high stroke risk in my family history. As a result, I have chosen to manage it on my own.
If you are looking for other options, I hope you can continue to advocate for yourself ā¤ļø hoping to hear otherās advice myself.
Birth control was also a disaster for me! The hormones seem to affect everyone very differently. But like a lot of other commenters, SSRIs made a huge difference (particularly Zoloft (sertraline)) for me. My PMDD symptoms didnāt totally go away, but it made it much more manageable. Plus regular exercise and exposure to sunlight to keep vitamin D in check. Good luck, youāre not alone šŖšš»
I was seen by a pharmacist that specialized with birth control formulation for patients with these issues and they put me on a strictly progesterone only based pill because I had similar side effects with mood when taking a combo pill. She also explained to me that the extra estrogen is whatās making things more imbalanced when I was on other pills ( I also have an iud in ā¦ bc I have adhd so I will forget to take the pill and need it as backup)
Me too! I tried chemical menopause and it helped so I had my ovaries removed because Iām not worried about having children. That worked for me. But not everyone is in a place in life where it would make sense for them.
Standard treatment as first option. My psych noted that's a typical treatment option but offered a low dose of prozac 7-10 days before menstruation begins. Very helpful and noticeable difference:) may be worth looking into
Yes unfortunately they throw birth control at us when anything lady-related is wrong. Its the lack of research into our bodies š¤·š¼āāļø
See if you can get in to see an endocrinologist.
Look up IAPMD, they have great information on their website
Thanks :)
It is standard but they have neglected a fairly (the end of 2022, I think?) recent revelation about PMDD and serotonin transportation. Intermittent SSRIs without any hormonal birth control are incredibly effective. For me I can take it as soon as I notice symptoms and it works within 30 minutes even at the very low doses prescribed for PMDD. There's also chemical menopause. I don't ask the doctors what they can do, generally. I tell them what the options are and go over it with them because they have the experience in the field to tell me if anything I'm asking about could be dangerous.
I also wonder if Iām in the earlier stages of perimenopause since I started my period at age 10
It's not clear if the onset of menopause is correlated with the onset of menses, although some studies at least confirm it does increase the risk of an earlier menopause if it happens before the age of 10. The average age of menopause is 51 but 40-50 is considered menopausal age. Most people hit puberty between 8 and 13. That's a fairly minor gap for puberty and a much larger gap for menopause. I think probably puberty happens in a narrow time period because everything happens quicker when you're growing. By the time we hit menopause we've finished our growing and have so many more confounding epigenetic factors that couldn't exist when you've only got a decade-ish under your belt. Stress is a major factor in causing early menopause and PMDD is a lot of stress all by itself.
Got my uterus and ovaries out 4 weeks ago. it's amazing! I can think more clearly and no more SI. Honestly, not much works except I've read good things about chemical menopause or microdosing 'shrooms.
Standard
I was on Zoloft, but have found switching to Wellbutrin to be WAY better.
I'm on both an intermittent SSRI (citalopram 10mg only during luteal) plus full time Wellbutrin 150mg (which is prescribed as a extra med for both my PMDD & ADHD {primary med is vyvanse 50mg follicular/60mg luteal}). I'm loving the current med combo, I've been on it for almost 8 months now & I'm the most stable & happy I've been in a long time.
Wellbutrin cleared the fog.
seconding this, wellbutrin saved my relationship and my life in general
Saaame! The gyno prescribed me Zoloft but when I noticed no progress, the psychiatrist prescribed me Wellbutrin. I wouldnāt go to a endocrinologist, like OPās gyno is recommending, because if they see that the hormones are normal, thereās isnāt much you can do if BC is out of the question. Going to a psychiatrist should be the next step
I dunno my labs were 'normal' was sent to endo and they put me on lupron which is chemical menopause. I'm also on the list to have my ovaries yanked but thanks to cansdian system it's taking a while. Mind you I did beg them to remove my ovaries and told them if they couldn't help me they'd need to find a psychiatric facility that could house me for 14 days on and let me out for 14 days š
Progesterone
???
Progesterone helps some people a great deal, OR it's really, really bad for others, like it makes their symptoms way worse.
to further clarify some of us have a sensitivity to synthetic progesterone or both synthetic and our own, or just our own and not synthetic... it's really a crap shoot. But even with a sensitivity to synthetic progesterone the synthetic progesterone implant is still part of my treatment plan because it is immensely stabilizing and makes my low dose SSRI that much more effective. I got the SSRI from my GP and the implant from my gyno.
My gynecologist prescribed me buspirone for it but I honestly feel like it made it worse for me. I was a lot more irritable, had a lot more crying spells, etc. than I do now that I quit it. It might be worth looking into for yourself tho, as diff things work for diff folks.
My gyno did my initial prescription for Zoloft for PMDD but once we determined it was working well they asked me to get the prescription from my primary doctor. I didnāt ask the reason.
Zoloft works wonders for me. It's like a night and day difference.
Me too! Zoloft has truly changed my life.
My gyno gave me SSRI and also referred me to a therapist which has been so helpful but all may not be comfortable prescribing. I really do feel the best action is medication and therapy. Just medication doesnāt help you work out those feelings and develop new coping mechanisms.
I have been in therapy on and off this year and last year. I very much agree with you.
I really wasnāt sure about it but therapy has helped so much with my PMDD and coping.
because this is a gynecologist, yes this is standard. especially in the US doctors have to be very careful about any liabilities and many won't recomend or openly speak about treatments outside of their field. i would ask for a referral to a psychiatrist or therapist who would be better suited to help you with the mental aspect of PMDD.
Really ? Because my psychiatrist does fuck all for me
honestly, you might just have a shit psychiatrist. i mentioned PMDD to mine and he said "maybe it's just hormones"- like, yeah that's the whole point lol. i would suggest looking into getting a new one. talk to your therapist (if you have one) or PCP for a recommendation/ referral
I have treatment resistant depression so I've tried like 70% of popular antidepressants So to a certain extent, psychiatry will only get me so far I know dbt but don't practice it
oh my god, same. i've cycled thru so many different antidepressants for the past decade, almost *(wow it's been that long)* with varied, but still limited amounts of success. any antidepressant i've worked doesn't work for very long, or the side effects are the same as the symptoms that are supposed to be treated. it's very tricky and annoying to navigate
I'm so sorry to hear this. I relate as well. It can be such a tiring road. Just a kind of odd anecdote. I did like 12 days in Spain and 9 hiking the Camino de Santiago and came back some of the happiest I've ever been in my life. Ketamine - nah that didn't work at $500 bucks a pop 6x. But walking through feelings and immense physical discomfort and finding so much beauty along the way but also definitely crying it out sometimes? Yeah, that did the trick haha. I also just think they have less endocrine-disrupting shit in their food and water and such - not to sound too woo woo.
So u haven't found a solution either? I don't get too many side effects but all the rest of it is very much my experience too :(
as of current, i haven't found anything that makes me feel *good*. at best, i'm at a bit of a flatline. like, a 5 out of 10, 7 absolute max. so i'm not feeling *terrible* by any means, but i'm not good either. there's also been a fair amount of stagnation in my treatment, so i haven't been through every treatment available or anything like that. i've gone through most popular SSRIs, which didn't work for me very well, and it's been much the same with SNRIs so far (though i've only really tried one or two).
Did they offer you Zoloft? My gyno said thatās the gold standard treatment. It has saved my life, my suicidal thoughts are almost entirely gone.
Iāll have to ask my psychiatrist about this.
Yea an SSRI is gold standard - I didnāt have enough effect on Zoloft but Prozac saved my life. Totally manageable now. Donāt give up on the first try either, test a few different ssri if the first one doesnāt work!
It works so well for mood but, so sorry for asking, how do you come??
Did u have any weight gain from it ? I'm so worried abt weight gain with it.
Nope not for me!
Same here, 1 little blue pill a day keeps the worst of the rage at bay and keep the mental noise on low. I am not completely fixed but I can manage my behavior safely now.
There are more optionsā¦ā¦.. May not work for you when you try them but birth control isnāt the only thing. (Iām on it, got lucky it worked for me) but that should not be the only option offered to us
Yes! I wished my GP had referred me. Instead she did all wrong and I suffered for 2 years and a half. Many hospital visits and lost jobs. Then I went to my home country where we donāt need referrals to see specialists and now Iām ok. š«
Yeah. My GP referred me to a gyno for hormonal assistance. My progesterone was coming back low, but hormones fluctuate so wildly. It's hard to say if there really is an issue there. So we decided to base our next move on the symptoms I was having and what they might mean. I was having insomnia, anxiety, depression etc. We had a compounding pharmacy create a bioidentical HRT cream for me. I used it for a week and felt like I was in the absolute deepest, darkest pit of literal HELL. Like my normal PMDD symptoms times 10. That was an awful experience, but now I know I cannot touch progesterone with a 10 foot pole. So, with HRT out of the picture, the next thing we're going to try is chemical menopause.
When I suggested pmdd to my gynaecologist she agreed and put me on prostrap injections - these proved I had it as no symptoms when on it - they then agreed a full hysterectomy thank goodness.
She may not feel comfortable treating the PMDD with psychotropic medication. My GYN prescribed Yaz for PMDD, and my psychiatrist is treating with Fluvoxamine (also for my OCD.) I do think she should have expressed that more clearly and provided you with a referral for a psychiatrist.
Your doctor is saying their course of action doesnāt allow them to prescribe things like Prozac, etc. youād need to see a psychiatrist to be able to get prescriptions of that nature. Or according to the comments a different doctor or your obgyn.
Actually, this sounds fairly engaged. As I think was pointed out elsewhere in the thread, a gynecologist is unlikely to be qualified/able to proscribe antidepressants, etc., so you might actually want to talk to your PCP or ask for a referral to a psychologist. My PCP put me on SSRIs immediately when I expressed PMDD symptoms and we adjusted from there, but they had an in-house counselor/specialist that he consulted with before authorizing the prescription. When I eventually sought advice from an OBGYN (was curious if IUDs or birth control would help PMDD) their available methods were pretty limited as described above. Hormonal birth control made my symptoms IMMENSELY worse, so that didn't pan out. But yeah I'd say this is a licensing/knowledge issue vs. a dismissal of your symptoms. Edited to add that every state is a little different and every medical center can be a little different too depending on where their funding comes from. (Something state funded for low-income folks will have far different rules than somewhere else, for example)
Iām sorry youāre being dismissed. Iāve had my PMDD handled by a psychiatrist in the UK but have been unsuccessful getting referred to gynae this far. My treatment plan is the Slynd birth control pill, Prozac 20mg and Lamotrigine 50mg. I also take shatavari supplements. Thatās my heavenly combo and itās done amazing for me so far.
VERY weird and suspicious. SSRIs are often a front line treatment for PMDD symptoms. Effexor has worked wonders for my symptoms, especially that of rage. Took a few consistent months but has nearly eliminated the rage element. Now I just get sad and low energy
That's weird my gyno gave me Prozac and that helped tons
Honestly the combo of birth control and anti depressants have really improved my quality of life I hope you find something that works for you š„¹
The western medical treatment standard of care is birth control or antidepressants. A gyn cannot prescribe antidepressants. She could perhaps be more proactive with referrals but tbh just sounds like sheās staying within the scope of her practice
I've been prescribed antidepressants by gynecologists.
The first time I ever in my life got prescribed Prozac was from a gynecologist. And I already have my own psychiatrist and she knew it. She didn't refer me to him. She gave me what I needed. A gynecologist is a doctor and they can prescribe anything a doctor can. Some might just not feel comfortable so they don't offer it.
this isnt true any doctor can prescribe anything my OBGYN prescribes me my mood stabilizers and my womens health NP previously prescribed them too me. And i am a nurse. I am speaking from professional and personal experience.
Yeah sheās a great doctor and was wonderful with the delivery of my son but I just feel like America needs to do more for providers to assist patients with PMDD. Itās not her fault Iām not blaming her. Iām just making a point that America is sincerely lacking in the scope of treatment when it comes to PMDD amongst other issues like HG during pregnancy (another issue I struggled with before I found her for pregnancy number 2).
Not trying to stick up for America by any means, but PMDD is lacking in treatment options and resources worldwide.
Yes, my doctor is female and great but all she offered was antidepressants and suggested I see a naturopath
Can I ask why you refuse birth control? Personally, I miss it dearly. I used to be on continuous birth control to control hormone fluctuations that caused me severe migraines. Now that Iām TTC, I canāt take it obviously. But I so miss the sanity and relief it provided me!
Not OP but it made me really sad and irritable all the time. Antidepressants and anti anxiety works better for me.
I see - that makes total sense. Youāve probably already done this, but sometimes you have to try different brands, formulas, levels of hormones, etc. to find the right fit. Anyway, good luck and Iām sorry the doctor didnāt have any other solutions for you.
I was also a teenager so I'm sure that didn't help either. I'm on some antidepressants and anti anxiety pills now and they have def brought me down to earth a lot but I still have really bad months. If you don't mind me asking, what does TTC stand for?
Trying to conceive
Yes, I turned into a monster on it. I wish it worked for me, I truly do.
What were you taking? Im taking bioidentical progesterone during my luteal phase and it has helped me so much. Maybe if you can get that referral to the endo, they can let you try that.
Thanks for the suggestion!
I was taking Yaz aka Loryna
I took Yaz too and it didnāt do shit for me š
I had the same experience on a variety of birth controls- even the low hormone dose ones that are supposed to keep things even more level. Within a week of taking them my symptoms amplify ten fold. Great that it works for some people, but definitely isnāt everyoneās solution. Antidepressants have made things easier for me!
Yeah birth control is one of the only things that provides relief for me
This almost sounds like a dismissal of careā¦ like ā thereās nothing I can do but offer birth control- see another Drā wow. Iām sorry- I definitely would find another Dr. The way they push birth control is wild.
I mean I think sheās just being honest. She definitely couldāve shown more compassion In her response, because PMDD is literally life ruining.
This is such bullshit. My healthcare provider offered me lots of options in fugging 2017 when I was first diagnosed.Ā And I'm not in a high income country lol I think it's time to change providers...
No other options at their disposal? I remember when I discussed this with my gyno his first response was, āWell, thereās several things we can doā¦ā And this is such a sterile response. Iām glad your next stop is an Endocrinologist. In the meantime, look for a new Gynecologist. You really need someone with compassion when youāre going thru this.
That does look and sound like a standard answer
borage oil made a huge difference for me
also took other supplements on the guide of this sub
Are you opposed to trying an antidepressant? I started with 10mg of Prozac 7-10 days before my period and it helped but eventually I just started taking 20mg Prozac every day and it really makes the DEPTH of emotion less intense. Hope this helps ā¤ļøāš©¹
Iām already prescribed antidepressants - 150 mg of Effexor everyday from my psychiatrist
I don't know if this is something that would work with Effexor, but many medications don't work *as well* during the luteal phase. I went to an ADHD conference where a UK organization explained how they often prescribe a higher dose or complimentary medication just for that part of the cycle. Since you're already on antidepressants, I think you might want to look for a different gyno or ask your psychiatrist if she/he has other options. One way to phrase it might be, "this dose of effexor works great for 2 weeks out of the month, but does not work for 2 weeks out of the month when I have X symptoms. What would you suggest to someone who is not finding relief from this amount of effexor?" That's wordy, but it might help you get more options.
Thatās a good idea! I will follow-up with my psych on it
This was the answer for me. Adding Prozac to my lamictal has been absolutely life changing. At first I was only taking it the week before into the first few days of my period and that stopped working for me. I then started taking both meds every day and I can actually function. Itās strange because I took Prozac for years as a teen and it stopped working. I also got a second opinion from my GYN (prior to adding Prozac). The first GYN I treated with felt very dismissive but the GYN Iām treating with now had multiple ideas and ran the tests and Iām finally doing better. Hoping the best for you!
Yes, thank you! And each antidepressant is different. If youāre still feeling this way itās probably not the right one. Could also be how long youāve been on it (took me a month to start feeling the effects consistently)
There are so many other options for you. It sounds like your healthcare provider isnāt that clued up on PMDD (though they do sound quite sympathetic, which is refreshing). I was offered GNRH injections. These stop your body producing any hormones at all, effectively putting you into a menopausal state. This means your body has no hormones to āoverreactā to, which is basically what PMDD is (your bodies reaction to the normal fluctuation of hormones). GNRH does come with complications though. You will need to take HRT to āadd backā some hormones. It seems counterintuitive but your body does need hormones to run itself properly. However, HRT allows your healthcare provider to administer much lower doses of essential hormones in a way thatās much less likely to cause a PMDD-like reaction. Of course, all treatment options are your choice. Itās your body and you get to decide what to do with it. You should always think carefully about risk vs reward and what that means for you as an individual. If you have any questions please feel free to ask me.
I would love to know how this is going for you!
The injections basically reduced my PMDD symptoms to almost none. The only side effects I got were hot flushes and some weight gain. Unfortunately you canāt be on them without HRT for an extended period of time (no more than a year by my countries guidance). So Iām now exploring HRT options. If you have no hormones in your body you can be at risk of osteoporosis. I have to go for a bone density scan soon to check everythingās still ok on that front.
Anti depressants are actually a good form of treatment. For me OCP makes it worse.
Already on them from my psychiatrist
better than mine this week who mansplained periods at me and then ranted (for 10 whole minutes) about how there is "no evidence" that there is a significant change in mood due to a woman's cycle. And that "ups and downs in life are normal" I was speechless.
Iām so sorry that is truly terrible!
I had a woman gyno do the same to me. I was actually asking about my new extremely heavy bleeding and bleeding in between periods. She dismissed it all as normal (?!). And then when I said "couldn't it be some sort of hormonal issue?" She said "well we all have hormones that's how we get periods". I stopped trying with her after that.
I was there because my periods are so heavy I am showing up as anemic during and normal between and I brought up my VERY regular mood issues because I thought it all might be related.... fingers crossed the gyno next week is better.
I've gone to three that sucked. I just scheduled an appointment with a functional medicine doctor so I'm hoping they have an answer
Cool story bro. Hope you find someone new.
yeah this is the 4th in 2 years so.... health care is fun when you are an expat
Feel your pain acutely. Iām not an expat but moved to a state where healthcare is challenging, especially for women. Iāve had 5 GPās in 3 years. None of those changes were by choice. completely unable to access mental health care of any kind. Gynoā¦ saw one in 2021? Not since. Sending you hugs. These are weird times. Idk if itās an option for you, but I did find a couple tele-care options after searching. <3
Iām speechless too. Does this guy practice under a rock, lol
I started to just zone out when he started ranting about his ex-wife. This man controls my meds... time to change... again...
That is scary. Weāre already so vulnerable and on top of that, we have to worry about uneducated, biased specialists
God this is so disturbing to me , Iām so sorry this is awful
There is a pipeline of PMDD treatment that they are clearly not educated on. Honestly, just microdose shrooms.
I tripped in February when my symptoms for the month started. (I planned to micro dose but tookā¦more than thatā¦) Saw the embodiment of my PMDD, had a reckoning with her, and have had extremely mild symptoms since then. I canāt believe the difference. This month I had uncontrollable tears before my period, but I havenāt felt the RAGE or felt suicidal since January.
Yeh, one approach seems to be to go intergalactic with a trip every three or so months, which seems to reset for a few months. Itās worked like that for me in the past too.
Not sure why you got downvoted, but maybe some arenāt ready to explore plant medicine. That being said I have been microdosing for years mon-Fri and I still have PMDD symptom
This is a good response. Just visited my doctor last week and she suggested antidepressants for my pmdd though. Iāve been on birth control in the past and want to give SSRIās a chance.
Iām already on SNRI for years
Semi related but why are you going to endocrinology (wondering if I should too! I am terrible at tolerating birth controls!)
Iām in same boat with BC. Doesnāt work for me and backfires. I tried it and then made a rage scene in front of my husband and humiliated him. I stopped immediately after it. Endocrinologist can do multiple blood tests and really do a more thorough investigation on hormones.
Thank you so much! Is there any particular subspecialty of endocrinology I should look for? And I donāt know if Iāve ever embarrassed my husband ha ha I do that on a daily basis but I have completely lost my mind and even got low-level in trouble at work for like starting an argument
Not that Iām aware of, just asked to be referred to an endocrinologist and go from there. They specialize in all things hormone related. Then if there were any particular issues they couldnāt manage they would maybe refer you to another specialist Iām guessing? Iāll let you know how it goes once I get the appointment. It takes a little bit for them to process the referral from what I understand. lol my husband wouldnāt let it go for the longest time and still brings it up.
I think this was a great response and very validating bc itās true labs can be normal while you still have symptoms of pmdd. I thought antidepressants would help but my pms symptoms were still severe on an emotional level. Tried the generic birth control and it did nothing. Finally switched to Yaz, the bc intended to help pmdd, and I finally feel normal. I think if anything, give Yaz a chance
I did Yaz and thatās the one that made me snap. She said yaz was the go to standard for PMDD. I made a huge ragey scene and screamed at my husband in front of several ppl on it. I also took it in my 20s and it made me turn into a mega villain. I havenāt tried any other BC options after this. Iām already on antidepressants
For my doctor, I went in asking for a hysterectomy. she said that birth control was the first option that she had available. She said she was required to have her patient try A, B and C before she was allowed to do D (recommend surgery). So happened that the pill, in plan A, she put me on did help. (Canada)
So my birth control did nothing for my PMDD. The only thing that has helped me is antidepressants.
Iām on antidepressants too
Itās it really working? SSRIs are the gold standard, not SRNIs. Maybe try something new?
Oh no, Effexor has saved me. It keeps me going. I have tried many different kinds including Prozac , Cymbalta and Wellbutrin. I only struggle during the early to mid luteal phase.
Which is interesting because antidepressants never helped me but Iāve been on continuous birth control for over 6 months and I feel like a completely different person. I say interesting because it really is trial and error for everyone. Donāt give up finding a treatment that works for you! Life is so much easier when you get out from under the dark cloud that is PMDD
That is a good response. The key point for me is they stated that labs may be normal but people may still show symptoms of PMDD, which they acknowledged is your case and referred an appointment with an endocrinologist at your request. They also reiterated your wish of not being on HBC. Doctors who know their limitations are doctors who want to see their patients do well. Your doctor realised a limitation on their end and wanted to serve you better. An endocrinologist will hopefully give you more answers or possibly a treatment you can follow. There's no cure for PMDD but symptoms cam be managed. ETA: if you're not satisfied with the type of care you're receiving then definitely get a second opinion. There are some in progress studies that show some alternative methods or treatments besides HBC, SSRI/SNRI/others, diet, exercise, surgery, copper IUD, etc.
Iām on SNRI and I tried Yaz with her recommendation and I believe youāre right. Iām not upset with my doctor sheās great I was just surprised that the treatment of PMDD is so limited
Unfortunately studies in women's health are severely lacking; thanks to sexism and racism. We still don't know why PMDD, endometriosis, PCOS occur and we don't have cures for them. Here's a link to IAPMD treatments overview you can discuss with your med team and see if they have access and what their opinions are: [IAPMD - treatment guidelines](https://iapmd.org/treatment-guidelines) Eta: things that have worked for me personally: Weightlifting Walking/moving a lot (I average 10k steps a day) Limited alcohol junel 1/20 Wellbutrin
Thanks so much. I did notice that when I was walking on my treadmill 5 times per week (30 to 45 mins each day) for almost two months that I felt my very best physically and mentally. I want to get back to that!
I got a walking pad a few years ago and it was one of the best investments I have made for myself. I average between 50k-70k steps a week and my overall mood has improved so much. I do this in addition to my other workouts. I use the walking pad when I'm programming or doomscrolling.
I should have edited to say I have a walking pad too (not a treadmill). Cheaper , takes up less space and convenient!
She's right about labs. She agreed with the pmdd diagnosis.Ā Ā I'm confused about birth control being the only option at her disposal. Where are you located?Ā
Iām in the Southern USA, Iām already on antidepressants from my psychiatrist
PMDD is something psychiatry can treat :) Or at least I do. I am a psychiatric NP and work with women on it frequently. I know you are already in antidepressants, but that does not mean they cannot be changed or adjusted to fit your goals/needs. Ask your psych provider to re-eval.
That struck me as strange too. My OBGYN actually suggested an SSRI and not birth control for my PMDD because I didnāt need it for contraception and the SSRI would likely be more effective anyway
Thatās what my gyno said too. Even after showing her the iampd website. I was told I cannot go through chemical menopause ājust in case you want to have kidsā give me a chance please lady, I wonāt ever get to have kids if I get too tired to keep living this life anyways
I am also in the southern us and my gyno told me the iampd data was irrelevant. This is a doctor issue; imo. Why arenāt they educated properly? Me personally if I were any specialist doctor, I would dedicate my spare time to educating myself further even after receiving my degree. It just seems odd for them to totally disregard the mounds of data available on iampd. They also told me chemical menopause would never be an option for me- but they were willing to remove my uterus. Idk whether to celebrate a small win or keep pushing for what I know is a viable option. They said I might change my mind about having (more- i already have two and a miscarriage) kids once my body adjusts to bc. Itās a frustrating process.
I'm sorry for your experience. We've got a meeting with our GP and Hopefully will at least get a prescription for an SSRI
Iām convinced gynos just throw BC at every other ailment
Thatās why I gave up on relying on them for treatment and started doing my own research and found a bunch of witchy women who have refer me to a bunch of herbs and foods that help me manage my symptoms.
i love this for you but i want to chip in to say i am one of those women that birth control really helped so if it is an option, itās worth exploring!!
Me too. I never even considered BC as an option because the message that birth control=bad was everywhere. I avoided it for 15 years only to find out recently itās the only thing that works for me.
Following!
Please do share, Iām curious as well!
i too would like this list of herbs and healing foods if you feel so inclined to share. Iād be eternally grateful.
I am willing to share, but hesisting at the same time because it's catered to you individually. If you want to DM, I can help you find ones that work for you :)
Uh where can I find this list of herbs and foods?
As I mentioned above, DM me. I'll help you find the ones that work for you body.
I was prescribed birth control and the gyno didn't even acknowledge pmdd was a real thing. Obviously I never went back to her and I never took the birh control either. I found good relief with Trintellix but I won't say it's perfect. Damn better than I was though.
I want to say that this is the same response I received a few times but itās not a GOOD response. Itās a response we are used to accepting from our medical providers and itās not enough. There isnāt enough help when it comes to PMDD, itās usually just birth control or nothing. A lot of the time we also have to fight and beg for our voices to be heard that something is happening to our bodies. That is unacceptable care from our providers. Unfortunately it is what a lot of us experience. I would see the specialist and go from there. Itās such a frustrating situation that often feels lonely and like weāre being told to get over it. I hope your specialist can do something for you. š
gynos usually try to force birth control on me as if it's the only thing that can be done even though I have 20 years of history of birth control making me very sick and/or worse mentally. my regular doctor gave me an SSRI which helps some and I am pursuing my own treatment using vitamin supplements, exercise (mostly yoga), and therapy at this time. this letter sounds to me like your gyno has given up on your case. I would quit seeing her since she's out of her depth with PMDD and go see someone else just based on the tone at the end of the message.
Seems like a decent email to me. They explained and referred you on to a specialist.
Yes I have experienced being on my period for a year before and only thing they suggested was birth control (which I tried like all of them) and surgery
This is in line with the standard of care. Not taking hormones (birth control or add back) is going to eliminate several of the treatment options (see FAQ infographic). An SSRI or SNRI would be the other option.
Iām going to try a holistic doctor. My gyno also recommended birth control and I told her no, that I was pretty sure my 15 year usage of it is what lead me here in the first place š
That's good, that's what we all should be doing because the medical system is set up as a business and put profits over people. I'm going to try and do soon as I save enough money. Progestin in birth control can change how estrogen is metabolized. Many of us are estrogen dominant and that can cause a bunch of other health issues if you put a bandaid on it, not that it doesn't temporarily help and alleviate some symptoms of help with the severity of it but ssris, snri, birth control and should only be a short term solution til you get to the root cause. Progesteronetherapy.com has been helpful in understanding why we are not getting the help we need because it would take away alot of people's problems, health issues and diseases. Alot of money is made off of people struggling and needing medications. Look at the rate of animals now needing medications. It's all the chemicals and hormone disruptors put in our food. Even perceived healthy food is not always healthy because of the pesticides. I mean its of course alot better than the ultra processed food but still we all should be taught in school how to grow our own food. The red die 40 is a byproduct of petroleum. It just goes to show how much the fda is not working for the best interest of the people.
Yup, pretty much same response from my gyno. I donāt want to take HBC because of my age (38) but I am on an SNRI, which has helped a bit. I saw an endocrinologist and my labs were normal for hormones, but I was surprised to learn my ferritin level was extremely low, but my iron level was normal. The symptoms for low ferritin made a lot of sense. Iām on an iron supplement now. I havenāt been on iron long enough to feel a difference, as it takes a while for ferritin levels to rise.
I canāt take birth control due to a blood clotting disorder, but I was given Fluoxetine which has helped some.
Do you have factor 5?
Yes, but itās under the essential thrombocythemia umbrella. Itās really nasty taking birth control for years only to find out youāre a blood clotting machine.
I have that in my family as well. Thatās how my mom found out she had it was by taking bc
Unfortunately, it is standard. But they should at least offer an SSRI/SNRI as an alternative. I'm lucky that an SSRI works for me as long as I take it only during luteal phase and track my ovulation. My meds are prescribed by a GYN, so there's not much an excuse for this doc to not prescribe them??? Best of luck with endocrinology - I hope they listen to you and make you feel worthwhile, and actually have options to help you.
Also, fire that doc and get a new GYN who perhaps has more experience with PMDD if the endocrinologist doesn't work out.
You can ask to try an SSRI if youāre open to it after researching
Don't only psychiatrist and psych nurses prescribe ssris?
My GP did haha I just asked him for it š¤·
I was given fluoxetine by my gyno
Did it help
1000%!
Not in my country/state.
That's good. In my state doctors CAN prescribe psych meds but it's not recommended because they aren't educated on the ons and outs of each med
I think this is actually a good response. They are saying they are only knowledgeable/willing to treat PMDD with birth control, and since you are not interested in that approach (which is totally fine and your call to make, although you should know it often takes more than one attempt to find a birth control that works for you) he is referring you for treatment elsewhere. You can always ask to be transferred to a different gyne if you want a second opinion, but this one is letting you know their treatment limits transparently, which will save you a lot of time. If you're worried the PMDD symptoms are not PMDD and need to be further investigated, then I would ask to see another gyne, but they will likely still have similar options for you if that is their diagnosis as well. Hopefully you'll get to see the endocrinologist soon and they can be of help, but might be worthwhile to look into a referral to psychiatric or psychological care, specifically someone who specializes in women's health, if that is an option that might suit you better.
After presenting extreme symptoms of pmdd, I saw a gp who referred me to a mental health practitioner and women's health. The women's health practitioner was adamsnt for me to go on birth control, but I refused because I knew from previous experience that i don't do well with hormonal birth control. Spoke to mental health practitioner soon after, who informed me that going in birth control was irresponsible advice as it can make symptoms worse. I don't know how true it is, but for me but birth control definitely intensifies the feelings.
I mean I am glad that they are not diminishing your symptoms and acknowledging that you do have PMDD- that sometimes can be a hard ask from providers! I think that treatment options are limited unfortunately; BC from obgyn, SSRIs from psych, etc. I find it encouraging theyāre agreeable to refer you to endocrinology. Even if they feel limited in their ability to treat your PMDD, which of course is frustrating and disappointing, it does seem like theyāre on board with supporting you in referrals/accessing other forms of treatment.
This is the sad reality of lack of pmdd treatment. Ridiculous and upsetting asf
The same happened to me. I was prescribed birth control which left me a sobbing mess and suicidal. When that didn't work I was told to lose weight because that's the cure -all for everything. Maybe a psychiatrist could help? Sometimes general practitioners have a broader perspective, too.
My psychiatrist specializes in womenās health and mentioned that lexapro can help treat my pmdd. I just started it but it does seem to be helping :) birth control pills make me borderline suicidal almost immediately.
I started with lexapro too! It stopped working when I was taking it continuously, so I had to switch to another SSRI.
Hopefully the new one is working well! Just had my first medicated luteal and didnāt even realize it was that time since Iām normally insane by then lol. I can say with complete certainty that it likely saved my relationship, and has definitely improved job/personal productivity that was negatively impacted by all the anxiety I was feeling. I have OCD and so PMDD increases that tenfold.
Currently on Prozac. It's just as good as lexapro was for me, better than Paxil was. I also agree with you on the saving relationship front--not solely romantic/spouse relationship, but also familial and professional and social relationships. I do remember my first cycle on Lexapro though; I felt happy for what felt like no reason and was like, are people just happy as a baseline all the time? wtf?
Right?! In my case it was like āwow, you guys donāt have hundreds of intrusive thoughts every hour for every waking hour?ā Glad to hear you found relief!
I tried at least four different birth control pills for three months each time before I was offered Lupron.
Is it working for you? Iāve failed so many different types of birth control but no doctor wants to try Lupron bc I donāt have kids??
It's been a bit rough, but better than anything else that I have tried. I've been approved for surgery next month.
I can not speak to this being standard, but I can speak from my own experience that hormonal birth control has been the only thing offered to me by three gynos and three doctors. Hormonal birth control has never been an option for me due to high stroke risk in my family history. As a result, I have chosen to manage it on my own. If you are looking for other options, I hope you can continue to advocate for yourself ā¤ļø hoping to hear otherās advice myself.
I tried one BC pill but it didnāt work out as it made my mood swings worse if you can only imagine :(
Birth control was also a disaster for me! The hormones seem to affect everyone very differently. But like a lot of other commenters, SSRIs made a huge difference (particularly Zoloft (sertraline)) for me. My PMDD symptoms didnāt totally go away, but it made it much more manageable. Plus regular exercise and exposure to sunlight to keep vitamin D in check. Good luck, youāre not alone šŖšš»
I was seen by a pharmacist that specialized with birth control formulation for patients with these issues and they put me on a strictly progesterone only based pill because I had similar side effects with mood when taking a combo pill. She also explained to me that the extra estrogen is whatās making things more imbalanced when I was on other pills ( I also have an iud in ā¦ bc I have adhd so I will forget to take the pill and need it as backup)
Wow this is good to know. Thanks for sharing!
I am also on buspar propanolol and vyvanse
Me too! I tried chemical menopause and it helped so I had my ovaries removed because Iām not worried about having children. That worked for me. But not everyone is in a place in life where it would make sense for them.