Lifestyle changes. Prioritizing exercise, sticking with a consistent sleep schedule and reducing stress as much as possible during the weeks before your period can also help, Dr. Lanza di Scalea said. “I’ve found these lifestyle changes, which do take effort, can feel very empowering for women.”
As with C.B.T., lifestyle changes can only go so far in alleviating severe cases of PMDD on their own, but they can supplement other treatments.
Calcium. There is also some limited evidence that taking certain supplements, particularly calcium, may lessen PMDD symptoms. Though the supplements may not work in severe cases, they may be worth trying. “If women are not taking a multivitamin with calcium, I usually have them start that,” Dr. Schiller said about her patients with PMDD.
Injectable medications. If none of these options quell your symptoms, your doctor may suggest that you consider an injectable medication called leuprolide acetate (Lupron Depot), which can be used off-label to treat PMDD. This medication, which can be given once a month or every three months, stops the ovaries from producing estrogen and progesterone, which can eliminate monthly symptoms.
For some women, it can make a “huge difference in terms of mood and ability to function,” Dr. Schiller said. The downside: It may not be sustainable in the long term because it’s expensive — around $2,000 (or more) per injection, she said — and insurance often doesn’t cover it. It can also cause side effects like headache, fever and muscle aches.
Surgery. If you have exhausted all other treatments for PMDD, the last option is to remove the ovaries. While extreme, Dr. Schiller said, many patients have success with this surgery.
“It’s a matter of finding a provider who will work with you to find a treatment that works,” she added.
