Medical treatments for PMDD focus on relieving symptoms, usually by increasing the availability of serotonin in the brain or by suppressing cyclic changes in sex hormones. Selective serotonin reuptake inhibitors (SSRIs) have the best evidence for efficacy and are the main medication used to treat PMDD. They can be taken continuously, only during the luteal phase, or at the time of symptom onset through the first few days of menstruation. Symptoms should improve by the first menstrual cycle following SSRI treatment.[1] Serotonin-norepinephrine reuptake inhibitors (SNRIs) may also be used.[2] For people who desire contraception, a combined estrogen-progestin oral contraceptive can be prescribed, although oral contraceptives may not decrease depressive symptoms.[3]
Gonadotropin-releasing hormone (GnRH) agonists in combination with low doses of estrogen and progesterone are reserved for people who do not respond to the aforementioned treatments. When all other therapies have failed and symptoms are debilitating, surgical removal of the ovaries may be considered.[4]