PMDD Treatment Options: SSRIs, Progesterone, Hormones, or Supplements — How Do You Decide?

If your mood, anxiety, or emotional reactivity reliably worsens in the days or weeks before your period — and then improves once your cycle begins — you may be dealing with Premenstrual Dysphoric Disorder (PMDD) or significant hormone-sensitive mood symptoms.

One of the most common (and frustrating) questions women ask is:
“Should I treat this with medication, hormones, supplements — or something else entirely?”

The answer is rarely simple — and that’s not because you’re doing something wrong. PMDD sits at the intersection of hormones, brain chemistry, and nervous system sensitivity, which is why multiple treatment paths exist.

A Quick Reminder: What PMDD Is (and Isn’t)

PMDD is not caused by a hormone imbalance in the traditional sense. Hormone levels are often “normal.”

Instead, PMDD reflects an increased sensitivity of the brain to normal hormonal fluctuations, particularly after ovulation (the luteal phase). That sensitivity can trigger significant mood and physical symptoms.

This is why treatments may target:

• Brain chemistry
• Hormonal signaling
• Nervous system regulation
• Or a combination of all three

SSRIs (Selective Serotonin Reuptake Inhibitors)

How SSRIs Help PMDD

SSRIs help regulate serotonin signaling, which plays a central role in mood, emotional regulation, and stress response.

In PMDD, SSRIs often work more quickly than they do for major depression and may be used:

• Daily
• Or only during the luteal phase

When SSRIs May Be Helpful

• Moderate to severe mood symptoms (depression, rage, panic, intrusive thoughts)
• Symptoms that significantly disrupt work, relationships, or daily functioning
• Clear cyclical emotional symptoms

Common Concerns

Many women worry about:

• Personality changes
• Emotional blunting
• Long-term use

These concerns are valid and deserve thoughtful discussion — not automatic prescribing.

Progesterone-Focused Approaches

How Progesterone May Help

Progesterone plays a role in calming the nervous system through its metabolite allopregnanolone, which interacts with GABA receptors in the brain.

For some women, supporting progesterone signaling — particularly during the luteal phase — may help reduce:

• Anxiety
• Irritability
• Sleep disruption
• Emotional reactivity

Important Nuance

Progesterone can be helpful for some women and destabilizing for others. Timing, formulation, dose, and individual sensitivity all matter.

This is very different from using progesterine to “correct a low level” — it’s about how the brain responds to hormonal signaling.

When Progesterone May Be Considered

• Luteal-phase anxiety or insomnia
• Symptoms that feel more “wired,” tense, or overstimulated
• Women who do not tolerate SSRIs or prefer a hormone-informed approach
• Perimenopausal women with cycle-related mood changes

Progesterone is not a universal solution — but for the right person, it can be an important part of care.

Birth Control (Hormonal Contraceptives)

How Birth Control Fits In

Some oral contraceptives aim to suppress ovulation and flatten hormonal fluctuations that trigger PMDD symptoms.

Why This Is Tricky

While certain formulations may help some women, others experience:

• Worsened mood
• Increased anxiety or depression
• Emotional flattening

Not all birth control is appropriate for PMDD, and response is highly individualized.

When It May Be Considered

• Co-existing gynecologic concerns
• Clear ovulation-triggered symptoms
• Prior positive response to specific formulations

Birth control is not the same as progesterone-focused treatment, and the two should not be lumped together.

Supplements and Supportive Strategies

How Supplements Fit In

Supplements don’t treat PMDD the way SSRIs or hormones do, but they can support:

• Nervous system regulation
• Stress resilience
• Sleep quality
• Nutrient repletion

Commonly discussed supports may include:

• Magnesium
• Omega-3 fatty acids
• Calcium
• B-complex vitamins

When Supplements May Be Helpful

• Milder PMDD symptoms
• As part of a layered approach
• Alongside medication or hormone-based care
• For women who prefer a conservative starting point

For moderate to severe PMDD, supplements are usually supportive rather than sufficient on their own.

So… Which Approach Is “Right”?

There is no single best option — only the best-fit approach.

Key factors include:

• Symptom severity
• Timing and pattern
• Past treatment experiences
• Sensitivity to medications or hormones
• Reproductive life stage
• Personal values and preferences

Many women benefit from a combined approach, adjusted over time as their needs change.

A Reproductive Psychiatry Perspective on PMDD

From a reproductive psychiatry lens, PMDD treatment is not about choosing between “psychiatric” or “hormonal” care.

It’s about:

• Understanding symptom patterns
• Matching interventions to how symptoms show up
• Avoiding one-size-fits-all recommendations
• Helping women feel informed and supported in their decisions

The goal is stability, clarity, and relief — not forcing a single path.