The answer (hopefully for many): bio-identical progesterone cream. No soy, red meat or hops from ovulation to menstruation and lots of omega 3's and cardio exercise.

I have had PMDD since I was 13, but did not know what it was or identified it as such until I was in my 30's, (which is also when the symptoms increased.) It wasn't until I had a child 2.5 years ago, and my period returned six months after giving birth that it became totally debilitating. OB/GYNS and psychiatrists all gave me the same answer: birth control pills or SSRI's. Nothing worked. I finally found a PMDD specialist at a women's psychiatric hospital just outside my city. (I am an american living in Berlin, Germany.) She is the head doc/researcher there and she prescribed me bio-identical progesterone cream and told me to stop taking everything else. (At least until we see how I react to the cream and what dosage is needed.)

She states that this is (sadly) a new field of research and that they are finding that women with PMDD usually have very low levels of progesterone and that during the luteal phase (ovulation to menstruation) that both progesterone and estrogen usually go up, but that women with PMDD have progesterone levels that stay low during this time as well. This does two things: causes a large differentiation in the level of progesterone/estrogen in the body, which is why one should avoid soy, red meat and hops at this time because they increase your estrogen levels. The imbalance of estrogen just causes the physical symptoms of PMDD though—sore breasts, bloating, heavy bleeding, etc, which is why the pill can sometimes help with those symptoms because they even out of the wide differential of the hormones.

The second thing is, and the most important for mood, is that progesterone affects your serotonin. When your brain is not getting that boost of progesterone it really affects one's mood; hence the feelings of craziness, hopelessness, irritability, and just total moodiness that ensues during this time. The reason contraceptives don't help with this symptom so much is because synthetic hormones cannot pass over the blood/brain barrier, so the progesterone is not reaching the place where it is needed most. Bio-identical hormones do pass over the blood brain barrier though, and that is why they can help your mood greatly. It can take up to 3 menstrual cycles for the progesterone levels to raise and then you have to work with your doc to see what dosage is right for you. Eating lots of oily fish and nuts and seeds with omega 3/6/9's really help your progesterone levels as well, as does cardio exercise.

I have only gotten to see her once and I am 2 months into treatment and I feel better than I have in my entire life. I will see her again in one month and am asking her for research articles I can post and pass along as well, as I can't believe there is so little information on effective treatments as this has been around as long as women have been bleeding. But the lack on concern for this issue and it's treatment is a whole other issue...

I know PMDD is complicated and can often mask or be effected by other mental health issues and disorders. I know that this treatment may not work for everyone as all our bodies are different and there can be different factors affecting people's symptoms and response to treatment. I do know that I have not found a great deal of information on precise causes and treatments of PMDD though, and I hope this helps even one person to stop going through the hell that I went through.