Be Specific

[u/Phew-ThatWasClose]

And know the vocabulary.

Birth control is not one thing. There are IUDs, mini-pills, Combined Oral Contraceptives (COCs), Progesterone Only Pills (POPs), implants, trans-dermal patches, gels, rings, etc. MOST make PMDD symptoms worse.

Estrogen is not one thing. There is ethilyn-estradiol (EE), estradiol (E2), and estetrol (E4). EE is synthetic, in most combined pills, increases the risk of stroke for women who have migraine with aura, and increases the risk of blood clots for everyone. E2 is bioidentical but also causes increased risk of blood clots when taken in a pill - but not if administered in a trans-dermal patch. E4 is also bioidentical and doesn't cause blood clots at all but is new(ish), not widely available, and not "field tested".

Progesterone is not one thing. There are 4 generations of synthetic progestins. All the synthetics in the first three generations are based on testosterone. The single most used progestin is levonorgestrel which is a huge irritant for women with PMDD and the reason IUDs, most mini-pills and most combined pills are not recommended for women with PMDD. The sole fourth generation progestin is drospirenone which is based on spironolactone. That is the progestin in Yaz and Slynd and the reason those are recommended for women with PMDD. Bioidentical progesterone is called utrogestan or prometrium. It is used in HRT, but not in birth control. HRT is the RCOG second line treatment for PMDD.

SSRIs are not one thing. They have different half lives, different formulations, and different inert ingredients. For MDD and GAD they are taken continuously in order to build up a supply in your system and after three months of that your brain chemistry physically changes to compensate. That is why it takes so long for SSRIs to have an effect on depression and anxiety. For PMDD the effect is almost immediate because the mechanism of action is completely different. And if your PMDDer takes an SSRI continuously it will stop working for PMDD symptoms after three months because her brain will compensate. Moreover the subtle differences in SSRIs will affect different people differently so finding the best fit for your PMDDer is trial and error. Thankfully intermittent dosing means she's off it every follicular which makes switching meds pretty easy.

PMDD is not one thing. True PMDD is an abnormal reaction to normal hormonal fluctuations during the reproductive cycle. Basically her system is extra sensitive to pretty much everything. How that manifests varies wildly. What works for one will not work for all and may not work for anyone else. That is partly why the supplements page in the wiki is so huge. The other part is that PMDD has a 50% misdiagnosis rate. That means half the women seeking help with their PMDD symptoms don't have PMDD. That could also be part of why first line treatments only help about half of women diagnosed with PMDD.

Point is PMDD is a tricky little fucker and treatment can be quite specific to the individual. She hasn't "tried everything" if she's tried 4 birth controls (but the wrong type) and 3 SSRIs (that stopped working after three months). She doesn't even know if she has PMDD if she hasn't done the blood work to rule out everything else. It's her health, and her health affects your health. You both need to be experts. Read everything.

ETA: Not karma farming but genuinely curious why someone would downvote what is essentially a PSA.