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Q: Is it possible to alternate back and forth between PMS and PMDD from one month to the next depending on the intensity of the cycle? I think PMDD may be part of what I'm experiencing. My doctor has suggested birth control pills to help with PMS but past experience tells me I will likely become depressed if I take them. In fact, I think I was mildly depressed throughout both of my pregnancies. In some ways I felt very relieved after my babies were born. I was fairly calm and happy while I was breastfeeding but my mood swings came back full force when I stopped breastfeeding and my menstrual cycle returned. I have to say I very much like the physical and mental high I get with ovulation but find the pain and depression that comes with menstruation barely tolerable.

Dr. Donnica: I think the answer to your question is in your last sentence. Making most medical decisions is all about choosing between what's tolerable and what's not. PMDD is a severe form of PMS. Yes, it's possible for symptoms to vary from cycle to cycle. I agree with your doctor that birth control pills--or the new patch, Ortho Evra--might be part of the solution. You may want to try one of the newest low dose birth control pills, or consider the patch. Just monitor yourself for signs of depression.

Another option is to treat your PMDD and your depression with an antidepressant in the SSRI family (e.g. Prozac, Zoloft, Effexor, or Paxil CR). This is very effective as well.

For more information about PMDD, click here.

With best regards,
Donnica Moore MD
President, DrDonnica.com

Created: 6/13/2003  -  Donnica Moore, M.D.
Reviewed: 12/8/2003  -  Donnica Moore, M.D.

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