Treatment of Premenstrual Dysphoria
Kristian Reveles Jensen, MD
I am a queer-friendly doctor focusing on the treatment of severe premenstrual syndrome (PMS) and dysphoria (PMDD).
In my private clinic in Copenhagen, I offer individualised, evidence-based treatment to relieve symptoms and improve life quality.
I am currently not taking new patients.
So, where do you get help for PMDD in Denmark?
I hear several good stories from women who get help from their general plasticisers. GPS can treat PMD with SSRIs and refer to a gynaecologist or psychiatrist. Some women describe going to their doctor in vain. However, I also hear a lot of good stories. Based on them, my recommendation is to:
Document your symptoms thoroughly using the DRSP form for at least two complete cycles. Take my Danish article on PMDD from Ugeskriftet for læger to your own doctor.
I also recommend being open to the fact that it can also be something else. What looks like PMDS can be many other things like a thyroid disorder, PMS, menopause, anxiety or depression. Why further referral and investigation may also be corrected. Most gynaecologists and psychiatrists I talk to are responsive. The Danish Gynecological Society has made a guideline on PMS for gynaecologists and general practitioners you can refer your doctor to.
Come as you are
I offer a thorough evaluation. The first conversation is an extended investigative conversation to confirm whether you have PMDD or a cyclic exacerbation of another illness that requires treatment.
I'll ask about your experiences, your life history, and diseases in the family, and your aims and wishes for treatment.
The PMDD diagnosis can rarely be made within the first interview, which may require a structured observation of the symptoms through two cycles. If you do not have PMDD, but another disorder, I may still provide treatment for you or refer you and help you get treatment where optimially avaliable.
Once PMDD is confirmed, we create an individually tailored treatment plan, and I will follow you on an ongoing basis to assess the effect of the treatment and adjust the various interventions. The treatment focuses on relieving your symptoms and increasing your quality of life in the long term, and we can include different elements.
Psychotropics: Includes drugs that affect serotonin and norepinephrine, which regulate the mood, eg. Escitalopram. In a meta-analysis of 31 clinical trials, it alleviated both mental and physical symptoms and improved psychosocial functioning in up to 80% of women with PMDD. There is a rapid treatment effect of the medication within the first cycle and generally within days, which allows the drug to be taken only half the period and minimize side effects.
Birth control: Although women with PMDD have normal hormone levels, it can help to switch birth control with and a progestin (drospirenone) as an alternative to psychotropic drugs.
Melatonin: The natural sleep hormone can help regulate sleep.
Optimizing lifestyle factors and well-being
Psychoeducation: Talk with you and your relatives and PMDD to gain a shared understanding of illness and help with coping.
Cognitive Behavioral Therapy (CBT): This is an empirically-supported treatment for affective disorders, including PMDD. The premise of CBT is that inaccurate beliefs and maladaptive information processing (forming the bases for repetitive negative thinking) have a causal role in the development and maintenance of symptoms. By changing maladaptive thinking, we can reduce both distress and the risk of subsequent symptoms. I employ cognitive methods in my consultations but do not provide psychotherapy.
Dietary changes: I recommend a diet with complex carbohydrates, rich in tryptophan and high in along with minimal intake of caffeine and alcohol for the two weeks up to menses.
Exercise: Promotes mental well-being and improves sleep. I recommend aerobics and yoga.
Smoking Cessation: Smoking worsens PMD symptoms, and I recommend smoking cessation. I can help you through smoking cessation with conversations and medicine.
Vitamins, minerals, and natural products:
The scientific evidence is sparse for vitamins, minerals, and natural remedies for PMDD. There is no doubt that some have positive experiences with using, e.g., vitamin B6 for nausea, or calcium and vitamin D for mood and sleep. In many cases, there are few side effects, and it can easily be combined with medical treatment. However, there are several advantages and disadvantages to over-the-counter products.
I have lived and studied in the US and UK. I work as a clinician, researcher and lecturer. In my spare time, I enjoy reading Ursula K. Le Guin and Eva Illouz.
2009 - Studied psychology, neuroscience and behaviour, Caltech
2017 - Medical Degree, University of Copenhagen
2017 - Masters Degree in Psychiatry, Oxford University
2018 - Full Registration/License in Denmark and Sweden
2019 - Clinician and researcher at Psychiatric Centre Copenhagen
2020 - Researcher at Rigshospitalet
2021- PhD-student at Rigshospitalet
2022 - Part-time lecturer at the University of Copenhagen
Consultations in my home office near Lergravsparken or via Facetime or Skype
You should preferably have an ECG from your general practitioner.
I am not a psychologist or specialist in psychiatry, gynaecology, or general practitioner.
I do not prescribe medical cannabis and I do not treat patients with drug or alcohol abuse.
As a medical practitioner, I have a duty to keep records and personal information about you as long as I treat you and for at least 10 years after the last entry to your medical history.
Other doctors, insurance companies, or agencies can only receive information on your treatment with your consent.