Millions of women in the United States suffer from a condition called Premenstrual Dysphoria (also known as Premenstrual Dysphoric Disorder or PMDD). An estimated 3-8% of women of reproductive age experience debilitating depression, rage, anxiety, and suicidal ideation every month before the start of their period. Harvard Medical has reported that an estimated 15% of these women have or will commit suicide as a result of this disorder.

Women with a history of trauma, depression, postpartum depression, or a specific genetic mutation are at an increased risk of developing PMDD. It is a terrible long-term illness that severely impacts a woman's quality of life.

PMDD is recognized by the American Psychiatric Association and is included in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It has the ICD-10 diagnosis code N94.3. Additionally, PMDD is included in several ongoing research studies around the world. While the top minds of the medical community acknowledge PMDD, a vast majority of medical insurance companies do not.

Anthem BlueCross BlueShield denies coverage of life-saving treatment options for women with Premenstrual Dysphoria (PMDD).

While the specific cause of PMDD is not well understood, studies have shown that women with this disorder can respond to a variety of treatment options including hormone supplementation therapy, anti-depressants, GnRH agonists, and oophorectomy/hysterectomy. When an insurance company does not provide clinical policy on treatment options for PMDD, women are forced to suffer. Those with extreme cases have or will attempt to take their own lives.

Doctors often have to "get creative" in order to get the less invasive treatment options for PMDD approved by insurance. Even worse, doctors are not often educated on this condition and prescribe heavy medications off-label that carry severe long-term risks. Many women with PMDD end up hospitalized and/or misdiagnosed with rapid cycling bipolar disorder.

For women with PMDD, menopause can save lives. When first line treatment options have failed, the last hope for many women are (1) chemical menopause with the use of GnRH agonists injections and (2) surgical menopause via bilateral oophorectomy/hysterectomy (removal of both ovaries and uterus). GnRH injections are a short-term treatment option and typically a precursor to surgery although not always required by the physician recommending surgery. Injections can cost upwards of $1400 each. Oophorectomy with Hysterectomy can cost as much as $20,000.

As of May 2015, BCBS's current Clinical UM Guidelines for GnRH include approval for Gender Dysphoria as long as the criteria set by the DSM-V is met, but makes no policy on Premenstrual Dysphoria (PMDD). Because of this, women with coverage through Anthem BCBS are denied treatment and forced to suffer despite clinical evidence that supports the efficacy of GnRH injections and surgery.

The National Association for Premenstrual Dysphoric Disorder (NAPMDD) agrees with studies published by W.H. Cronje, A. Vashisht, and J.W.W. Studd that hysterectomy with bilateral oophorectomy is an effective and live saving treatment option for severe cases of PMDD.

Furthermore, Women with PMDD have been increasingly vocal on their right to choose what treatment option may be right for them:

"My brain and my ovaries are at war and I can't remove my brain"

"My surgery saved my life. I no longer want to leave my husband, abandon my children, or kill myself. I feel so blessed." 

"I would rather dig my ovaries out with a spoon than suffer another day with PMDD"

"I do not want children. I have never wanted children. Yet my doctor refuses to give me surgery because 'someday I might'. This should be my choice my body."

We ask that Anthem BCBS update their current Clinical UM Guidelines to include coverage for medically necessary treatment options for PMDD.

Unless insurance companies like Anthem include a specific policy on this disorder, both doctors and patients are not given the opportunity to make educated decisions for treatment.