Explains what PMDD is and explores issues around getting a diagnosis. Also provides information on self care and treatment options, and how friends and family can help.
"It took me two years to realise that my symptoms were cyclical – my best friend made the connection. It’s then taken me another three years to get to a treatment that works. Looking back it seems like such a long haul, and I’m glad I’m this end of it for now."
To help manage the psychological symptoms you experience you may want to consider seeing a therapist for talking treatment. Your doctor may refer you to Improving Access to Psychological Therapies (IAPT). This is an NHS programme which can provide talking treatments for various mental health problems, such as anxiety and depression.
However, IAPT is not available in all areas and the waiting lists can be long. You can find out whether IAPT services are available near you through the IAPT website. In some cases you might be able to self-refer to a service.
(See our pages on talking treatments for more information about different kinds of therapy, including how to find a therapist.)
You may be offered antidepressants to help treat feelings of depression. In this case your doctor will likely offer you a three month trial, and then see how you are doing. Your doctor may suggest you to take them just on the run up to your period, or continuously throughout the month.
Research has shown that some SSRI (selective serotonin reuptake inhibitor) antidepressants can be effective at reducing PMS and PMDD symptoms, but they can also cause a range of side effects, so they may not be right for everyone.
(See our pages on antidepressants for more information).
Your doctor may suggest you take painkillers or anti-inflammatory drugs (for example ibuprofen) to help you manage the physical symptoms of PMDD such as headaches, joint and muscle pains.
Although you may be able to get these without a prescription from your doctor, it's a good idea to discuss it with your doctor or pharmacist first to make sure that they're suitable for you.
Oral contraceptives (often just called 'the pill') may reduce the symptoms of PMDD by controlling or stopping your periods, but the evidence for the pill as a treatment for PMDD is mixed. Some people do find it helps to reduce their symptoms, but others find it makes their symptoms worse. The pill can also cause side effects.
If you and your doctor do think this medication might help, it is likely that you will be given a three month trial to see if the treatment is right for you. You can find more information about combined oral contraceptives on the NHS Choices website.
Gonadotropin releasing hormone (GnRH) analogues can be helpful for some people, as they reduce the symptoms of PMDD by bringing on a temporary menopause. They typically come as injections or a nasal spray. However, they can cause side effects such as loss of bone density, which puts you at higher risk of developing osteoporosis (a condition in which your bones become weak and break more easily).
Because of this, treatment is sometimes limited to six months, and should be combined with hormone replacement therapy (HRT), which relieves symptoms of the menopause and reduces bone density loss. If you're prescribed GnRH analogues as a long-term treatment your doctor should give you an annual check-up to measure your bone mineral density.
"[My symptoms] took almost three months to settle down [after starting hormonal treatment] but now I am able to go to work every day and only have 1-2 bad days a month, which is much more manageable."
In very severe cases your doctor may talk to you about the possibility of a total hysterectomy (an operation to remove your uterus) with bilateral salpingo-oophorectomy (an operation to remove your ovaries and fallopian tubes). The aim of this surgery is to get rid of your PMDD symptoms by permanently stopping your monthly cycle.
Some people may be offered a bilateral oophorectomy alone (to remove just the ovaries and fallopian tubes). However, this may mean having to take progesterone afterwards as part of your hormone replacement therapy, which may mean you continue to experience symptoms similar to PMS.
All surgery carries a risk of complications – and this surgery is non-reversible – so this would only be something you and your doctor would consider when you've already tried every other possible treatment and nothing has worked.
This information was published in October 2017. We will revise it in 2020.
References are available on request. If you would like to reproduce any of this information, see our page on permissions and licensing.