Treatment for premenstrual dysphoric disorder (PMDD)

There are different treatments available for PMDD. You and your doctor should decide your treatment together.

The decision should be based on how bad your PMDD symptoms are, your personal preferences, and whether you plan to get pregnant.

It took me two years to realise that my symptoms were cyclical. My best friend made the connection. It's then taken 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.

Making healthy lifestyle changes

When you first talk to your doctor, they may suggest lifestyle changes to improve your physical and mental health. These may reduce your PMDD symptoms to a manageable level, without other treatments. Or it may be something you try alongside another treatment.

They might suggest that you:

• Do more physical activity
• Change your diet
• Try to get regular sleep
• Try to reduce your stress levels
• Reduce the amount of alcohol you drink
• Cut down smoking or stop entirely
• Reduce the amount of caffeine in your diet

This will be different for everyone. The changes you feel able to make will depend on your personal circumstances and experiences.

Talking therapy and counselling

Talking therapy may help you manage the mental health symptoms of PMDD. For example, cognitive behavioural therapy (CBT) is effective for some people with PMDD.

Your doctor may refer you to an NHS talking therapies service. These services treat mental health problems such as anxiety and depression.

But what services are available depends on where you live. The waiting lists can be long. You can find out whether services are available near you through the NHS talking therapies webpage.

In England, you can self-refer to see a therapist. In Wales, you need to ask your GP to refer you to a therapist.

See our pages on talking therapy and counselling for more information about different kinds of therapy. There's also information on how to find therapy or counselling.

Antidepressants

SSRIs (selective serotonin reuptake inhibitors) are a type of antidepressant. They're often the first recommended treatment for PMDD.

Your doctor may recommend you take SSRIs daily throughout the whole month or just during your luteal phase. The luteal phase is the time between when you ovulate and when your period starts. 

It's normally recommended that you don't start and stop taking SSRIs suddenly. But studies have shown that taking SSRIs only during the luteal phase can help with PMDD. And withdrawal symptoms are not as intense.

If your doctor prescribes you SSRIs, they should review them with you after 2 months. This is to make sure they're working for you. You can also contact your doctor, if you have any concerns about the SSRIs you're taking.

If they aren't working, your doctor may suggest a different treatment. Or an adjustment to the antidepressants. 

There's also some evidence that SNRIs (serotonin and norepinephrine reuptake inhibitors) can help with PMDD. But your doctor is most likely to offer you an SSRI. See our pages on antidepressants for more information on SSRIs and SNRIs.

Before deciding to take any drug, it's important to make sure you have all the facts you need to make an informed choice.

See our pages on things to consider before taking medication and your right to refuse medication for more information.

Combined oral contraceptives

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 find it helps to reduce their symptoms, but others find it makes their symptoms worse.

The pill can also cause side effects. And you shouldn't take it if you're trying to get pregnant.

Oral contraceptives come in different types with different mixes of hormones. Some hormone combinations may not work well for you. As PMDD happens during your ovulation, pills that stop ovulation may be better for managing your PMDD symptoms.

If you and your doctor think this medication might help, it's likely your doctor will give you a 3 month trial. This is to see if the treatment is right for you. Visit the NHS information about combined oral contraceptives to learn more. 

Painkillers or anti-inflammatory drugs

Your doctor may suggest you take painkillers or anti-inflammatory drugs, such as ibuprofen. These may help you manage the physical symptoms of PMDD, like headaches, joint and muscle pains.

You may be able to get these without a prescription from your doctor. But it's a good idea to discuss it with your doctor or pharmacist first to make sure that they're suitable for you.

GnRH analogue injections

Gonadotropin releasing hormone (GnRH) analogues are medications. They typically come as injections. They reduce the symptoms of PMDD by bringing on a temporary menopause.

This treatment should only be considered if no other treatments have worked. They can help some people, but can cause side effects like loss of bone density. This increases your risk of developing osteoporosis (a condition in which your bones become weak and break more easily).

Because of this, treatment is often limited to 6 months. And it's usually combined with hormone replacement therapy (HRT). HRT relieves symptoms of menopause and reduces bone density loss. Visit the NHS page about HRT to learn more about this treatment. 

If you use GnRH analogues for more than 2 years your doctor should organise regular bone density scans to check for osteoporosis. 

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.

Surgery

In very severe cases, your doctor may talk to you about removing your womb (uterus), ovaries and fallopian tubes.

The aim of this surgery is to stop your PMDD symptoms by stopping your monthly cycle. It should only be considered if other treatments haven't helped.

If you're considering surgery, your healthcare professional should first advise you to use GnRH analogues and hormone replacement therapy (HRT) for 3 to 6 months. GnRH analogues have a similar effect on your hormones as having your ovaries removed. So they will give you an idea of how you may feel after the operation.

Some people may be offered an operation to remove the ovaries and fallopian tubes, but not the womb. This is called a bilateral oophorectomy.

This may mean having to take progesterone (a hormone produced during the second half of the menstrual cycle) afterwards, as part of your HRT. It may mean you continue to experience symptoms similar to PMS.

All surgery has a risk of complications. And these operations can't be reversed. You and your doctor should only consider them if you've already tried every other treatment, and nothing has worked.

The surgery would not be appropriate if you want to get pregnant or think you would want to get pregnant in the future.

Vitamins and supplements

There is some limited evidence that certain supplements may reduce premenstrual symptoms. For example:

• Calcium carbonate may help to reduce the physical and psychological symptoms.
• Vitamin B6 may help to relieve symptoms. But if you take too much, it may lead to a condition called peripheral neuropathy. This is where you lose feeling in your arms and legs.
• Agnus castus (a herb known as chasteberry) may help reduce symptoms of irritability, anger, headaches and breast pain. It's not recommended if you're trying to get pregnant or are breastfeeding.

But these are not officially recommended as treatments. This is because there's not enough strong evidence that they can treat PMDD.

If you're thinking about taking a supplement, speak to your doctor or pharmacist first. Taking them alongside other medications or in the wrong dose could be dangerous.

Published: October 2024. 

Next review planned: October 2027. 

References and bibliography available on request.

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