Premenstrual dysphoric disorder (PMDD)
Explains what PMDD is, including possible causes, symptoms and how to access treatment and support. Includes self-care tips for helping yourself, plus guidance for friends and family.
What are the treatments?
There are a number of different treatments for PMDD that have been found to work for some people. 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 if you have any plans to become pregnant.
This page covers:
- Combined oral contraceptives
- Talking therapy and counselling
- Painkillers or anti-inflammatory drugs
- GnRH analogue injections
If you are trans or non-binary, your treatment options may differ if you are taking or considering taking hormone treatments. You can speak to your GP or specialist to explore what treatment would work best for you. You can see our pages on specialist organisations supporting LGBTQIA+ mental health if you are unsure of where to start.
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.
SSRIs (selective serotonin reuptake inhibitor) are a type of antidepressant. They are often the first recommended treatment for PMDD and are the only type of antidepressant which has been shown to work for PMDD.
Some studies have suggested that SSRIs may work differently for PMDD symptoms than they do for mental health problems such as depression. Your doctor may recommend you take SSRIs daily throughout the whole month or just during your luteal phase. It is normally recommended that you do not start and stop taking SSRIs suddenly, but studies have shown that for some people with PMDD taking SSRIs during just the luteal phase can be effective and withdrawal symptoms are not as intense.
If your doctor prescribes you SSRIs, they should review them with you after two months to make sure they are working for you. If they aren't, your doctor may suggest a different treatment or an adjustment to the antidepressants. See our pages on antidepressants for more information on SSRIs.
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.
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 and is not appropriate if you are trying to get pregnant.
Oral contraceptives come in different types with different mixes of hormones. It may mean that certain hormone combinations won't work well for you. As PMDD occurs during your ovulation, pills that prevent ovulation may be more successful in managing your PMDD symptoms.
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 website.
To help manage the psychological symptoms you experience you may want to consider seeing a therapist for talking treatment. Cognitive behavioural therapy (CBT) has shown to be effective for some people with PMDD in managing their symptoms.
Your doctor may refer you to an NHS talking therapies service (previously known as IAPT). These services treat various mental health problems, such as anxiety and depression. However, they aren't available in all areas and the waiting lists can be long. You can find out whether services are available near you through the NHS talking therapies webpage. In some cases you might be able to self-refer to see a therapist.
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.
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.
This treatment should only be considered if no other treatments have been effective though. 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 often 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 (a hormone produced during the second half of the menstrual cycle) afterwards as part of your hormone replacement therapy (HRT), which may mean you continue to experience symptoms similar to PMS. More information on HRT can be found on the You and Your Hormones website.
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. The surgery would not be appropriate if you are wanting to get pregnant.
This information was published in August 2021. We will revise it in 2024.
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