Managing PMS and PMDD

If premenstrual symptoms keep disrupting work, relationships or ordinary tasks, treatment can go beyond self-care. Options for PMS include cognitive behavioural therapy, hormonal medicines and antidepressants. PMDD can involve more intense mood symptoms, and treatment is available for this too. You can ask for help based on the impact on your life.

Choose what you want treatment to improve

Start with a concrete example: “I keep missing work before my period,” or “My mood changes are affecting my relationships.” Put the problem you most want help with at the top of your appointment notes. Ask what improvement to look for and when you will review the plan together.

A daily record can help a clinician see the pattern and review treatment. Note which symptoms occur, how severe they feel and how long they last. Include days when symptoms ease. RCOG advises keeping up the diary after treatment begins to see how well it is working.

Everyday changes that are manageable

NHS advice includes regular exercise, a balanced diet, enough sleep and stress-reduction approaches such as yoga or meditation. Choose a change that fits your circumstances. You can book care while making these changes. The NHS advises seeing a GP when symptoms affect daily life.

If pain is part of the problem, pain relief may help. Your pharmacist, GP or doctor can advise on medicines such as ibuprofen and whether they suit you; follow the leaflet. Be cautious about supplement promises. Evidence for complementary therapies is limited. The NHS advises checking supplements with a GP or pharmacist if you also take medicines.

CBT and medicine choices

Cognitive behavioural therapy, or CBT, works on ways of managing symptoms and reducing their effect on daily life. It is an option for PMS, and MedlinePlus describes it as a treatment for PMDD either alongside antidepressants or on its own. Ask about access to a therapist with relevant experience.

Selective serotonin reuptake inhibitors, usually called SSRIs, are a common medicine option for PMDD and a first-choice treatment for severe PMS. Your clinician can explain how they may help and what side effects they can cause. RCOG lists nausea, sleep difficulties, tiredness and lower sexual desire among possible effects of antidepressant treatment.

Some combined contraceptive pills can also help. Pills containing drospirenone are among the options described in UK and US guidance. Talk to your prescriber about your health and preferences when choosing a pill. Ask what to do if mood symptoms or other side effects become troublesome.

Do not stop or change a prescribed antidepressant without talking to your clinician. Stopping needs a plan because withdrawal symptoms can occur. Tell the prescriber if you are planning a pregnancy or become pregnant, so treatment can be discussed with that in mind.

When to ask for specialist care

Book a GP appointment (UK), or see your doctor (US or elsewhere), if symptoms affect daily life or have not improved with the treatment you have tried. If symptoms continue despite treatment, you may be referred to a gynaecologist, psychiatrist or counsellor. Ask who will organise your care if several services are involved.

A specialist may discuss medicines that suppress ovarian activity when other approaches have not helped. These can cause menopause-like side effects and need careful discussion. Ask about the risks, monitoring and alternatives before deciding. Bring a list of treatments you have tried. Note what helped and any side effects you found hard to manage.

Help now for a mental health crisis

Call 999 now (UK) or 911 (US), or your local emergency number, if you cannot keep yourself safe or have seriously harmed yourself. NHS advice also says to call 999 or go to A&E if you have PMDD symptoms and feel suicidal. Do not wait for your period or for a planned review.

Contact an urgent GP service or call NHS 111 and select the mental health option in England, or contact your doctor or local urgent mental health service elsewhere, if you need urgent mental health help. Use emergency services for immediate danger.

In the UK, call Samaritans on 116 123 for free support, day or night. In the US, call or text 988 for the Suicide & Crisis Lifeline. Elsewhere, use your local crisis service. These listening services do not replace emergency care when you are in immediate danger.