Medicines for Premenstrual dysphoric disorder

What it is

Premenstrual dysphoric disorder (PMDD) is a severe form of premenstrual syndrome (PMS) in which the symptoms — particularly the effects on mood and emotional wellbeing — are intense enough to significantly disrupt daily life, relationships, and work or study. Like PMS, symptoms occur in the second half of the menstrual cycle, in the days to about two weeks before a period, and then improve soon after the period starts, with a symptom-free time in between — this cyclical pattern is a key feature. In PMDD, the symptoms are much more severe than typical PMS, and prominently include marked emotional and psychological symptoms: severe low mood, hopelessness, anxiety, tension, irritability or anger, mood swings, feeling overwhelmed, tearfulness, and, in some, thoughts of self-harm or suicide, alongside physical symptoms (such as tiredness, bloating, breast tenderness, and sleep and appetite changes). PMDD is thought to be related to an abnormal sensitivity to the normal hormonal changes of the menstrual cycle, rather than abnormal hormone levels. It is a recognised medical condition — not simply "bad PMS" or something a person should have to endure — and, importantly, it is treatable, so recognising it and seeking help is worthwhile.

How it is treated

Because PMDD can significantly affect wellbeing and, at its most severe, safety, it is important to take it seriously and treat it, and effective options exist. A helpful first step is often tracking symptoms across at least two cycles (for example with a symptom diary), which confirms the cyclical pattern (symptoms in the second half of the cycle, resolving after the period) that characterises PMDD and distinguishes it from other conditions. Treatment is individualised and may include: lifestyle measures (regular exercise, good sleep, stress management, and dietary measures) which help some people; psychological therapy, particularly cognitive behavioural therapy, which can be effective; and, importantly, specific medical treatments — certain antidepressants (SSRIs), which are effective for PMDD and can be taken continuously or just in the second half of the cycle, and hormonal treatments (such as certain combined hormonal contraceptives, and other hormonal approaches) that work by stabilising or suppressing the cyclical hormonal changes. For severe, treatment-resistant PMDD, specialist care and other options are considered. Crucially, because PMDD can include thoughts of self-harm, support and safety are prioritised, and anyone with such thoughts should seek help promptly. The reassuring message is that PMDD is a recognised, treatable condition — with lifestyle measures, psychological therapy, and specific medical treatments all able to help — so it is well worth seeking support rather than enduring it.