Managing PMS and PMDD

If symptoms before your period keep disrupting work, relationships or everyday tasks, treatment can go beyond self-care. Options for PMS (premenstrual syndrome) include cognitive behavioural therapy, hormone medicines and antidepressants. PMDD (premenstrual dysphoric disorder) can bring stronger mood symptoms, and there is treatment for this too. You can ask for help based on how much it affects your life.

Choose what you want treatment to improve

Start with a real 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’ll review the plan together.

A daily record can help a clinician see the pattern and check how treatment is going. Note which symptoms you have, how bad they feel and how long they last. Include the days when they ease. RCOG advises carrying on with the diary after treatment starts, to see how well it’s working.

Everyday changes that are manageable

NHS advice includes regular exercise, a balanced diet, enough sleep, and ways to lower stress such as yoga or meditation. Pick a change that fits your life. You can get care while you make 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 wary of what supplements promise. There’s little evidence for complementary therapies. The NHS advises checking supplements with a GP or pharmacist if you also take medicines.

CBT and medicine choices

Cognitive behavioural therapy (CBT) is a talking therapy. It helps you find ways to manage symptoms and lessen their effect on daily life. It’s an option for PMS. MedlinePlus describes it as a treatment for PMDD, either alongside antidepressants or on its own. Ask how to see a therapist with the right experience.

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant. They’re a common medicine 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 feeling sick, trouble sleeping, tiredness and lower sex drive among possible side effects.

Some combined contraceptive pills can also help. UK and US guidance describe pills containing drospirenone among the options. Talk to your prescriber about your health and what you prefer when choosing a pill. Ask what to do if mood symptoms or other side effects start to bother you.

Don’t stop or change a prescribed antidepressant without talking to your clinician. Stopping needs a plan, because you can get withdrawal symptoms. Tell the prescriber if you’re planning a pregnancy or get pregnant, so you can talk about your treatment 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 haven’t got better with the treatment you’ve tried. If symptoms carry on despite treatment, you may be referred to a gynaecologist, psychiatrist or counsellor. Ask who will join up your care if several services are involved.

A specialist may talk about medicines that switch off the ovaries’ hormone activity when other options haven’t helped. These can cause side effects like those of menopause, and need careful discussion. Ask about the risks, check-ups and other options before you decide. Bring a list of treatments you’ve tried. Note what helped and any side effects you found hard to cope with.

Help now for a mental health crisis

Call 999 now (UK) or 911 (US), or your local emergency number, if you can’t 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. Don’t wait for your period or a planned review.

If you need urgent mental health help in England, contact an urgent GP service or call NHS 111 and choose the mental health option. Elsewhere, contact your doctor or local urgent mental health service. Use emergency services if there’s 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 don’t replace emergency care when you’re in immediate danger.