What a doctor
may suggest
By Ben Jonas Goedeke · 4 min read · checked against its sources
There is no single answer for PMDD, but there is a well-worn path. Knowing it helps you take part in the decision. This is general information; your doctor will fit it to you.
Everyday changes
Doctors often start with regular exercise, a balanced diet, enough sleep and ways to manage stress, alongside the other options.
Talking therapy
Cognitive behavioral therapy, CBT, is recommended for premenstrual symptoms. It teaches practical ways to handle the thoughts and situations the hard week brings.
Antidepressants called SSRIs
SSRIs are one of the first choices for severe premenstrual symptoms, and in PMDD they often work faster than they do for depression. Some people take them every day, others only in the second half of the cycle. They should be stopped gradually, with your doctor.
Some contraceptive pills
Combined pills containing a progestogen called drospirenone can help, usually taken without the monthly break. The aim is to stop ovulation, and with it the rise and fall that sets symptoms off.
When nothing else has worked
For severe PMDD, a specialist may offer medicines that pause the ovaries for a while, usually with hormone replacement alongside. These also show whether switching the cycle off switches the symptoms off. Surgery is a last step, considered only after that.
Keep your record going through any change. It is the clearest way to see what is helping.
Keep the record your doctor needs. Tideline is a period and mood tracker for iPhone: write one sentence a day, and after two cycles it puts the week before your period next to the week after it starts. Free to track, no account.
Get Tideline on the App Store
Keep reading
Sources
- Royal College of Obstetricians and Gynaecologists: Managing premenstrual syndrome (PMS)
- IAPMD: Treatments with strong evidence
- ACOG: Premenstrual Syndrome (PMS)
- NHS: PMS (premenstrual syndrome)