PMS and PMDD
Premenstrual syndrome (PMS) is physical and mood symptoms in the 1 to 2 weeks before a period that ease once it starts. Premenstrual dysphoric disorder (PMDD) is a severe form, affecting about 1 in 20, with marked low mood, anxiety or irritability. A daily symptom diary over 2 cycles helps with diagnosis.
Treatment options
Ratings show how strong the research is.
- Strong evidenceSSRI antidepressantsSuch as fluoxetine or sertraline. Help about 6 in 10 people with PMDD or severe PMS. Can be taken daily or only in the 2 weeks before a period, and work within days.
- Strong evidenceSpecialist hormone treatmentFor severe PMDD when other options fail: medicines that pause the cycle, with hormone "add-back", via a gynaecologist.
- Moderate evidenceContraceptive pillA pill containing drospirenone, taken with a short break or continuously, can reduce symptoms. Not suitable for everyone, for example with migraine with aura or a past blood clot.
- Moderate evidenceCognitive behavioural therapy (CBT)Reduces distress and helps with coping strategies.
- Limited evidenceCalcium1,000 to 1,200 mg a day, from food or a supplement, may ease mood and bloating.
- Limited evidenceExerciseRegular exercise across the whole month, not just before a period, may help mood and sleep.
- Limited evidenceVitex (chasteberry) or vitamin B6Mixed evidence. Keep B6 to low doses, as high doses can damage nerves. Check with your pharmacist.
- Not recommendedEvening primrose oilNo better than placebo in trials.
What you can do
- Track symptoms daily for 2 to 3 cycles, using an app or the free IAPMD diary.
- Plan demanding tasks and big events for your better weeks where you can.
- Prioritise sleep, and cut back on alcohol and caffeine before your period.
See your GP if
- Symptoms affect work, study or relationships
- Low mood or anxiety lasts all month, not just before periods
- You also have heavy or very painful periods
If you have thoughts of self-harm or suicide, even only before your period, call Lifeline on 13 11 14, or 000 in an emergency. Tell your GP: this is treatable.
Evidence and more information
maladywise.com/pms/