PMS and PMDD
Physical and mood symptoms in the 1 to 2 weeks before a period that ease once it starts. PMDD is the severe form, affecting about 1 in 20. Both are real, and both are treatable.
The PMS ladder
Track symptoms for 2 cycles first: it confirms the pattern and shows whether treatment works. Give each step 2 to 3 cycles.
- Step 1 · Self-careSymptom diary, exercise and sleepA daily diary, regular exercise across the whole month, decent sleep, and less alcohol and caffeine before your period.
- Works
- Diary is key to diagnosis; exercise has only small, weak trials but is low risk
- Cost
- Free (an app or the IAPMD diary)
- How long
- 2–3 cycles
- Watch for
- Exercising only in the bad week. It works best all month.
Book the big stuff for your good weeks. That’s strategy, not weakness.
- Step 2 · PharmacyCalcium1,000–1,200 mg a day, from food or a supplement.
- Works
- Symptoms fell about 50% vs 30% on a dummy treatment in the main trial; eases mood and bloating
- Cost
- About $10–20 a month
- How long
- 2–3 cycles
- Watch for
- Constipation. Count the dairy you already eat before adding tablets.
Cheap, safe, worth a go. Evening primrose oil, sadly, did no better than a dummy treatment.
- Step 3 · PrescriptionContraceptive pill containing drospirenoneTaken continuously or with a short break, it smooths out the hormone swings.
- Works
- About 1 in 2 with PMDD respond vs 1 in 3 on a dummy treatment
- Cost
- $25 on the PBS for 3 months ($7.70 concession)
- How long
- 2–3 cycles to judge
- Watch for
- Nausea, spotting, small clot risk. Not with migraine with aura, a past clot, or smoking over 35.
Skipping the sugar pills is allowed. A monthly bleed on the pill isn’t medically needed.
- Step 4 · PrescriptionSSRI antidepressant (such as fluoxetine or sertraline)The best-proven treatment for PMDD and severe PMS. Taken daily, or just in the 2 weeks before a period.
- Works
- About 6 in 10 improve (vs about 3 in 10 on a dummy treatment), often within days
- Cost
- Under the $25 PBS co-payment, about $18–25 a month
- How long
- Works within days; judge over 2 cycles
- Watch for
- Nausea, sleep changes, lower libido. Tell your doctor if mood gets worse.
Part-month dosing is a legitimate option, not a cheat code.
- Step 5 · Allied healthCBT with a psychologistCoping skills that reduce distress and help you plan around your cycle.
- Works
- Small trials: reduces distress and improves coping
- Cost
- About $150–250 a session; Medicare rebates with a mental health care plan
- How long
- Usually 6–10 sessions
- Watch for
- Needs practice between sessions.
Tools you keep, whatever your cycle gets up to.
- Step 6 · SpecialistMedicines that pause the cycle, with hormone “add-back”For severe PMDD when other options fail, through a gynaecologist.
- Works
- Large benefit over a dummy treatment in small trials; works for most with confirmed PMDD
- Cost
- Specialist fees, plus medicines that can cost more if not PBS-subsidised for this use
- How long
- A trial of 3–6 months; longer use needs bone monitoring
- Watch for
- Menopause-like symptoms and bone thinning, which add-back hormones reduce.
A serious option for a serious problem. Specialist-only for good reason.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Evening primrose oilNo better than a dummy treatment in trials.
- High-dose vitamin B6Mixed evidence, and high doses can damage nerves. If you try it, keep the dose low.
- Vitex (chaste tree)Mixed results from low-quality trials, and not for everyone, including people on the pill.
- Progesterone creams and pessariesNo better than a dummy treatment in trials.
- Hormone or saliva testsPMS isn’t diagnosed by hormone levels, which are usually normal. A symptom diary does the job for free.
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.
Support lines
If you or someone else is in danger right now, call your emergency number. To talk to someone, any time:
- Australia: Lifeline 13 11 14 (24/7, or text 0477 13 11 14), Suicide Call Back Service 1300 659 467, Beyond Blue 1300 22 4636, 13YARN 13 92 76 for Aboriginal and Torres Strait Islander people. Emergency: 000.
- Young people in Australia: Kids Helpline 1800 55 1800 (24/7, ages 5 to 25) or headspace (ages 12 to 25).
- New Zealand: call or text 1737. Emergency: 111.
- UK and Ireland: Samaritans 116 123. Emergency: 999 (or 112).
- US and Canada: call or text 988. Emergency: 911.
- Anywhere else: findahelpline.com lists free helplines in more than 100 countries.
Common questions
What is the difference between PMS and PMDD?
PMS is physical and mood symptoms in the 1 to 2 weeks before a period that ease once it starts. PMDD is a severe form, affecting about 1 in 20, with marked low mood, anxiety or irritability.
Do antidepressants help PMDD?
SSRIs such as fluoxetine or sertraline help about 6 in 10 people with PMDD or severe PMS. They can be taken daily or only in the 2 weeks before a period, and often work within days.
Can the pill help PMS?
A pill containing drospirenone, taken with a short break or continuously, can reduce symptoms. It isn’t suitable for everyone, for example with migraine with aura or a past blood clot.
Do supplements help PMS?
Calcium may ease mood and bloating. Vitex and vitamin B6 have mixed evidence (keep B6 to low doses), and evening primrose oil is no better than a dummy treatment.
What are the symptoms of PMS?
Mood changes, irritability, anxiety, tiredness, breast tenderness, bloating, headaches and food cravings in the 1 to 2 weeks before a period, easing within a few days of bleeding starting.
Does PMS get worse with age?
It can, especially in your late 30s and 40s and during perimenopause, when hormone swings become larger and less predictable. A symptom diary over 2 to 3 months helps your doctor sort out PMS from perimenopause, depression or anxiety.
Does exercise help PMS?
Regular aerobic exercise may reduce PMS symptoms such as low mood, tiredness and bloating, though the studies are small. It’s low-risk and worth trying alongside other treatments.
Helpful resources
- IAPMD symptom trackerPrintable daily diary, including the validated DRSP chart, to bring to your GP. Free.
- Jean Hailes: PMS fact versus fictionMyths, evidence on supplements and when to get help. Free, Australia.
- MindSpotOnline and phone psychological courses for anxiety and low mood, with a therapist. Free, Australian adults.
Evidence and more information
- Healthdirect: Premenstrual syndrome
- Jean Hailes: PMDD
- IAPMD: Treatments with strong evidence
- Cochrane: SSRIs for PMS and PMDD
- Thys-Jacobs et al: Calcium carbonate for PMS, RCT (1998)
- Cochrane: Drospirenone pills for PMS
- Wyatt et al: GnRH analogues for PMS, meta-analysis (2004)
maladywise.com/pms/