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Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS). Symptoms begin in the second half of the menstrual cycle and end shortly after menstruation begins.

Women with PMDD have severe symptoms, which present following ovulation and resolve once bleeding starts. Symptoms vary from depression and anxiety to thoughts or attempts at suicide. Symptoms can cause disruption to relationships and family life.

Physical symptoms, including headaches, bloating and breast tenderness, may occur in addition to the common psychological symptoms listed below:

  • Panic attacks
  • Mood swings
  • Difficulty concentrating
  • Trouble sleeping
  • Lack of energy
  • Tension and anxiety
  • Sadness
  • Binge eating
  • Suicidal thoughts

What are the treatment options?

There are currently no treatments licensed to manage premenstrual disorders, including the most severe end of the spectrum, PMDD.

Treatment options include:

  • Combined contraceptive pills ideally containing a progestogen called drospirenone (as long as there are no contraindications).
  • Fluoxetine (works much more quickly than when used for depression) and can be used only when symptoms kick in eg. day 14 – 28 of a regular 28 day cycle
  • Mirena with sufficient “add-back “ oestrogen to override the menstrual cycle eg 100mg patch
  • GnRH analogues (usually in addition to hormone replacement therapy)


To book an appointment please call 0151 257 6700

Dr Paula Briggs

MBChB, FRCGP, FFSRH, Dip Ven , DMJ (Clin), Diploma Gynaecology

Call 111 the NHS non-emergency number or 999 for all medical emergencies