Medical treatments for PMS and PMDD

All the following medications can be bought from your local pharmacy or supermarket.

NSAIDs

If you’re experiencing pain such as cramps, back pain or headaches, one way to relieve it is by taking painkillers, for example, non-steroidal anti-inflammatory drugs (NSAIDs). These include aspirin, ibuprofen,  mefanamic acid, and naproxen. NSAIDs work by blocking the production of pain-triggering chemicals and reducing inflammation. Although there isn’t much research on the effect of NSAIDs on PMS symptoms specifically, they are very frequently taken for pain relief (you probably already use them) and are generally well tolerated. Some come in stronger forms, which can be prescribed by your doctor if needed.

One study conducted back in 1989 looked into how Naproxen could ease the symptoms of PMS. It found that both menstrual and premenstrual pain decreased in the patients taking the drug treatment. Interestingly, the results also showed a ‘significant improvement in PMS behavioural changes’ from taking Naproxen. 

Side effects - most people take NSAIDs without any issues. However, the side effects can include headaches, changes in vision, tiredness and drowsiness. Whilst it’s safe for most of us to use these medications, they aren’t suitable for those with a history of stomach ulcers, high blood pressure, severe liver and kidney failure or heart problems. If you’re trying to get pregnant, doctors also recommended you only take NSAIDs for short periods of time (no longer than one week). 

Paracetamol

Another popular pain relief medication is paracetamol, but research suggests that, when it comes to relieving menstrual-related pain, it’s slightly less effective than NSAIDs, like Ibuprofen. One study comparing these two types of medication showed that Ibuprofen relieved 98.9% of pain, whereas paracetamol relieved 91.1%. Although Ibuprofen may pip paracetamol ever so slightly for pain relief, it’s a close draw. So, if you can’t take Ibuprofen, then paracetamol is an effective alternative. Most people can take paracetamol, but it may not be suitable if you’ve ever had an allergic reaction to it, have liver and kidney problems, or drink more than the recommended quantity of alcohol (14 units per week). 

‍Side effects - the biggest upside to paracetamol is that it rarely causes side effects and can be used alongside NSAIDs for extra pain relief – as long as you stick to the recommended dose.

If you feel like over-the-counter pain relief isn’t easing your symptoms, there are also other options out there, such as non-hormonal treatments.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant medication and are the primary recommended treatment for PMDD. They work by preventing serotonin reuptake, meaning there’s more of it around in the brain. As serotonin is the happy hormone, this helps improve our mood. The most common SSRIs include sertraline, citalopram and fluoxetine. Studies have found sertraline effective in relieving PMS symptoms, including improving pain, mood, irritability, depression and anxiety, and improving quality of life in people with PMDD. SSRIs are prescribed by your doctor and can either be taken continuously, or only during the luteal phase of your cycle (your doctor will advise you on this).

Side effects - some people experience side effects when taking SSRIs such as headaches, dry mouth, tiredness, sexual dysfunction (difficulty reaching orgasm), sleep disturbances, weight changes, and worsened anxiety. Further, they aren’t suitable for people with heart problems, bipolar disorder, glaucoma, a history of epilepsy, diabetes, or those who are pregnant.

SNRIs

SNRIs (serotonin and norepinephrine reuptake inhibitors) are antidepressants similar to SSRIs, but instead of blocking serotonin uptake, they increase serotonin production. SNRIs can also relieve nerve and muscle pain, as well as improve mood. Examples include duloxetine and venlafaxine. Some people find them more effective than SSRIs, but conversely, some people find SSRIs work better; the response seems to vary from person to person.

Side effects - side effects of SNRIs can include nausea and vomiting, dry mouth, constipation, fatigue, drowsiness, excess sweating and sexual dysfunction. SNRIs may not be suitable if you have a history of heart disease or poorly controlled high blood pressure.

Diuretics

People who experience severe bloating during PMS or PMDD may be offered a treatment called diuretics, or ‘water pills’, such as spironolactone. They work by helping your body flush more fluid through your kidneys, and may be prescribed by your doctor if increasing your exercise and limiting your salt intake don’t work. Despite there not being a significant amount of evidence for their use, there are studies that show spironolactone can help reduce PMS-related bloating.

‍Side effects - although not common, some side effects of taking water pills include dizziness, headache, dehydration, muscle cramps, and joint disorders (gout).

Many people choose hormonal treatments to ease their PMS and PMDD symptoms, including the combined oral contraceptive pill, oestrogen hormone therapy and GnRH analogues. These treatments all work in a slightly different way, but ultimately work to balance our oestrogen and progesterone levels, which are thought to be one of the main causes of PMS and PMDD symptoms. However, it’s important to have a detailed discussion with your doctor before trying these treatments, as there are many factors to consider before choosing a hormone-based therapy.

Combined oral contraceptive (COC)

Traditionally, the combined oral contraceptive pill has been one of the most frequently used treatments for easing symptoms of PMS – especially the variety that contains drospirenone, a specific type of progestogen. It may seem odd to treat PMS and PMDD with progesterone (when progesterone is thought to be one main triggers of PMS symptoms), but, these work for lots of people because the structure of drospirenone is different to the structure of progesterone found in our bodies.

It’s recommended these COCs are taken continuously (back-to-back packets) rather than cyclically (whereby you have a break from taking the pill and have a period) to maximise the chances of them working. Not all pills can be taken continuously though, so check with your healthcare provider before making any changes to your medication.

According to research, COCs containing drospirenone can significantly reduce breast pain and help reduce fluctuations in weight, appetite, mood swings, and acne. However, while hormonal pills can relieve your PMS/PMDD symptoms, some people feel they make their PMD/PMDD symptoms worse. Speak to your doctor if you’re unsure whether this treatment is right for you.

Oestrogen therapy

Oestrogen therapy has also been put forward as a way to control PMS symptoms. Traditionally, oestrogen is used as a contraceptive, rather than as a way to specifically help with PMS. Oestradiol (a specific form of oestrogen) can be absorbed through the skin when applied in a patch or gel, or into the bloodstream through an implant. It works by preventing ovulation and the cyclical hormone changes that usually follow. Because it’s these hormones and their metabolites which are thought to cause PMS/PMDD symptoms, oestrogen therapy can subsequently help reduce symptom severity.

Although these treatments typically contain lower doses of oestrogen than those in COCs, they must also be taken alongside progestogen to protect your womb from excess oestrogen. However, this progesterone can also cause PMS symptoms to show up again, so this treatment doesn’t work for everyone.

A review of current studies looking at oestrogen therapy for PMS found little evidence to support its use for PMS. Most studies contained inconclusive evidence, small sample sizes, and uncertainty around the safety of taking this treatment for long periods of time.

Side effects - possible side effects of taking oestrogen therapy can include bloating, breast tenderness/swelling, swelling in other parts of the body, feeling sick, leg cramps, headaches, indigestion, and vaginal bleeding. Therefore, it’s likely that your doctor will advise trying other treament options before oestrogen therapy.

GnRH analogues

Alternatively, GnRH analogues are also an option for PMS symptom relief, but are typically reserved for people experiencing severe PMS. GnRH analogues are usually given as injections, and work by reducing the levels of oestrogen in the body. In a way, these injections ‘turn off’ the ovaries and induce temporary menopause. This subsequently prevents the rest of the sex hormones from rising and falling, leading to a reduction in PMS symptoms.

However, because oestrogen plays many important roles throughout the body, for example, in protecting bone strength, GnRH analogue injections are less suitable as a long-term solution. Research suggests that GnRH analogies significantly reduce premenstrual depression, irritability, and headaches, and can help people feel happier.

‍Side effects - because these treatments reduce oestrogen levels, they subsequently prevent ovulation (and thus prevents pregnancy). As PMS affects people of child-bearing age, your GP will likely refer you to a gynaecologist before prescribing this treatment. Other side effects can include hot flashes, fatigue, weight gain, fluid retention, and decreased libido.

Surgical treatment for PMS and PMDD is usually the very last option and is only offered when all other treatments aren’t working. This is usually the case for people with extremely severe symptoms. Surgery is considered the only ‘cure’ for PMS and PMDD, and may either involve removal of the ovaries (‘bilateral oophorectomy’) or removal of the ovaries, uterus, fallopian tubes, and cervix. Your doctor will advise which is best for you depending on how you react to specific progesterones. As this removes the ovaries, the hormone-producing organs, it induces surgical menopause, and hormone replacement therapy (HRT) may subsequently be recommended depending on your age.

After the surgery, you’ll enter what is known as ‘surgical menopause’, as you won’t produce the oestrogen your body once did when the ovaries were present. If you’re under 50 years old, you’ll likely be offered hormone replacement therapy (HRT) (which will consist of just oestrogen, no progesterone) to protect your heart and bones, and prevent menopausal symptoms from occurring, such as hot flushes, mood swings, anxiety, bone weakening and libido changes.

While this effectively cures your PMS/PMDD, it’s important to note that this is an irreversible option, and it makes a person infertile, therefore unable to get pregnant.