Medical treatments for PMS and PMDD

Summary

This article explores the range of medical treatments for PMS and PMDD - from over-the-counter pain relief to prescription antidepressants, hormone-based therapies, and surgical options. It explains how treatments like NSAIDs, SSRIs, SNRIs, and drospirenone-containing contraceptive pills can help manage both physical and emotional symptoms, and when more advanced interventions such as GnRH analogues or surgery may be considered.

Over-the-counter treatments

All the following medications can be bought from your local pharmacy or supermarket without a prescription.

NSAIDs

For pain such as cramps, back pain, or headaches, non-steroidal anti-inflammatory drugs (NSAIDs) are a common first step. These include aspirin, ibuprofen, mefenamic acid, and naproxen. NSAIDs work by blocking the production of pain-triggering prostaglandins and reducing inflammation. Although there is limited specific research on NSAIDs for PMS symptoms, they are widely used for pain relief and generally well tolerated. Stronger versions can be prescribed by a doctor.

One study found that naproxen reduced both menstrual and premenstrual pain, and also showed a significant improvement in PMS behavioural changes.

Paracetamol

Paracetamol is another popular pain relief option. Research suggests it is slightly less effective than NSAIDs for menstrual pain - one comparative study found ibuprofen relieved 98.9% of pain versus 91.1% for paracetamol. However, paracetamol is a very close alternative and is appropriate when ibuprofen cannot be used. It is not suitable for people who have had allergic reactions to it, have liver or kidney problems, or drink above the recommended alcohol limits (14 units per week).

Non-hormonal therapy

If over-the-counter pain relief is not sufficient, there are non-hormonal prescription options available.

SSRIs

Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant and the primary recommended treatment for PMDD. They work by preventing serotonin reuptake, leaving more of it active in the brain and improving mood. The most common SSRIs include sertraline, citalopram, and fluoxetine. Studies have found sertraline effective in reducing PMS symptoms including pain, mood, irritability, depression, and anxiety, and improving quality of life in people with PMDD. SSRIs can be taken continuously or only during the luteal phase - your doctor will advise.

SNRIs

Serotonin and norepinephrine reuptake inhibitors (SNRIs) are antidepressants similar to SSRIs but work differently - increasing serotonin production rather than blocking reuptake. They can also relieve nerve and muscle pain. Examples include duloxetine and venlafaxine. Some people find SNRIs more effective than SSRIs; others find the reverse. Response varies by individual.

Diuretics

People with severe bloating during PMS or PMDD may be offered diuretics (water pills), such as spironolactone. These work by helping the body flush fluid through the kidneys. They are typically prescribed when exercise and salt reduction have not provided sufficient relief. Studies show spironolactone can help reduce PMS-related bloating, though the evidence base remains limited.

Hormonal therapy

Many people use hormonal treatments to ease PMS and PMDD symptoms. These treatments work in different ways but ultimately aim to balance oestrogen and progesterone levels - changes in which are thought to be a primary driver of PMS and PMDD. A detailed discussion with your doctor is essential before starting any hormonal treatment, as there are many individual factors to consider.

Combined oral contraceptive (COC)

The combined oral contraceptive pill - particularly varieties containing drospirenone - has traditionally been one of the most commonly prescribed treatments for PMS. It may seem counterintuitive to treat PMS with progesterone-like compounds, but the structure of drospirenone is different from the body's own progesterone, which is why it works for many people.

COCs are most effective when taken continuously (back-to-back packets rather than with a break). Not all pills can be taken this way, so always check with your GP. According to research, drospirenone-containing COCs significantly reduce breast pain and help reduce fluctuations in weight, appetite, mood swings, and acne. However, some people find hormonal pills worsen their PMS or PMDD symptoms. Speak to your doctor if you are unsure whether this is right for you.

Oestrogen therapy

Oestradiol (a form of oestrogen) can be applied as a patch, gel, or implant. It works by preventing ovulation and the cyclical hormonal changes that trigger PMS and PMDD. However, it must be taken alongside progestogen to protect the womb - and this progestogen can itself reintroduce PMS symptoms in some people, so it does not work for everyone.

A review of studies on oestrogen therapy for PMS found limited evidence to support its use - most studies had inconclusive results, small sample sizes, and uncertainty about long-term safety.

GnRH analogues

GnRH analogues are reserved for people with severe PMS or PMDD. Usually given as injections, they work by reducing oestrogen levels to effectively pause the menstrual cycle and induce temporary menopause - preventing the hormonal fluctuations that drive symptoms. Research shows they significantly reduce premenstrual depression, irritability, and headaches.

However, because oestrogen plays important roles throughout the body - including protecting bone density - GnRH analogues are not suitable as a long-term solution. Your GP will likely refer you to a gynaecologist before prescribing them.

Surgical interventions

Surgical treatment for PMS and PMDD is the very last resort - only considered when all other treatments have failed and symptoms are extremely severe. Surgery is considered the only permanent cure for PMS and PMDD. It may involve removal of the ovaries (bilateral oophorectomy) or a more extensive procedure involving the ovaries, uterus, fallopian tubes, and cervix. Your doctor will advise which approach is most appropriate.

Because the ovaries produce oestrogen, removing them induces surgical menopause. For people under 50, hormone replacement therapy (HRT) - oestrogen only, without progesterone - is typically offered afterwards to protect bone and heart health and prevent menopausal symptoms such as hot flushes, mood swings, and reduced libido.

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Disclaimer: This content is for informational purposes only and is not intended as medical advice. Always speak to a qualified healthcare professional about any health concerns.