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Dr. Chrysoula I. Liakou MD, PhD
- Treated online: Yes, usually. PMDD is diagnosed from your symptoms and a diary of your cycle, and treated by video; specialist treatment and surgery are in person.
- What it is: severe emotional and physical symptoms that start 1 to 2 weeks before a period and ease a few days after it starts.
- How common: up to about 5% of women of childbearing age have PMDD. It can affect anyone who has periods.
- Treatment: SSRIs, every day or only in the second half of the cycle, the combined pill, CBT and lifestyle changes. Most people find their symptoms go away or become manageable.
- Emergency: call 112 or go to an emergency department if you might act on thoughts of ending your life, or have harmed yourself.
Do not book a video appointment if you are thinking about ending your life and might act on it, or if you have harmed yourself or taken an overdose. Call 112 or go to an emergency department. PMDD can bring these thoughts for a few days each month, and they need help straight away, every time.
Can an online doctor treat PMDD?
Yes. PMDD is diagnosed from your symptoms and their timing in your cycle, with no physical examination or lab test that confirms it, so a doctor can assess it well by video. The doctor can recommend lifestyle changes, refer you for talking therapy, and prescribe an SSRI or the combined pill when they suit you. Specialist treatment, including surgery to stop periods as a last resort, is in person, for when other treatments have not helped.
How an online consultation helps with PMDD
- PMDD, or something else?: Depression, anxiety, bipolar disorder and thyroid problems can look similar, and the timing in your cycle tells them apart.
- A diary that gives an answer: What to record over 2 cycles, and how to read the pattern.
- Treatment that fits your plans: An SSRI every day or for half the cycle, the combined pill, or both, chosen around your contraception and pregnancy plans.
- The dark days taken seriously: A plan for the days when mood drops, including what to do if thoughts of suicide come.
What the doctor checks in an online PMDD consultation
The doctor asks about safety first, then about your symptoms and your cycle. The doctor asks about:
- Safety: thoughts of suicide or self-harm, and whether they come at the same point in each cycle.
- Your symptoms: low mood, anxiety, irritability, mood swings, and physical symptoms such as breast tenderness or bloating.
- The timing: when symptoms start and stop in relation to your period, for how many months, and whether you feel well after your period.
- Your cycle and contraception: how regular your periods are, the contraception you use, and pregnancy plans.
- Your mood between periods: low mood or anxiety that continues all month points to another cause.
- Your health: migraines, blood clots, smoking, thyroid problems and the medicines you take.
Before the call, a symptom diary for at least 2 cycles is the most useful thing you can bring. If you have not kept one, start now: the doctor can still begin with what you remember.
What are the symptoms of PMDD?
PMDD causes severe emotional and physical symptoms that start about 1 or 2 weeks before each period and improve a few days after it starts. They are similar to PMS but more intense, and they make it hard to work, socialise and keep up relationships.
Swipe sideways to compare →
| Emotional symptoms | Physical and other symptoms |
|---|---|
| Feeling depressed, hopeless or worthless | Breast tenderness or swelling |
| Anxiety, tension or feeling on edge | Joint and muscle pain, headaches |
| Sudden mood swings, tearfulness, sensitivity to rejection | Bloating and weight gain |
| Irritability or anger, and conflict with others | Feeling more tired than usual |
| Less interest in things you normally enjoy | Sleeping poorly or sleeping too much |
| Feeling overwhelmed or out of control | Food cravings or binge eating |
| Thoughts of suicide | Problems concentrating |
Doctors look for 5 or more symptoms, including at least one mood symptom, in most cycles, which cause real distress or get in the way of work and relationships, and which are not explained by another condition.
When does PMDD hit hardest?
In the week or two before a period. Symptoms usually ease 2 to 3 days after the period starts, and you feel well again until the next cycle. That symptom-free week after the period is what sets PMDD apart from depression or anxiety, which last all month.
PMS or PMDD?
PMDD symptoms are similar to those of PMS, premenstrual syndrome, but much more intense. PMDD is a severe, long-term form of PMS that makes it hard to work, socialise and keep up relationships, and it often needs treatment such as an SSRI, the combined pill or talking therapy.
What causes PMDD, and who gets it?
The exact cause is not known. PMDD is not a hormone imbalance: hormone levels are usually normal, but the brain seems more sensitive to the normal rise and fall of oestrogen and progesterone in the cycle. These make it more likely:
- PMS or PMDD in the family
- depression, postnatal depression or another mood condition, in you or your family
- smoking
Up to about 5% of women of childbearing age have PMDD, and the International Association for Premenstrual Disorders puts it at 1 in 20 people who menstruate. Many people with PMDD also have anxiety or depression, and many live with PMDD undiagnosed for years; its symptoms can look like depression, an anxiety disorder or a thyroid problem. For some, symptoms get worse over time and continue until the menopause, so treatment may be needed for years.
How is PMDD diagnosed?
No physical examination or lab test can diagnose PMDD. A doctor diagnoses it from your symptoms when they happen every month, about 1 or 2 weeks before your period, and you have had them for at least 2 months. A symptom diary for at least 2 cycles shows the pattern clearly, and a blood test for thyroid problems can rule out a look-alike.
Swipe sideways to compare →
| Record | Why it helps |
|---|---|
| The day of your cycle, and the days you bleed | Shows whether symptoms follow the cycle |
| Mood, anxiety and irritability, scored from 0 to 10 | Shows how severe the bad days are, and whether you feel well after your period |
| Physical symptoms, sleep and energy | Completes the picture |
| How much symptoms affected work, home and relationships | Shows the effect on your life |
| Any thoughts of self-harm or suicide | Helps you and the doctor plan for the hardest days |
PMDD or something else?
Swipe sideways to compare →
| Condition | How it differs from PMDD | Read more |
|---|---|---|
| Depression | Low mood most of the day, nearly every day, for 2 weeks or more, not only before periods | Depression |
| Anxiety | Worry most days, all month | Anxiety |
| Bipolar disorder | Episodes of high and low mood lasting days or weeks, not tied to the cycle | Bipolar disorder |
| Mood swings | Swings over hours, often with stress or poor sleep | Mood swings |
| Perimenopause | Mood changes in the years around the menopause | Menopause |
Which PMDD treatment might the doctor recommend?
Treatment depends on how severe the symptoms are, which ones trouble you most, and whether you need contraception or are planning a pregnancy. This is the framework the doctors use:
Swipe sideways to compare →
| What you have | Likely first step | Suitable for online care? | When in-person care is needed |
|---|---|---|---|
| Possible PMDD, no diary yet | A symptom diary for 2 cycles, lifestyle changes, and a review | Yes | Not usually needed |
| Mood symptoms that follow the cycle and affect your life | An SSRI, every day or in the second half of the cycle | Yes | If several treatments have not helped |
| PMDD and you also want contraception | The combined pill, often taken continuously | Yes | If the pill is not safe for you |
| Mainly physical symptoms | Painkillers such as ibuprofen or naproxen, and lifestyle changes | Yes | Not usually needed |
| Low mood that continues all month | Assessment for depression or anxiety | Yes | If symptoms are severe |
| PMDD that has not responded to several treatments | Referral to a gynaecologist | Partly | For specialist treatment, including surgery as a last resort |
| Thoughts of ending your life that you might act on | Emergency help | No | Call 112 now |
Dreading the week before your period? A doctor can tell you in one consultation which treatment fits.
See available times →Treatment options for PMDD
What you can do yourself
- Keep a daily symptom diary for at least 2 cycles.
- Get regular aerobic exercise throughout the month.
- Eat a balanced diet with whole grains, vegetables and fruit, and cut down on salt, sugar and caffeine; smaller meals every 2 to 3 hours can help.
- Drink less alcohol, ideally no more than 14 units a week, and stop smoking.
- Get plenty of sleep, and try relaxation, meditation or mindfulness.
- Plan around the hardest days where you can, and tell someone you trust how they affect you.
- Take paracetamol or ibuprofen for aches and pains.
Prescription treatment
A prescription is never issued without a consultation. The doctor may prescribe an SSRI, such as sertraline or fluoxetine, taken every day or only from the second half of the cycle until your period starts. The combined pill can also help, and pills taken continuously, without a monthly break, work best; the doctor first checks that the pill is safe for you. Cognitive behavioural therapy, usually about 10 sessions, helps you manage the feelings. When nothing else has helped, a gynaecologist may consider surgery to stop periods, which is not suitable if you want to become pregnant. If the doctor prescribes, use the prescription at a pharmacy near you.
What does not help
Vitamin B6, calcium and magnesium supplements, which have not been shown to relieve PMDD. Waiting for it to pass each month, or pushing through the worst days alone: PMDD is a recognised condition, and treatment helps most people.
Special situations
Planning a pregnancy
Tell the doctor if you are trying for a baby: it changes which treatments suit you, and whether the combined pill is an option.
Contraception
If you would like contraception as well, the combined pill can do both jobs. The combined pill page explains who can take it.
Approaching the menopause
In the years before the menopause, periods and mood can change in new ways. The menopause page covers perimenopausal mood changes.
While travelling in Europe
Keep taking an SSRI or the pill on schedule across time zones, and pack enough for the trip. If the worst days fall while you are away, plan a lighter schedule.
Children
Mobi Doctor consultations are for adults aged 18 and over. A child who is unwell needs a paediatrician or a local doctor in person, and emergency signs in a child mean 112.
When PMDD is treated online, and when you need in-person care
Treated online: diagnosis from your symptoms and diary, SSRIs, the combined pill when it is safe for you, painkillers, referral for CBT, and reviews of how treatment is working.
In-person care: specialist gynaecological treatment, surgery, examinations for other gynaecological problems, and any emergency.
When to get in-person care
Call 112 or go to an emergency department now for:
- thoughts of ending your life that you might act on
- having harmed yourself, or taken an overdose
Get medical advice the same day for:
- thoughts of death or self-harm, even if they pass when your period starts
- symptoms so severe that you cannot look after yourself or go to work
- low mood or anxiety that no longer lifts after your period
You can also find a free, confidential crisis helpline in your country at findahelpline.com.
How Mobi Doctor works
- Book a time that suits you: daily 7am–11pm CEST. You can see a doctor over video, usually within 15 minutes. No subscription, and the exact price is shown before you pay.
- Speak to a licensed doctor about your symptoms: say when they start and stop in your cycle, bring your diary if you have one, and mention your contraception and medicines.
- Leave with a plan: what to do, what to take and for how long, and which signs mean you should be seen in person. If the doctor prescribes, use the prescription at a pharmacy near you.
No sign-up needed
Not sure it’s PMDD? Tick every symptom you have to see each condition page that mentions it. It finds the right page, not a diagnosis: a doctor gives you that on a video call.
Tap the body — an area or a point — to browse symptoms anywhere
Similar symptoms, different condition? Mood Swings can start the same way. Compare them, or look up any other symptom in the full symptom checker.
Frequently asked questions about PMDD
What is PMDD?
Premenstrual dysphoric disorder is a condition that causes severe emotional and physical symptoms in the 1 to 2 weeks before a period, easing a few days after it starts. It is like PMS but much more intense.
What are the symptoms of PMDD?
PMDD symptoms are low mood or hopelessness, anxiety, irritability or anger, mood swings, losing interest, feeling overwhelmed, poor concentration, tiredness, sleep and appetite changes, and physical symptoms such as breast tenderness and bloating. Some people have thoughts of suicide.
What does PMDD feel like?
Many people with PMDD describe becoming a different person for a week or two each month: very low, anxious or angry, then feeling like themselves again a few days after the period starts.
When does PMDD hit hardest?
PMDD hits hardest in the week or two before a period, the luteal phase, when the brain reacts to the normal changes in oestrogen and progesterone; symptoms build day by day, peak just before bleeding starts and usually ease 2 to 3 days after the period begins, leaving a symptom-free stretch until the next cycle. Keeping a daily diary shows this pattern clearly.
What is the difference between PMS and PMDD?
PMS is very common and mostly causes physical symptoms with milder mood changes. PMDD is less common, and its mood symptoms are severe enough to affect work and relationships.
What causes PMDD?
The exact cause of PMDD is not known. Hormone levels are usually normal, but the brain seems more sensitive to the normal changes in oestrogen and progesterone during the cycle. It is more likely with a family history or a history of depression.
How is PMDD diagnosed?
PMDD is diagnosed from your symptoms, when they happen every month 1 to 2 weeks before your period and you have had them for at least 2 months. A symptom diary for at least 2 cycles helps, and there is no lab test for it.
What helps PMDD?
For PMDD, regular exercise, a balanced diet, less alcohol, salt, sugar and caffeine, and enough sleep help some people. When that is not enough, SSRIs, the combined pill and CBT are the main treatments.
Can PMDD be prevented?
PMDD itself cannot be prevented, because it comes from how the brain responds to the normal hormone cycle, but the monthly episodes can be: SSRIs taken every day or only in the second half of the cycle, or the combined pill taken continuously, stop or greatly reduce the symptoms for most people. Sleeping and exercising regularly, cutting alcohol and caffeine, and not smoking all soften it, and CBT helps you handle the days that remain.
Can the contraceptive pill help PMDD?
Yes. The combined pill can help PMDD, and taking it continuously, without a monthly break, works best. A doctor checks first that the pill is safe for you.
Does PMDD go away?
With treatment, most people with PMDD find their symptoms go away or become manageable. For some, symptoms continue until the menopause, so treatment may be needed for years.
Can an online doctor treat PMDD?
Yes, usually. A doctor can assess PMDD by video, recommend lifestyle changes, refer you for CBT, and prescribe an SSRI or the combined pill when they suit you. Specialist treatment and surgery are in person.
- PMDD (premenstrual dysphoric disorder), NHS, National Health Service (UK), reviewed 20 August 2026.
- Premenstrual dysphoric disorder (PMDD), Johns Hopkins Medicine (US), accessed 15 October 2026.
- Premenstrual dysphoric disorder (PMDD), Office on Women’s Health, US Department of Health and Human Services, updated 26 September 2025.
- Premenstrual dysphoric disorder, MedlinePlus, US National Library of Medicine, reviewed October 2024.
- What is PMDD?, IAPMD, International Association for Premenstrual Disorders, accessed 15 October 2026.
This page is for information only and is not a substitute for a medical consultation. Guideline links are provided for transparency; treatment decisions are made with your doctor.
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