What is the first treatment for premenstrual dysphoric disorder?

PMDD symptoms appear in a recurring pattern before menstruation and improve after the period begins. A combined pill can suppress ovulation and smooth hormonal fluctuations for some people. It is not suitable for everyone, including some people with migraine with aura, a history of blood clots or certain cardiovascular conditions. A clinician will check your medical history, medicines, blood pressure and pregnancy plans before prescribing.

Record mood changes, irritability, anxiety, sleep, pain and bleeding across several cycles, noting when symptoms start and settle. Take prescribed treatment as directed and report troublesome effects such as persistent mood worsening, severe headache, chest pain or leg swelling. Regular sleep, movement, balanced meals and reducing alcohol may support symptoms, but they do not replace assessment when PMDD disrupts daily life. Other medication or psychological support may be considered if the initial option is unsuitable or does not help.

Get urgent mental health help if you feel unsafe, have thoughts of self-harm or suicide, or cannot care for yourself. Seek urgent medical care for sudden chest pain, breathlessness, coughing blood, or a painful swollen leg while using a combined pill. Contact your clinician promptly if mood symptoms become markedly worse.

Ask whether a combined pill is safe with your migraine, blood pressure and clot history, how to track response, what side effects need review, and which alternatives could be used if symptoms continue.