PMS and PMDD
PMS and PMDD explained: common symptoms, what helps, what reviews say about SSRIs, chasteberry, evening primrose oil and supplements, and when to get help.
Content last updated . This page has not been medically reviewed.
What PMS and PMDD are
Premenstrual syndrome (PMS) is a group of physical and emotional symptoms in the weeks before a period. The NHS says symptoms vary between people and from month to month, and most women have PMS at some point. Common ones include mood swings, irritability, tiredness, sleep trouble, bloating, breast tenderness, headaches and changes in appetite. [1] The cause is not fully understood, but it may relate to hormone changes across the cycle. [1]A small number of people have premenstrual dysphoric disorder (PMDD), which has similar but much more intense symptoms and a greater effect on everyday life. [1]
Self-care steps
The NHS suggests regular exercise, a balanced diet with smaller, more frequent meals, enough sleep, stress reduction through yoga or meditation, and over-the-counter pain relievers. It advises avoiding smoking and too much alcohol and keeping a symptom diary for at least 2 cycles to bring to an appointment. [1] See how to relieve stress and sleep.Medical treatments
For symptoms that lifestyle changes do not ease, the NHS lists hormonal medicine such as the combined pill, cognitive behavioral therapy, and antidepressants. [1] A Cochrane review of 34 trials found SSRIs (a class of antidepressants) probably reduce overall premenstrual symptoms in PMS and PMDD, with side effects such as nausea, insomnia and reduced libido. [2] That is an established treatment option, but it is a prescription decision.Supplements and herbs: what the sources say
Evidence labels: promising but limited, mixed, insufficient evidence.| Option | What the source found | Strength of evidence |
|---|---|---|
| Vitamin B6, calcium, vitamin D, magnesium; acupuncture; reflexology | The NHS says they may help but there is not much evidence that they work. [1] | Insufficient evidence |
| Chasteberry (Vitex agnus-castus) | NCCIH says some research suggests it might reduce symptoms such as breast pain, but higher-quality evidence is needed. [3] A review of 17 trials found a large pooled effect, but high risk of bias and publication bias prevent a definite conclusion. [4] | Promising but limited |
| Evening primrose oil | NCCIH says there is insufficient evidence for PMS. [5] | Insufficient evidence |
Safety: NCCIH says chasteberry may not be safe for people with hormone-sensitive conditions such as breast, uterine or ovarian cancer, and may be unsafe in pregnancy or breastfeeding. [3] The NHS advises checking with a clinician or pharmacist before regular supplements if you take medicines. [1] See medication interactions and pregnancy and breastfeeding safety.
When to get help
See a clinician if lifestyle changes have not helped or symptoms affect daily life. [1] PMDD can include feeling very anxious, angry, depressed or suicidal. [1] If you are thinking about harming yourself, call or text 988 in the US (free, 24/7), or call 911 in an emergency. See also anxiety disorders and heavy and irregular periods.Frequently asked questions
What is the difference between PMS and PMDD?
PMDD has similar symptoms, but they are much more intense and have a much greater effect on daily life. [1]
Do SSRIs help PMS?
A Cochrane review found they probably reduce overall premenstrual symptoms in PMS and PMDD, with some side effects. [2]
Does chasteberry work for PMS?
Evidence is promising but limited, with high risk of bias in the studies. [3][4]
Should I keep a diary?
The NHS suggests keeping a symptom diary for at least 2 menstrual cycles. [1]
References
- NHS. PMS (premenstrual syndrome). Read 2026-10-22.
- Selective serotonin reuptake inhibitors for premenstrual syndrome and premenstrual dysphoric disorder. Cochrane Database Syst Rev. 2024. PubMed. Read 2026-10-22.
- NCCIH. Chasteberry. Read 2026-10-22.
- Vitex agnus castus preparations for premenstrual syndrome: systematic review and meta-analysis. Am J Obstet Gynecol. 2017. PubMed. Read 2026-10-22.
- NCCIH. Evening primrose oil. Read 2026-10-22.