top of page
Search

HRT for PMDD treatment

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS), affecting about 3–8% of women and people assigned female at birth.


PMDD treatment options discussed with PMDD Specialist
Kate Organ, PMDD Specialist

It causes significant emotional and physical symptoms during the luteal phase (two weeks before a period), such as:

  • Severe low mood or depression

  • Anxiety or panic attacks

  • Mood swings, irritability or anger

  • Fatigue and poor concentration

  • Sleep disturbance

  • Bloating, breast tenderness, headaches, joint pains


Symptoms usually improve once menstruation starts and are absent in the first half of the cycle.


Why Use HRT for PMDD?


HRT (Hormone Replacement Therapy) is a treatment designed to provide stable, consistent hormone levels. In PMDD, symptoms are thought to be caused by abnormal sensitivity to natural fluctuations in oestrogen and progesterone across the cycle — rather than absolute hormone deficiency.


The aim of using HRT in PMDD is to flatten out these hormonal fluctuations, reducing the cycle-triggered mood and physical symptoms.


In some people, HRT can be used alone, or combined with GnRH analogues or other approaches if symptoms are very severe or resistant to standard treatments.


How Does HRT Help in PMDD?

  • Stabilises hormone levels, reducing cyclical dips that trigger PMDD symptoms

  • Can reduce mood swings, anxiety, irritability, fatigue

  • Improves physical symptoms such as bloating and breast tenderness

  • May improve sleep and reduce premenstrual migraines

  • Can be used flexibly — with cycle suppression if needed


How is HRT Used for PMDD Treatment?

There are two main approaches:


1. Cycle-stabilising HRT

  • Continuous or semi-continuous transdermal oestradiol 

  • Combined with cyclical or continuous progestogen 

  • Aims to smooth hormone levels and reduce symptoms


2. Cycle-suppressing HRT

  • Higher dose transdermal oestradiol (e.g. 100–200 micrograms) to override the natural cycle

  • Continuous progestogen or Mirena coil for womb protection

  • Often combined with GnRH analogues to fully suppress ovulation in severe PMDD


Your specialist will advise on the best approach based on your symptoms and cycle pattern.


Benefits of Using HRT for PMDD

  • Reduces mood-related and physical PMDD symptoms

  • Stabilises hormone levels across the cycle

  • Improves quality of life and daily functioning

  • May reduce migraines, sleep disturbance and fatigue

  • Can be personalised to your needs — dose and method can be adjusted


Possible Side Effects


Oestrogen-related:

  • Breast tenderness

  • Nausea (usually mild)

  • Headache (less likely with transdermal forms)


Progestogen-related:

  • Bloating

  • Mood changes (if sensitive to progestogen — specialist adjustments can help)

  • Irregular bleeding (often settles with time)


Most side effects can be managed by adjusting the dose, route, or type of HRT — this will be done with your specialist.


Who Should Not Use HRT?

  • History of hormone-sensitive cancers (discuss with your specialist — case-by-case decisions)

  • Active or recent blood clot (DVT, PE)

  • Untreated high blood pressure

  • Liver disease

  • Certain heart conditions

Your menopause or PMDD specialist will do a full risk assessment with you.


Is HRT Safe for Long-Term Use?

For most women, modern body-identical HRT (e.g. transdermal oestradiol + micronised progesterone) is safe and well tolerated.


Annual reviews are recommended to assess ongoing benefit and risks, in line with British Menopause Society (BMS) and NICE guidance.


Evidence for HRT Use in PMDD


  • Panay & Studd, 1997: transdermal oestradiol significantly reduces PMDD symptoms in cycle suppression regimens

  • O’Brien et al, 2001 (Cochrane Review): suppression of ovulation and stabilisation of hormones is effective in treating severe PMDD

  • BMS & Royal College of Obstetricians and Gynaecologists (RCOG) guidelines: HRT can be used to manage PMDD symptoms, particularly in those with cycle sensitivity

  • NICE NG23 guidance recognises the role of HRT for severe PMS/PMDD where standard treatments are insufficient


Summary

HRT can be an effective treatment for PMDD — by providing stable oestrogen levels and reducing the hormone fluctuations that trigger mood and physical symptoms.


Our PMDD specialist will personalise your HRT plan.


HRT can be used alone or combined with other therapies such as GnRH analogues or SSRIs if needed.


If you would like to explore using HRT for PMDD, please speak to our PMS/PMDD specialist.




References

  1. Panay N, Studd J. The use of oestradiol in severe premenstrual syndrome. BJOG, 1997.

  2. O’Brien PMS et al. Management of premenstrual syndrome. Cochrane Database Syst Rev, 2001.

  3. British Menopause Society Consensus Statement: PMS and PMDD, 2023.

  4. Royal College of Obstetricians and Gynaecologists. Management of Premenstrual Syndrome, Green-top Guideline 48, 2016.

  5. NICE Guidelines NG23. Menopause: diagnosis and management.

Comments

bottom of page