Spital Clinic offers specialist care for women living with premenstrual dysphoric disorder (PMDD), a severe hormonal condition that causes debilitating psychological and physical symptoms before each period. Our Women's Health doctors provide personalised assessment and evidence-based treatment.PMDD & Women's Health Specialists.
Book your appointment online or visit us at our City of London clinic, open 7 days a week with same-day appointments available. You can choose to see one of our Women's Helath GPs.
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Our PMDD specialists will discuss your symptoms in detail, review your cycle history, and arrange any appropriate blood tests. They will create a personalised treatment plan which may include SSRIs, hormonal therapies, or other evidence-based approaches. Any additional investigations will be billed separately.
After your initial assessment, a follow-up appointment allows our specialists to review your progress, check how treatment is working, and make any adjustments needed for optimal results. The follow up appointment is charged at £60
The information provided in this article is for educational purposes only and is based on NHS recommendations. It is not a substitute for professional medical advice. Always consult your doctor or a qualified healthcare provider for advice on medical conditions or treatments.
Premenstrual dysphoric disorder (PMDD) is a severe, cyclical hormonal condition that affects women of reproductive age. Unlike premenstrual syndrome (PMS), which causes mild to moderate discomfort before a period, PMDD produces intense psychological and physical symptoms that can significantly impair daily functioning. Symptoms typically emerge in the one to two weeks before menstruation — known as the luteal phase — and resolve within a few days of the period beginning. The condition is thought to result from an abnormal sensitivity to the normal hormonal fluctuations of the menstrual cycle, particularly to changes in progesterone and its metabolites.
PMDD affects an estimated 3–8% of women of reproductive age and is recognised as a distinct clinical condition in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). Many women go undiagnosed for years, often having their symptoms dismissed or misattributed to anxiety or depression. If you experience debilitating mood, physical, or behavioural changes that follow a predictable pattern linked to your menstrual cycle, PMDD may be the underlying cause. Seeking specialist assessment is the vital first step towards effective management and improved quality of life.
PMDD is diagnosed through a careful assessment of your symptoms and their timing in relation to your menstrual cycle. There is no single blood test or scan that can confirm PMDD; instead, diagnosis relies on symptom tracking over at least two menstrual cycles. Your doctor will ask you to record your symptoms daily, noting when they begin, peak, and resolve. A diagnosis is made when you consistently experience at least five PMDD symptoms — including at least one mood-related symptom — during the luteal phase, with significant improvement after your period starts.
For women over 40, or those with atypical symptoms, a follicle-stimulating hormone (FSH) test may be requested to exclude perimenopause as a contributing factor. Thyroid function tests may also be arranged to rule out conditions such as hypothyroidism, which can mimic perimenopausal symptoms. At Spital Clinic, our Women's Health GPs take a thorough, whole-person approach to ensure an accurate diagnosis and personalised care plan.
Treatment for PMDD is highly individualised and may combine several approaches depending on the severity of your symptoms. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine or sertraline, are a first-line treatment for PMDD and can be taken either continuously throughout the month or only during the luteal phase. Cognitive behavioural therapy (CBT) has also demonstrated strong evidence for reducing the psychological impact of PMDD, particularly in managing mood symptoms and improving coping strategies.
For women with moderate to severe PMDD, combining approaches is often most effective. According to the NHS, PMDD can be effectively treated. For women whose PMDD is driven by hormonal sensitivity, suppressing ovulation can be highly effective. Combined oral contraceptives, particularly those containing drospirenone, may help regulate symptoms by stabilising the hormonal fluctuations of the cycle. In more severe or treatment-resistant cases, GnRH analogues — which temporarily suppress ovarian function — may be considered. Our Women's Health GPs at Spital Clinic will work with you to find the most appropriate and effective treatment pathway for your individual needs.
Whilst PMDD can affect any woman of reproductive age, certain factors are associated with a higher risk of developing the condition. A personal or family history of depression, anxiety, or other mood disorders significantly increases susceptibility, as does a history of trauma, abuse, or post-traumatic stress disorder. Women who have experienced postnatal depression may also be at greater risk. Research suggests that PMDD has a strong genetic component, with studies indicating it may be linked to differences in how brain cells respond to changes in oestrogen and progesterone. High levels of chronic stress, poor sleep, low physical activity, and a diet lacking in key nutrients such as calcium, magnesium, and vitamin B6 may all worsen symptoms. Being aware of these risk factors can help you and your doctor develop a comprehensive, proactive management plan tailored to your circumstances.
PMDD can have a profound impact on every area of life — from work and relationships to self-esteem and overall mental wellbeing. The cyclical nature of the condition means that women may spend a significant portion of each month feeling severely unwell, only to recover briefly before symptoms return. This pattern can be deeply isolating and is frequently misunderstood by employers, partners, and even healthcare professionals. Many women with PMDD report strained relationships, reduced career performance, and a diminished sense of identity during symptomatic phases. Seeking the right support is therefore not just beneficial — it is essential. Our experienced Women’s Health specialists at Spital Clinic are here to provide compassionate, expert care and to help you reclaim your quality of life throughout your cycle. Women's Health GPs at Spital Clinic are here to guide you through every step.
We provide a comprehensive range of services, from private GP consultations and specialised men's and women's health care to advanced ultrasound scans and proactive health screenings, all within a reassuring and state-of-the-art environment.
You have a question about PMDD? We have an answer.
Yes — PMDD is a formally recognised medical and psychiatric condition. It is listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) as a depressive disorder, and is also classified in the ICD-11, the World Health Organisation’s international classification of diseases. Recognition of PMDD as a distinct clinical entity has grown significantly over the past decade, and there are now established clinical guidelines to support its diagnosis and management. Despite this, many women still experience delays in receiving a diagnosis, often because their symptoms are attributed to stress, anxiety, or simply having a difficult period. If you suspect you have PMDD, it is important to seek an assessment with a healthcare professional experienced in women’s hormonal health. Early, accurate diagnosis leads to faster access to evidence-based treatments and a meaningful improvement in quality of life.
PMDD is also formally recognised by the World Health Organisation in the International Classification of Diseases (ICD-11). Research published by the WHO estimates that PMDD affects 3–8% of women of reproductive age globally, representing millions of women whose quality of life is significantly impacted each month.
Both PMDD and premenstrual syndrome (PMS) cause symptoms in the days or weeks before a period, but there are important differences in severity and impact. PMS typically involves mild to moderate physical and emotional symptoms — such as bloating, breast tenderness, and irritability — that are uncomfortable but generally manageable. PMDD, by contrast, causes severe psychological symptoms including intense depression, anxiety, and mood dysregulation that can make it impossible to carry out normal daily activities. The key distinction is the degree of functional impairment: PMDD symptoms are significantly more debilitating and have a marked effect on work, relationships, and overall wellbeing. If your premenstrual symptoms feel overwhelming and follow a predictable monthly pattern, it is worth speaking to our Women’s Health GPs, who can assess whether PMDD may be the underlying cause and discuss appropriate treatment options with you.
Whilst lifestyle changes alone are unlikely to fully resolve PMDD, they can meaningfully reduce the frequency and severity of symptoms alongside medical treatment. Here are some key recommendations:
Exercise Regularly: Regular aerobic exercise has been shown to significantly reduce PMDD symptoms including depression, anxiety, and fatigue. Aim for at least 30 minutes of moderate activity on most days. Exercise helps stabilise mood by boosting serotonin and endorphin levels.
Prioritise Sleep: Poor sleep worsens every PMDD symptom. Aim for a consistent sleep schedule, avoid screens before bed, and limit caffeine in the afternoon. If PMDD is severely disrupting your sleep, speak to your doctor as targeted support is available.
Manage Stress: Chronic stress worsens PMDD symptoms by disrupting the hormonal stress response. Mindfulness, yoga, breathing exercises, and therapy can all help reduce stress levels and improve emotional resilience during the luteal phase.
Optimise Your Diet: Eating regularly throughout the day helps stabilise blood sugar, which can reduce mood swings and irritability. Focus on complex carbohydrates, lean protein, and plenty of vegetables. Reducing salt, sugar, and processed foods in the luteal phase may also ease bloating and cravings.
Limit Alcohol: Alcohol is a depressant and can significantly worsen PMDD symptoms including low mood, anxiety, and irritability — particularly in the luteal phase. Reducing or eliminating alcohol during the two weeks before your period can make a meaningful difference to how you feel.
Track Your Symptoms: Keeping a daily symptom diary across at least two menstrual cycles is essential for diagnosing PMDD and monitoring treatment. Apps such as Clue or Me v PMDD can help you track patterns. Sharing this data with your doctor will support more accurate and timely care.
Consider Supplements: Several supplements have evidence supporting their use in PMDD. Calcium (1,200mg daily), magnesium, and vitamin B6 have all been shown to reduce luteal phase symptoms. Chasteberry (Vitex agnus-castus) may also help. Always discuss supplements with your doctor before starting them.
Seek Support: PMDD can feel isolating, but you do not have to manage it alone. Cognitive behavioural therapy (CBT) has good evidence for reducing the psychological impact of PMDD. Support groups, PMDD-informed therapists, and organisations such as Vicious Cycle (Me v PMDD) can also provide community and practical guidance.
Our Women’s Health GPs can help you develop a comprehensive self-management plan alongside any medical treatment you receive at Spital Clinic.
There is currently no permanent cure for PMDD, but it is highly treatable, and many women achieve significant or complete symptom relief with the right management plan. The condition is intrinsically linked to the hormonal fluctuations of the menstrual cycle, which means it naturally resolves at menopause when cyclical hormonal changes cease. Until that point, a combination of medical treatments, lifestyle modifications, and psychological support can substantially reduce the impact of PMDD on daily life.
SSRIs and SNRIs (selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors) are the most evidence-based first-line treatment for PMDD. They can be taken continuously throughout the cycle or only during the luteal phase. Many women experience significant relief within one to two cycles.
Hormonal Therapies can help by suppressing ovulation and stabilising hormone fluctuations. Options include the combined oral contraceptive pill, GnRH analogues, or oestrogen patches with progesterone cover. These are particularly useful when PMDD is driven by sensitivity to hormonal changes.
Surgical Options such as oophorectomy (surgical removal of the ovaries) can eliminate PMDD permanently by stopping ovulation altogether. This is considered a last resort and is only recommended after other treatments have been fully explored.
PMDD does not have to be endured without support. Effective treatments are available, and with the right management plan, the majority of women see a meaningful improvement in their quality of life. Our team at Spital Clinic is here to help you find the right approach.
PMDD and perimenopause are distinct conditions, but they can overlap and are sometimes confused with one another. PMDD is a cyclical condition tied to the luteal phase of the menstrual cycle, whereas perimenopause refers to the transitional period leading up to menopause, typically beginning in a woman’s 40s. During perimenopause, fluctuating oestrogen and progesterone levels can trigger or worsen PMDD symptoms, making the distinction particularly difficult to identify without a thorough clinical assessment.
Some women who have lived with PMDD may find their symptoms intensify as they approach perimenopause, whilst others may develop PMDD-like symptoms for the first time during this period. Hormone therapy, including oestrogen, may be used to stabilise hormonal fluctuations and reduce symptoms in these cases. If you are unsure whether your symptoms are related to PMDD, perimenopause, or both, a specialist assessment at Spital Clinic can help clarify your diagnosis and guide you towards the most appropriate treatment.
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Our medical centre is at 36 Spital Square, E1 6DY, City of London.
