Antidepressants vs Hormone Treatment for PMS and PMDD: Breaking the Stigma

For many women, premenstrual symptoms are more than a passing inconvenience—they can be debilitating, interfering with work, relationships, and overall wellbeing. While antidepressants such as SSRIs are proven effective for premenstrual dysphoric disorder (PMDD) and premenstrual exacerbation (PME) of mood disorders, stigma often prevents women from accessing them. Paradoxically, many women feel far more comfortable starting hormone treatments like the oral contraceptive pill or progesterone, even though antidepressants may be equally or more effective for their specific symptoms.

This reluctance contributes to under-treated premenstrual conditions, especially when the issue is PME rather than “pure PMS.” Let’s explore why stigma persists, what the evidence shows, and how women can make informed decisions about treatment.

Why the Stigma Around Antidepressants Persists

Despite decades of research supporting the use of SSRIs (selective serotonin reuptake inhibitors) for PMDD, women often hesitate to consider them. Reasons include:

• Cultural beliefs: Antidepressants are often seen as a sign of “mental illness” or personal weakness.

• Fear of dependence: Many women worry they’ll be on medication “for life.”

• Side effects: Concerns about weight gain, sexual dysfunction, or emotional blunting.

• Misinformation: Online discussions often magnify rare risks while overlooking benefits.

In contrast, hormone treatments are often perceived as a “natural” continuation of reproductive care, and taking the pill or HRT is socially normalised.

Why Women Prefer Hormone-Based Treatments

Hormone treatments—such as oral contraceptives, estrogen patches, or progesterone—are often viewed as extensions of routine gynaecological care. Women are used to hormones being prescribed across the reproductive lifespan (e.g., for contraception, fertility support, or menopause).

This makes them feel more acceptable than antidepressants, even when:

• The symptoms are primarily mood-related.

• Evidence shows SSRIs work within the same cycle and can even be used intermittently (luteal phase only).

• Hormone treatments may not be the most effective first-line option for PMDD.

The Overlap of PMS, PMDD, and PME

Understanding diagnosis is critical.

• PMS: Physical and emotional symptoms in the luteal phase that resolve with menstruation.

• PMDD: Severe mood symptoms meeting DSM-5 criteria, with significant functional impairment. You can rea more about the diagnosis of PMDD in my blog on this topic.

• PME (Premenstrual Exacerbation): Worsening of an existing mood disorder (e.g., depression, anxiety) premenstrually.

Women with PME are often misclassified as having PMS and started on hormones, which may do little to address their underlying mood disorder. Without addressing the PME with antidepressants or mood stabilisers, symptoms remain under-treated.

Evidence for Antidepressants in PMDD

Clinical studies consistently demonstrate that SSRIs (e.g., fluoxetine, sertraline, escitalopram):

• Provide rapid improvement—often within the first cycle.

• Can be used intermittently (only in the luteal phase) to reduce exposure and side effects.

• Improve both emotional and physical symptoms of PMDD.

Guidelines from bodies such as the NICE and American College of Obstetricians and Gynecologists (ACOG) recommend SSRIs as a first-line treatment for PMDD.

Breaking the Cycle of Under-Treatment

By avoiding antidepressants due to stigma, women may:

• Miss out on the most effective therapy for their condition.

• Continue to struggle with significant impairment.

• Receive hormone-based treatment that does not adequately address their symptoms.

The key is accurate diagnosis and personalised care: distinguishing PMS, PMDD, and PME, then matching treatment accordingly.

FAQ

• Are antidepressants safe for PMDD?

  Yes. SSRIs are well-studied, effective, and can even be prescribed for just part of the cycle to reduce side effects.

• Why do some women prefer hormone treatments?

  Hormones feel familiar and socially accepted, while antidepressants carry stigma. However, hormones are not always the most effective option for mood-related premenstrual symptoms.

• What’s the difference between PMS, PMDD, and PME?

  • PMS: Moderate premenstrual symptoms.

  • PMDD: Severe, disabling symptoms that meet DSM-5 criteria.

  • PME: A worsening of an existing mood disorder before menstruation.

• Can PME be treated with hormones?

  Can PME be treated with hormones?

• Should I see a doctor if I think I have PMDD?

  Yes. An accurate diagnosis is key to getting effective treatment, whether hormonal or antidepressant.

About the Author

Dr Georgina Standen is a Women’s Health GP and Medical Director of Sirona Health. She specialises in the diagnosis and treatment of PMS (premenstrual syndrome) and PMDD (premenstrual dysphoric disorder), as well as broader hormonal health and menopause care. Her approach blends evidence-based medicine with personalised, compassionate support to help women regain control of their health and wellbeing.

Sirona Health offers PMS and PMDD consultations in Stroud, Cirencester, Tetbury, Fairford, Lechlade, Calne, Corsham, Chippenham, Malmesbury and Bath, along with nationwide secure online appointments.

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