PMDD, Hormones & the Art of Blocking and Replacing

If your hormone symptoms feel like they’re cycling you into the ground, especially if you’ve already started hormone therapy but still feel unwell, you’re not alone.

For many people with PMDD or severe cyclical symptoms (ie perimenopause), it’s not a lack of hormones that causes distress. It’s the ups and downs and the fluctuations.  The storm that comes even when the levels look “normal.”  This is when I talk about the bleed being the ‘bench mark’ because is many cases it’s actually not the challenging this – it’s what comes before!  Sometimes the best way forward isn’t to add more hormones, but to override your cycle entirely and create a stable foundation from there.

Let’s talk about why we do this, how it works, and what we do to make it safer and smoother.

Why Block Hormones at All?

If your symptoms come and go like clockwork (or chaos-clockwork), it may be the fluctuating nature of your hormones, not the absolute levels, that’s triggering your distress.  That’s why in some situations (particularly PMDD or hormone sensitivity*) that hasn’t responded to HRT — we may consider suppressing ovulation and stopping the cycle altogether.  This doesn’t mean giving up on hormones. It means getting off the hormonal rollercoaster so we can support your body in a calmer, more consistent way.

But If You Block Without Replacing?

You’re effectively putting your body into a sudden menopause. And it’s often much harder than a natural transition.  That’s why replacement is (generally/for most) non-negotiable. If we’re blocking, we’re also building a supportive stable hormonal foundation — ideally one that helps you feel more like yourself.

What Are the ‘Blocking’ (or Overriding) Options?

There are several ways to override your natural cycle — including contraceptive pills (like Cerazette, Slinda, or Zoely), cyproterone acetate, or GnRH analogues — each working differently to stop ovulation or suppress hormones, with varying levels of intensity and side effect.  Research shows that the first 2–3 months on ‘blockers’ can be a challenge (it takes a while for the stability to follow, and you have a ‘big drop first’),  but with good support and the right replacement, many people feel more stable and well than ever before.  And data states that this approach is underused in PMDD (so I then think… what about perimenopause!)

How to Prepare Before Blocking

To avoid a sudden hormonal crash, we build a strong foundation first.

✅ Get you on the highest tolerable dose of HRT before starting blockers – to soften the drop!

✅ Check that you feel well at some point in your cycle (usually post-period) – suggesting you are responding to hormone stability

Personalising Your Hormone Replacement

Once we block, we can start fresh and rebuild in a more stable way. Everyone responds differently — so we tailor your approach carefully.

🩸 Some people feel better starting with estrogen first

🌙 Others need to increase progesterone first (especially for sleep or anxiety)

🔁 Some need a change in progesterone type 

🌿 Antihistamines can help with side effects 

🔄 Overlapping or phasing in medications can smooth transitions

Even after blocking and replacing, lingering symptoms may point to other eg stress or trauma, the impact of unpredictable bleeding, or a need for short-term support like antidepressants.

Should You Consider Surgery?

Hysterectomy (uterus removal) - can be a game-changer if:

• You’re progesterone sensitive or intolerant

• Bleeding patterns are triggering distress (physical or psychological, or it means you can’t have stability because of need to take medications cyclically)

Removing the uterus means you no longer need progesterone and that can make a big difference for some people.

Ovary removal (oophorectomy) - this is permanent, so it’s only considered in specific situations. 

• You’ve trialled blocking + replacing and know you feel better

• You have a clear, sustainable HRT plan in place

• You’re informed about long-term health impacts (bone, brain, heart)

Final Thought: It's Not About Shutting You Down.. It's About Setting You Free

Blocking hormones isn't about “turning you off”  it’s about turning off the chaos, so you can finally feel consistently like yourself.  And we have medical and surgical options of how to achieve this.  We just need to figure out the best way to fit your puzzle pieces together!!

With the right replacement, the right support, and a plan tailored to your needs and blocking can be a powerful and liberating step.

You deserve a steady foundation to build your wellbeing on.