Synarel and PMDD: What You Need to Know About Chemical Menopause
Synarel and PMDD: What You Need to Know About Chemical Menopause
If you've exhausted the usual PMDD treatment options — SSRIs, lifestyle changes, the contraceptive pill — and you're still suffering, you may have started hearing about chemical menopause. And specifically, about a nasal spray called Synarel.
It sounds dramatic. Medically induced menopause, delivered via a spray up your nose. But for women with severe, treatment-resistant PMDD, it can be genuinely life-changing. Here's what you need to know before you bring it up with your doctor.
What Is Synarel?
Synarel is the brand name for nafarelin acetate, a synthetic hormone that belongs to a class of drugs called GnRH agonists (gonadotropin-releasing hormone agonists). It comes as a nasal spray and works by acting on the pituitary gland in your brain — effectively telling your ovaries to stop producing oestrogen and progesterone.
The result is a temporary, reversible state of chemical menopause. No ovulation. No hormonal fluctuations. No luteal phase. And for women with PMDD — whose symptoms are driven entirely by their brain's sensitivity to those fluctuations — no PMDD episodes.
By shutting down the ovaries, Synarel eliminates the hormonal fluctuations that lead to PMDD symptoms entirely. That's the goal, and for many women, it delivers exactly that.
Why It's Relevant for PMDD
Remember that PMDD is not caused by abnormal hormone levels. Your oestrogen and progesterone are completely normal — the problem is how your brain responds to their natural rise and fall across the cycle. Synarel works not by fixing that neurological sensitivity, but by removing the trigger entirely. No hormonal fluctuation means no PMDD response.
Synarel is sometimes prescribed off-label for PMDD since it is a GnRH analogue that can be used to produce chemical menopause. It's also used as a diagnostic tool — if your ovulation is stopped and your cycle is entirely suppressed and you no longer experience PMDD symptoms, this helps confirm the diagnosis. If symptoms continue despite full suppression, other potential diagnoses may need to be explored.
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What Using Synarel Actually Looks Like
Synarel is a nasal spray taken twice daily. One thing women are often warned about — and it's worth knowing ahead of time — is the taste. It has an unusual salty, slightly chemical flavour that most people find strange at first but get used to quickly. Many women find taking it just before bed helps with this.
The first few weeks can actually feel worse before they feel better. In the first weeks, it is common to have a "flare" in hormone levels as your brain adjusts and downregulates its hormonal stimulation to your ovaries. You may experience PMDD-like symptoms during this period. This is normal, expected, and not a reason to stop — but it does mean you need extra support around you during the initial adjustment phase.
After that initial flare settles — usually within one to two months — many women experience significant or complete relief from PMDD symptoms.
Add-Back Therapy: The Essential Companion
Here's the catch. When you remove oestrogen from your system, you also create menopausal side effects — hot flashes, night sweats, and vaginal dryness are among the most common. There's also the issue of bone density: the low oestrogen state and the temporary menopause induced by nafarelin can cause a small amount of bone thinning, which may only partially recover after stopping treatment.
This is why Synarel is almost always used alongside what's called "add-back therapy" — a low dose of oestrogen (and sometimes progesterone) added back in to manage menopausal side effects and protect bone density, without re-triggering PMDD symptoms. Getting the right add-back dose is a careful balancing act that requires close work with a knowledgeable specialist.
Is It Permanent?
No. The ovaries wake up after you stop taking these medications, so it's temporary. After this therapy, menstrual cycles may be irregular initially but quickly settle back into their normal routine. This reversibility is actually one of the things that makes Synarel appealing compared to some other GnRH options — you're not committed to a months-long injection if things aren't working.
That said, there is currently no research about the ongoing effectiveness of GnRH agonist treatment in those with PMDD. Some patients do well initially but find that over time it does not continue to suppress ovarian function as well as at first. This is another reason close monitoring with your specialist matters.
Who Is Synarel Suitable For?
Synarel is generally considered when other treatments have been tried and haven't provided adequate relief. It's not a first-line treatment — it's typically explored after SSRIs, hormonal contraceptives, and lifestyle-based management have been given a genuine trial. It's also sometimes used as a pre-surgical diagnostic step for women considering a bilateral oophorectomy (removal of the ovaries), to confirm that eliminating the hormonal cycle does in fact resolve symptoms before committing to permanent surgery — as I wrote about in my own hysterectomy blog.
It's not suitable for everyone. Women with a history of osteoporosis, significant bone density concerns, or certain other medical conditions will need careful consideration. And it must not be used during pregnancy — non-hormonal birth control such as condoms or a copper IUD is essential during treatment as hormonal methods may not be effective while taking Synarel.
What to Expect from the Conversation with Your Doctor
Many GPs are unfamiliar with using Synarel specifically for PMDD, since it's an off-label use. You'll likely need a referral to a gynaecologist or reproductive endocrinologist who has experience with both PMDD and GnRH agonist therapy. Going into that appointment with clear symptom tracking data — showing the cyclical pattern of your symptoms over multiple months — will strengthen your case significantly. Read more about how cycle tracking works for PMDD if you haven't started yet.
It's also worth asking your specialist specifically about add-back therapy from the outset, rather than waiting until side effects become a problem.
The Bigger Picture
Synarel is a significant medical intervention and it's not the right fit for everyone. But for women with severe, treatment-resistant PMDD who are struggling to find relief through other means, knowing it exists — and knowing you can ask about it — matters enormously. Too many women suffer for years without ever being told this option is available to them.
Medication is one part of the puzzle. Alongside any medical treatment, having a solid framework for understanding your cycle, managing your nervous system, and building a life that works with your PMDD rather than against it makes a real difference in outcomes. That's exactly the work we do inside the PMDD Reset Method™.
Please note: This blog is for informational purposes only and does not constitute medical advice. Synarel is a prescription medication with significant side effects that requires specialist supervision. Always discuss treatment options with your own doctor or gynaecologist.
Ready for Support Alongside Your Treatment?
Whether you're exploring Synarel, already on it, or still figuring out your treatment path, The PMDD Reset Method™ gives you the tools to manage PMDD at every stage. For just $19/month you get a 6-module evidence-based framework, monthly live group support calls, a private community of women who understand, and 20+ practical tools for your hardest days.
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Frequently Asked Questions
Is Synarel approved for PMDD in Australia? Synarel is approved in Australia for endometriosis and central precocious puberty. Its use for PMDD is off-label, meaning your doctor can prescribe it for this purpose but it's not its primary approved indication. You'll likely need a referral to a specialist experienced in PMDD treatment.
How long does it take for Synarel to work for PMDD? Most women experience the initial hormone flare in the first few weeks, with symptom relief beginning once the ovaries are fully suppressed — typically within one to two months. If your periods haven't stopped after two months of correct use, speak with your doctor.
Will I still need other PMDD management tools while on Synarel? Yes. Synarel addresses the hormonal trigger, but the emotional and relational patterns that PMDD creates — shame spirals, relationship damage, nervous system dysregulation — benefit from ongoing therapeutic support alongside any medical treatment.
What happens when I stop taking Synarel? Your ovaries will resume normal function and your cycle will return, usually within a few months. PMDD symptoms are likely to return with your cycle. Synarel is therefore most useful as a diagnostic tool, a bridge to surgery, or a medium-term management option under specialist supervision — not a permanent cure.
Can I take Synarel if I want to have children in the future? Yes — the effects are reversible and fertility typically returns after stopping the medication. However, you must use non-hormonal contraception during treatment as the medication does not reliably prevent pregnancy and can cause harm to a developing baby.
