Melatonin Side Effects and Safety 101

Can’t sleep and looking for a nonhabit-forming sleep aid?

It’s not unusual to deal with insomnia from time to time. You may have difficulty falling asleep. Or if you’re able to fall asleep quickly, you may wake up after two or three hours. This can cause daytime sleepiness, irritability, and decreased productivity.

One night of bad sleep might not wreak too much havoc on your body. But when the problem goes on for days, weeks, or months, supplementing with melatonin can get your sleep back on track.

Melatonin is a hormone that your body makes naturally. Your melatonin level increases a couple of hours before bedtime, which signals your body to prepare for rest. (1) It’s important to note, however, that melatonin isn’t a sleep initiator but rather a sleep regulator, explains Carolyn Dean, MD, a sleep expert and author of 365 Ways to Boost Your Brain Power: Tips, Exercise, Advice.

Some people, however, don’t produce enough melatonin. And as a result, sleep doesn’t come easily. But while melatonin is a natural hormone that can help reset your circadian clock, oral melatonin isn’t right for everyone. (2)

What Are Melatonin Side Effects?

Melatonin needs vary from person to person. On average, most people need less than 3 milligrams (mg) per night to sleep better. Yet some people take more. (3)

Melatonin is generally safe for short-term use of one to two months in most healthy adults. But some people are more sensitive to the oral hormone and experience side effects. Adverse effects tend to occur with long-term use or when a person takes too much. (2,4)

Possible side effects of oral melatonin include: (1,3,5)

• Headache A mild to moderate headache can indicate that you’ve taken too much or that your body is sensitive to oral melatonin.
• Stomach Problems Melatonin also causes stomach discomfort in some people. This may include cramps, nausea, and diarrhea.
• Dizziness Some people who take melatonin also report mild dizziness, lightheadedness, or vertigo.
• Irritability Too much melatonin can also affect mood. You may feel cranky, anxious, or have periods of depression.
• Drowsiness Even though melatonin doesn’t usually cause a “hangover effect,” some people do experience daytime drowsiness. This can reduce alertness and make it difficult to drive or operate machinery. If you take melatonin, wait at least five hours before operating machinery. Keep in mind that some medication may intensify drowsiness, such as depressants and selective serotonin reuptake inhibitors. (1)
• Low Blood Pressure Sometimes, melatonin causes abnormally low blood pressure. Melatonin side effects are usually mild. (6) However, untreated low blood pressure can lead to life-threatening complications. Low blood pressure means that your body can’t carry enough oxygen to your organs. This can affect heart and brain function. Symptoms of low blood pressure include dizziness, fainting, blurry vision, confusion, and fatigue. (7)

If you experience mild side effects of oral melatonin, reduce your dosage to see if symptoms improve. Talk with your doctor about your dosage if your symptoms persist or worsen. Everyone’s body is different. So while one person may be able to tolerate 3 mg of melatonin a night, another person may be able to tolerate only 1 mg.

Melatonin for Children

Adults aren’t the only ones with acute or chronic sleep problems. Melatonin is also safe for children who have difficulty sleeping due to insomnia, circadian rhythm disorders, attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), autism, and other neurological disorders.

Dosing for children varies. Some children may need only 1 to 3 mg a night, whereas a child with ADHD or autism may need 3 to 6 mg per night. But because oral melatonin is a supplement and is not regulated by the U. S. Food and Drug Administration, experts caution that parents should consult with a doctor before allowing children and adolescents to try melatonin. (10,11)

Your doctor can help you understand whether melatonin is right for your child and review the risk of side effects. “Side effects reported for children include nausea, diarrhea, headaches, changes in mood, sleepiness the next day, and bed-wetting,” notes Dr. Dean.

Who Shouldn’t Take Melatonin?

Some herbal and dietary supplements can interact negatively with prescription medication, and melatonin is no exception.

Before you take this supplement to improve the quality of your sleep, speak with your doctor.

Melatonin doesn’t interact with every prescription drug, but it can make some medicines less effective, like blood pressure and seizure medication. It can also boost blood sugar and is therefore not recommended for people with diabetes, warns Dean.

The supplement can also interact with blood-thinning medication, immunosuppressants, and corticosteroids. There’s also the risk of increased drowsiness when taken with birth control pills, depressants, or selective serotonin reuptake inhibitors. (1)

If you have chronic pain due to an inflammatory disease, melatonin might seem like a safe solution for better sleep. But this supplement isn’t recommended for people who have an autoimmune disease like lupus or arthritis. (12)

Melatonin can stimulate the immune system, triggering an inflammatory response and worsening these diseases.

There is no definitive research on the safety of using melatonin during pregnancy or while breastfeeding, so experts recommend talking to your doctor if that’s something you want to consider. (13)

Melatonin is preferred by some because it’s nonhabit-forming and a natural sleep aid. But the supplement isn’t right for everyone, and side effects can occur if not taken properly.

If you experience side effects, reduce the amount you take. If symptoms continue, stop taking oral melatonin. Also, don’t forget to consult your doctor before combining melatonin with a prescription medication.

For the most part, melatonin should be used only as a short-term remedy. See your doctor or a sleep specialist if sleep problems worsen or don’t improve after a few months.

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Side effects of melatonin – NHS

Like all medicines, melatonin can cause side effects, but most people will not have any side effects.

Common side effects

Melatonin does not have many common side effects but there are things you can do to help cope with them:

Feeling sleepy or tired in the daytime

Do not drive, cycle or use tools or machinery if you’re feeling this way. Do not drink any alcohol as this will make you feel more tired.

If you’re taking more than one 2mg tablet talk to your doctor to see if you can reduce your dose. If this does not help, talk to your doctor as melatonin may not be the right medicine for you.

Headache

Make sure you rest and drink plenty of fluids. Do not drink too much alcohol as it can make your headache worse, and it affects the way that melatonin works. Ask a pharmacist to recommend a painkiller.

Talk to a doctor if headaches last longer than a week or are severe.

Stomach ache

Try putting a heat pad or covered hot water bottle on your tummy. Talk to your doctor if the pain continues or is severe.

Feeling sick (nausea)

Take melatonin tablets or liquid after food. Stick to simple meals and do not eat rich or spicy food. It can help to eat and drink slowly and have smaller and more frequent meals.

Feeling dizzy

If taking melatonin makes you feel dizzy, stop what you’re doing and sit or lie down until you feel better. Do not drive, cycle or use tools or machinery if you’re feeling dizzy. Do not drink alcohol as it will make you feel worse.

Feeling irritable or restless

If this does not get better after a few days, stop taking the medicine and talk to your doctor.

Dry mouth

Chew sugar-free gum or suck sugar-free sweets.

Dry or itchy skin

Apply a moisturiser often. Try using an oil-free face moisturiser for sensitive skin.

If this does not get better after 1 week, stop taking the medicine and talk to your doctor.

Pains in your arms or legs

If this does not get better after a few days, stop taking the medicine and talk to your doctor.

Strange dreams or night sweats

If this does not get better after a few days, stop taking the medicine and talk to your doctor.

Speak to a doctor or pharmacist if the advice on how to cope does not help and a side effect is still bothering you or does not go away.

Serious side effects

Serious side effects are rare and happen to less than 1 in 1,000 people.

Speak to your doctor if you start feeling low or sad as this could be a sign of depression.

Call your doctor or call 111 now if you:

• get changes to your eyesight, such as blurred vision
• feel faint or pass out
• start feeling confused or dizzy, or things seem to be spinning around you (vertigo)
• have any bleeding that does not stop, unexplained bruising or blood in your urine

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to melatonin.

Immediate action required: Call 999 now if:

• your lips, mouth, throat or tongue suddenly become swollen
• you’re breathing very fast or struggling to breathe (you may become very wheezy or feel like you’re choking or gasping for air)
• your throat feels tight or you’re struggling to swallow
• your skin, tongue or lips turn blue, grey or pale (if you have black or brown skin, this may be easier to see on the palms of your hands or soles of your feet)
• you suddenly become very confused, drowsy or dizzy
• someone faints and cannot be woken up
• a child is limp, floppy or not responding like they normally do (their head may fall to the side, backwards or forwards, or they may find it difficult to lift their head or focus on your face)

You or the person who’s unwell may also have a rash that’s swollen, raised, itchy, blistered or peeling.

These can be signs of a serious allergic reaction and may need immediate treatment in hospital.

Other side effects

These are not all the side effects of melatonin. For a full list, see the leaflet inside your medicine packet.

Information:

You can report any suspected side effect using the Yellow Card safety scheme.

Visit Yellow Card for further information.

Page last reviewed: 13 February 2023

Next review due: 13 February 2026

Melatonin: Here’s what you need to know

What is melatonin?

Melatonin is the hormone that controls your circadian rhythm, or the internal clock that tells you when to sleep. Your brain produces and releases melatonin depending on the time of day. As you get older, your brain produces less melatonin. Fortunately, you can also get this hormone as a supplement.

Sleep supplement

Melatonin is best known for helping with sleep problems such as jet lag, insomnia, and delayed sleep phases, a disorder that causes you to fall asleep later and wake up later. It can also treat circadian rhythm sleep disorders in the blind. Melatonin may help you fall asleep a little faster than usual, but its impact on the quality of your sleep and the amount of time you sleep is still being studied. More research is also needed on whether melatonin can help you fall asleep if you work late shifts.

Other health benefits

Melatonin can control more than just sleep. While more research is needed, early research suggests that the hormone can influence your body temperature and lower nighttime blood pressure if you have hypertension. But research on how melatonin affects blood sugar levels is conflicting. Animal studies show it may help with weight loss, but more research is needed to see if this is true in humans.

Additional benefits being explored

Early research suggests that melatonin may also be helpful for macular degeneration, gastroesophageal reflux disease (heartburn), tinnitus (tinnitus), and migraines.

Is it safe?

Think of melatonin as a sleeping pill that you take for a short period of time, but not all the time. Melatonin is generally safe for occasional use, but researchers aren’t sure about its long-term effects. Always consult your physician first regarding use and dosage, especially if you are pregnant or nursing, have dementia, epilepsy, or an autoimmune disease. Some people may have an allergic reaction to melatonin.

Potential side effects

The most common side effects of melatonin supplements are headache, dizziness, nausea, and daytime sleepiness. Rare side effects include confusion, stomach cramps, irritability or depression, tremors, and restlessness. If you have any side effects, ask your doctor if it is safe to continue taking melatonin.

Drug interactions

Melatonin is considered a dietary supplement in the US, which means it is not regulated as tightly as over-the-counter drugs. In some countries, this requires a prescription. Melatonin does not mix well with certain medications, including:
Anticonvulsants
Contraceptives
Blood thinners
Blood pressure medicines
Central nervous system depressants
Medicines for diabetes
Diazepam
Medications that lower your seizure threshold
Fluvoxamine
Immunosuppressants

Natural melatonin in food

Your body produces melatonin naturally – it is even found in breast milk. Some products also contain natural melatonin. The highest amounts are found in eggs, fish, and nuts, but you can also find it in certain types of mushrooms and grains. Tart cherries contain both melatonin and tryptophan, an amino acid used to make melatonin and serotonin. This combination can help you fall asleep faster and stay awake longer.

How much to take and why

Take just enough melatonin to get the job done, starting at 0.3-1 milligram. If that doesn’t work, talk to your doctor about increasing your dose. If you take too much melatonin, you may experience headaches, nausea, or daytime sleepiness.

Can children take Melatonin?

In general, short-term use of low doses of melatonin is safe for children and adults, but not for infants. Because it is not strictly regulated by the FDA, it is best to ask your pediatrician to recommend a safe brand and dosage for your child’s age, weight, and general health.

How to choose it

Melatonin comes in two forms: natural and synthetic. The natural version is made from animal glands and may contain viruses that make you sick. To avoid this risk, use the synthetic version instead.

When to take it

Melatonin is not a fast acting supplement. For maximum benefit, take it a few hours before bedtime. Closer to bed, set yourself up for a successful sleep by making sure your room is cool and dark. Turn off your screens and go to bed around the same time every night.

Melatonin and premenstrual syndrome

The life of the human body, like other living beings, is subject to biological rhythms, which in turn are formed by internal drivers and are more or less influenced by the external environment, adapting the body to its changing conditions. The reproductive system lives according to the laws of low-frequency biorhythms, a classic example of which is the lunar (circal-lunar, or circa-monthly) menstrual cycle, which is necessary for conception. Monthly cyclic changes in the uterus and ovaries result from the action of hormones, including estrogens, progesterone, luteinizing hormone (LH) and follicle stimulating hormone (FSH), the secretion of each of which bears features not only of a circa-monthly, but also of a high-frequency ultradian rhythm.

Biological rhythms do not exist in isolation, they interact with each other, organizing a complex system for maintaining homeostasis. One of the most important regulatory roles is played by mid-frequency circadian (daily) rhythms, among which the sleep-wake cycle is best studied. The interaction of the menstrual cycle and circadian processes changes the diurnal variability of REM sleep and basal body temperature during the luteal phase compared to the follicular phase [1], which can be explained by the influence of sex hormones. In particular, estrogens prolong the REM phase, reduce the time to fall asleep and the total number of spontaneous awakenings during the night, and increase the total duration of sleep. Progesterone stimulates benzodiazepine receptors and thus increases the activity of γ-aminobutyric acid (GABA), the most important inhibitory mediator responsible for the onset of sleep.

On the other hand, it should be taken into account that circadian rhythms are formed mainly by the pineal gland, and the hormone melatonin produced by it has a significant effect on the neuronal regulation of the menstrual cycle, mediating it mainly through the neuronal network of gonadotropin-inhibiting hormone [2]. Melatonin, apparently, is able to directly influence the production of hormones. In particular, reduced progesterone production by luteal cells as a result of oxidative stress is restored under the action of melatonin [3]. It can be assumed that melatonin has a similar effect in the brain, restoring the balance of neurosteroids.

Melatonin itself, which plays the role of an adaptogen in the central nervous system (CNS), is affected by numerous exogenous and endogenous factors that can change its secretion [4]. These changes, designed to synchronize internal and external biorhythms, with significant and / or long-term alterations, can become the basis for the development of a number of diseases, accompanied by sleep disorders.

The chronobiological basis of affective disorders is known. Mental illnesses such as major depressive disorder, seasonal affective disorder, bipolar disorder, and schizophrenia are associated with circadian rhythm dysregulation [5], and genetic abnormalities of the biological clock have been identified in patients with bipolar disorder and schizophrenia [6, 7]. Among gynecological diseases, pronounced desynchronosis includes premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) [8], for which sleep disorders are very characteristic [9].

The term “premenstrual syndrome” refers to a clinical condition representing a variety of cyclically recurring physical, emotional, behavioral and cognitive symptoms that develop during the luteal phase of the menstrual cycle and disappear with the onset of menstruation [10]. About 200 premenstrual signs have been described, and more than 80% of women have experienced them at some point in their lives. But in 30-48% of women in the middle and younger fertile groups and approximately 20% of women in the older fertile group, these symptoms disrupt the quality of life and persist throughout most menstrual cycles, thus falling under the criteria for the diagnosis of PMS [11, 12].

The classification of the disease has been refined by the consensus of the International Society for Premenstrual Disorders (ISPMD). In accordance with the recommendations of the ISPMD, for the diagnosis of PMS, its symptoms must be severe enough to negatively affect daily activities and/or interfere with work, study, and/or disrupt interpersonal relationships [13]. Signs of PMS are non-specific and recur during ovulatory cycles. The variety and number of symptoms vary greatly from individual to individual, but some individuals may have predominantly mental, or predominantly somatic, or mixed symptoms. A single symptom can become the basis for diagnosing a disease if its “behavior” corresponds to the diagnostic definitions.

In accordance with the ISPMD consensus [14], the diagnosis of PMS should not be based solely on a retrospective evaluation of symptoms. No matter how classic the symptom complex looks, the clinician must convince the patient to keep a diary for 2-3 menstrual cycles, in which she must write down the symptoms and assess their severity on a 10-point scale (1 – absent, 10 – unbearable severity). In principle, any symptom can be attributed to the manifestation of PMS if it meets the following characteristics for at least 2 cycles:

– the patient evaluates it at 4-10 points;

– the symptom is present for 2-14 days of the cycle preceding menstruation (luteal phase), but absent (severity 0-3 points) for at least 6 days of the follicular phase (it is the first 7 days from the onset of menstruation that are important).

The severity of premenstrual symptoms can be different and range from moderate to very pronounced, when it comes to diagnosing not PMS, but premenstrual dysphoric disorder (PMDD). “Late luteal phase dysphoric disorder” has been isolated and listed in the DSM-III-R section entitled “Suggested Diagnostic Categories for Further Study” at 1987 d. After 7 years, a working group on “late luteal dysphoric disorder” recommended that the condition be included in the DSM-IV section “Mood disorders without further specification” under the name “premenstrual dysphoric disorder. ” Currently, PMDD is included in the DSM-V and is defined as a severe form of PMS, including physical, mental and behavioral symptoms that recur regularly during the luteal phase of the menstrual cycle and decrease within a few days after the onset of menstruation [15]. The criteria for this condition, which occurs in 3-8% of women in the population, are the following positions [4].

A . During most menstrual cycles in the last year, 5 or more of the following symptoms (at least one of symptoms 1, 2, 3, 4 must be present) were observed for the longest time during the last week of the luteal phase, began to subside within a few days after the onset of the follicular phase, and were absent within a week after the cessation of menstruation:

1) visibly depressed mood, feelings of hopelessness or ideas of self-abasement;

2) noticeable anxiety, tension, feeling of agitation;

3) pronounced emotional lability;

4) anger or irritability, or exacerbation of interpersonal conflicts;

5) subjective feeling of difficulty concentrating;

6) drowsiness, fatigue or marked lack of energy;

7) marked change in appetite, overeating or craving for particular foods;

8) pathological drowsiness or insomnia;

9) subjective sense of shock or loss of control;

10) physical symptoms, eg painful breast engorgement, headache, joint or muscle pain, bloating, weight gain.

B. The disorder noticeably interferes with work or study or normal social activities and relationships with others.

B. Possible exacerbation of symptoms of another medical condition, such as depression, panic disorder, dysthymic disorder, or personality disorder.

D. Criteria A, B and B must be confirmed by prospective daily assessments for at least two consecutive symptomatic cycles (preliminary diagnosis may be made prior to this confirmation).

Four subtypes of so-called “variant” disorders have also been described that do not meet generally accepted criteria.

The first subtype is premenstrual exacerbation of the underlying disorder, which means worsening of the course of the underlying disease in the luteal phase of the menstrual cycle. Similar cyclicity occurs in patients with diabetes, depression, epilepsy, bronchial asthma, migraine, etc.

The second subtype, non-ovulatory premenstrual disorders, occurs in cycles without ovulation. The origin of these disorders is unknown, the current hypothesis is that the symptoms may be caused by ovarian follicular activity.

The third subtype, progestogen-induced premenstrual disorders, is provoked by exogenous progestogens present in combined preparations for contraception and menopausal hormone therapy. Against the background of purely progestogenic contraception, similar symptoms may occur, but, due to non-cyclicity, they are not included in the classification and are considered side effects (probably with similar mechanisms) of the continuous use of this group of drugs.

The fourth subtype includes premenstrual disorders in amenorrhea in women who, in the presence of ovulatory cycles, do not have periods due to hysterectomy, endometrial ablation, or use of long-term progestogen contraception.

In any type of PMS and its classical clinical picture, an important place among the symptoms is occupied by transient or persistent sleep disturbances, which are observed in 66-70% of patients and are considered as one of the diagnostic clusters of PMDD [8, 16]. Sleep disorders in patients with PMS/PMDD are usually expressed in a deterioration in the quality of sleep, frequent nocturnal awakenings, a long falling asleep, and a feeling of dissatisfaction with sleep. At the same time, only minor changes can be detected during polysomnography, for example, an increase in the representation of non-REM sleep in the luteal phase of the cycle. However, most objective studies of sleep in women with PMDD have been conducted with small sample sizes or with women who have not actively sought medical attention [17], which may have confounded the results.

According to a subjective assessment, sleep disturbances are also observed in relatively healthy women [18]. It is likely that the anxiety inherent in women with PMDD exacerbates the course of natural sleep changes after ovulation and makes them clinically significant. From these positions, PMS and PMDD are similar to paradoxical insomnia.

The origin of sleep disorders, like the pathogenesis of PMS itself, is not well understood. Modern ideas about PMS interpret it as a maladaptive condition, reflecting an inadequate response of the brain to normal fluctuations in steroid hormone levels within the ovulatory menstrual cycle. The pathogenesis of the disease includes disorders of various neuronal systems and the exchange of neurotransmitters such as norepinephrine, epinephrine, serotonin, dopamine, and opioid peptides. Despite the fact that the “central” nature of the disease is not in doubt, the specific area of ​​\u200b\u200bthe brain responsible for the onset of symptoms has not been named. Obviously, the cause of premenstrual disorders has no topical binding and lies in the violation of the metabolism of neurotransmitters and neurosteroids in various parts of the central nervous system in response to normal fluctuations in the levels of sex hormones, most of all, to an increase in the level of progesterone in the luteal phase of the cycle.

One of the candidates for the role of the pathogenetic factor of PMS is the neurosteroid allopregnenolone, a neuroactive progesterone metabolite that stimulates GABA receptors in the brain and, therefore, determines behavioral responses, response to stress, mood changes, and the onset of sleep. The content of allopregnenolone in the peripheral blood of patients with PMS is reduced compared to that in healthy women, especially in the luteal phase of the cycle [19].

Another participant in the pathogenesis of PMS/PMDD is serotonin – a decrease in the level of this neurotransmitter leads to an increase in the sensitivity of the brain to progesterone. The hypothesis about the role of serotonin deficiency in the development of symptoms of PMS and, especially, PMDD is supported by the well-known fact about the effectiveness of the use of selective serotonin reuptake inhibitors (SSRIs) in this category of patients [20]. At the same time, the close relationship between the symptoms of the disease and sleep disorders suggests the existence of pathogenetic mechanisms mediated by melatonin secretion.

This hypothesis is supported by the fact that agomelatine, an effective antidepressant agent, an agonist of MT ₁ and MT ₂ melatonin receptors, has antagonistic activity against 5-HT _2C receptors. The presence of 5-HT _2C and MT1/MT2 receptors has been demonstrated in various brain regions, including the suprachiasmatic nucleus, hippocampus, nucleus accumbens, and amygdala [21]. Thus, the relationship between the two systems that regulate circadian rhythms and behavior becomes apparent [22].

In fairness, it should be noted that a decrease in the level of melatonin in patients with PMS/PMDD was not detected in all studies on this topic [23]. But more recent work has revealed the relationship between melatonin secretion and premenstrual disorders. In one of the clinical trials, women with PMDD underwent a complete examination 2 times within the same menstrual cycle in the follicular and luteal phases. The results of the study showed that in women with PMDD, the normal organization of the melatonin secretion rhythm was disturbed and the melatonin level was significantly reduced at night. During the onset of symptoms of the disease, the content of melatonin decreased even more [24]. This observation is consistent with data on an increased incidence of subsyndromal depression in patients with low endogenous melatonin secretion [25].

The management of patients with PMS involves a multidisciplinary and individualized approach [26]. The concepts of suppression of ovulation and thereby a decrease in progesterone levels, as well as an increase in serotonin levels and a decrease in the sensitivity of the central nervous system to progesterone, seem logical. The most popular method of inhibiting ovulation in patients with PMS is the appointment of combined oral contraceptives containing drospirenone, and an increase in the level of serotonin in the brain is achieved with the help of SSRIs. Several complementary therapies have proven successful in the treatment of PMS. Lifestyle correction, cognitive-behavioral therapy, the appointment of vitamin complexes are included in the complex of therapeutic measures.

Cognitive behavioral therapy is the treatment of choice for sleep disorders associated with PMS and PMDD [27]. This effective and safe method gives lasting results, helps to better cope with stress in everyday life and increases a woman’s resilience to the emotional “swings” that are characteristic of PMS/PMDD. The organization of cognitive-behavioral therapy is hampered by the rather high cost of a therapeutic session and an acute shortage of specialists.

But sleep disorders are a particular problem in the treatment of patients with premenstrual disorders, not only due to the limited availability of the cognitive-behavioral method. Insomnia and other variants of disorders are not always perceived as a pathology, and women often consider their disturbed sleep to be a variant of the norm, being skeptical about the need for medical advice. However, untreated sleep disorders, especially insomnia, prevent patients from adequately evaluating the result of treatment, so the standard methods of treating PMS and PMDD may not be effective enough. In these cases, it is advisable to correct sleep disorders with medication.

Most drugs for the short-term (benzodiazepines and their agonists) and long-term (antidepressants, antipsychotics, anticonvulsants) treatment of insomnia are also used to treat the symptoms of PMDD, but they are available only by prescription and require careful adherence to the patient regimen, and an understanding of possible drug interactions and adverse reactions from the doctor. Only neurologists or psychiatrists have the right to prescribe such drugs in our country.

Patients with PMDD should definitely consult a psychiatrist. This type of premenstrual disorder often occurs against the background of borderline and subclinical mental disorders and may be their mask. Therefore, consultation with a psychiatrist is necessary not so much to establish a diagnosis as to conduct a differential diagnosis. It should also be remembered that sleep disturbances associated with the menstrual cycle can mask objectively existing sleep disorders in women [27]. Therefore, if there are doubts about the purely premenstrual nature of the existing disorders, it is advisable to refer the patient for a consultation with a somnologist.

A gynecologist may recommend over-the-counter medications such as melatonin for managing menstrual-related sleep disorders. Interacting with membrane and nuclear receptors, exogenous melatonin, like its endogenous counterpart, promotes sleep and organizes the daily rhythm of sleep and wakefulness. In addition, melatonin and its metabolites have antioxidant, anti-inflammatory, analgesic effects. Melatonin preparations are annotated for the treatment of sleep disorders, including those associated with PMS or PMDD.

One of the quick release melatonin preparations on the Russian pharmaceutical market is Melaxen. The drug Melaxen is prescribed at a dose of 3-6 mg 30 minutes before going to bed. Due to its short half-life, melatonin is more effective for difficulty falling asleep and maintaining sleep in the first half of the night. Taking into account the available data on the high efficacy and safety of the drug, Melaxen can be recommended to a wide range of patients with sleep disorders. Treatment of sleep disorders with the drug Melaxen is not accompanied by any adverse events, as well as an aftereffect.

Melatonin preparations prescribed for sleep disturbances in women with PMS or PMDD appear to be effective in correcting other premenstrual symptoms. The use of melatonin for 3 months significantly improved the quality of life and contributed to a decrease in anxiety and the severity of neurovegetative disorders [28]. Certain pilot studies do not, of course, allow us to conclude that melatonin preparations are effective in the treatment of premenstrual symptoms. But the presence of sleep disorders in the structure of PMS/PMDD makes it possible to reasonably prescribe these drugs within the annotated indications. In the absence of a positive result from the prescribed therapy, a chronic sleep disorder should be assumed and the woman should be referred for a consultation with a somnologist.

The problem of treating women suffering from PMS and PMDD is far from being resolved.