Hormonal Birth Control for PMDD: How It Works

Learn the benefits of birth control for PMDD

Noncontraceptive benefits of the Pill
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If you have premenstrual dysphoric disorder (PMDD), you may want to consider looking into hormonal birth control to help combat the side effects. Although selective serotonin reuptake inhibitors (SSRIs) are considered the first line of treatment for PMDD, many women don't want to take them and would prefer to combine their need for contraception with their need for relief from PMDD.

Understanding PMDD

PMDD is a severe and comparatively rare form of the more common premenstrual syndrome (PMS), which affects around 75 percent of women.

With PMS, you may experience a wide range of physical and/or emotional symptoms about five to 11 days before your monthly menstrual cycle begins.

The more severe PMDD is a condition that adversely affects the psychological well-being, social interactions, and relationships of about 3 percent to 8 percent of women of reproductive age. Its primary features are anger, irritability, and anxiety. Hormonal birth control methods, including extended-cycle pills, have been shown to offer some relief and may work as a treatment for PMS as well as PMDD.

Hormonal Contraception for PMDD

Hormonal contraception, like the Pill, is a very popular contraceptive choice for many women, yet women using this type of birth control may not be aware of its non-contraceptive benefits. Various hormonal contraceptives have shown some ability to diminish PMDD symptoms, as well as provide some PMS relief.

You may react differently to certain contraceptive methods; therefore, this information is intended to be a general overview.

Also, keep in mind that the chief reason to use hormonal birth control is for contraception (to prevent an unintended pregnancy).

Options for Treating PMDD With Hormonal Contraceptives

If you and your doctor are considering the non-contraceptive benefits of birth control for treating your PMDD, there are a number of hormonal methods to consider.

The following is a list of prescription birth control methods that have been shown to be effective as treatment for PMDD as well as PMS:

  • Certain combination birth control pills can offer some relief for PMDD symptoms. In randomized controlled trials, the combination pills that have shown the most improvement in PMDD symptoms are those with a combination of ethinyl estradiol and drospirenone (like Yaz, Ocella, and Beyaz). Yaz is the only birth control FDA-approved to treat PMDD.

    These pills have been shown to offer relief from both physical and psychological PMDD symptoms, with improvement in health-related quality of life. Additionally, they decrease premenstrual mood deterioration in reproductive-aged women receiving treatment for depression.
  • Combination birth control pills that contain levonorgestrel and ethinyl estradiol have also been shown to help PMDD symptoms when taken continuously without the placebo.
  • Because extended-cycle pills can reduce your number of periods to 4 times a year (Seasonique) or suppress menstruation altogether (Amythest) for the year, these pills can offer some PMDD and PMS relief.
  • Women on cyclic hormonal contraception (21-day active pills/7-day placebo) may experience premenstrual symptoms as well as pelvic pain, headaches, breast tenderness, and bloating during the hormone-free interval. Extending the usual 21-day cycle of contraceptive pills has been shown to reduce pelvic pain and headaches while improving overall mood.
  • Because you have fewer periods when using them, extended use of the contraceptive patch and the contraceptive ring may provide similar benefits as the extended-cycle pills. 

    Note: The Ortho Evra contraceptive patch has been discontinued in the United States. A generic form, Xulane, is available.

Sources:

Casper RF. Patient Education: Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD) (Beyond the Basics). UpToDate. Updated March 6, 2017.

Freeman EW, Halbreich U, Grubb GS, et al.  An overview of four studies of a continuous oral contraceptive (levonorgestrel 90 mcg/<ethinyl estradiol 20 mcg) on premenstrual dysphoric disorder and premenstrual syndromeContraception. May 2012;85(5):437-45.

Mayo Clinic Staff. Birth Control Patch. Published December 23, 2015.