Medicine 4: Oral Contraceptives

Please consult a doctor to get medical prescription before administering the solutions.

What is it?

Birth control pills (also known as 'the pill') are oral contraceptive pills (OCPs) that typically contain the hormones: estrogen and progestin. Usually, these pills come in two forms:

1. Combination pills: These contain both estrogen and progestin, and are the most common type.

2. Progestin-only pills: These contain only progestin, and are also known as 'mini-pills'.

While not all birth control pills are effective for PMDD, those containing Drospirenone (a type of progestin) have shown promise in easing emotional and physical symptoms.

Well-known drospirenone pills include Yaz and Yasmin.

Further, birth control pills also have three specific pack formats.

Pack	Format
Conventional pack	Contains 21 active pills and 7 inactive pills (which do not contain hormones). Formulations containing 24 active pills and 4 inactive pills (which are hormone-free), known as a shortened pill-free intervals, are also available. Some newer pills may contain only 2 inactive pills. Take a pill every day and start a new pack when you finish the old one. Packs usually contain 28 days of pills in total. Bleeding may occur every month during the time you take the inactive pills (that are at the end of each pack).
Extended-cycle pack	These packs typically contain 84 active pills and 7 inactive pills (which are hormone-free). Bleeding occurs only four times a year during the 7 days that you take the inactive pills.
Continuous-dosing pack	A 365-day pill also is available. You take this pill every day at the same time. You do not take any inactive pills1. For some, periods may stop altogether, while for others, periods may become lighter.

How does it work?

Research has shown that women with PMDD on OCP treatments experience the following:

• More hormone-free days = more symptom flare-ups

• Less hormone-free days = less PMDD symptoms and greater hormonal stability

That is why OCP treatments with few hormone-free days (aka few inactive pills) might be beneficial to women dealing with PMDD².

Research has also shown that drospirenone is particularly effective in treating PMDD symptoms because of its anti-aldosterone and anti-androgenic effects³. Unlike many other progestin pills, drospirenone suppresses hormonal fluctuations and blocks androgen receptors, helping reduce:

• Acne

• Excess facial/body hair

• Excess sebum production

• Mood-related symptoms (like irritability, anger, unusually high sex drive, etc.)

Because the pill delivers everything in steady doses, it can make your hormone levels more predictable and your period symptoms less unpleasant¹.

What is the efficacy?

Although studies have shown mixed results, research has shown a 30–59% improvement for women suffering from PMDD⁴. However, continuous dosing of 112 days brought the most benefits⁵.

A 2012 study examined five clinical trials involving 1,920 women who took oral contraceptives containing drospirenone. The findings indicated that the drospirenone combination pill helped improve productivity and social functioning in women experiencing PMDD⁶.

What are the side effects?

Short-term effects: Nausea, headache, irritability and moodiness, breast tenderness¹.

Long-term effects: Long-term side effects of birth control pills may include a higher risk of blood clots and some cancers. However, hormonal methods of birth control are safe for most people, as long as they have a doctor’s approval⁷.

References

1. Cooper DB, Patel P. Oral contraceptive pills. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. [cited 2025 Apr 23].

2. Mishra S., Elliott H., Marwaha R. Premenstrual Dysphoric Disorder. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.

3. Rubig A. Drospirenone: a new cardiovascular-active progestin with antialdosterone and antiandrogenic properties. Climateric. 2003;6:49–54.

4. Hofmeister S., Bodden S. Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American Academy of Family Physicians. 2016;94(3):236-240.

5. Halbreich U, Freeman EW, Rapkin AJ, et al. Continuous oral levonorgestrel/ethinyl estradiol for treating premenstrual dysphoric disorder. Contraception. 2012;85(1):19-27

6. Lopez LM., Kaptein AA., Helmerhorst FM. Oral contraceptives containing drospirenone for premenstrual syndrome. Cochrane Database of Systematic Reviews. 2012; (2): CD006586.

7. Smith JS, Green J, Berrington de Gonzalez A, Appleby P, Peto J, Plummer M, Franceschi S, Beral V. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet. 2003 Apr 5; 361(9364): 1159–67.