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Does hormonal birth control help with PMS and PMDD?
Navigating your hormonal birth control options
Top things to know:
Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) can cause emotional and physical symptoms during the luteal phase of the menstrual cycle
PMDD affects 7 in 100 women and people with cycles
Yaz is the only hormonal birth control that has been FDA-approved specifically for preventing pregnancy and treating PMS and PMDD
Depression and suicidal thoughts are serious and frightening. If you experience either, text 988 (in the USA) to reach a crisis counselor
Tracking with the Clue app can help you recognize mood swings caused by PMDD and reduce the impact these symptoms may have on your daily life
What is premenstrual dysphoric disorder (PMDD)?
People with PMS or PMDD seem to be sensitive to changes in the hormones progesterone and estrogen (1-3). These hormones are naturally produced in the ovaries, but can also be found in synthetic form in hormonal birth control (2,3). These ovarian hormones are called “neuroactive steroids” because they affect the brain and can impact mood (4,5).
PMDD causes mood symptoms around ovulation (3). Hormonal birth control pills prevent ovulation and can help with PMDD symptoms for some people (3). In trials of the effects of birth control on PMDD symptoms, the benefits of taking oral contraceptive pills (OCPs) varied based on which formulation of the pill was taken. In some cases, certain symptoms worsened (6).
Some research suggests that people who have experienced negative moods from hormonal birth control in the past might experience them again. So, birth control might not be a good treatment option for this group (7).
What is the difference between PMS and PMDD?
Most people (9 in 10) experience some discomfort during their menstrual cycle. Bloating, mood changes, and tender breasts are common around ovulation (8). If these experiences impact your daily activities, as they do for around a quarter of people with cycles, healthcare providers call this PMS (8). It’s worth noting that PMS is often used as a catch-all term for “women’s bad moods” because it can be considered (at least partly) a cultural construct. Using the term “PMS” like this risks marginalizing people who experience severe PMS or PMDD, and who already feel they are not taken seriously by medical professionals. In this article, we discuss PMS as defined by the American College of Obstetricians and Gynecologists (ACOG).
In around 4 in 100 people, these menstrual experiences are so negative and severe that healthcare providers diagnose PMDD (8). Some of these symptoms can also be caused by other health conditions like thyroid conditions, depression, or anxiety, so it’s important to tell a healthcare provider about your symptoms so they can find the right diagnosis (8).
PMS and PMDD both happen during the luteal phase of the menstrual cycle (1). Symptoms start a few days before bleeding begins and go away once bleeding starts (1). Mood symptoms like irritability, moodiness, or anxiety are thought to be due to changing hormone levels between ovulation and the period (2).
What are some signs and symptoms of PMDD?
Mood changes are noticeable and can include a very depressed mood, fatigue, or not enjoying usually fun activities—and these symptoms interfere with the person's work, school, and relationships (4).
Other signs and symptoms of PMDD are (4):
Persistent anger or irritability
Marked anxiety or tension
Difficulty sleeping or excessive sleeping
A significant change in appetite
Difficulty concentrating
Feeling overwhelmed or out of control
Some people may also notice physical changes, like bloating, muscle pain, weight gain, headaches, or joint tenderness (4).
More than 1 in 10 Clue users track PMS symptoms in the Clue app. Tracking at least five of your most bothersome experiences in the Clue app for at least two cycles can help your healthcare provider see patterns in your symptoms and suggest the right treatment for you (5).
What causes PMDD?
Fluctuations in the reproductive hormones estrogen and progesterone have long been blamed for PMDD symptoms (8). These hormone levels change throughout the menstrual cycle, but not everyone is impacted negatively. Research suggests that people with PMDD might have increased sensitivity to changes in hormones (8,9). Ultimately, more research is needed to better understand the exact cause of PMDD.
Some people experience PMDD symptoms only in the days leading up to their period. For others, symptoms can begin after ovulation and last until the period starts. We don't know if it's ovulation itself, or the hormone fluctuations that follow ovulation that trigger PMDD symptoms. (9,10). Medications that suppress ovulation, like some combined oral contraceptive pills and IUDs, may help reduce symptoms of PMDD for some people (2-4). Other treatments like therapy, exercise, mental health medications, acupuncture, and taking calcium supplements also might work for some people (3).
Hormonal birth control and mood
Some people report relief from mood symptoms when they take hormonal birth control, while others find that hormonal birth control makes their symptoms worse (7). Mood-related side effects are sometimes cited as a reason why people stop using hormonal birth control (8,11). But it’s important to remember that studies on hormonal birth control and mood often look for negative side effects without looking for positive ones (12).
A 2023 study found a link between low mood and hormonal birth control withdrawal—this suggests that continuous birth control with no withdrawal bleeding might be beneficial to people with PMDD (13). Another study found links to both positive and negative mood changes (7). Another study found links between birth control pills and depression (14). With so much data out there, conflicting conclusions can arise. Ultimately, we don’t know exactly what works for everyone. Everybody is unique, so it might take trying a few things to find out if they are right for you.
In one study, 16 in 100 women reported that the birth control pill worsened their mood premenstrually, compared to 12 in 100 women who said that the pill improved their mood (15). A study in 2016 made news when it reported that hormonal birth control use was associated with depression (14), although many researchers believe it had several flaws. Another study of women with severe PMS found that the women who used hormonal birth control had less severe premenstrual depression, anger, and irritability, compared to those not using hormonal birth control (16).
Do birth control pills help with PMDD or make it worse?
Birth control side effects can vary from person to person, birth control pills can help some people with PMDD, while making it worse for others (7). Some people stop taking hormonal birth control because of the way it impacts their mood (9,17) while others are more satisfied with life when they take it (18). Studies on PMDD and birth control mostly focus on mood, but researchers believe there are other side effects to living with PMDD, including trouble with school, disordered eating, and insomnia (19-21). More research is needed to look into how birth control impacts people with PMDD beyond mood-related symptoms.
Here are the different types of birth control pill and their effects on mood:
It’s important to know about the different types of birth control pills. Monophasic pills mean that hormone levels stay the same throughout the cycle. Triphasic means that the levels of estrogen and progestin change three times throughout the cycle. Extended-cycle oral contraceptives involve taking active hormone pills daily, with a pause for a withdrawal bleed only 1-4 times per year (8).
One study found that ulipristal acetate, known as the emergency contraception Ella, might be a promising treatment for PMDD (22). This was a small study of 95 women and the drug has not been approved to treat PMDD (22).
How Yaz affects people with PMDD or PMS
Yaz is the only hormonal birth control pill that’s FDA-approved to treat PMDD (3). Yaz is a monophasic pill and follows a 24/4 dosing, so there are 24 active hormone pills and 4 hormone-free “sugar pills” (8).
Here’s what the research says about Yaz and mood:
Yaz worked better than a placebo in improving PMDD mood symptoms (23).
In women with PMDD, Yaz reduced premenstrual negative emotions and food cravings (24,25).
Yaz improved premenstrual symptoms affecting work, relationships, and social activities in women with PMDD, compared to a placebo (25).
One review of Yaz studies found that although Yaz reduced premenstrual symptoms in women with PMDD, a high number of women who took a placebo pill also reported an improvement in their symptoms (26).
Of all of the hormonal birth control methods, Yaz has the most evidence supporting its use for improving PMS and PMDD symptoms.
How 21/7 monophasic and triphasic pills (Ortho-Cept, Nordette, Yasmin, Ocella) affect people with PMDD or PMS
Pills that use a 21/7 schedule mean that there are 21 days of hormone pills followed by 7 days of sugar pills.
Several studies in which participants knew they were receiving Yasmin—and not a placebo—found Yasmin to be effective for minor PMS symptoms (27,28). In another study, women who took Yasmin for three months showed significant improvement in PMS symptoms compared to calcium (which slightly improved symptoms) and placebo pills (which barely improved symptoms) (29).
For women with more severe PMDD, Yasmin provided a greater improvement in mood swings, anger, irritability, sensitivity, crying, anxiety, and depressed mood compared to a placebo pill (30). At the same time, almost half of the women in this study who took a placebo pill also experienced symptom improvement. One study in women with PMS compared monophasic (Ortho-Cept, Levlen) and a triphasic pill (Trivora), finding that the monophasic Ortho-Cept significantly decreased tension and irritability symptoms compared with Levlen or Trivora (31). Among the 21/7 pills, research suggests that Yasmin may improve PMS/PMDD symptoms.
How extended-cycle pills (Amethyst, Lybrel, Seasonique, LoSeasonique) affect people with PMDD or PMS
A review of four studies suggests that Amethyst and Lybrel may help with PMDD and PMS (32). These studies tested the drug continuously for at least three months (32). In another study, women with PMDD took this type of pill for four cycles with no hormone-free interval (33). They had an improvement in premenstrual depressive symptoms, anger, irritability, and physical symptoms like headaches, breast tenderness, bloating, and joint pain compared to women who took a placebo (33).
While more research is needed, the existing studies suggest that extended-cycle pills may be effective in reducing PMS and PMDD symptoms.
How progestin-only mini pills (ANora-Be (norethindrone), Slynd (drospirenone), and Opill (norgestrel) affect people with PMDD or PMS
Mini pills do not contain estrogen. The active ingredient in these pills is progestin, the synthetic version of the hormone progesterone (this just means the hormone is made in a lab instead of by your body). There isn’t much research specifically on these pills and mood, but there is some data to link progestin in birth control pills to negative mood side effects (7).
On the other hand, a medication called Brexanolone has been FDA-approved to treat postpartum depression. Brexanolone is a synthetic version of allopregnanolone, a substance that is made when the body breaks down progesterone (34). This isn’t the same as cycle-related mood changes, but it is currently the most relevant research. With this conflicting information, it’s hard to know exactly how the mini pill might affect an individual.
Other hormonal birth control options and PMDD
Here’s how the other types of hormonal contraception affect mood in people with PMS or PMDD:
How hormonal IUDs (Mirena) affect people with PMDD or PMS
Hormonal intrauterine devices (IUDs) work by releasing a progestin into the uterus to prevent pregnancy (8). Ovulation can still occur, but might not after a certain amount of time using the IUD (8). Most studies on birth control and PMDD focus on the pill. There have been very few studies on hormonal IUD’s impact on premenstrual mood symptoms, and none examining the use of hormonal IUDs, specifically in women with PMS / PMDD. More research is needed on how the IUD impacts PMDD, but here is some information from other studies that weren’t specific to PMDD.
There have been reports of women discontinuing the levonorgestrel IUD due to mood-related side effects (35). IUDs with the brand names Kyleena, LILETTA, Mirena, and Skyla all contain levonorgestrel. Generally, studies do not suggest associations between the levonorgestrel IUD and depression in healthy women (36). One study, which did not focus on women with PMS/PMDD, suggests that the hormonal IUD may make women more physiologically responsive to stress, both in the short and long term (37). Placebo-controlled studies of hormonal IUD impact on mood are needed, particularly for women with PMS or PMDD.
How the birth control shot affects people with PMDD or PMS
Depo-Provera is a shot administered every three months. It prevents ovulation and thickens cervical mucus to prevent pregnancy.
There have been mixed reports of mood-related symptoms with Depo-Provera, with some people experiencing a worsening and some remaining unchanged. These studies did not focus specifically on women with PMS or PMDD (38,39). Progestin-only birth control, like the Depo-Provera shot and the Mirena IUD, has been linked in the press to an increased risk of depression. The research does not show a clear link between progestin-only methods and depressive symptoms in healthy women (36). There haven’t been studies on how the Depo shot affects premenstrual mood symptoms in people with PMS or PMDD, but depression is listed as a possible side effect (40). More research is needed.
How the patch (Ortho Evra, Xulane) affects mood in people with PMDD or PMS
The contraceptive patch releases hormones through the skin for three weeks, followed by a hormone-free week in which a withdrawal bleed occurs. The synthetic hormones in the patch prevent ovulation.
In one study, adolescent women reported improvement in premenstrual mood symptoms on the patch—but this study was open-label—meaning that participants knew that they were receiving an active patch and not a placebo (41). There are no studies on the patch and mood symptoms specifically in women with PMS/PMDD, and more research is needed.
How the ring affects mood in people with PMDD or PMS
The NuvaRing is a hormonal vaginal ring that is inserted for three weeks and removed for one week to prevent ovulation and pregnancy.
In one study, women starting the ring experienced a reduction in PMS symptoms, but these women did not have severe or diagnosed PMS (42). There are no studies specifically on the contraceptive vaginal ring’s effect on premenstrual symptoms in women with PMS or PMDD.
More research is needed.
What should you do if you have PMDD and are considering hormonal birth control?
1. Communicate with your healthcare provider
Let your birth control provider know that you experience PMS or PMDD symptoms. The only hormonal birth control method that has been FDA-approved specifically for preventing pregnancy and treating PMS or PMDD is Yaz (23-26). That means your healthcare provider may prescribe this pill first.
2. If symptoms worsen, let your provider know
Evidence suggests that triphasic (Ortho Tri-Cyclen, Tri Sprintec) or biphasic pills (Mircette, Azurette) may affect mood symptoms more than monophasic pills (Ortho Cyclen, Sprintec) (31). If you try a tri- or biphasic pill and after several cycles, your premenstrual symptoms worsen, let your healthcare provider know.
3. Track your symptoms daily
If you have PMS or PMDD professionals recommend tracking your symptoms daily (43,44). If you start a new birth control method, track all of your symptoms and sensations—both body and mind—for two to three months to look for any changes. Tracking in Clue can be helpful. If you track your top five most bothersome symptoms for at least two months, this information can help your healthcare provider give the best birth control recommendations and medical advice for you (5,45).
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4. Be aware of interactions with other medications
Your treatment options may be influenced by other medications you are taking. Your mental health history should also be considered. If you’re taking an antidepressant to manage your PMS or PMDD symptoms, this could influence what your provider prescribes. If you’ve had major depression in the past, (whether you currently have PMS or PMDD or not) you may be more at risk for contraceptive-induced mood changes (15).
5. Seek help if you experience thoughts of self-harm or suicide
If you are experiencing severe symptoms such as suicidal ideation or thoughts of self-harm when starting or stopping a hormonal birth control method, let your healthcare provider know right away. You can also call or text 988 (in the USA) to reach a crisis counselor.
What other treatments may help with PMDD?
SSRIs and SNRIs: These antidepressants can help with PMDD symptoms. Serotonin, a neurotransmitter in these medications, can help regulate mood and behavior (3).
Gonadotropin-releasing hormone (GnRH) analogues: These drugs prevent ovulation. While taking these, people experience “medical menopause.” They are only used in severe cases of PMDD (3).
Cognitive behavioral therapy (CBT): This method of therapy for PMS and PMDD can help reframe negative thoughts and break irrational thought patterns (3).
Exercise: Running, pilates, and yoga are linked to improved PMS symptoms (3).
Calcium supplementation: ACOG suggests taking 1,000–1,200 mg of calcium per day to reduce both mind and body PMS symptoms (3).
Acupuncture: This can potentially reduce PMS by reducing pain and inflammation (3).
Vitex agnus castus (chasteberry): An herb that is believed to treat PMS. It may work by stimulating dopamine receptors, but the exact way it helps symptoms is still not totally understood (3).
Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications treat both pain and inflammation (3).
Bilateral oophorectomy: This surgery removes the ovaries. This is reserved as a last treatment option for people who have not found relief with any other treatment. It is irreversible (3).
FAQs
Why is Yaz used for PMDD?
Yaz is the only hormonal birth control pill that’s FDA-approved to treat PMDD (3). Out of all of the hormonal birth control methods, Yaz has the most evidence supporting its use for improving PMS/PMDD symptoms.
How do I balance my hormones for PMDD?
Hormonal birth control pills can change the hormonal balance in your body. They are believed to improve PMS and PMDD symptoms by preventing ovulation. One theory is that without ovulation, the ovaries do not produce the hormones that are linked to PMS and PMDD symptoms (3,43,45). On the other hand, hormonal birth control might make mood symptoms worse for some people (7). Talk to your healthcare provider who knows your specific circumstances and they can help you choose what’s right for you.
How do I choose the right PMDD treatment for me?
Choosing the right PMDD treatment is a big deal, and it’s not a decision you need to wade through all alone. Your OB/GYN, women’s health/reproductive health nurse practitioner, or midwife can help you dig through all the options to find out what is right for you. Before your healthcare provider visit, you can track your symptoms in the Clue app. ACOG recommends tracking your symptoms for at least two cycles to help your healthcare provider find the right treatment for you (5,43,44).
