From the FDA Drug Label
Drospirenone and ethinyl estradiol tablets are also indicated for the treatment of symptoms of premenstrual dysphoric disorder (PMDD) in females of reproductive potential who choose to use an oral contraceptive as their method of contraception The effectiveness of drospirenone and ethinyl estradiol tablets for PMDD when used for more than three menstrual cycles has not been evaluated.
The role of oral contraceptive pills (OCPs), specifically drospirenone and ethinyl estradiol tablets, in the management of premenstrual dysphoric disorder (PMDD) is for the treatment of symptoms in females of reproductive potential who choose to use an oral contraceptive as their method of contraception 1.
- The effectiveness of drospirenone and ethinyl estradiol tablets for PMDD has been evaluated for up to three menstrual cycles.
- Key symptoms of PMDD that may be treated with drospirenone and ethinyl estradiol tablets include:
- Markedly depressed mood
- Anxiety or tension
- Affective lability
- Persistent anger or irritability
- Physical symptoms such as breast tenderness, headache, joint and muscle pain, bloating, and weight gain.
From the Research
Oral contraceptive pills (OCPs) containing drospirenone are a recommended treatment option for premenstrual dysphoric disorder (PMDD), as they have been shown to improve emotional and physical symptoms. The most effective OCPs for PMDD contain drospirenone, such as Yaz or Yasmin, which combine 3 mg drospirenone with 20-30 mcg ethinyl estradiol 2. These should be taken daily for 24 active days followed by 4 placebo days per cycle. Some patients may benefit from continuous use (skipping placebo pills) to avoid hormone fluctuations entirely.
Key Considerations
- Treatment typically requires at least 2-3 months to achieve full effectiveness, and patients should continue for at least 6-12 months before considering discontinuation.
- Drospirenone-containing OCPs work particularly well for PMDD because drospirenone has anti-androgenic and anti-mineralocorticoid properties that help reduce bloating, mood swings, and irritability.
- These OCPs stabilize hormone levels throughout the menstrual cycle, which helps prevent the dramatic fluctuations that trigger PMDD symptoms.
- Side effects may include breakthrough bleeding, breast tenderness, nausea, and headaches, which typically improve after 2-3 months.
Contraindications and Precautions
- OCPs are contraindicated in women with certain conditions, including history of blood clots, stroke, certain types of migraines, liver disease, or smokers over 35 years old.
- Careful counseling and close follow-up are recommended for patients with PMDD seeking these contraceptive methods, especially those with a history of mood disorders 3.
Evidence Summary
The evidence from recent studies, including a 2024 literature review 4 and a 2023 systematic review 2, supports the use of drospirenone-containing OCPs for the treatment of PMDD. These studies demonstrate the effectiveness of drospirenone in reducing premenstrual symptoms, including mood swings, bloating, and irritability. However, it is essential to weigh the benefits against the potential risks and side effects, and to carefully select patients who are suitable for this treatment option.