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 essential features of PMDD according to the Diagnostic and Statistical Manual-4th edition (DSM-IV) include markedly depressed mood, anxiety or tension, affective lability, and persistent anger or irritability Drospirenone and ethinyl estradiol tablets are indicated for use by females of reproductive potential to prevent pregnancy.
The best birth control for a patient with mood lability and dysmenorrhea is drospirenone and ethinyl estradiol tablets because it is indicated for the treatment of symptoms of premenstrual dysphoric disorder (PMDD), which includes mood lability, and can help prevent pregnancy. However, the label does not directly address dysmenorrhea. Key points to consider:
- Contraindications: Women over 35 years of age who smoke should not use this medication.
- Dosage and administration: Take one tablet by mouth at the same time every day.
- Effectiveness: The medication must be taken exactly as directed to achieve maximum contraceptive and PMDD effectiveness 1.
From the Research
For a patient with mood lability and dysmenorrhea, a monophasic combined oral contraceptive pill containing drospirenone, such as Yaz, is the best option. This is because drospirenone has anti-androgenic and anti-mineralocorticoid properties that can help stabilize mood and reduce premenstrual symptoms, as shown in a study published in 2012 2. The standard regimen involves taking one pill daily for 21 days followed by 7 placebo days, though extended or continuous cycling (skipping the placebo pills) can further reduce dysmenorrhea by minimizing menstrual periods.
Some key points to consider when prescribing this medication include:
- The estrogen component helps stabilize the endometrium, while the progestin prevents ovulation and provides cycle control.
- Side effects may include nausea, breast tenderness, and headaches, which typically resolve after 2-3 months of use, as noted in a study from 2008 3.
- Contraindications include history of thromboembolism, uncontrolled hypertension, migraines with aura, and certain liver conditions, so a thorough medical history is essential before prescribing.
- A 24/4 regimen of drospirenone 3 mg and ethinyl estradiol 20 μg has been shown to improve symptoms associated with premenstrual dysphoric disorder, as demonstrated in a study published in 2005 4.
- Drospirenone/ethinylestradiol 3mg/20microg (24/4) is also approved for the treatment of moderate acne vulgaris in women who wish to use an oral contraceptive for contraception, as stated in a review from 2007 5.
Overall, the benefits of using a monophasic combined oral contraceptive pill containing drospirenone for a patient with mood lability and dysmenorrhea outweigh the risks, making it a suitable treatment option.