Premenstrual Syndrome - Therapy

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The birth control pill, Yaz, is approved specifically for treatment of premenstrual dysmorphic disorder (PMDD). Yaz is a low-dose birth control pill that combines the estrogen estradiol with a newer type of progestin called drospirenone. This type of progestin is related to spironolactone, a diuretic. Yaz uses a 24-day dosing regimen (24 days active pills, 4 days placebo pills).

Newer “continuous-dosing” (also called “continuous-use”) oral contraceptives aim to reduce -- or even eliminate -- monthly periods and thereby prevent the pain and discomfort that often accompanies menstruation. These OCs contain a combination of estradiol and the progesterone levonorgestrel, but use extending dosing of active pills. Examples of these include:

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• Seasonale, the first continuous-dosing contraceptive, contains 81 days of active pills followed by 7 days of inactive pills. Women who take Seasonale have on average a period every 3 months.
• Seasonique produces about 4 periods a year. With Seasonique, a woman takes 84 days of levonorgestrol-estradiol pills followed by 7 days of pills that contain only low-dose estradiol.
• Lybrel, which supplies a daily low dose of levonorgestrol and estradiol, contains no inactive pills. Because Lybrel contains only active pills, which are taken 365 days a year, it completely eliminates monthly menstrual periods in about 60% of women by the end of the first year. Some women, however, experience occasional unscheduled bleeding or spotting during the first 3 - 6 months. In clinical trials, women who took Lybrel experienced relief of PMS symptoms within a month of starting the drug.

Side effects of OCs include nausea, breakthrough bleeding, breast tenderness, headache (which may worsen in smokers or women with with a history of migraine), and weight gain. Women who smoke, or who are at risk for blood clots or stroke, should avoid oral contraceptives or use them with caution. Drospirenone, the progestin contained in Yaz, can increase potassium levels and should not be used by women with kidney, liver, or adrenal disease.