Treating PMS With the Pill

Oral Contraceptive May Relieve Wide Range of Symptoms

By Salynn Boyles
WebMD Health News

Feb. 27, 2003 -- From weight gain to breast tenderness to the munchies, most women who menstruate experience some premenstrual symptoms at some point in their lives. Surveys suggest that nine out of 10 have at least one cycle-related symptom each month, with up to 10% meeting the definition for premenstrual syndrome (PMS).

Now early research suggests that a popular birth control pill that uses a new type of hormone may effectively treat PMS symptoms. Women taking the pill for contraception reported significant reductions in both physical and depressive symptoms prior to menstruation in a study published in the latest issue of the Journal of Reproductive Medicine.

The two-year-old pill, known by the trade name Yasmin, is the first to use the progestin drospirenone, which is believed to have diuretic properties because it is similar in structure to a water pill called spironolactone. While it is not approved for the treatment of PMS, women may be choosing it as their contraceptive for this reason.

Other oral contraceptives have been shown to provide PMS relief and have been prescribed for that "off-label" purpose for years.

In the manufacturer-funded study, more than 800 women who were taking Yasmin were surveyed about their premenstrual symptoms. A total of 72% reported suffering from PMS, although they had not been clinically diagnosed with the condition. During the month before entry into the study, half of the women reported that they were treating their symptoms with over-the-counter, prescription or alternative medicines.

Prior to taking the contraceptive 30% of the women reported that PMS affected their daily activities, but that figure dropped to 16% for those on the pill. The number of women reporting that PMS affected their general well-being also dropped, from 35% prior to taking the birth control pill to 21% while on it.

Positive effects on weight gain, breast swelling, anxiety, restlessness, food cravings, irritability, depression, and other symptoms of PMS were reported for both women who had not taken oral contraceptives prior to taking Yasmin and those who switched from another birth control pill.

Researcher Andrea Rapkin, MD, of the UCLA School of Medicine, acknowledges that the study is far from definitive, and that the outcome could easily have been influenced by the fact that the women most likely had been told Yasmin might relieve their PMS symptoms.

"You certainly can't rule out the placebo effect here," she tells WebMD. "But it is interesting that even women who had used another form of oral contraceptive reported a very positive experience with the drospirenone-containing pill."

Studies are currently under way to determine if Yasmin is effective against the most severe form of PMS, known as premenstrual dysphorric disorder (PMDD). A diagnosis of PMDD is made if at least five out of 10 symptoms and one core symptom are present, including depressed mood, anxiety, tension and emotional liability. If this research is positive the manufacturer hopes to win FDA approval to allow it to market the drug as a treatment for premenstrual symptoms.

PMS expert Raphael S. Good, MD, tells WebMD that there are already many good treatments for individual premenstrual symptoms, but he remains skeptical that a single drug can effectively treat all symptoms. Good is a professor of ob-gyn and psychiatry at South Florida's University of Miami School of Medicine.

"You have to deal with each patient individually because symptoms vary greatly from woman to woman," he tells WebMD. "And although antidepressants and anti-anxiety drugs are very good for some symptoms, teaching a woman how to recognize stressful events in her life and avoid them, if possible, is also important."

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