Here are some key points to remember:

• Mood symptoms (irritability, moodiness, anxiety) that occur during PMS and PMDD (premenstrual dysphoric disorder) are believed to be caused by fluctuations in hormone levels.
• Some people find that taking hormonal birth control improves their mood, while others find that it worsens their mood.
• Yaz is the only hormonal birth control that has been approved by the FDA for both preventing pregnancy and treating PMS and PMDD.

How hormone fluctuations affect your mood

Individuals who have been diagnosed with PMS or PMDD may be sensitive to changes in hormones such as progesterone and estrogen, which are produced by the ovaries and are also present in synthetic form in hormonal birth control. These hormones, produced by the ovaries, are known as "neuroactive steroids" because they can affect the brain and mood.

If you don’t experience ovulation, cyclical mood symptoms do not happen

People with PMDD experience mood symptoms during normal menstrual cycles, but if they have an anovulatory cycle (a cycle in which ovulation does not occur), their hormone levels do not fluctuate, and their PMDD symptoms resolve.

Hormonal birth control pills

Most hormonal birth control pills prevent ovulation, which can improve PMS/PMDD symptoms by preventing ovulation-related hormone fluctuations. Some people who take the pill have a hormone-free interval (a week or so of "sugar pills") which can cause a sudden drop in hormones from the active pill weeks to the sugar pill week. This sudden change in hormone levels may worsen PMS/PMDD symptoms in people who are sensitive to hormone fluctuations.

Some people report that hormonal birth control improves their mood symptoms, while others say it worsens them. In one study, 16.3% of women reported that the birth control pill worsened their mood premenstrually, compared to 12.3% who said it improved their mood. A study in 2016 found that women who filled prescriptions for hormonal birth control were more likely to later fill prescriptions for antidepressants or receive a diagnosis of depression, but this does not prove that the birth control caused the antidepressant use or depression diagnosis. Another study of women with severe PMS found that those who used hormonal birth control had less severe premenstrual depression, anger, and irritability compared to those who did not use hormonal birth control.

What is the best hormonal birth control pill?

There is evidence to suggest that different types of hormonal birth control may affect mood in different ways in people with PMS or PMDD. Yaz is a monophasic birth control pill that follows a 24/4 dosing scheme, meaning that there are 24 active hormone pills and 4 hormone-free "sugar pills." Research has shown that Yaz is effective in improving PMDD mood symptoms and reducing premenstrual negative emotions and food cravings in women with PMDD. It has also been shown to improve premenstrual symptoms affecting work, relationships, and social activities in women with PMDD compared to a placebo.

However, one review of Yaz studies found that while it reduced premenstrual symptoms in women with PMDD, a high number of women who took a placebo pill also reported an improvement in their symptoms. Among the 21/7 pills, Yasmin may be effective in improving PMS/PMDD symptoms. Studies have shown that Yasmin is effective in improving minor PMS symptoms and providing a greater improvement in mood swings, anger, irritability, sensitivity, crying, anxiety, and depressed mood in women with PMDD compared to a placebo. However, 43% of women in one study who took a placebo pill also experienced symptom improvement.

Extended-cycle pills like Amethyst or Lybrel, which are taken daily with a hormone-free interval only 1-4 times per year, may also be effective in reducing PMS/PMDD symptoms. A review of four studies of Amethyst/Lybrel taken continuously for at least three months suggests that these types of extended-cycle oral contraceptives may reduce symptoms of PMDD and PMS. Women with PMDD who took these pills for four cycles had an improvement in premenstrual depressive symptoms, anger, irritability, and physical symptoms compared to women who took a placebo. However, more research is needed to confirm these findings.

What causes mood changes?

It is difficult to determine whether the mood changes associated with hormonal birth control are caused by the hormones themselves or the length of time that placebo pills are taken. One study attempted to examine the role of the hormone-free interval in premenstrual mood changes by keeping the type and amount of hormones constant while varying the length of time without hormones. The researchers tested Yaz taken in a 21/7 schedule or a continuous schedule (no hormone-free break) compared to a placebo pill and found no difference in the effect on mood symptoms between the different options. This suggests that it may be the length of time without hormones rather than the type of hormones that affects mood changes.

There have been few studies on how hormonal IUDs affect premenstrual mood symptoms, and none have specifically examined the impact in women with PMS or PMDD. Research suggests that the levonorgestrel IUD may make women more physiologically responsive to stress, but further placebo-controlled studies, particularly in women with PMS or PMDD, are needed. The Depo-Provera shot has not been studied in relation to premenstrual mood symptoms in people with PMS or PMDD, and the patch and ring have only been studied in women without severe PMS or PMDD, with mixed results. More research is needed to determine the impact of these birth control methods on mood in women with PMS or PMDD.

What to do if you have PMS or PMDD and are considering hormonal birth control

If you have PMS or PMDD, it is important to communicate with your healthcare provider about your symptoms and any concerns you have about starting or continuing to use hormonal birth control. You may want to consider trying Yaz, which has been FDA-approved specifically for preventing pregnancy and treating PMS or PMDD. If you experience worsening symptoms while taking a triphasic or biphasic pill, let your healthcare provider know. It is also helpful to track your symptoms daily using a tool such as the Daily Record of Severity of Problems. Keep in mind that other medications you are taking or your mental health history may also affect treatment options. If you experience thoughts of self-harm or suicide while using hormonal birth control, it is important to seek help immediately.