Some people swear that hormonal birth control messes with their moods and causes premenstrual syndrome (PMS), while others report the opposite. So which is it?
For answers, we dug into the research and reached out to Nicole Williams, MD, a board certified gynecologic surgeon and the founder of the Gynecology Institute of Chicago.
According to Williams, hormonal birth control is more likely to help PMS than worsen it.
“Although I have many patients concerned that taking a hormonal pregnancy suppression medication will cause or worsen PMS or premenstrual dysphoric disorder (PMDD), exactly the opposite is true,” Williams says.
FYI, PMDD is a much more severe form of PMS that’s considered a chronic condition.
PMS is a combo of physical and emotional symptoms that some people experience before the start of their period.
Not everyone experiences PMS, but more than 90 percent of people who get periods report experiencing some PMS symptoms, according to the Office on Women’s Health.
The symptoms can range from mild to severe, and they usually go away after your period starts.
Physical symptoms may include:
- swollen or tender breasts
- bloating or feeling gassy
- changes in bowel movements
- low back pain
Emotional or mental symptoms may include:
Most of the research centers on oral contraceptives, but any type of hormonal birth control can potentially have an effect on mood and PMS symptoms.
“If [you’re] taking a hormonal medication that keeps estrogen and progesterone levels at a steady state, it’s far less likely that you’ll experience the massive shifts that happen naturally, causing PMS,” Williams says.
“In fact, there are some hormonal birth control pills that are made specifically to combat the symptoms of PMS,” she adds. “Technically, any birth control that maintains hormones in a steady state should help.”
The time between uses appears to be what does it, thanks to that dip in estrogen during your week off.
By “week off,” we’re talking about the week of placebo or sugar pills at the end of your pill pack or the week you don’t wear your birth control ring.
“PMS symptoms occur primarily when estrogen levels drop from their peak,” Williams says. “When you’re hormonally controlled, even during the placebo week, the drop is far less. So the symptoms are either very mild or nonexistent.”
“I do, however, have a few patients who choose to skip the placebo pills or ring-free week because their PMS symptoms are particularly severe,” she adds.
If you want to avoid the time off and subsequent estrogen nosedive, you could consider an extended or continuous dose birth control pill.
With extended or continuous cycle birth control, your hormone-free intervals would only happen 1 to 4 times per year.
No matter what the research says, if your symptoms flare up during your week off, it may be worth asking your prescribing doctor or another healthcare professional about extended or continuous dosing.
Most of the research points to combination birth control having a positive effect on PMS and PMDD symptoms. But if you have PMDD, Yaz is the only hormonal birth control pill that’s FDA approved to treat PMDD.
It’s also been shown to be as effective as selective serotonin reuptake inhibitors (SSRIs) in treating PMDD mood symptoms and more effective than SSRIs for physical symptoms. SSRIs are a type of drug mainly used to treat depression.
There’s no way to know for sure.
But hormonal birth control is considered to be more likely to help PMS symptoms than worsen them.
That said, everybody’s different. Some people find that some symptoms get better while others get worse. With so many methods and brands to choose from, you can probably find an option that works for you with a little trial and error.
Being upfront with your prescribing doctor or another healthcare professional about your concerns and symptoms can help narrow down your options.
Tracking your symptoms will help you figure it out. You can try:
- writing them down in a journal
- tracking them with an app
- using a printable tracker (like this one from the International Association For Premenstrual Disorders)
Keeping a record of your symptoms can help you and your healthcare professional spot patterns that can pinpoint or rule out your birth control as the culprit.
There’s lots you can do!
You might not be able to cure PMS, but you might be able to manage your symptoms with a few lifestyle tweaks and over-the-counter (OTC) treatments.
If you haven’t tried them already, one or more of the following might help:
- Eat a balanced diet. The cravings for all the sweets and salty snacks are real, but opting for whole foods and hydrating beverages in the 2 weeks leading up to your period can help. Cut back on caffeine, salt, sugar, and starchy carbs to help with bloating and tummy issues. This can also improve energy levels, mood, and sleep.
- Get 7 to 8 hours of sleep. Getting enough sleep can help with PMS-related fatigue. It may also help reduce feelings of anxiety and depression, since lack of sleep can exacerbate both.
- Take supplements. Certain supplements can help reduce cramps, mood swings, and cravings. Some of these include folic acid, vitamin B6, calcium, and magnesium.
- Get regular exercise. Ugh, right? Exercise might be the last thing you feel like doing while in PMS hell, but it may help with your symptoms: from improving your mood and sleep, to helping with cramps, water retention, and digestion. It might even perk up your libido, according to some research, thankyouverymuch.
- Take an OTC pain reliever. Ibuprofen, acetaminophen, and aspirin can help relieve cramps, muscle aches, and headache.
- Drink water. Sounds counterproductive, but drinking more water can help with bloating and fluid retention. It can also help you avoid dehydration, which can cause headaches and make you feel pretty lousy overall.
- Limit or consider quitting smoking. Smoking and hormonal contraceptives don’t mix to begin with. Turns out, it can also worsen or cause PMS. Talk with a healthcare professional for help.
Birth control is mostly well tolerated. Even though side effects can happen, they’re generally mild. They tend to resolve within 2 to 3 months once your body adjusts to the hormones.
The side effects you might notice after starting hormonal birth control include:
- sore breasts
- changes to your period flow or schedule
Most symptoms are mild enough that you may be able to ride them out or manage them with treatment at home, including taking ginger or dimenhydrinate (Gravol) for nausea and OTC pain relievers for headaches.
Birth control shouldn’t make you sick or interfere with your ability to function. If you find the side effects disruptive, talk with a healthcare professional.
It might! People report different reactions to different birth control methods. Trying a method with a different hormone dose, combination, or schedule might do the trick.
If that’s what you want, then you’ve got a few nonhormonal birth control options to choose from.
Barrier methods protect against pregnancy by creating a barrier — obviously — between the penis and vagina. This stops sperm from getting into the uterus and making contact with an egg. No sperm-to-egg contact = no pregnancy.
If you want to switch to a barrier method, these are your options:
Barrier methods aren’t as effective as hormonal methods, but they’re still great options when used correctly. Plus, you can double-up barriers for extra protection. No, we don’t mean wearing two condoms at once. Think: condoms plus spermicide.
If you’re ready for a permanent solution, talk with a healthcare professional about tubal ligation or vasectomy.
Hormonal birth control is more likely to help PMS symptoms than make them worse, but that’s not the case for everyone.
If you’re worried about birth control making your symptoms worse, you have other options. Talk with a healthcare professional to find the best fit.
Adrienne Santos-Longhurst is a Canada-based freelance writer and author who has written extensively on all things health and lifestyle for more than a decade. When she’s not holed-up in her writing shed researching an article or off interviewing health professionals, she can be found frolicking around her beach town with husband and dogs in tow or splashing about the lake trying to master the stand-up paddle board.