Does the pill help with PMS?
Reviewed by our clinical team
Premenstrual syndrome (PMS), also known as premenstrual tension (PMT) is the name for a collection of distressing symptoms that occurs in women in the days leading up to their period,
Women with PMS might experience a range of symptoms, including mood swings, anxiety, irritability and food cravings, as well as physical symptoms such as nausea, headaches, bloating or breast tenderness, as well as physical symptoms such as bloating and tenderness.
It's thought that for some women, the combined contraceptive pill can help minimise the symptoms of PMS, and many women use it to not only prevent pregnancy but also to help with PMS.
Why does PMS happen?
We don’t know for sure what causes PMS, but it is thought to be triggered by changing hormone levels between ovulation and the onset of your period (the so-called luteal phase).
According to the National Association for Premenstrual Syndromes, up to 30% of women might experience moderate to severe PMS at some point during their their lifetime, with up to 5% experiencing severe PMS symptoms.
PMS isn’t believed to be caused by an imbalance of hormones but rather increased sensitivity to rapidly changing levels of hormones like progesterone.
Your natural cycle
During the monthly cycle your body produces several different hormones, but the main hormones responsible for PMS symptoms seem to be oestrogen and progesterone.
During a normal menstrual cycle your oestrogen level starts to rise after your period until it peaks, triggering ovulation- the release of an egg from the ovary. After ovulation, the oestrogen level falls quite rapidly.
Once ovulation has taken place, progesterone levels continue to rise. Progesterone stimulates the growth of the lining of the womb (endometrium), to prepare for pregnancy. If no pregnancy occurs, your progesterone level falls back to baseline and the cycle starts again.
It’s thought that if you have a sensitivity to these changing hormone levels, you’re more likely to experience PMS.
Your cycle on the pill
When taking the combined contraceptive pill, your cycle changes. The combined pill contains synthetic versions of both oestrogen and progesterone and works by giving you a steady dose of oestrogen with no peak, meaning your ovaries do not release an egg.
The pill also releases a fixed level of progesterone, stopping the lining of the womb from growing. During the pill free week your hormone levels drop, which triggers your period. This isn't actually a normal period - it is a so- called "withdrawal bleed".
It’s thought to be this steady release of synthetic hormones that minimises the likelihood and symptoms of PMS.
What are the symptoms of PMS?
Everyone is different, and not every woman will experience the same symptoms of PMS. Some of the most common symptoms include:
Mood swings
You might feel fine one minute, and then very angry or sad the next.
Feeling upset/anxious
You might find yourself becoming upset about trivial things, or feel a constant sense of anxiety or unease.
Tiredness
Changing hormone levels can cause you to feel tired or run down.
Bloating
Some people feel quite bloated in the week(s) leading up to their period, particularly if they suffer from IBS as well.
Headaches
You might experience headaches due to the changing hormone levels and/or increased stress/tension levels.
Acne
Changing hormone levels are a big contributor to acne in women, and you might experience breakouts alongside PMS.
Other symptoms of PMS include:
- Tender breasts
- Tummy pain
- Greasy skin
- Sleep issues
- Changes in appetite
- Changes in sex drive
What is the difference between PMS and PMDD?
Premenstrual dysphoric disorder, or PMDD, is a much more severe form of PMS. PMDD is a chronic disorder that often has to be managed with medication and lifestyle changes.
The symptoms of PMDD are similar to PMS but much more severe, having a significant impact on your overall health, wellbeing and ability to cope and get on with your life.
You’re more at risk of PMDD if you have a family history of PMS, PMDD, depression, post-partum depression, or other mood disorders. Smoking could also be a factor.
PMDD can sometimes be misdiagnosed as other illnesses, such as thyroid conditions, depression, or anxiety disorders. Symptoms can worsen over time, so it’s important to speak to your doctor if you suspect you might have PMDD.
Treatments include anti-depressants (specifically SSRIs) and birth control. Lifestyle changes and dietary adjustments can also help.
How does the pill help with PMS?
If you’re experiencing PMS often, or the symptoms are severe, your doctor might recommend the combined contraceptive pill as treatment.
Although we don’t know the exact cause of PMS, it’s thought that it’s due to a sensitivity to changing hormone levels during your period. Birth control helps by steadying your levels of the hormones oestrogen and progesterone, and flattening the ‘peaks’ for those who are sensitive to these hormones.
Your doctor or pharmacist will recommend the best pill for you based on your circumstances. Progesterone-only pills, also known as POP pills or the mini-pill, are not thought to be effective in treating PMS and might make symptoms worse.
Can you still get PMS on birth control?
Yes, it’s still possible to get PMS on birth control. Although many women find that symptoms improve while on the pill, others find that their symptoms stay the same or even get worse.
This can be dependent on the type of pill you’re taking and the hormones it contains: trying a different pill might help, but you should try each pill for a minimum of three months before switching.
Does birth control stop your period?
As birth control pills work by preventing your body from releasing an egg and shedding the lining of your uterus, most women don’t experience a period whilst taking the tablets.
However, it’s usually recommended that you take a break every 21 days, either taking no pills or taking placebo (dummy) pills. This leads to a drop in hormone levels, and your body responds with a ‘withdrawal bleed’. This bleeding is an artificial response to the drop in hormones and does not necessarily mean you are not pregnant.
It is possible to take the pills back to back, without a withdrawal period, which will entirely prevent bleeding. This is completely safe and a preferred option for many women.
Which contraceptive pill is best for PMS?
There are a number of different combined contraceptive pills available, coming in different strengths and hormone mixes which might have a different impact on PMS symptoms.
Combined contraceptive pills are sold under different brand names, and you should seek out the advice of a doctor or GP to find the best one for your needs.
The most commonly used combined contraceptive pills are:
If the pill you are taking is not effective at reducing the symptoms of your PMS, you can switch to a different brand. However, it’s recommended that you take each pill for at least three months to see the results.
The mini pill is not recommended to treat PMS as increased progesterone levels can make the symptoms of PMS worse.
Other, non-hormonal treatments for PMS include lifestyle changes, antidepressants (SSRIs) and a certain kind of diuretic (water tablet) called Spironolactone. this might help with water retention, bloating and acne.
Conclusion
PMS can be quite distressing and have a negative impact on your wellbeing and on the people around you. If your symptoms don't improve with lifestyle and dietary changes you should speak to a doctor to identify the best course of action for you.
The contraceptive pill can be very effective at reducing the symptoms of PMS, and these pills are available from LloydsPharmacy Online Doctor after a quick online consultation with one of our online doctors.
References
https://www.pms.org.uk/about-pms/
https://www.nhs.uk/conditions/pre-menstrual-syndrome/
https://www.hopkinsmedicine.org/health/conditions-and-diseases/premenstrual-dysphoric-disorder-pmdd
https://www.pms.org.uk/members-library/contraception-and-the-pms-sufferer/
https://www.letstalkaboutit.nhs.uk/media/whrl3ibq/continuous-combined-pill-taking.pdf
https://www.rcog.org.uk/for-the-public/browse-all-patient-information-leaflets/managing-premenstrual-syndrome-pms-patient-information-leaflet
https://www.mind.org.uk/information-support/types-of-mental-health-problems/premenstrual-dysphoric-disorder-pmdd/about-pmdd/
