PMS and the Pill

Medically Reviewed by Traci C. Johnson, MD on March 03, 2023
4 min read

Premenstrual syndrome (PMS) affects a good chunk of the world’s women. Up to 90% who are of childbearing age have symptoms at one time or another. But it has no cure, and there aren’t many relief methods that work across the board.

PMS is frustrating, both to women who suffer from it and researchers who study it. Doctors know that PMS is caused by the constantly changing hormone levels of the menstrual cycle. But they don’t have all the answers about exactly how this happens or why some women are more affected by PMS than others.

PMS has a large range of symptoms, including abdominal cramps, acne, and mood swings, and no two women have the same issues. Your own symptoms can vary from month to month, too. And there’s no one-size-fits-all treatment. What works for one woman’s cramps, headaches, and fatiguemight not help another woman at all.

But one treatment that’s been successful for many women is the hormone regulating pill, also known as the birth control pill. It turns out that the pill is good for a lot more than preventing pregnancies.

There are several hormones at work during your menstrual cycle, but the main ones are estrogen and progesterone. If you’re not on the pill, your body produces estrogen in the first half of your cycle:

Estrogen signals the uterine lining to grow and get ready for a possible fertilized egg. When estrogen is at its peak, one of your ovaries releases an egg.

Your body then adds progesterone to the mix, which stops the uterine lining growth. If there is no pregnancy, both hormones drop off, which starts the shedding of the lining – this is your period.

Most birth control pills (combination pills) contain synthetic versions of estrogen and progesterone, and they work by stopping ovulation. At first, the pill gives a steady dose of estrogen with no peak -- so there’s no signal for your ovaries to release an egg.

Then the pill starts delivering a fixed level of progesterone to stop the uterine lining from growing.

Finally, most pills have a week of placebos, which make hormone levels fall and your period start. It’s actually called withdrawal bleeding when you’re on the pill because it’s a reaction to the loss of hormones.

Because the pill delivers everything in steady doses, it can make your hormone levels more predictable and your period symptoms less unpleasant.

Taking the birth control pill can get rid of many unpleasant symptoms, including:

Irregular periods. Many women don’t have regular cycles. If you aren’t producing enough progesterone, for example, your cycle could be a few days longer. With the pill, there’s no more guessing when your period might start. It’ll be the same day every month.

Heavy periods. The progesterone in the pill thins out the uterine lining, making your periods lighter.

Cramps. This is the most common menstrual symptom. Cramps are caused by too much of the hormone prostaglandin, which makes the uterus contract. The pill can get rid of this issue.

Endometriosis. Birth control pills help control estrogen, which causes the buildup of endometrial tissue each month. It’s the pill’s exact dose of progesterone that helps reduce or even eliminate endometriosis, and the pain that comes with it.

Acne. Pimples that appear with your menstrual cycle are caused by androgens (male hormones). Again, the pill can get rid of this problem.

Mood swings, anxiety, and depression. Doctors aren’t quite sure how it happens, but the steady hormones in the pill can also lessen the emotional symptoms of PMS in some women.

Premenstrual dysphoric disorder (PMDD). A small number of women have this severe form of PMS. The combination birth control pill drospirenone and ethinyl estradiol (Yaz), has been shown to help with PMDD. Another combination pill used to treat this is drospirenone, ethinyl estradiol, and levomefolate (Beyaz), which has folic acid.

The most common form of the pill involves a week of placebos, which allows your uterine lining to come out (withdrawal bleeding). But you can stop withdrawal bleeding if you want to. This is called menstrual suppression, and it can also get rid of your period symptoms.

There are two ways to achieve menstrual suppression through the pill. You can stop taking the placebos, or you can change to a pill that works differently. Depending on what you take, you can have a period every month, every 3 months, once a year, or never.

You’ll have to talk with your doctor before starting the pill, changing the way you take it, or getting a new prescription. They will be able to tell you which oral contraceptive option will work best with your symptoms and your lifestyle.