Yaz For PMS And PMDD Treatment

There are not a few people who repeatedly experience changes each month, for several days before menstruation, of feeling low, growing sensitive, and the body swelling and feeling heavy. In the clinic, many come having endured it, thinking "isn't this just how it is for everyone?" But if the severity of symptoms is such that it disrupts daily life, this may not be a simple off day but a condition described under the name premenstrual syndrome. In this article, from the perspective of an OB/GYN specialist, I will summarize what premenstrual syndrome and premenstrual dysphoric disorder are, and by what principle Yaz, a combined oral contraceptive containing the ingredient drospirenone, is used for symptom control.

Premenstrual syndrome refers to a condition in which emotional and physical symptoms appearing from several days before menstruation recur to a degree that affects daily life. Symptoms usually begin around 7 to 10 days before menstruation starts and tend to subside as menstruation begins, and because of this cyclical pattern they are understood to be related to hormonal changes after ovulation.

The interesting point is that no clear difference is found in the measured hormone concentrations themselves between women who have premenstrual syndrome and those who do not. In other words, it appears that symptoms are governed not by hormones being abnormally high or low, but by differences in the sensitivity of our body and brain to hormonal fluctuations within the normal range. According to the 2023 clinical practice guideline of the American College of Obstetricians and Gynecologists (ACOG), premenstrual syndrome is not uncommonly experienced in women of reproductive age, and some of them are reported to have symptoms severe enough to clearly disrupt daily life.

The burden that premenstrual syndrome and menstruation-related symptoms place on life feels, in lived experience, far greater than what statistics show. Synthesizing society reports, it appears that a not insignificant number of women are affected at a moderate or greater level in daily activities such as home life and work around menstruation.

Let us think about it simply. If your condition collapses for several days each month, converted to a yearly basis it amounts to dozens of days during which you cannot move as much as your usual self. For those in a fiercely competitive workplace, or carrying several roles at once at home, or preparing for studies and exams, this much time is by no means short. Moreover, women experience menstruation over several decades across their lives.

In the clinic, it is common to see people struggling with studies and life due to premenstrual symptoms already from adolescence, and even as adults a considerable number live carrying similar discomfort. If the pain requires painkillers and makes daily functioning difficult, it is better to take it as a signal that enduring is not a virtue and a check-up is needed once. If menstrual pain or irregular periods recur, please refer to the menstrual pain and irregularity care guide.

Premenstrual dysphoric disorder (PMDD) is the most severe form of premenstrual syndrome, in which premenstrual symptoms cause serious impairment of daily life. The core lies in emotional symptoms rather than physical ones, with changes such as marked low mood, anxiety, tension, nervous irritability, and anger standing out, and it is also associated with depressive and anxiety disorders.

ACOG points out that premenstrual dysphoric disorder is not infrequently underrated or missed in diagnosis. For diagnosis, rather than merely recalling symptoms, it is recommended to directly record, over at least two menstrual cycles, when symptoms appear and disappear. Only by confirming the link between cycle and symptoms in this way can it be distinguished from other emotional disorders and an appropriate treatment direction be decided.

If symptoms feel emotionally severe, it is safer to consult a specialist than to judge alone. Get a consultation on premenstrual symptoms

Yaz is a combined oral contraceptive containing ethinylestradiol 0.02mg and drospirenone 3.0mg. The U.S. Food and Drug Administration (FDA) recognizes an indication for the treatment of premenstrual dysphoric disorder symptoms in women who want contraception, and there is an important premise here. Yaz is an option intended for those who also want contraception; it is not approved as a standalone treatment for premenstrual dysphoric disorder alone.

Looking at its mechanism of action, there are several characteristics.

• Ovulation suppression: Nearly all oral contraceptives suppress ovulation and are used for premenstrual symptom control. However, depending on the progestin ingredient contained, the effect on sensitivity or neurotransmitters can differ, so the choice of ingredient is important.
• Anti-mineralocorticoid action: Drospirenone blocks the action of aldosterone in the kidneys, reducing the retention of water and sodium in the body. This may ease swelling or related discomfort.
• Anti-androgenic action: It has the property of reducing the influence of male hormones, acting in a direction that partly offsets the negative effects related to progesterone sensitivity.

These ingredient differences between drugs are also covered in the article on milder single-ingredient birth control pills, so looking at it together helps understanding.

Yaz uses a 24/4 regimen in which, out of a 28-day pack, active hormone tablets are taken for 24 days and placebo for the remaining 4 days. Compared with the past 21/7 regimen, the key is that the hormone-free interval is shorter.

The longer the hormone-free interval, the more the blood estradiol concentration fluctuates greatly during that time, and such fluctuation can lead to discomfort such as premenstrual symptoms or headache. The 24/4 regimen, with a reduced hormone-free interval, is designed to keep the range of hormone concentration fluctuation relatively small, and is reported to have fewer fluctuation-related symptoms. In a condition like premenstrual dysphoric disorder where emotional symptoms cyclically worsen, this point can carry meaning.

In clinical experience, some people say that even with the same ingredient, a different regimen changes the sense of stability they feel. However, since there is individual variation in this, it is advisable to decide the drug and regimen that suit you through a medical consultation.

International evidence reviews have been carried out on the efficacy of drospirenone-containing oral contraceptives. The Cochrane systematic review updated in 2023, synthesizing several clinical trials in which most of the included participants had premenstrual dysphoric disorder, reported that drospirenone-containing contraceptives have an effect in the direction of improving symptom response compared with placebo. However, the certainty of this evidence was rated from low to moderate, and there may be individual variation in the degree of effect.

The society lecture cited in the original article also introduced that Yaz improves emotional and physical symptoms, and that core emotional symptoms gradually improved over several cycles after medication. Taken together, Yaz can be summarized as having established itself as one of the options that may help with premenstrual dysphoric disorder symptom control.

At the same time, the same Cochrane review also points out that drospirenone-containing contraceptives were reported to have more adverse reactions such as breast pain, nausea, and breakthrough bleeding than placebo. This means it is a drug whose effect and discomfort must be weighed together.

Although Yaz is an option that may help with premenstrual syndrome and premenstrual dysphoric disorder, it is by no means the only method. ACOG's 2023 clinical practice guideline presents an approach of starting from lifestyle adjustment and, as needed, stepwise applying selective serotonin reuptake inhibitors (SSRIs), oral contraceptives, cognitive behavioral therapy, and so on, considering additional drug treatment only in very severe cases. Even with the same diagnosis, which treatment suits well differs from person to person, so a process of reviewing several methods together is needed.

Also, every drug has points to consider. For combined oral contraceptives including drospirenone, sufficient prior evaluation is recommended in relation to rare but caution-requiring risks such as venous thromboembolism. Since suitability differs according to individual status such as smoking, age, history of thrombosis, and high blood pressure, before starting, please refer to the need for consultation on contraceptive pills and clot risk and be sure to discuss with your attending physician. The choice of contraceptive pill in cases of high blood pressure is covered separately in choosing oral contraceptives when you have high blood pressure.

If you are struggling with daily and working life due to premenstrual symptoms, rather than starting a drug by self-diagnosis, we recommend finding together the direction suited to your symptoms and health status at the pregnancy and contraception clinic. Spending the few days that recur each month more comfortably is a matter well worth checking. Check the method that suits you through a consultation.

Written by: Lee Dong-hee, Director · OB/GYN Specialist · View physician profile

First published November 26, 2023 · Last reviewed May 30, 2026

References: ACOG Clinical Practice Guideline, Management of Premenstrual Disorders (2023), U.S. FDA YAZ Prescribing Information (drospirenone and ethinyl estradiol), Cochrane Database of Systematic Reviews, Oral contraceptives containing drospirenone for premenstrual syndrome (2023)

This article is intended to provide general health information and is not a substitute for individual diagnosis or treatment. If you have symptoms, please consult through a medical visit.