Treatment for PMDD (Premenstrual Dysphoric Disorder), Drospirenone containing oral contraceptives

What is PMDD?

Premenstrual Dysphoric Disorder (PMDD) is a severe form of premenstrual syndrome (PMS), affecting around 3–8% of women and people assigned female at birth of reproductive age.

It typically causes significant emotional and physical symptoms in the luteal phase (5-14 days before your period), including:

• Low mood or depression

• Irritability or anger

• Anxiety or tension

• Fatigue

• Poor concentration

• Sleep disturbance

• Physical symptoms such as bloating, breast tenderness, headaches, joint pain

Symptoms ease after your period starts and are absent in the first half of the cycle.

Kate Organ, PMDD Specialist

What is a drospirenone oral contraceptive for PMDD treatment

Eloine is a combined oral contraceptive pill (COCP) that contains:

• Ethinylestradiol 20 micrograms (low-dose oestrogen)

• Drospirenone 3 milligrams (a modern progestogen with mild anti-androgenic and anti-mineralocorticoid properties)

Eloine is licensed in the UK as a form of contraception but is commonly used in PMDD.

It works by stabilising hormone fluctuations across the cycle — helping to reduce the mood and physical symptoms associated with PMDD.

Evidence for Eloine in PMDD

• Freeman et al, 2001 (randomised trial): demonstrated significant symptom reduction in PMDD with drospirenone-containing COC

• Yonkers et al, 2005: drospirenone + ethinylestradiol significantly reduced core PMDD symptoms

• Cochrane Review, 2012: COCPs with drospirenone and low-dose oestrogen were the most effective for PMDD

• British Menopause Society and FSRH guidelines: recommend drospirenone-containing COCP as a treatment option for PMDD

How Does Eloine Help in PMDD?

• Reduces hormonal fluctuation across the menstrual cycle

• Improves mood symptoms (low mood, irritability, anxiety)

• Reduces physical symptoms (bloating, breast pain, headaches)

• Drospirenone reduces water retention and can improve skin

• Regulates periods or can reduce/stop them if taken continuously

How to Take Eloine for PMDD

Standard licensed schedule:

• Take one tablet daily for 28 days (24 active tablets followed by 4 placebo tablets)

• Withdrawal bleed typically occurs during placebo phase

Extended or continuous use:

• For some people with severe PMDD, continuous use of active tablets (no break) can further improve symptom control and prevent hormone withdrawal effects

• This approach is commonly recommended in UK practice for PMDD, following FSRH and British Menopause Society guidance

Benefits of Using Eloine for PMDD

• Licensed in the UK for PMDD

• Reduces emotional and physical PMDD symptoms

• Helps stabilise mood across the cycle

• Reduces water retention and bloating

• Predictable or absent periods (depending on regimen)

• Provides effective contraception

• May improve skin in some users

Possible Side Effects

Common:

• Headache

• Nausea

• Breast tenderness

• Mood changes (often improves after first 2–3 cycles)

• Spotting or irregular bleeding in early cycles

Less common:

• Weight changes

• Changes in libido

• Bloating

• Skin changes

Rare/serious (seek urgent medical advice):

• Signs of blood clots: chest pain, breathlessness, swelling/redness of leg

• Migraine with aura

• Sudden weakness, numbness, visual changes

Who Should Not Take Eloine?

• People with history of blood clots (DVT or PE)

• Certain types of migraine (with aura)

• Smokers over age 35

• Liver disease

• Uncontrolled high blood pressure

• Certain heart conditions or strong family history of blood clots

Your GP or specialist will do a thorough assessment of risks and suitability for you.

Is Eloine Safe for Long-Term Use?

Yes — in healthy, non-smoking individuals with no contraindications, long-term use of Eloine is considered safe.

Annual reviews are recommended (as per FSRH and NICE guidance) to check ongoing suitability.

Summary

Eloine is an evidence-based treatment for PMDD. It can effectively reduce emotional and physical symptoms, regulate the menstrual cycle, and provide reliable contraception.

The way you take Eloine can be tailored (standard, extended, or continuous) depending on your symptoms.

Please discuss with your GP or menopause specialist for personalised advice about using Eloine for PMDD.

References

1. Freeman EW et al. Efficacy of a unique oral contraceptive in premenstrual dysphoric disorder. Obstet Gynecol. 2001.

2. Yonkers KA et al. Luteal phase treatment of PMDD with oral contraceptive drospirenone/ethinyl estradiol. JAMA Psychiatry. 2005.

3. Lopez LM et al. Combined hormonal contraceptives for treatment of premenstrual syndrome. Cochrane Database Syst Rev. 2012.

4. Faculty of Sexual and Reproductive Healthcare (FSRH) Clinical Guideline: Combined hormonal contraception. 2019.

5. British Menopause Society Guidance on Managing PMDD, 2023.

6. UK MHRA Summary of Product Characteristics for Eloine.