Extended Pill Regimen Decreases PMS

A study looking at the incidence and severity of premenstrual-type symptoms in patients converted from a 21/7 Pill regimen to an extended regimen found that the extended regimen (168-day one) led to a decrease in symptoms compared with the 21/7-day regimen. From the comment section:

The present study confirms that many women experience a multitude of premenstrual type symptoms while utilizing standard 21/7 OCs. Regardless of the progestin content of the pill, symptoms worsen during the last week of active pills, peaking in intensity during the 7-day HFI [placebo week]. The occurrence and severity of symptoms interestingly coincides with the decline in endogenous estradiol levels during the last week of active pills into the beginning of the HFI....

Elimination of the 7-day HFI with the extended 168-day DRSP/EE [Yasmin] OC regimen resulted in a statistically significant reduction (P < .001) in premenstrual type symptoms.... ... Since many patients discontinue OCs because of premenstrual type symptoms including breast tenderness, bloating, headaches, and mood swings, warning patients of their possible occurrence and management options can be crucial in OC continuation. Our study along with others confirms that 21/7 regimens can induce PMS type symptoms. Extended regimens may reduce these problems. Knowing this, 2 issues need to be addressed. First, patients currently on 21/7 OCs need to be questioned regarding symptoms occurring during the end of the active pills into the HFI. Our experience with a simple 0-10 scale for rating mood on a daily basis during 1 or more 21/7 cycles can assist with this documentation in a clinical setting where detailed daily symptom logs are often not practical. Those with significant cyclic variation in symptomatology can be offered the option of an extended regimen. Patients initiating a 21/7 regimen also need to be informed of the documented increase in symptoms associated with the HFI and instructed to report their occurrence. Second, these results provide further evidence of the need to redesign OCs with modification of the standard monthly 7-day HFI.