Yaz vs Junel: how they compare for PMS and PMDD

Yaz and Junel are both combined birth control pills, but they pair ethinyl estradiol with different progestins.

Yaz combines 20 mcg of ethinyl estradiol with 3 mg of drospirenone, taken for 24 active days followed by 4 placebo days [4]. Drospirenone is unusual among progestins because it has antimineralocorticoid and antiandrogenic effects that most other progestins don't share [4].

Junel pairs ethinyl estradiol with norethindrone acetate, an older progestin without those extra effects. Most Junel formulas, including Junel Fe 1/20, follow the standard 21 active days and 7 placebo days, with iron added to the placebo pills in the Fe version.

That shortened hormone-free interval in Yaz isn't incidental. A shorter gap between hormone doses smooths out the swings in estrogen and progesterone that can bring on headaches, breast tenderness and mood changes before a period [1].

• Yaz: ethinyl estradiol 20 mcg plus drospirenone 3 mg, 24 active days and 4 placebo days.
• Junel: ethinyl estradiol plus norethindrone acetate, usually 21 active days and 7 placebo days.

For more on how Yaz's formula works, see Yaz: what it is and whether it helps PMS.

The trial evidence here isn't balanced between the two pills.

Two key trials found that Yaz's drospirenone and ethinyl estradiol combination eased the mood, physical and behavioral symptoms of PMDD, including symptoms tied to food cravings, water retention and conflict with people close to you [3]. That evidence is why the FDA approved it as one of four treatments for PMDD, alongside three SSRIs [3].

The shortened hormone-free interval is thought to matter too. Reducing hormone fluctuation across the cycle is linked to fewer withdrawal symptoms, like mood swings and breast tenderness, both in PMDD and in premenstrual symptoms more broadly [1]. Beyaz, a folate-fortified version of the same drospirenone and ethinyl estradiol combination, carries the same contraception and PMDD indications, which suggests the benefit sits with the hormone combination itself [2].

Junel hasn't been tested this way. None of the trials behind this comparison evaluated norethindrone acetate pills for PMS or PMDD specifically, and norethindrone acetate doesn't share drospirenone's antiandrogenic activity.

If premenstrual mood symptoms are why you're looking at birth control, the current evidence points toward drospirenone-containing pills like Yaz, not Junel. Read more in Yaz for PMDD: does it work? and Yaz for PMS: does it work?.

Both pills carry the side effects typical of combined hormonal birth control: nausea, breast tenderness and breakthrough bleeding in the first few cycles.

Where they differ is in a few risks tied to the progestin itself.

For a fuller list, see Yaz side effects, including mood.

Switching between combined pills is common, and most people can move from Junel to Yaz or back without a break in protection.

A few things matter more than the switch itself:

1. Your doctor or pharmacist decides exactly when to start the new pack based on where you are in your current one.
2. If you're switching because of premenstrual mood symptoms, give the new pill a few cycles before judging whether it's helping. See how long does Yaz take to work for what that timeline usually looks like.
3. Tell your prescriber about any side effects from your current pill, including mood changes, so they can factor those in.
4. Mention any other medicines or health conditions again, even if you listed them before, since the progestin is changing.

None of this requires guessing on your own. A short conversation with whoever prescribes your pill covers it.

What you ask depends on what you're trying to solve.

• Is my main goal contraception, acne control, or easing premenstrual mood symptoms?
• Do I have a condition, like kidney problems or long-term NSAID use, that makes drospirenone riskier for me?
• How many cycles should I expect to wait before judging if a pill is helping?
• What should I be tracking day to day to show you what's changing?

If your premenstrual mood symptoms take over a week of most months, or make it hard to function at work or with people you care about, see a GP or gynecologist and bring two months of daily notes. That record, more than a brand name, usually decides which pill makes sense.

Writing down what a day before your period actually looked like can make that record easier to put together.

Niyora is a PMS and PMDD support app. Its Moon feature lets you write down what happened, see it from another angle, and draft how you want to respond.

That gives you real examples to bring to an appointment, instead of a vague memory of your premenstrual week. For more on options beyond Yaz and Junel, see Birth control for PMDD: does it work?.