Can hormonal birth control affect mental health?
Many women report that they stopped taking hormonal birth control because it caused depression. Researchers still don't have clear evidence of the link between hormonal birth control and mood, but recent evidence suggests that women who are using hormonal birth control may experience higher rates of depression.
If you're considering or currently using a form of hormonal birth control, you'll want to learn a little bit about what is known today about hormonal birth control and depression.
The role that hormones play
Once they reach puberty, women are twice as likely as men to be diagnosed with a mood disorder or a cyclical mood disorder. Experts believe that estrogen and progesterone, the most important female sex hormones for puberty, play a role in this. Estrogen and progesterone help regulate women's sexual and reproductive development.
- Estrogen: Supports breast development, supports pubic and armpit hair development, controls the menstrual cycle, and helps stop ovulation once a woman is pregnant. Estrogen has been shown to improve and regulate women's mood and overall well-being - but the amount of estrogen you have is important. Too little, too much, or fluctuating levels of estrogen have been linked with depression, anxiety, and mood swings.
- Progesterone: Maintains the uterine lining, controls breast tissue growth, regulates blood clotting, and helps the body prepare for and maintain pregnancy. If progesterone levels fall too low, women may experience low sex drive, mood swings, anxiety, and depression. “Progestin” is a substance, usually made in a lab, that is identical to progesterone. You will typically see progestin listed as an active ingredient in birth control.
How does hormonal birth control factor in?
Hormonal birth control contains either estrogen, progestin, or both, depending on the type you use. Increased amounts of these hormones prevent pregnancy, and cause the more common side effects of birth control, like a lighter period, a thicker cervical mucus, or sore breasts.
Because these hormones have mood-related effects, there has always been a question of whether or not hormonal birth control causes side effects like depression.
What does the research say?
Researchers have been studying this for decades, and the results are mixed. Some studies have found that hormonal birth control was linked with higher rates of depression, while other studies found that hormonal birth control alleviated rates of depression in a sample.
A study from the University of Copenhagen published in 2016 found that women in the study who were using hormonal birth control (the pill, the patch, the ring, or a progestin-containing intrauterine device) were diagnosed with depression and prescribed antidepressants more often than women who weren't on hormonal birth control. This difference was especially pronounced among young women ages 15-19, and women who were on progestin-only pills were more likely to be diagnosed with depression than women on another form of hormonal birth control.
What other factors could be at play?
In the case of hormonal birth control and depression, it's important to consider a few different things that might factor into the equation.
- High rates of depression among women: Certain types of depression only affect women, including depression during pregnancy, after pregnancy, and around the time of menopause. It's possible that depression is even more common among women than we currently know.
- Different definitions of depression: Many women self-report that they stopped taking hormonal birth control because of depression, but it's not always clear what mental health diagnosis a woman had when she stopped taking hormonal birth control.
- Women are already depressed before they start birth control: Researchers have found that women who are depressed are less likely to take medication consistently. It's possible that many women are already depressed before they begin hormonal birth control, and discontinue it as a side effect of their preexisting depression.
- Placebo effect: The questionable relationship between hormonal birth control and mood changes is fairly well known. It's possible that some women attribute mood changes to their hormonal birth control and, as a result, stop taking the medication.
The bottom line?
Ultimately, there's no one specific answer to the question of whether or not birth control will affect someone's mental health. But it's possible that there is a link between the two, and you shouldn't dismiss any negative mood changes while on hormonal birth control. Here are some things you can do to protect your mental health:
- Know your own medical history and family history of depression before starting any medication, especially medications that impact your hormones, like hormonal birth control.
- Learn or ask your provider to explain the risks associated with taking hormonal birth control. Understand the signs of depression.
- If you decide to use hormonal birth control or are on it already, pay close attention to any mood changes that you experience.
- You can also consider birth control options that don’t use hormones, like the copper IUD or condoms.
If you do notice anything, you should talk to your provider right away so that you can switch methods and treat any side effects that you're experiencing. For many women, hormonal contraception is an extremely helpful and effective form of birth control. But what matters most is whether or not it's right for you.
Belinda A Pletzer and Hubert H Kerschbaum. "50 years of hormonal contraception - time to find out, what it does to our brain." Front Neurosci. 8: 256. Web. Aug 21 2014.
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Julia R Steinberg and Lisa R Rubin. "Psychological Aspects of Contraception, Unintended Pregnancy, and Abortion." Policy Insights Behav Brain Sci. 1(1):239-247. Oct 2014. Web.
KM Keyes, K Cheslack-Postava, C Westhoff, CM Heim, M Haloossim, K Walsh, K. Koenen. "Association of hormonal contraceptive use with reduced levels of depressive symptoms: a national study of sexually active women in the United States." Am J Epidemiol. 178(9):1378-88. Sep 15 2013. Web.
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Kimberly Daniels, William D. Mosher, and Jo Jones. "Contraceptive Methods Women Have Ever Used: United States, 1982-2010." CDC. National health statistics reports; No. 62. National Center for Health Statistics, Feb 14 2013. Web.
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"Progestin-Only Hormonal Birth Control: Pill and Injection." ACOG. FAQ 186. American College of Obstetricians and Gynecologists, Jul 2014. Web.
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