Information about hormonal birth control, what type you should switch to, horror stories with IUD placement, and personal anecdotes about the pill making patients anxious seem to come from everywhere except your doctor’s office. The hashtag #depressedonbirthcontrol on TikTok has over 46 million views, with commentary from many people who are not medical professionals.
Even on the scientific side of things, there is conflicting information about how hormonal contraception affects the brain. Some studies seem to support that taking birth control may contribute to mood changes, anxiety, or depressive symptoms, while other studies haven’t been able to draw any distinct conclusions between birth control and any mood disorders.
What are you supposed to do when you’re trying to find the best contraception for your body? Things can easily get confusing.
That’s why we decided to cut through the noise and speak to experts Tiffany Pham, DO, a board-certified OB/GYN based in Houston, Texas, and medical advisor for the app Flo Health, and Katrina Furey, MD, a board-certified adult psychiatrist specializing in women's mental health and co-host of Analyze Scripts, a podcast analyzing the depiction of mental health in the media.
Here’s what you should know about birth control and your mood and mental health.
Does hormonal birth control have a negative impact on your mental health?
Hormonal birth control comes in so many different forms, from IUDs to implants, rings, and patches, to multiple types and many different formulations of oral contraceptive pills. Each formulation can have separate side effects on each individual person’s body, the experts emphasize—it’s important to start there.
The experts have heard some of the same anecdotes that you have from friends at brunch, like patients experiencing mood changes and increased anxiety while being on hormonal contraceptives. There are some studies that back this up: In a newly published study in the journal Contraception and Reproductive Medicine, 43.6% of survey respondents reported mood changes on hormonal contraception. However, 61.2% of those people also had a history of psychiatric conditions, so it’s almost a chicken-or-egg question.
Another Cambridge University report from 2020 found that adolescent contraceptive users (so basically, anyone 18 and under) had a higher prevalence of depression in the first two years of birth control use than non-users. Dr. Pham notes that birth control could be a factor in depression, but that there’s not a super direct causal link between mood disorders and birth control. For example, teens who engage in early sexual behavior may also participate in smoking, and alcohol use, and have a non-intact family structure, Dr. Pham says, so the mental health changes could be multifactorial. “Is that increase in depression linked to alcohol use, hormones, family issues, etc.?,” Dr. Pham questions.
Mood disorders including depression are also typically diagnosed in the years after puberty.
“Women are most likely to be diagnosed with a mental health condition during their reproductive years, so the underlying prevalence of mood disorders is likely quite high, and there are likely many confounding variables that independently contribute to mood changes (i.e. physical side effects associated with combined hormonal contraceptives, socioeconomic factors, and social stressors),” Dr. Furey adds.
Are there any potential benefits of birth control for your mental health?
Other studies, like this 2020 report in the Journal of Psychiatry, suggest that birth control might have more of a neutral effect on mental health or at least an inconclusive one. The research states that people who don’t take birth control and people who do take it tend to have similar likelihoods of negative mood symptoms.
For some people with certain conditions who rely on hormonal birth control for reasons beyond just preventing pregnancy, taking it can have positive effects (even just the peace of mind of not being pregnant, especially if you live in a state that is hostile toward reproductive rights). People with premenstrual dysphoric disorder or PMDD, a severe form of PMS that might involve symptoms like low mood, difficulty concentrating, irritability, anxiousness, and crying spells, might be able to use hormonal birth control to regulate their hormones. “PMDD and other hormonally-driven mental health conditions like postpartum depression are believed to be triggered by rapid hormonal fluctuations, specifically the precipitous drop in the hormone progesterone after ovulation and after delivering a child,” Dr. Furey says. During the cycle, people who have PMS or PMDD have an abnormal response to the mood-boosting neurotransmitter serotonin. Since hormonal contraceptives generally prevent ovulation, skipping that step can help you avoid the often intense hormonal and mood changes associated with ovulation, adds Dr. Furey.
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How do you choose the best birth control for you?
If birth control is something that is helpful to you as either a contraceptive or a medical device, get really specific about why you feel you need to use it before you head into your OB-GYN appointment. “What is your primary goal: Is it pregnancy prevention, pain relief from endometriosis, or dealing with heavy bleeding?” Dr. Pham says. Some of those side effects of your period or reproductive health condition can also cause mental distress, which birth control can help alleviate in some cases.
Choosing the right birth control formulation for you is a highly individualized process—keep in mind that someone else’s side effects on a particular pill are not necessarily going to be the same as yours. Dr. Pham assures that if someone is coming in with a worsening mood, your doctor should take that concern seriously and help you find an alternative contraceptive method or medicine. “Having that line of communication open with your medical provider, finding someone who’s willing to listen to your potential concerns, is important,” Dr. Pham says. If a certain pill or IUD doesn’t work for you, there are other types and options. According to Dr. Pham, “It’s not one-size-fits-all.”
Mara Santilli is a journalist reporting on health and wellness and how social and political systems influence the well-being of certain groups, including but not limited to Black and brown communities, women, and the LGBTQ+ community. Her editorial work has appeared in publications such as Shape, Marie Claire, Cosmopolitan, Women’s Health, InStyle, Glamour, and more. Outside of reading and writing, she enjoys traveling (especially to Italy), singing, dancing, musical theatre, and playing guitar and piano.