Being on hormonal birth control (HBC) is a miracle for many, and can deliver lighter periods, sunnier moods, clearer skin, and, of course, protection against pregnancy.
However, some contraceptive users experience moodiness and, in most severe cases, depression and suicidal ideation. For women with mood disorders, these effects run the risk of being magnified while on hormonal birth control (HBC). Those who have a history of depression or anxiety may find that only birth control with incredibly low doses of hormones (or no hormones at all) work to keep their moods relatively stable.
Birth control works by adding synthetic hormones, such as estrogen and progestin, to the body. Heightened levels of these hormones prevent ovulation, and thus keep you from getting pregnant. Again, for many users, the addition of synthetic hormones provides only temporary negative mood and physical changes, which are outweighed by the longer-lasting, more positive side effects. For some birth control users, an added boost of estrogen can decrease depressive symptoms, with or without the help of a selective serotonin reuptake inhibitor (SSRI). Doctors have also had success treating postmenopausal patients with estrogen replacement therapy “to improve mood, energy level, and general well-being.” In the Harvard Study of Moods and Cycles, 14% of women with a history of depression report improved moods while on oral contraceptives, while 61% experience no changes in mood at all.
For others though, it can be very tricky to find the right balance of added hormones. Too little estrogen causes serotonin levels to drop, which can trigger depressive symptoms; too much estrogen leads to increased levels of serotonin, which can cause anxiety. Too much progestin, the synthetic version of progesterone, can also spur anxiety and depressive symptoms. For some women with mood disorders, hormonal birth control only exacerbates their symptoms before and during menstruation. The same Harvard Study of Moods and Cycles as above found that 25% of women with a history of depression experienced “premenstrual mood worsening” while taking birth control pills. Contraceptives with high levels of progestin are especially known for worsening symptoms of PMS. Women who have experienced major depression may re-live their depressive symptoms while on birth control, even when paired with an antidepressant.
Combining antidepressants and other medications used to treat mood disorders with birth control can throw hormones for an even bigger loop. Women who suffer from both PMDD and a mood disorder sometimes experience little to no efficacy from their antidepressants just before their periods, so even if their birth control and antidepressant combo works well the entire rest of the month, the PMS stage of the cycle can still be debilitating. Women taking SSRIs also must be careful about combining their antidepressants with high estrogen contraceptives, since the combination can surge serotonin levels.
Of course, birth control is not the cause of mood disorders; again, it can even provide relief from some of the symptoms. However, if you are on birth control and feel it may be taking a toll on your mental health, you are certainly not alone. Talk to your doctor about the symptoms you are experiencing, and be sure to be upfront about any and all medications you take along with your birth control. You may need to try a few different contraceptive methods before finding what works best for both your physical and mental wellbeing.