How Hormonal Birth Control Affects Bipolar Disorder And Mood
Research into the impact of hormonal birth control on mood, emotional well-being, and mental state has come up with a mixed bag of answers. While some studies suggest that women who take hormonal birth control are at increased risk of depression, others show no link between birth control and mental health.
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Over the course of a typical menstrual cycle, levels of estrogen and progestin go through large fluctuations in a womans body. Hormonal birth control prevents these fluctuations by keeping estrogen and progestin levels relatively stable. For some women, this can regulate and normalize mood, while others might find it has a more negative impact.
Different hormonal birth control methods interact with different bipolar medications in different ways, so make sure to talk to a medical professional before making any decisions.
Your doctor might recommend a non-hormonal option, advise you to track any spotting you have, or ask you to increase your dosage of hormonal birth control. Some women with bipolar disorder have also found success with low-dosage birth control options.
For women living with bipolar disorder, the idea of hormones impacting their mood in any way can be scary. Its important to remember that hormonal birth control was designed for women who arent living with a mood disorder.
Why Does Birth Control Cause Depression
The addition of hormones in birth control may affect an individuals mental state. While many women report improved moods while taking birth control, others may respond differently. If you notice increased feelings of sadness after starting birth control, consult a doctor to determine whether you should try a different method.
Why Choose Nonhormonal Birth Control
Hormonal contraceptives, like the birth control pill and hormonal implants, change a womanâs hormone levels to keep her body from getting pregnant. They can be convenient and reliable. But they might not be ideal choices for some people for reasons like:
- You have to remember to take the pill at the same time every day.
- You need to see a doctor for prescriptions or to insert the device.
- They donât protect you from sexually transmitted diseases.
- They may raise your chances for blood clots or breast cancer, or have side effects like mood swings or weight gain.
- You may not have sex often enough to need ongoing birth control.
- You may pass hormones to your baby if youâre breastfeeding.
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Adolescents And The Pill
Adolescents using COCs in the Danish study had a higher risk for being diagnosed with depression and prescribed an antidepressant than adults in the study .
Adolescents in the study Finnish study were more likely than people not using hormonal birth control to be prescribed an antidepressant for every COC formulation they studied .
A study of adolescents in the U.S. who were currently or had ever used the pill showed an increased risk for ever having experienced depression, but no increased risk for current depression . But when other factors such as age, smoking, BMI, family socioeconomic status, and whether the adolescents were sexually active were considered along with the use of birth control pills, there was no increased risk for depression .
A small study where adolescents were randomly assigned to use COCs containing ethinyl estradiol/levonorgestrel or placebo for three months showed no difference in depression scores between the two groups at the end of the study .
The key takeaway: The pill may increase the chance of being diagnosed with or treated for depression, but the specific pill formulation may make a difference. Overall, it appears as though COCs do not have a harmful effect on mood reported by users, but this may vary between individuals.
The Connection Between Birth Control And Depression
While these statistics may be interesting and helpful when you’re deciding what form of birth control is right for you, it’s important to remember that this is an associative study. Meaning, the research can’t definitely conclude that birth control causes depression it simply shows that there’s some link between the two.
This distinction is important for a few reasons, says Anisha Patel-Dunn, D.O., chief medical officer at LifeStance Health. First of all, researchers in this study only knew that a contraceptive user was depressed if they sought out medical treatment. And thus, there could be more folks living with depression who simply aren’t represented in these statistics. Plus, depression affects about one in 15 adults each year per the APA, so researchers can’t single out birth control as the factor that’s causing depression. “Because so many women are using birth control, we would still expect to see that same prevalence â but whether it’s because of the birth control or not, is unclear,” says Dr. Patel-Dunn.
She also points out that a 1999 study from Harvard published in JAMA Psychiatry found that women with a history of depression were more likely to experience mood worsening when on oral conception than those birth-control users with no history of depression, which is something to keep in mind if you have a similar health history. Although, it’s important to note that this study was conducted on a fairly small sample size of around 700 people.
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Do Birth Control Pills Affect Your Mood Scientists Cant Agree
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Earlier this month, the surprising findings of some new research were presented at a conference. At the virtual European Congress of Psychiatry, Elena Toffol and her team from the University of Helsinki in Finland reported that they had found that attempted suicide rates were lower in women who used hormonal contraception compared to those who didnt. In fact, the latter group were almost 40 percent more likely to attempt suicide than the former, they reported.
These findings might be the opposite of what youve heardor experienced: Doesnt hormonal birth control have a reputation for exacerbating mental illness? Your confusion would be forgiven. Perhaps you recallheadlines from 2017, when a Danish study found that hormonal contraception was linked with an increase in attempted suicides.
This giant contradiction is but one of many in the years of research that has tried to answer the question of whether hormonal birth control causes psychological side effectsand the jury is still out. In September 2016, The New York Times published an article with the headline Contraceptives Tied to Depression Risk. Six months later, the same publication came out with a piece headlined Birth Control Causes Depression? Not So Fast.
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When To Talk To Your Health Care Provider
Depression is serious and it should not be taken lightly. If you are experiencing depressive symptoms, you may ask your health care provider to refer you to a mental health professional, especially when the symptoms of depression you are having begin to affect your relationship with your family or at work.
If you or someone you know is having overwhelming feelings of depression or suicidal thoughts, seek help right away.
You can call the National Suicide Prevention Lifeline at 1-800-273-TALK .
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What To Do If You Have Birth Control Side Effects
Be sure to discuss what you want to achieve or avoid with your provider. You aren’t locked in to one method. If you’re experiencing side effects, or the method isn’t a good fit for you, we can try something else. Our goal is effective birth control that you’re satisfied with.
For people who want to avoid hormones, many nonhormonal birth control options are available.
If you have any questions about women’s health, a certified nurse-midwife can help. Board-certified and licensed through the state, certified nurse-midwives have training that includes a nursing degree, graduate degree and midwifery education program.
Midwives provide care for women from adolescence through menopause:
- Contraception or birth control
How Will It Affect Any Preexisting Conditions
If you have any preexisting conditions, youll want to talk with a healthcare professional about how different birth control might impact your condition or any medications you take.
This is especially important if you have a history of depression, PMS, PMDD, or another mood disorder, since some people have reported a worsening of symptoms after starting hormonal contraceptives.
A good place to start is with your healthcare professional, if you already have one you like.
You have other options, too:
Read Also: Anti Anxiety Anti Depression Medication List
How Can Birth Control Help With Pmdd Symptoms
While birth control is typically perceived as only being used for pregnancy prevention, it has numerous health benefits, such as alleviating symptoms of PMS and PMDD. Those that contain a combination of hormones estrogen and progestin are typically recommended for individuals with PMDD.
More specifically, birth control pills that contain ethinyl estradiol and drospirenone are the most helpful for alleviating symptoms in PMDD sufferers. Popular brands that contain this unique combination of hormones include Yaz, Ocella, and Beyaz. However, only Yaz is FDA-approved for treating PMDD, as it has been found to increase the quality of life and day-to-day functioning in individuals who typically suffer from the disorder. Other birth control options that can help treat PMDD include the following:
- Combination pills that contain both Ethinyl estradiol and levonorgestrel taken continuously
- Contraceptive patches and rings
Does Birth Control Cause Depression In Studies
Not all studies agree on whether hormonal birth control can cause depression or mood changes. Most published studies suggest that hormonal birth control does not lead to negative impacts on mood. Contact your healthcare provider for any questions you have related to depression or birth control.
The product labeling for the pill states mood changes may occur in some women. For example, 1% to 10% of women using ethinyl estradiol and norethindrone have reported side effects like mood swings, depression, or a change in mood. These changes typically clear up in 2 to 3 months while continuing on birth control.
Depression has also been reported to occur with other forms of hormonal contraception, such as the patch, the implant, the vaginal ring, or the intrauterine device .
Some studies suggest that depression may be more common in:
- younger women or teens
- when using contraceptives with higher levels of estrogen
- when using progestin-only products.
But researchers and clinicians agree that the concern over mood changes is not a reason to avoid hormonal birth control in most cases.
Studies
1. A large study from the Netherlands in 2021 looked at 12 randomized controlled clinical studies with 5833 participants to determine if there was a link between hormonal contraceptive use and symptoms of depression.
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How Pandia Health Can Help
Pandia Health is here to help you find a birth control method thats safe and effective for you. The right type of birth control for you will depend on your health history, your lifestyle, and your hormone levels. Sign up to Pandia Health today to get access to our knowledgeable, helpful doctors and FREE delivery of your birth control directly to your mailbox.
With just one $25 payment a year, you can get access to our expert doctors for 364 days . That means unlimited questions and advice, which is especially important if you want to try a new type of birth control to help stabilize your moods. Get started to begin your birth control journey today!
Emerging Research: Nomegestrol Acetate With 17
Currently, all available oral contraceptive pills affect mood. We have shown that nomegestrol acetate with 17-beta estradiol is better tolerated by women with mood disorders.30 Our pilot study was a single-site clinical follow-up study that assessed the tolerability and subjective mood response to nomegestrol acetate 17-beta estradiol. Based on a sample of 49 women, we showed that women report a positive mood response and reduced self-reported overall DASS-21 score after taking nomegestrol acetate with 17-beta estradiol compared to previously used oral contraceptive pills.30 Future research with a larger sample is required.
Nomegestrol acetate with 17-beta estradiol is a monophasic preparation with an extended regimen of 24 active pills followed by four placebo pills. The drug can cross the bloodbrain barrier, interact with serotonin receptors and regulate cerebral blood flow to the amygdala, dorsolateral prefrontal cortex and many other areas of the brain involved in depression.31 Women who develop depression soon after taking other oral contraceptive pills may better tolerate nomegestrol acetate with 17-beta estradiol. This is consistent with its successful use in clinical practice for the off-label treatment of mood symptoms associated with premenstrual dysphoric disorder.30
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Most Studies Have Found No Link
To conduct their latest literature review, Worly and colleagues used several research databases to search for past studies on progestin-only contraception and depression.
They found 26 studies that met their inclusion criteria. They included studies on progestin-only birth control pills, intrauterine devices , implants, and injections.
Across these studies, some patients reported increased symptoms of depression after they began to use progestin-only contraception.
However, the most robust studies found no link between depressive symptoms and progestin-only contraception use.
This was true even when the research team focused on patients at higher risk of depression, including postpartum patients, adolescent patients, and those with a history of depression.
Unfortunately, a lot of people have depression, Worly said, including some women who use progestin-only contraception.
But just because theyre both simultaneously there doesnt mean that one necessarily causes the other, he added, and I feel safe at this point saying, for most women, progestin-only contraception should not cause them to have depression.
What Birth Control Doesnt Cause Depression
Its normal for women to try out several types of birth control method before settling on one option that ultimately fits her lifestyle and personal health.
In case of the birth control pill, there are different types and levels for each that women can try in order to see what would work best for her. However, it is still important to talk to your health care provider first if you have any concerns about your medical history or if you are planning to try a new hormonal contraceptive method.
Meanwhile, when it comes to non-hormonal contraceptives such as the copper IUD or condoms, there is no known risk of depression or anxiety with the use of these birth control methods.
However, a number of women who had a copper IUD implanted have reported increased depression and irritability 2-5 months after IUD insertion which went away after removal of the device.
Research is still mixed on progestin only methods such as the hormonal IUD, implant, and the progestin only pills.
For women with history of depression and anxiety, there are different safe and effective birth control methods they can try before sticking with one that ultimately suits them.
But communication with your health care provider is still crucial in order to address your needs and concerns regarding the perfect birth control option for you.
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What You May Have Heard
You may hear people say hormonal birth control negatively affected their mood, making them feel depressed, anxious, or irritable. You may also hear people say that hormonal birth control improved their mood, making them feel more calm or stable. Of course each personâs bodyâand brainâis unique and their response to hormonal birth control can be different.
Hormonal birth control comes in several forms, including the implant, the intrauterine device , the shot, the pill, the patch, and the ring. Progestin-only hormonal birth control contains just progestin . Combined-hormonal birth control contains both progestin and a form of estrogen.
Several large studies have explored whether there is a connection between different types and formulations of hormonal birth control and changes in mood or mental health with some conflicting results.
A 2016 study of more than one million women in Denmark really brought the possible connection between birth control and mental health to mainstream attention . This study analyzed nationwide health records and showed that hormonal birth control users were more likely to be diagnosed with or treated for depression .
Two large studies in the United States and Finland showed something different. In these studies, people using hormonal birth control of any type reported fewer symptoms of depression and anxiety .
Common Effects Of Oral Contraceptive Pills On Mood
There is evidence to suggest that both oestrogen and progesterone influence brain function, which may be responsible for the negative mood changes and depression commonly reported in women taking oral contraceptive pills.17-19 One of the most common reasons given for the discontinuation of oral contraceptive pills is changes in mood or an increase in depressive symptoms.20,21 Currently, all oral contraceptive pills may cause mood changes, but the newer oral contraceptive pills containing estradiol or estradiol valerate may be less likely to cause mood changes.
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Can Birth Control Make Depression Worse
Recent studies indicate that women who do not suffer from PMDD are at a slight risk of developing depression when taking certain hormonal forms of birth control, though this risk is fairly insignificant. Here is what has been found so far: Compared with non-users, combined oral contraceptives RR of a first use of antidepressants of 1.2 Progestin-only pills had an RR of 1.3 IUD with hormone a levonorgestrel intrauterine system, 1.4 Vaginal ring , 1.6 Transdermal patch , 2.0 Implant, 2.1 The shot medroxyprogesterone acetate depot, 2.7 TLDR the shot had the highest correlation with depression, whereas the combination pill posed the lowest risk of depression.