The Lowdown:

Most women experience fluctuations in their mood throughout the month; one week you’re feeling calm and in control, the next you’re crying over an episode of Antiques Roadshow (or maybe that’s just us). Since the birth of the pill, however, some women have been noticing a more pronounced change in their mental health, and for some of us, hormonal contraception seems to make the fluctuations in our mood more noticeable. In fact, the most common reason women change or stop their contraception is because of mood side effects.

Of all the potential threats that could be posed to our mood, depression is perhaps the most worrying. Some research shows that hormonal contraception is associated with the risk of attempted suicide, and while findings like these are definitely alarming, they don’t paint a complete picture. What they do do, is highlight how important it is that we understand how our contraception choices can affect our mental health. 

Is there a proven link between hormonal contraception and low mood?

Yes – but it isn’t quite as simple as that. A quick Google search of this question is a bit baffling: for every piece of research showing that low-mood side effects exist, there is another study claiming the opposite. The problem is that women have been reporting these possible side effects for years, but actual research into this topic has been patchy to say the least. In 2016, a few heroes of the research world looked at all the available evidence and concluded that it was virtually impossible to say what the low-mood risks were, and who was most likely to suffer.

A Danish study from 2016 reported that women are more likely to be started on antidepressants for the first time or to be diagnosed with depression for the first time if they are currently using or have recently used hormonal contraception. However the study did not account for possible confounding factors and importantly does not establish a causal link between hormonal contraception and depression.

The Faculty of Sexual and Reproductive Health in the UK have released two statements in recent years in response to studies that look at hormonal contraception and depression. At present they advise healthcare professionals to tell women that whilst it is recognised that some women report that they experience mood changes associated with hormonal contraception, there is no clear evidence that hormonal contraception causes depression.

How might hormonal contraception influence mood?

Hormonal contraception contains different rates of oestrogen and/or progestin (this article explains a little more about how these hormones work).  Research suggests that oestrogen is linked to feeling anxious and fearful, and progesterone with irritability and depression.

Here’s the particularly bamboozling part: different combined contraceptives (those with both oestrogen and progestin) have markedly different rates of each hormone. You might find that some pills contain high levels of progestin and a small amount of oestrogen, for example, or vice versa. Add to this the fact that there are eleven different types of progestin, and that oestrogen and progestin can counteract or interact with each other in different ways, and we have ourselves a research minefield. Essentially, we have oodles of pills, patches, coils and injections, all with their own unique recipes and potential side-effects. 

This must mean that there are specific brands that we know to steer clear of?

Sort of. Research conclusions vary, but here’s what the evidence seems to suggest:

But if speaking to our friends about hormonal contraception has taught us anything, it’s that how it affects one person can be very different to how it affects another. In fact, who you are might actually be the most pressing thing to consider.

From clinical experience doctors say women who find their mood adversely affected by a specific hormonal contraceptive preparation will not necessarily have the same problem with other hormonal contraceptives.

How can I weigh up my individual risk?

There are several factors that research has found may mean you are more susceptible to the negative mental health effects of hormonal contraception:

What are the women taking these contraceptives saying?

We’ve been asking The Lowdown users how their contraception affects them. For some types of contraception, we had over 100 responses, and these are listed in the table below.  

Contraception typePercentage of women who experienced negative effects on their mood and emotions
Combined pill (oestrogen and progestin)63%
Implant (progestin only)61%
Progesterone-only/mini-pill (progestin only)58%
Injection (progestin only)51%
Hormonal coil (IUS) (progestin only)34%
Copper coil (no hormones)25%

As research shows that progesterone-only contraception is more likely to be linked to low-mood side effects, it might be surprising to see the combined pill top the charts here. These results are also contradictory to the idea that non-oral hormonal contraceptives present a higher risk of low mood, and it is interesting to see the IUS may have a lower impact than its oral counterparts. This shows that even women not using hormonal contraceptives report effects on their mood – what does this mean?

We don’t currently have more detailed information about the brands of contraception these women are taking, or the specific effects on their mood that they are reporting – it could be that these percentages reflect not only low mood, but mood swings, anxiety and irritability, for example, so we’re working on getting more detailed figures.

What information should I look for when choosing hormonal contraception? 

As we learned before, facts and figures about the vague concept of ‘the pill’ or other contraceptive methods should be taken with a pinch of salt. What we should really be looking out for robust studies to clarify any association between hormonal contraception and depression. Research into the effects of different types and levels of progestins, different levels of oestrogen and the interaction between these two compounds would also be helpful. 

Annoying as it might seem, the take-home message is one that you have probably heard a million times before: try it and see. As the research stands at the minute, the most important factors to consider are your age, medical background and contraceptive history; something which didn’t suit your friend might be a good fit for you, and vice versa. 

It is important to remember that not every woman experiences low mood when using hormonal contraception. Some women find no change to their emotional state, and others notice an improvement as their contraception can reduce the intensity of their PMS symptoms.

Under the guidance of your Doctor, keep an eye on the levels and types of the progestin and oestrogen in your contraception to find the balance that works for you. And if you’re frustrated, remember that the perfect pill doesn’t exist for every woman, but there are lots of other options out there!

References

Bengtsdotter, H., Lundin, C., Gemzell Danielsson, K., Bixo, M., Baumgart, J., & Marions, L. et al. (2018). Ongoing or previous mental disorders predispose to adverse mood reporting during combined oral contraceptive use. The European Journal Of Contraception & Reproductive Health Care23(1), 45-51. doi: 10.1080/13625187.2017.1422239

Böttcher, B., Radenbach, K., Wildt, L., & Hinney, B. (2012). Hormonal contraception and depression: a survey of the present state of knowledge. Archives Of Gynecology And Obstetrics286(1), 231-236. doi: 10.1007/s00404-012-2298-2

Kahn, L., & Halbreich, U. (2001). Oral contraceptives and mood. Expert Opinion On Pharmacotherapy2(9), 1367-1382. doi: 10.1517/14656566.2.9.1367

Kulkarni, J. (2007). Depression as a side effect of the contraceptive pill. Expert Opinion On Drug Safety6(4), 371-374. doi: 10.1517/14740338.6.4.371

Progestin (Progesterone-Like Hormones) Induced Dysphoria (Depressed Mood, Irritability, Anxiety) – Full Text View – ClinicalTrials.gov. (2020). Retrieved 11 August 2020, from https://clinicaltrials.gov/ct2/show/NCT00001770

Robinson, S., Dowell, M., Pedulla, D., & McCauley, L. (2004). Do the emotional side-effects of hormonal contraceptives come from pharmacologic or psychological mechanisms?. Medical Hypotheses63(2), 268-273. doi: 10.1016/j.mehy.2004.02.013

Schaffir, J., Worly, B., & Gur, T. (2016). Combined hormonal contraception and its effects on mood: a critical review. The European Journal Of Contraception & Reproductive Health Care21(5), 347-355. doi: 10.1080/13625187.2016.1217327

Skovlund, C., Mørch, L., Kessing, L., & Lidegaard, Ø. (2016). Association of Hormonal Contraception With Depression. JAMA Psychiatry73(11), 1154. doi: 10.1001/jamapsychiatry.2016.2387

Skovlund, C., Mørch, L., Kessing, L., Lange, T., & Lidegaard, Ø. (2018). Association of Hormonal Contraception With Suicide Attempts and Suicides. American Journal Of Psychiatry175(4), 336-342. doi: 10.1176/appi.ajp.2017.17060616

The influence of estrogen on female mood changes. (2012). Chinese Science Bulletin57(11), 1351-1351. doi: 10.1007/s11434-011-9936-0

What you should know about progestins. (2020). Retrieved 11 August 2020, from https://helloclue.com/articles/sex/progestins-101

How Hormonal Birth Control Can Affect Your Mood. Retrieved 11 August 2020, from https://www.webmd.com/sex/birth-control/birth-control-mood-link

Women need to know about the link between the pill and depression. (2020). Retrieved 11 August 2020, from https://medicalxpress.com/news/2018-05-women-link-pill-depression.html

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