The birth control pill comes with a slew of benefits, including better skin, reduced rates of ovarian cancer, and decreased possibility of pregnancy—which remains its primary purpose. In 1960 the first oral contraceptive was approved by the FDA, a result of women’s activist Margaret Sanger persuading Dr. Gregory Pincus to create a contraceptive pill for women. In fact, Sanger is responsible for coining the phrase “birth control.”
The pill and where it came from
At first, the pill was only prescribed to women with severe menstrual issues, and it was not until 1969 that it became legal to prescribe the pill for contraception—that was only 50 years ago!
Reported side effects of the first pill included headaches, nausea, dizziness, and blood clots. But most importantly, side effects of the pill also included a lack of full disclosure and a large lack of relevant research on the psychological effects of the pill.
Since the 1960s, the information available on birth control options has grown, as have birth control options available to women, but knowledge gaps and misinformation surrounding birth control remains prevalent. With the new options available an even wider array of birth control side effects exist. Hopefully, these risks are being more readily researched and openly discussed. The sad truth is, research on the pill was often written in a way that dismissed its effects on women’s mental health; the misinformation persists today.
So, let’s dig into the underreported emotional side effects of hormonal birth control in the form of the contraceptive pill. Just as a note, other forms of hormonal birth control apart from the pill include, the NuvaRing, the Patch, Nexplanon (an arm insert in the form of a small rod), and hormonal IUDs (such as Skyla or Mirena). Though the side effects of all these birth control options vary, hormonal birth control is often associated with an increased risk of depression and anxiety.
How Birth Control Works: The Combo Pill vs. the Mini Pill
Today the pill comes in two categories: the combination, or “combo,” birth control pill and the mini-pill. The combo birth control pill is called a combo because it contains ethinyl estradiol, a form of estrogen, and a type of progestin, a form of progesterone. These two hormones naturally flood the body when women ovulate, and create many of the symptoms women experience during PMS.
In contrast, the mini-pill contains only progestin, but no estrogen. As a result of the decreased hormones in the mini pill, or progestin-only birth control option, it’s often labeled as a “safer” alternative to the combo pill for women. Which is why it is prescribed to women who are breastfeeding due to overall decreased levels of common birth control side effects—but this does not mean there are NO side effects.
Both progesterone and estrogen are hormones that impact our moods. Most women who have experienced PMS know how intense these impacts can be, so when you add more of these chemicals to the body via hormonal birth control, exercise caution. Data reveals fluctuations in progesterone may induce depression in women, while certain estrogens have been linked to causing anxiety and depression.
A short note on hormonal birth control
Hormonal birth control has been linked to reports of increased depression and anxiety among patients. In a study of 90 women, with 44 of the women taking birth control pills, researchers found the pill affected mental states by altering the brain. Two parts of the brain revealed changes in particular; the posterior cingulate cortex (linked to emotional stimuli based on internal states of mind or the view of the “self”) and the lateral orbitofrontal cortex (linked to emotion and behavior in relation to external stimuli) appeared thinner in women on the pill. Thinning of these regions reveals heightened risks of abnormal emotional functioning.
The marked changes in these two regions alone suggest that the pill not only affects how women view external circumstances, but may also affect their view of themselves. With emotional stimuli affected on both the external and internal levels, it makes sense that we may react differently than we typically would—and perhaps even be more prone to depression and anxiety as a result of the abnormal functioning the pill may create in these regions.
Even though we know sex hormones play a large role in our brain and decision making, the research suggests that as a result of the hormone-altering nature of the pill, it may have profound impacts on our emotions and these changes in our brains could lead to increased levels of mental health risks among women. A recent Danish study supported this evidence by finding women on either the combo or mini pill experienced a greater likelihood of depression and were prescribed antidepressants more often than women taking non-hormonal forms of birth control.
Birth control side effects via the pill may lead to an onset of depression and anxiety in women who have not experienced depressive symptoms before. But it should also be noted that hormonal birth control pills are more likely to lead to depression and anxiety in women who are already prone to depressive symptoms. So if you suffer from depression and anxiety already, you should take into account you are at greater risk of hormonal forms of birth control potentially altering your emotions.
Mood swings and hormonal birth control
When beginning the pill, mood swings can be a common indicator of an onset of emotional changes. The mood swings can be characterized by anger, sudden onset of tears, feelings of lack of joy, etc. If you notice these symptoms do not waste any time and set up a time to see your doctor. The earlier you can address the symptoms the better. From personal experience, sometimes doctors will advise you to stay on the pill, promising these feelings will level out. Worse, one doctor shared that she knows of other colleagues who will tell patients the feelings “are all in their heads.”
If it feels like a doctor is brushing aside the very real emotional symptoms you are experiencing, try getting a second opinion. Your emotions and mental health matter and you should not have to suffer from depression and anxiety in exchange for contraception. When you visit a doctor, discuss potential alternative contraceptive options if the symptoms feel unbearable (or even if they just feel uncomfortable). And if you have a history of anxiety or depression be sure to share that with your doctor too.
The problem with the research on hormonal birth control
A peculiar puzzle has emerged. Many prior studies in the U.S. were released over the years when birth control was still relatively new (keep in mind, it’s still only 50 years old). For years the studies stated that hormonal birth control had no impact on women’s emotions. Despite these studies, many women continued to self-report that the pill led to negative emotions, mood swings, depression, and anxiety.
So what gives?
The sad truth is women’s health is often under-addressed in many circumstances. Women’s health care in the U.S. is often ranked last out of the major developed countries. This could explain those sneaky claims from earlier studies reporting no link between hormonal birth control and depression occurred despite women self-reporting negative mental health symptoms while taking birth control.
With the times changing, those research claims are changing too; today many studies are showing that there is indeed a link between hormonal birth control and increased risks of depression and anxiety. As noted earlier, the large majority of these studies reveal a correlation to depression and anxiety at the onset of taking the pill, which is particularly worsened if the patient is already prone to these mood symptoms.
Why confusion surrounding birth control and mental health continues
The confusion appears to be a result of the longstanding fact that men have dominated the healthcare space, and as a result, have determined women’s health care outcomes and treatment options. Perhaps that’s the reason we have years of research claiming hormonal birth control did not impact women’s emotions, despite many women sharing first hand that they were feeling sad, anxious, and depressed after starting the pill.
At the end of the day, understanding that the women’s health care space (and health care in general) has been largely dominated by male scientists is important. That dynamic is changing, as are people’s views—women’s voices are being heard and the impact is resounding. Voicing our views and symptoms from the effects we feel from birth control is important.
Women tend to underreport or choose not to self-report symptoms of depression or anxiety because of the societal stigma that remains. But by women reporting how certain health care solutions make them feel, we allow other women to do the same, paving the pathway to change and improved healthcare solutions for a variety of women’s health care issues.
So if you’re feeling adverse emotional symptoms from birth control, or any medical solution, reporting these adverse symptoms is powerful. By doing so, you’re playing your part in improving women’s health care for women everywhere.