How Hormonal Birth Control Can Affect Your Mood

Lots of women get irritable, depressed, or feel out of sorts just before their monthly periods. Those can be symptoms of a common condition called premenstrual syndrome (PMS).

But could your birth control pills and other hormonal contraceptives trigger similar emotional swings? Or might they do the reverse and actually improve your moods?

How Hormonal Contraceptives Work

Most birth control pills, patches, and rings combine two lab-made female sex hormones, estrogen and progestin. “Minipills” have only progestin, and in a smaller amount.

Combined hormonal contraceptives stop the normal rise and fall of your body’s natural hormones. That blocks your body from ovulating and releasing an egg to be fertilized by sperm.

Is There a Link Between Birth Control and Emotions?

Women have complained about mood-related changes like depression and anxiety ever since the pill came out in 1960. The newest generation of pills have lower doses of hormones. Even so, a sizeable number of women still quit the pill because of side effects.

During a typical 28-day menstrual cycle, estrogen levels reach their peak around day 14. That’s when many women feel best emotionally and physically. Most hormonal contraceptives smooth this mountain-shaped hormonal cycle into an even line for the first 21 days. Then the levels of estrogen and progestin plunge during the final 7 days.

Limited research suggests that compared with women who don’t use hormonal birth control, those who do are more likely report feeling depressed, anxious, and angry. But those symptoms don’t make the list of common side effects. Other studies have turned up no significant link between hormone combinations or concentrations and differences in mood. Still more research has found that women on the pill and those taking dummy pills report similar symptoms, suggesting that any effects they noticed were unrelated to the actual pills.

Benefits

Doctors sometimes prescribe hormonal contraceptives to ease the discomfort that practically every woman notices at one time or another during their monthly periods.

Symptoms of premenstrual syndrome can include:

The FDA has approved a specific type of hormonal birth control pill -- containing drospirenone and ethinyl estradiol -- to treat a more serious form of PMS called premenstrual dysphoric disorder. But the hormones may work better to ease physical symptoms than mood-related ones. It also can take some trial and error for your doctors to hit on the right medication and dosage.

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Possible Explanations

If scientists can’t firmly connect the dots between birth control hormones and emotional turbulence, why do some women believe there’s a link?

  • Greater sensitivity to changes to levels of estrogen and other hormones
  • Stress from the need to avoid pregnancy and to take the pill as prescribed
  • Heightened perception of possible symptoms among women with existing depression, anxiety, or other mental health conditions

When to See a Doctor

If your mood swings are mild or moderate, exercise, healthier eating, relaxation, and other lifestyle changes may bring you relief. See your doctor if you feel depressed, feel no energy, or have other severe symptoms that interfere with your daily life.

WebMD Medical Reference Reviewed by Traci C. Johnson, MD on May 21, 2019

Sources

SOURCES:

American Family Physician: “Do the emotional side-effects of hormonal contraceptives come from pharmacologic or psychological mechanisms?” “Managing Adverse Effects of Hormonal Contraceptives.”

Medical Hypotheses: “Do the emotional side-effects of hormonal contraceptives come from pharmacologic or psychological mechanisms?”

Mayo Clinic: “Combination Birth Control Pills.”

Contraception: “The relationship between progestin hormonal contraception and depression: a systematic review.”

International Journal of Environmental Research and Public Health: “Do Progestin-Only Contraceptives Contribute to the Risk of Developing Depression as Implied by Beta-Arrestin 1 Levels in Leukocytes? A Pilot Study.”

American Society for Reproductive Medicine: “Hormonal Contraception.”

Womenshealth.gov: “What happens during the typical 28-day menstrual cycle?” “Premenstrual syndrome (PMS),” “Premenstrual dysphoric disorder (PMDD).”

UpToDate: “Patient education: Premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Beyond the Basics).”

JAMA Psychiatry: “Association of Hormonal Contraception With Depression.”

American College of Obstetricians and Gynecologists: “FAQ: Combined Hormonal Birth Control: Pill, Patch, and Ring,” “Premenstrual Syndrome (PMS).”

The European Journal of Contraception and Reproductive Health Care: “Contraceptive use and behavior in the 21st century: a comprehensive study across five European countries.”

CDC: “National Health Statistics Reports: Contraceptive Methods Women Have Ever Used: United States, 1982-2010.”

Harvard Health Publishing: “Premenstrual dysphoric disorder: When it’s more than just PMS.”

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