Have you ever wondered if your birth control is causing mood swings? Feel angry or depressed after starting contraceptives? Is birth control causing crying spells? You are not the only woman to wonder these things.
The emotional side effects of birth control pills have been reported by women since the introduction of the pill in the 1960's. Anxiety, mood swings, depression, anger, crying spells and feelings that something is not quite right are among the many emotional symptoms my patients express after beginning the pill. And they are not alone. Jump on any online forum of women chatting about birth control side effects and you will read thousands of women reporting that their mood changed when they started birth control.
Emotional Side Effects of Birth Control Pills
Hormonal birth control, such as the pill, has been associated with:
- Mood swings
- Crying easily, or crying spells
- Being prescribed anti-depressants
- Increased risk of suicide
If you are having thoughts of harming yourself, immediately call the National Suicide Prevention Lifeline at 800-273-8255. There's also a chat option on their website.
Depression, Mood Swings, Weight Gain – Maddy's Story
Weight gain, mood swings and severe depression were the main side effects Maddy experienced with going on the pill. As I explain in Beyond the Pill, there are several reasons why we can experience weight gain on hormonal birth control. And there are several studies that have shown a correlation between hormonal birth and depression.
For Maddy, she struggled for years with severe depression after beginning hormonal birth control. It was finally after she met with a therapist who encouraged her to track her cycles that she came off of birth control. Maddy wasn't totally ready for what came next.
Maddy experienced post-birth control syndrome symptoms and lost her period for a year after discontinuing the pill. Her periods were regular prior to starting hormonal birth control, so this was a new experience for her. But her mood improved in a short period of time. Her mom actually said to her after she came off the pill, “wow, we finally got Maddy back!”
In the below video, Maddy discusses how dietary shifts helped her get her period back and improve her health overall. I hope you enjoy this discussion and the other Beyond the Pill discussions on my channel.
Can Birth Control Cause Mood Swings?
We all know someone who swears that birth control completely wrecked their mood. Whether it was making them feel anxious, depressed, angry or like a crazy, jealous mad woman, there's no denying there's a link between birth control and mood swings or mood changes.
And maybe you were one of those people. I know I was.
When I was a teenager, my doctor put me on birth control pills. These made me feel depressed and I honestly had days where I didn't even recognize who I was anymore. But despite my insistence that the pill was the cause of my mood swings, my doctor assured me that there was no link.Mood swings since starting the pill? Find out why. Click To Tweet
Fast forward to me now. A doctor who works with women every day in my medical practice to undo the effects that hormonal birth control causes. Because it is real. Women come to me with new onset of depression, anxiety and mood swings after starting hormonal birth control. And I listen to their stories of how the pill or other synthetic hormones have created a huge disruption in their life.
I've had patients tell me stories about completely falling out of love with their husband or partner after starting birth control.
Many women report lacking all motivation and joy, losing interest in hobbies and feeling like birth control robbed them of their mental edge at work.
And there are the women who feel disconnected— from their child, their friends, even themselves.
We know our natural cycling hormones can impact our mood in profound ways. So it makes sense that if you're taking synthetic hormones, those can also have a big impact on your mood, your mindset and your motivation. So if you're wondering whether birth control is making you crazy, you're not the only one.
And news flash to your doctor! If your logic is to give a woman synthetic hormones to treat the mood symptoms caused by her natural hormones, you cannot dismiss the fact that these drugs affect mood.
Birth control and mood swings are nothing new. In fact, they are what women have been noticing since the pill was introduced over fifty years ago.
Birth Control Mood Swings, Side Effects & Symptoms
More recent studies have helped medicine understand what women have been telling doctors for years. And it’s been validating for many women to learn that their story has been more than accurate… and that these symptoms weren’t just in their head.
In a large epidemiological study published in JAMA, it was found that women were more likely to be diagnosed with depression and prescribed antidepressants after beginning hormonal contraceptives. This study followed women for 13 years and found that women who were prescribed the combination birth control pill, that is estrogen and progestin, were 23% more likely to be prescribed an antidepressant.
Can Birth Control Make You Emotional?
Since the introduction of the birth control pill, women have come out in droves complaining of depression and anxiety associated with the use of the pill.
And while this is a side effect listed in the package insert of these hormonal contraceptives, there are still many skeptics within the scientific and medical community that are quick to dismiss women’s stories. As a result, many women have struggled for decades due to the connection between the pill and anxiety.
I’ve had many patients tell stories of doctors dismissing them. They are told that these symptoms “are all in their head,” or that it’s a coincidence. And then they’re met with the next prescription for a mood-altering drug without a single pause or question as to what role these hormones could be playing.
Birth Control and Depression
In the largest epidemiological study to date, researchers followed over one million women ages 15-34 for 13 years and found that women were more likely to be diagnosed with depression after being given the pill. In fact, women prescribed combination pills were 23% more likely to be prescribed anti-depressants.
This is concerning, but perhaps the most startling finding was that teens were 80% more likely to develop depression when prescribed the combined pill. The progestin-only pill wasn’t much better, increasing teens risk 2 fold.
This was a groundbreaking study because it was the first time a study of this size showed a relationship between birth control and depression. While other studies have been unable to show a definitive association between the pill and depression, this study finally gave women (and doctors) a good look at the risk of birth control and depression.
Increased Suicide Risk
A more recent study has shown young women who use hormonal contraceptives, including the birth control pill, the ring, IUDs and the patch have three times the risk of suicide compared to women who have never used hormonal birth control.Young women were found to have three times the risk of suicide while using hormonal birth control! Click To Tweet
This study found the risk of suicide peaked in the first two months from beginning hormonal birth control. Although the risk plateaued after a year, it still remained higher compared to those who never used hormonal contraceptives. The patch had the highest association of suicide attempts, with the IUD, vaginal ring and the pill following close behind.
Epidemiological studies can have many variables that make it difficult to show cause and effect. But, these findings should give us all pause with regards to how freely hormonal contraceptives are prescribed.
I believe in a woman’s right to prevent pregnancy, as much as I believe in her right to have true informed consent. Knowing the risks, along with the signs to look out for and how to protect yourself is important to maintaining your health.
In light of this data, many experts are calling for more thorough screening and personalized counseling by doctors before they recommend hormonal contraceptives to their patients. This is something I have been advocated for in women’s health for years because not all of us respond the same to hormones. So having individualized recommendations can make all the difference in a woman's life.
Who Is at Risk for Depression on Birth Control?
While I love seeing new data and gaining a deeper understanding of risks. I think it is time we turn our attention to asking the question— who is at risk? If we can understand the mechanism and what makes someone susceptible then we can do a better job. Counseling our women better about the risk of hormonal contraceptives and the link between birth control and depression.
What we currently understand is a personal or family history of depression is a risk factor for depression when you begin hormonal contraceptives.
Hormonal Contraceptives and Depression Risks
- Women taking combined contraceptive pill were 23% more likely to be prescribed antidepressants.
- Teens are 80% more likely to be prescribed an antidepressant with the combination hormone pill.
- Women taking progestin pill only were 34% more likely to be prescribed an antidepressant.
- Teens taking the progestin-only pill were 2 times more likely to be prescribed an antidepressant.
- Teens have at least double the risk of suicide after a year and a 30% higher risk after seven years on hormonal birth control.
- Suicide risk peaks around 2 months from beginning hormonal birth control.
Why Can Birth Control Cause Mood Swings in Some People?
The way birth control tanks your mood is multifactorial. And truly, we haven't done enough studies to understand why one woman has issues, while another is just fine. At this current time, we can't say that birth control “causes” mood swings, depression or anxiety based on the current research. However, we do know there is a correlation between starting birth control and then experiencing mood symptoms.
In my naturopathic medical practice, I consider the many factors at play on an individualized basis.
Here are just a few of the issues doctors should consider.
Birth control depletes crucial mood supporting nutrients, including magnesium and antioxidants like vitamin E, vitamin C, which can lead to oxidative stress.
Oxidative stress is basically a situation where free radicals are winning. They are ripping apart your cells and definitely messing with your neurological health.
The pill depletes vitamin B6 and messes with tryptophan within the brain. Vitamin B6 and tryptophan are necessary for serotonin production, the happy neurotransmitter. Vitamin B6 is also an important cofactor for GABA, which literally puts the stop on the panic button in your brain. When that’s missing you can wave a big hello to anxiety.
If you're on these hormones, replenishing these nutrients is an absolute must. That is why I recommend beginning a quality prenatal with methylated B vitamins and mineral cofactors for women in my practice choosing to stay on.
Birth Control is Inflammatory
These hormones are inflammatory and we know inflammation interrupts neurotransmitter production and can affect healthy neurotransmitter levels significantly.
You can test for markers of inflammation with a simple blood panel. Clinically, I find the majority of women who are on hormonal contraceptives have higher levels of inflammation than what I find in women not on birth control.
Adrenal and Thyroid Health
Hypothyroid women are more prone to having depression and anxiety.
The adrenal glands help regulate inflammation. When function is compromised, this can also lead to mood symptoms.
How Could the Pill Be Contributing to Depression?
There are several mechanisms at play and more research is needed to understand the far-reaching impacts of the pill. What we do know is the pill depletes nutrients crucial for brain health, disrupts thyroid hormone, causes issues with your adrenals, and inflammation in your gut. Any of these can cause someone to feel depressed.
But more recently there has been evidence showing that pill users experience a decrease in neuroprotective molecules (protect brain cells) and have increased levels of neurotoxic chemicals (destroy brain cells) compared to women who are not on the pill. That means being on the pill can be bad news for your brain.
How does this happen? It all comes down to how the amino acid tryptophan gets processed while on the pill.
The Tryptophan Kynurenine Pathway
Ever heard that turkey helps you sleep? People say this because turkey contains tryptophan. This is an amino acid you use to make serotonin (the happy neurotransmitter) and melatonin (sleepy neurotransmitter). While that Thanksgiving making you sleep business is a myth (it’s more about the carbs, sugar & alcohol), tryptophan is an important amino acid in the brain, hormone, and mental health.
When tryptophan metabolism is functioning optimally your body produces serotonin and melatonin and kynurenic acid. Kynurenic acid protects your brain.
In a recent study, women using the pill were found to have reduced kynurenic acid and elevated CRP, indicating inflammation and immune system activation. This makes sense since the pill is understood to be inflammatory.
When inflammation or cortisol goes high, the body favors the production of quinolinic acid. Quinolinic acid which is inflammatory and harmful in the brain. We know that inflammation and immune dysregulation have been shown to play a role in the development of depression.
Larger studies are needed to understand clearly if this is the primary way birth control and depression are linked.
Hormonal Contraceptives Are for Healthy People
Remember that oral contraceptives and hormonal birth control have all been designed with a healthy woman in mind. Studies also aim to eliminate anyone who has a diagnosis that could skew results.
So, if you're a woman who already has a preexisting condition, like autoimmune disease, thyroid disease, an adrenal condition or a mood disorder, starting off with these hormones may just be a recipe for disaster in your body.
Sadly, many women and young girls are being put on these hormones to treat symptoms, such as acne, irregular periods, PCOS, or extremely painful periods. Hey, you name the period problem, and you're going to get a prescription from your doctor for some hormonal suppression.
I take issue with using the pill to mask symptoms and telling a woman that this is the only way to fix her hormones.
They don’t fix your hormones. And if you’ve had a suspicion this is true, but fear to return to nightmare periods then girl, I got you. You need to attend my free masterclass called The Pill Free Period™.
And please ladies, this is in no way judgement if you use hormones to manage symptoms. I did it too. But I want you to know you have options.
Why Don’t Doctors Make the Connection?
Part of the issue is that there have been multiple studies done, showing that there is no correlation between mood symptoms and hormonal birth control. This has caused many clinicians to conclude that there must be something else to the mood swings on the pill. They believe that the symptoms of anxiety and depression can't be attributed to the current hormonal contraceptive you're using.
Nevermind that there have been numerous studies showing that sex hormones influence neurotransmitters and brain function. But please, tell me again how it is impossible for synthetic estrogen or progestin to influence our moods.
Then there is the education doctors receive. Doctors are taught that side effects are few and far between. They are taught that the risk of pregnancy is so extreme that these side effects are of very little concern.
Your Doctor Wants to Help
Let’s not forget your doctor wants to help you. We all went to medical school with a desire to help. Trust me, we don’t give up a decade of our life, go into a crazy scary amount of debt and sacrifice our own health and relationships just to push pills. Nope. Doctors want to help you. Trouble is, when you’re provided with a toolkit that includes only hormonal suppression for every female concern then that is all your patient is going to get.
Take a moment to reframe what you’ve heard and what you may have been thinking. I see a lot of smack talking about how doctors are the worst because their only solution is the pill. They are not the worst. They are just working with what they’ve got.
And they are relying on the research they are being presented with during their continuing education.
While I value the research, I think it's equally important to listen and really hear the story of the woman who is sitting in front of me. If she's telling me that her mood has changed since beginning a hormonal contraceptive, then that is valuable data that should be considered in her care.
As doctors, we can’t rely solely on evidenced-based research because it does not always translate clinically. We also need the information that the woman who's sitting in our office is providing—her story.
Our clinical experience has tremendous value. Bridging this with her story and the research is the sweet spot for individualized medicine.
Studies Have Limitations that We Must Recognize in Medicine
One of the biggest limitations is that women who are experiencing profound or negative side effects with birth control are more likely to stop taking it. Studies seeking to compare women on and off birth control, won't necessarily account for the woman whose mood was interfering so significantly with her life that she stopped it, left the trial and cut off all communication.
These studies aim to demonstrate what the average experience is like for every woman. But when you consider that those with extreme mood symptoms are more likely to quit the studies then you have to question just what is “average?”
We also need to consider that many studies rely on self-reporting, which is not always completely accurate. Some women feel shame to report mood symptoms. Others figure it’s just par for the course.
And like many of my patients have shared with me, they didn’t want to be prescribed an antidepressant or have that diagnosis in their chart… So they just didn’t tell their doctor.
Whole Person vs. Measured Outcomes
No one is really asking the question of what happens when we interrupt hormonal pathways and disrupt the natural process within the body. They look to certain variables, but never really the whole person. And to their credit, that is a difficult thing to study.
Let us also not forget, studies don’t take into account all the unforeseen variables of your life that can put you at risk.
But what it all comes down to is, what is true for you? What is your normal? And what is your experience since starting hormonal birth control?
What can you do if you feel like birth control is messing with your mood?
Real talks. Think you're suffering from birth control mood swings and want these to go away? Then it is time for a conversation with your doctor about getting off of them.
Unfortunately, I have not seen a woman’s mood get better by staying on them. In fact, in my clinical experience, they get a whole lot worse.
And just because you come off these hormones doesn't mean those symptoms will just magically disappear. In fact, it's common within post-birth control syndrome to see mood symptoms persist even after stopping these hormones.
If you start a hormonal contraceptive and you see a decline in your mood or anything less than your normal joyous self, it's time for a conversation with your doctor.
Listen, this is a medication and you can choose to take it or not. But I want to be clear, only a licensed health care practitioner can advise you about birth control medications and devices.
Sorry, not sorry Dr. Google.
If you chat with your doctor and you feel they aren’t listening, they’re telling you it's all in your head, or they just aren’t picking up what you’re putting down, then get a second opinion.
Many of my patients have reported being met with a new prescription for a mood-altering medication when they tell their doctor about their new-found mood symptoms since starting hormonal birth control. Layering on another pharmaceutical with even more side effects is not the answer.
This fails to address the root cause and may actually make your symptoms worse. Your doctor is smart. So I say, challenge them to use their brain and think through what is happening in your body through the lens of individualized medicine.
And here’s a pro tip for navigating that conversation. Come to it with respect for what your doctor knows and how they can help. Also, be clear in your timeline when you started hormones and when your mood symptoms began. Also, have questions prepared and a way to take notes during your visit.
While the “your doctor works for you so you tell them what to do” mindset is popular these days, I can assure you that attitude won’t get you very far with your physician. Treat your doc like you want them to treat you. And if you aren’t jiving, no worries. You can ask for a referral or find a new doc. Trust me, we do not take offense if you feel someone else can better serve you. Remember, we got into medicine to help.
If you don't want to get pregnant, you're going to need a backup method first before kicking that pill to the curb. This is also something your doc can help with. And here’s a resource on non-hormonal birth control I’ve created so you can know your options and come to the conversation educated.
Below are some of the ways you can help to improve your mood whilst on birth control:
Replenish Nutrients, Stat
I recommend a whole foods diet with healthy fats, plenty of veggies and high-quality protein to any woman wanting to thrive and especially those who are on synthetic hormones.
In addition to eating a whole foods diet, I also recommend that women start a prenatal or a multivitamin. This will provide you with the crucial B vitamins, antioxidants and minerals that are being depleted by the pill and help you restore your nutrient status.
In my programs, we leverage my Paleo Detox (a bone broth-based protein) or Plant-Based Detox kits because they are loaded with nutrients depleted by hormonal birth control and have added antioxidant support.
Tame Inflammation with Turmeric
Whether you're on these hormones or you're coming off, turmeric is a potent anti-inflammatory. So it can help drop inflammation throughout the entire body, including the brain.
Turmeric also supports liver health and healthy detoxification pathways. After all, the liver packages up those hormones and eliminates them from your body.
I recommend adding turmeric to foods, drinking golden milk lattes and taking a highly absorbable form of turmeric as a supplement to my patients.
The majority of your immune system (responsible for inflammation) lives in your gut. This is a key place to focus on when lowering inflammation. Add a probiotic and make shifts in your diet to support a healthy microbiome. Adding in beneficial fiber and eating in a calm environment help you to experience more regularity and fewer episodes of indigestion.
Introduce an Omega-3 supplement and include omega-3 sources of fish like sardines, salmon, and mackerel in your diet. Omega-3 fatty acids, specifically EPA and DHA have been shown in research to be neuroprotective or in other words, they protect the brain. Your brain is structurally made up of a lot of fat. So it makes sense that you want to fuel it with the healthiest fats.
In addition, Omega-3s are anti-inflammatory fats. Research has shown that hormonal birth control is inflammatory as observed through measuring C-Reactive Protein (CRP), an inflammatory protein.
As I talk about in my book, Beyond the Pill, Omeg-3s have the benefit of lowering inflammation and prostaglandins. This can make periods overall easier with fewer cramps.
Additional B6 will help to rebuild your stores and support healthy neurotransmitter metabolism. The B-Vitamins and minerals also support liver detoxification pathways, which are important post-pill.
Move & Have Fun
I recommended get moving every day to support both your mood and your hormones. This is especially important if your birth control is making you angry or depressed. Regular activity does wonders for the mood and helps your body regulate its hormones. Be sure to engage in exercise that you enjoy.
I can't overstate the importance of sleep. If you’re not getting at least 7 hours per night then you can kiss healthy hormones and awesome moods goodbye! Sleep is when your brain and body recover from the day. So if you’re not getting enough of it you can expect your body to struggle.
The Pill-Free Period: Get back to normal after birth control
If you're looking for more support and more help navigating the world of hormonal contraceptives, then I want to invite you to my free masterclass.
In this important class, I’m going to help you:
- Finally understand what’s going on with your hormones and why you feel the way you do since you got off birth control (and what to expect if you’re getting off the pill soon)
- Know the difference between a much bigger issue that requires immediate medical attention and a side effect that will go away with a little detox action. (The most common side effects of going off birth control can be remedied this way)
- Identify Post Birth Control Syndrome so you know if you have it and what you can do about it)
- Take the first steps to finally feel normal again. (There are 3 things you must do to get your hormones to finally work the way they’re supposed to. Don’t worry, I’ll let you in on all of them before we’re done.)
KEEPING IT REAL, WHILE KEEPING YOU EDUCATED
Featuring a 28 day plan to take back your cycle and dozens of charts, checklists, and diagrams to help along the way.
- Abdullatif H, Ashraf A. Reversible subclinical hypothyroidism in the presence of adrenal insufficiency. Endocr Pract. 2006. 12(5). 572.
- Bay-Richter et al. A role for inflammatory metabolites as modulators of the glutamate N-methyl-d-aspartate receptor in depression and suicidality. Brain Behav. Immun. 2015. 43 (2015). 110-117.
- Dreon, D., Slavin, J, Phinney, S. Oral contraceptive use and increased plasma concentration of C-reactive protein. Life Sci. 2003. 73 (2003). 1245-1252.
- Fink, G., Sumner, B.E.H., Rosie, R. et al. Estrogen control of central neurotransmission: Effect on mood, mental state, and memory. Cellular and Molecular Neurobiology. 1996. 16 (1996). 325–344.
- Rapkin, A. J. The role of serotonin in premenstrual syndrome. Clin. Obstet. Gynecol. 1992. 35. 629–636.
- Studd, J., and Zamblera, D. Premenstrual depression. Focus Depress. 1994. 26. 9.
- Sumner, B. E. H., and Fink, G. Effects of acute estradiol on 5-hydroxytryptamine and dopamine receptor subtype mRNA expression in female rat brain. Mol. Cell. Neurosci. 1993. 483–92.
- Sumner, B. E. H., and Fink, G. Estrogen increases the density of 5-HT2A receptors in cerebral cortex and nucleus accumbens in the female rat. J. Steroid Biochem. Mol. Biol. 1995. 545–20.
- Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016. 73(11). 1154–1162.
- Skovlund CW, Mørch LS, Kessing LV, Lange T, Lidegaard. Association of Hormonal Contraception With Suicide Attempts and Suicides. Am J Psychiatry. 2018. 175(4). 336-342.
- Tsuru J, I, et al. The thyrotropin-releasing hormone test may predict recurrence of clinical depression within ten years after discharge. Neuro Endocrinol Lett. 2013. 34(5). 409-17.
- Timothy B.Meierab. Wayne C.Drevetsc T. KentTeaguedefg. Brent E.Wurfelh. Sven C.Muelleri. JerzyBodurkahj. Robert Dantzerk. Jonathan Savitzhl. Kynurenic acid is reduced in females and oral contraceptive users: Implications for depression. Brain, Behavior, and Immunity. 2018. 67. 59-64.
- Gregory F. Oxenkrug, MD, PhD. Tryptophan–Kynurenine Metabolism as a Common Mediator of Genetic and Environmental Impacts in Major Depressive Disorder: The Serotonin Hypothesis Revisited 40 Years Later. Isr J Psychiatry Relat Sci. 2010. 47(1). 56–63.
- Won E, Kim YK1. Stress, the Autonomic Nervous System, and the Immune-kynurenine Pathway in the Etiology of Depression. Curr Neuropharmacol. 2016. 14(7). 665-73.
- Williams WV.. Hormonal contraception and the development of autoimmunity: A review of the literature.. Linacre Q.. 2017. 84(3). 275-295.
- Darrell W. Brann,*,1,2,3 Krishnan Dhandapani,1,2,4 Chandramohan Wakade,1 Virendra B. Mahesh,1 and Mohammad M. Khan1,2. Neurotrophic and Neuroprotective Actions of Estrogen: Basic Mechanisms and Clinical Implications. Steroids. 2007. 72(5). 381–405.
- Linus Pauling Institute. Oregon State University. Vitamin B6. Micronutrient Information Center.
- Charlotte Wessel Skovlund, MSc1; Lina Steinrud Mørch, PhD1; Lars Vedel Kessing, MD, DMSc2; et al. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016. 73(11). 1154-1162.