Birth Control and Mood Swings

We all know someone who swears that birth control completely wrecked their mood. Whether it was making them feel anxious, depressed 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 that 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.

Fast forward to me now, the doctor who works with women every day in my medical practice to undo the effects hormonal birth control causes. Because it is real. Women come to me with new onset of depression, anxiety and mood swings after starting hormonal contraceptives. 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, 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.

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 effect these drugs can have on her mood.

Birth control and mood swings are nothing new. In fact, they are what women have been complaining of since the pill was introduced some fifty years ago.

Birth Control and Mood Swings That Follow

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 with mood symptoms like anxiety and depression.

I’ve had many patients tell stories of doctors dismissing them, telling them 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.

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, anxiety, and depression that 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 to influence our moods.

Your Doctor Wants to Help

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.

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 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 in 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?.

Birth Control and Mood Symptoms Are Real

More recent studies have helped medicine understand that 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.

Hormonal birth control is having a big impact on our mood.

What’s even scarier is that more recent studies have shown that teenage girls starting the pill, the patch, and the IUD, were 80% more likely to develop depression.

It gets scarier.

The suicide risk skyrockets within the first couple of months of taking hormonal birth control for these young women.

Whether it’s the patch, the pill, the IUD, the ring, or the implant it doesn’t really matter. Any type of synthetic hormone can put you at risk for mood-related symptoms and side effects.

Why can birth control mess with your mood?

The way birth control tanks your mood is multifactorial. In my medical practice, I consider the many factors at play on an individualized basis.

Here are just a few of the issues doctors should consider.

Nutrient Depletion

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, 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

The pill, the ring, IUDs, implants and the patch all mess with your thyroid and your adrenal glands, which we know also affect mood.

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.

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.

What can you do if you feel like birth control is messing with your mood?

Real talks. If you think the pill or any other hormone is messing with your mood, 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. You 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, how they can help and 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.

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 that 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 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.

It’s called The Pill-Free Period™: Get back to normal after birth control

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.)

 

beat birth control and mood swings, pill free period masterclass

 

References:

Abdullatif H, Ashraf A. Reversible subclinical hypothyroidism in the presence of adrenal insufficiency. 2006 Sep-Oct;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., 43 (2015), pp. 110-117

Dreon, D.,  Slavin, J, Phinney, S. Oral contraceptive use and increased plasma concentration of C-reactive protein Life Sci., 73 (2003), pp. 1245-1252

Fink, G., Sumner, B.E.H., Rosie, R. et al. Cell Mol Neurobiol (1996) 16: 325. https://doi.org/10.1007/BF02088099

Rapkin, A. J. (1992). The role of serotonin in premenstrual syndrome.Clin. Obstet. Gynecol. 35629–636.

Studd, J., and Zamblera, D. (1994). Premenstrual depression.Focus Depress. 26–9.

Sumner, B. E. H., and Fink, G. (1993). Effects of acute estradiol on 5-hydroxytryptamine and dopamine receptor subtype mRNA expression in female rat brain.Mol. Cell. Neurosci.483–92.

Sumner, B. E. H., and Fink, G. (1995a). Estrogen increases the density of 5-HT2A receptors in cerebral cortex and nucleus accumbens in the female rat.J. Steroid Biochem. Mol. Biol.545–20.

Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154–1162. doi:10.1001/jamapsychiatry.2016.2387

Skovlund CW, Mørch LS, Kessing LV, Lange T, Lidegaard. Association of Hormonal Contraception With Suicide Attempts and Suicides. Am J Psychiatry. 2018 Apr 1;175(4):336-342. doi: 10.1176/appi.ajp.2017.17060616. Epub 2017 Nov 17.

Tsuru J, I, et al. The thyrotropin-releasing hormone test may predict recurrence of clinical depression within ten years after discharge.  2013;34(5):409-17.

 

 

 

 

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About The Author

Dr. Jolene Brighten

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Dr. Jolene Brighten is a Functional Medicine Naturopathic Doctor and the founder of Rubus Health, a women’s medicine clinic that specializes in women's hormones. She is recognized as a leading expert in Post-Birth Control Syndrome and the long-term side effects associated with hormonal contraceptives. Dr. Brighten is the best selling author, speaker and regular contributor to several online publications including MindBodyGreen. She is a medical advisor for one of the first data-driven apps to offer women personalized birth control recommendations.