The Link Between Birth Control Pills and Depression

By Dr. Mercola

Birth control pills are the most popular form of contraception among U.S. women. They're taken by 16 percent of this population, while just over 7 percent use long-acting reversible forms of contraception, such as a hormonal intrauterine device or implant.

What these pills, devices and implants have in common is that they're forms of hormonal birth control — that is, they contain or release synthetic forms of hormones, such as estrogen and progestin (a form of progesterone), which work to prevent pregnancy in various ways.  

The problem is that these sex hormones also affect mood and other biological processes and artificially manipulating them can lead to many unintended consequences in your body, some of them uncomfortable and some quite serious, including altering your mental health.

Birth Control Pills Linked to Depression

Researchers from the University of Copenhagen in Denmark analyzed data from more than 1 million women over a period of 14 years. None of the women, who were between 15 and 34 years of age, had been diagnosed with depression at the start of the study.¹

However, the analysis showed that women who used hormonal birth control had a 40 percent increased risk of developing depression after six months compared to women who did not. The risk was greatest among adolescents.

The use of hormonal birth control was also associated with subsequent use of antidepressant drugs. Certain types of hormonal contraception had varying risks. Specifically, the use of:

• Progestin-only pills led to a 1.3-fold higher rate of antidepressant use
• Combined birth control pills led to a 1.2 higher rate
• Transdermal patch led to a 2-fold increased risk
• Vaginal ring led to a 1.5-fold increased risk

Anecdotal Reports Suggest Hormonal Contraceptives Lead to Mood Changes

Lead study supervisor, Dr. Øjvind Lidegaard, a professor at the University of Copenhagen in Denmark, told CNN:²

"We have known for decades that women's sex hormones estrogen and progesterone have an influence on many women's mood.

Therefore, it is not very surprising that also external artificial hormones acting in the same way and on the same centers as the natural hormones might also influence women's mood or even be responsible for depression development."

Despite this knowledge, many health care professionals are reluctant to suggest that the risks of hormonal birth control may be too steep for some women, especially those with a history of depression.

While scientific validation has yielded some conflicting results, one report in the Oxford Medical Case Reports journal detailed two cases of women with a history of depression who developed depressive symptoms after treatment with hormonal contraceptives (the combined oral contraceptive pill, progestin-only pill and combined contraceptive vaginal ring).³

Case Reports Detail Onset of Depressive Symptoms After Use of Hormonal Contraceptives

In one case, a 31-year-old woman experienced gradual improvement of her depressive symptoms after she stopped using the vaginal ring. However, "a sudden and acute worsening occurred" shortly after she started using a combined birth control pill.

About a month later, she again experienced a worsening of symptoms "almost simultaneously with the initiation of treatment with combined contraceptive vaginal ring." The researchers noted:⁴

"HC [Hormonal contraception] was again interrupted, with a subsequent clear improvement in depressive symptoms. The patient remained stable without depression for the following [six] months."

In the second case, a 33-year-old woman developed depressive symptoms shortly after starting a progestin-only birth control pill. Her symptoms disappeared completely within one week of stopping the pill. The researchers concluded:⁵

"Caution should be used when starting up treatment with HC in women diagnosed with depression, since it might in some cases lead to worsening of the depressive symptoms.

Likewise, attention should be paid to the pre-existing use of HC in women who develop depression, as discontinuation of HC might in some cases be sufficient to treat the depression."

Hormonal Contraceptives Are Linked to Glaucoma and Other Health Risks

Women who used oral contraceptives for longer than three years were more than twice as likely to have been diagnosed with glaucoma, a leading cause of vision loss and blindness, according to one study.⁶

The results were so striking that the researchers recommended women taking the pill for three or more years be screened for glaucoma and followed closely by an ophthalmologist.

It might seem unusual that contraceptives could affect your vision, but it's important to understand that there are body-wide repercussions of artificially manipulating your hormones.

Most birth control pills, patches, vaginal rings and implants contain a combination of the derivatives of the hormones estrogen and progestin. They work by mimicking these hormones in your body to fool your reproductive system into producing the following effects:

• Preventing your ovaries from releasing eggs
• Thickening your cervical mucus to help block sperm from fertilizing an egg
• Thinning the lining of your uterus, which makes it difficult for an egg to implant, should it become fertilized

However, your reproductive system does not exist in a bubble. It is connected to all of your other bodily systems, and therefore hormonal contraception is capable of altering much more than your reproductive status.

According to one report by the U.S. Centers for Disease Control and Prevention (CDC), 30 percent of women who have used the pill and nearly half of women using other hormonal contraception methods stopped their use due to "dissatisfaction," which was most often caused by side effects.⁷ Potential health risks include:

The Pill May Be a Libido Killer

About 15 percent of women taking oral contraceptives report a decrease in libido, likely because they lower levels of sex hormones, including testosterone.⁸ One study also found seven times the amount of the libido-killing sex hormone binding globulin (SHBG) was present in women who took oral contraceptives compared to women who never used the pill.

Even though SHBG levels declined in women who had stopped taking the pill, they still remained three to four times higher than they were in women with no history of using oral contraceptives, which suggests oral contraceptives may kill a woman's libido for the long-term. Researchers concluded:⁹

"Long-term sexual, metabolic, and mental health consequences might result as a consequence of chronic SHBG elevation [in women who take, or have taken, oral contraceptives]."

Synthetic Hormones in Drinking Water May Be Increasing Cancer Rates in Men

It's not only women who are at risk from synthetic hormones contained in hormonal contraceptives. An analysis of data from 100 countries found oral contraceptive use is associated with prostate cancer, which may be due to exposure to synthetic estrogens excreted by women that end up in the drinking water supply.¹⁰

While it's been argued that only a small amount of additional estrogen is excreted by a woman using this form of contraception, this "small amount" is compounded by millions of women, many of whom use the pill for long periods of time. Also, synthetic estrogen and progestin does not biodegrade rapidly and is far harder to remove through conventional water purification systems, resulting in greater accumulation in the environment.

While this study did not prove cause and effect — that is, it did not prove that environmental estrogen from women's oral contraceptive use causes prostate cancer in men — it did find a significant association between the two that deserves further investigation, especially in light of estrogen's well-established role in a wide range of cancers and the prevalence of hormonal contraceptive use.

Non-Hormonal Methods of Contraception

Women and men looking for reversible non-hormonal options of contraception may be surprised to learn that there are many options. Conventional health care providers typically steer patients toward the popular hormonal options, but they are far from the only ones.

Barrier methods, which work by preventing the man's sperm from reaching the woman's egg, include the diaphragm, cervical cap, sponge and male and female condoms. None of these are foolproof, which is why many couples use them in combination with fertility awareness-based methods.

Fertility awareness involves knowing when a woman's fertile period occurs each month, and then avoiding sexual intercourse during (and just prior to) this time (or using a barrier method if you do).

When used consistently and correctly, fertility awareness is highly effective at preventing pregnancy; fewer than 1 to 5 women out of 100 will become pregnant using fertility awareness in this manner.¹¹ In order to track fertility, a number of methods can be used by women, including tracking basal body temperature, mucus production, saliva indicators and cervical position.

Many women use a combination of methods, and there are also commercially available ovulation monitors that can be used in conjunction with the other methods. Ninety-nine percent of U.S. women of reproductive age have used at least one contraceptive method at some point in their lifetime, with 88 percent choosing hormonal options.¹²

However, you may be relieved to learn that you don't have to subject yourself to the risks of hormonal contraception, or learn to live with the side effects, in order to take control of your reproductive health. An experienced holistic health care provider can help you choose the best non-hormonal contraception options for you.