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Can birth control help with mood, anxiety, and depression?
What do we know about birth control and mental health
Top things to know about birth control and mood:
Each person’s body—and brain—is unique, and their response to hormonal birth control and its side effects can be different.
Hormonal contraception can lead to or worsen depression in some people while for others, it can improve mood, helping them feel calm or stable.
Within the "My Health Record" feature in the Clue app, anxiety and depression are the most frequently reported diagnoses.
Some people say that tracking their mood in an app like Clue helps them gain self-awareness and understanding of their mood changes.
There are many contraceptive options to choose from. Your healthcare provider can help find the right one for your needs. Non-hormonal birth control options are also available.
How hormones impact your mental health
You may hear people say hormonal birth control negatively affects their mood, causing depression, anxiety, or irritability. You may also hear people say that hormonal birth control improves their mood, making them feel more calm or stable. Of course, each person’s body—and brain—is unique, and their response to hormonal birth control and its side effects can be different. Is there a link between hormones and mental health? Can “hormonal imbalances” cause anxiety, depression, or other mental health conditions?
The answer isn’t as straightforward as you might think. Several large studies have explored a link between hormonal birth control and mood changes. The results were conflicting. To understand these results, let’s review the basics:
Hormonal birth control comes in several forms, including the implant, the intrauterine device (IUD), the shot, the pill, the patch, and the ring.
Progestin-only hormonal birth control contains just progestin (a synthetic form of the body’s naturally-occurring hormone, progesterone).
Combined hormonal birth control contains both progestin and a form of estrogen.
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A 2016 study of over one million women in Denmark raised awareness about the possible connection between hormonal birth control and mental health (1). This study analyzed nationwide health records and found that hormonal birth control users were more likely to be diagnosed with or treated for depression (1).
Two large studies in the USA and Finland showed something different. In these studies, people using any type of hormonal birth control reported fewer symptoms of depression and anxiety (2,3).
So, what does this mean when it comes to selecting a birth control method that’s right for you? Studies on hormonal contraception and mood effects have had inconsistent results. This inconsistency is likely because of differences in how the studies were designed and carried out and how they measured mood and mental health outcomes (4). That is why it’s important to talk to a healthcare provider openly about your mental well-being when you are discussing birth control options. We’ll answer some common questions about birth control and mental health, but remember that every person’s situation is different.
Are hormones connected with anxiety and depression?
There is reason to believe that hormones play a role in depression. Women are about twice as likely as men to have depression—a difference that begins during puberty (5). One small study showed that people with depression had lower estrogen levels during the follicular phase (the time when estrogen levels normally rise between the start of a period and ovulation) (6). Changes in estrogen levels may explain why some people experience depressive symptoms more frequently during the premenstrual phase, postpartum, and perimenopause (7).
The effect of birth control on depression and anxiety
Hormonal birth control methods, like the pill, generally have more benefits than risks, but some people may experience negative mood side effects (8). Some studies find no differences between people who use hormonal birth control and those who don’t (8). Other studies show increases in symptoms of depression, anxiety, and eating disorders (8). In yet more studies, a relationship between people who take the pill and the use of antidepressants has been found (8). On the other hand, some people have reported that their mood improved when they took the pill (8). Research has found negative mental health side effects are more likely in adolescents, people with a history of mood changes when using hormonal contraception, and those who already have a mental health condition (8). Forms of hormonal birth control that only contain progestin may impact mood more negatively than those combining estrogen and progestin (8).
The U.S. Center for Disease Control (CDC) and the World Health Organization (WHO) guidelines put no restrictions on the use of any type of birth control for people who have depression (9, 10). The use of combined hormonal birth control, the hormonal IUD, implant, and the shot is not associated with worsening symptoms among people with depression or bipolar disorder (11, 12). One study even showed fewer depressive symptoms among combined hormonal birth control users compared to those not using hormonal methods (11).
There aren’t believed to be any interactions between selective serotonin reuptake inhibitors (SSRIs) (commonly prescribed for depression) and hormonal contraception (13). The CDC puts no restriction on the use of any hormonal birth control for people who are taking SSRIs (10).
Other supplements and medications used for depression, such as tricyclic antidepressants, bupropion, and St. John’s Wort may interact with hormonal contraception (10, 11).
What the research says about the impact of birth control on mood stability
Mood swings are the most often tracked option in the feelings category in the Clue app. Researchers often ask about mood swings when studying people’s experiences with hormonal birth control.
In one study, about 14% of users of the implant reported mood swings (14). In another study, shot users were less likely to report mood swings compared to people not using hormonal contraception (15).
One study found that users of the combined oral contraceptive pill or (COC), which contains estrogen and progestin, who were tracking daily mood, had small increases in anxiety, irritability, and mood swings in the intermenstrual phase (roughly cycle days 5-22 of a 28-day cycle), but improvement in depression in the premenstrual phase (the seven days leading up to the start of the next period) compared to those on a placebo pill (16).
While some people may experience improvement in nervousness and mood swings while taking COCs (15), others who have experienced negative mood effects while on birth control pills in the past may be more likely to experience depressed mood and mood swings (17).
Studies have shown that ring users may be less likely than pill users to report depression, irritability, and mood swings as side effects (18).
Some people are more sensitive to hormonal changes than others. Hormonal changes can be linked to mental health conditions in these people. However, studying mental health conditions like depression and anxiety is difficult because there are so many factors that can contribute to them. It’s easy to blame hormonal birth control for mental health conditions, but the truth is that mental health is complicated. Many things can impact mental health conditions, such as past trauma, physical or emotional abuse, conflicts with family or friends, social isolation, major events (like moving or losing a job), serious illnesses or other health challenges, some medications, and substance use (19).
That being said, it's also been shown that people who have regular cycles are more likely to have mood disorders after puberty and during perimenopause–both periods of hormonal change. This suggests that hormonal changes may affect mental health (20). When a person uses hormonal birth control, it can change their body’s natural hormone level and could possibly cause changes to their mental health.
Can birth control help stabilize mood?
During the luteal phase of the menstrual cycle, estrogen levels change and progesterone levels increase. This is the time when most people who are not using hormonal contraception report a negative mood. (21, 22). When you take oral contraceptives (the pill), your reproductive hormones are stabilized throughout the entire cycle. This is believed to be the reason why some people feel their mood is more stable on the pill. They don’t experience hormonal ups and downs that might usually be connected to their cycle (22).
One study of almost 7,000 women found that using hormonal contraceptives was linked with lower levels of depressive symptoms and suicide attempts (23). The pill in particular has been linked with decreased depression symptoms and generally improved mental well-being (23);
Can birth control make mood swings worse?
Hormonal contraception can make depression worse for some people (24). Researchers believe the link between the pill and depression is related to the amount and type of progestin in the specific type of pill taken (24). There are a wide variety of birth control pills for people to choose from, and the amount of progestin in each brand really varies (24).
Most of the research on birth control and mood has been done on birth control pills that contain ethinyl estradiol, but newer birth control pills that contain physiological forms of estrogen, such as estradiol and estradiol valerate, may be better tolerated, although more research is needed (25).
How do you know if birth control will improve or worsen your mood?
Your healthcare provider can help you choose the right birth control method for you, but you may have to try a few to see which works for you. They will look at your symptoms and the research on each method.
Studies measure mood and mental health in different ways. Some studies look at medical records to see if people using hormonal birth control are more likely to be diagnosed with depression or prescribed antidepressants. Some ask participants to answer questions about depression or anxiety before and after using hormonal birth control. Others rely on users' reports of symptoms like depression or mood swings. It's hard to compare studies because they have different outcomes.
Study results are often reported as the average for the group of participants, and do not take into account the experience of individuals. Even in studies that conclude that hormonal birth control does not affect mood, there will be small numbers of individuals that experience improvements or worsening in their mood (4).
What’s the best birth control for mood stability?
It’s hard to say which is the best type of birth control for mood stability because most studies focus solely on one type of birth control, like the pill or the IUD. Globally, hormonal contraceptives are used by more than 100 million people with cycles. Whether hormonal birth control is linked to depressive symptoms for all women and people with cycles is still a matter of debate amongst researchers (26). For people with a history of mental health conditions, hormonal birth control might make depression more likely (26).
Are some methods more likely to cause mood swings than others?
Here is what the research says about each type of hormonal birth control:
Combination birth control pill
COCs are pills that contain both synthetic estrogen—usually in the form of ethinylestradiol—and a progestin (27).
One review that focused on the combination birth control pill found that it was difficult to draw a conclusion about their impact on mood, due to inconsistent research methods (28). Overall, though, it appears that intensely negative effects from COCs are fairly infrequent, but not unheard of (28). It’s believed that combination pills with “less androgenic progestins” have the fewest negative effects on mood. Your healthcare provider can help you navigate the different options (28).
Here’s what some specific studies have found:
In a large Danish study, users of COCs were more likely to be diagnosed with depression and prescribed antidepressants for the first time compared to those not currently using them (1). But let’s take a look at the actual numbers in this study: the prescription medication records of 1,061 ,997 women were studied. Over half of these women were current or former users of hormonal contraception. Of the 584,098 women, 133,178 (23%) got their first prescription for antidepressants and 23,077 (4%) were diagnosed with depression in the first 15 months of using hormonal contraception.
A large Swedish study looked at the likelihood of being prescribed an antidepressant medication while taking different formulations of the birth control pill. It found that users aged 16–31 were more likely to be prescribed an antidepressant when taking birth control pills containing the combination ethinylestradiol/lynestrenol and ethinylestradiol/drospirenone (29). People using pills containing ethinylestradiol/norethindrone, ethinylestradiol/levonorgestrel, and ethinylestradiol/desogestrel were less likely to be prescribed an antidepressant (29). People taking ethinylestradiol/norgestimate were just as likely as non-users of hormonal birth control to be prescribed an antidepressant (29).
Several studies have found that birth control pill users are not more likely to report symptoms of depression (3, 30, 31), although one of these studies did show a decrease in general well-being among pill users (30). Another showed that people using birth control pills for reasons other than for birth control were more likely to experience depression (31).
One study found that COC users tracking their daily mood had small increases in anxiety, irritability, and mood swings in the intermenstrual phase (roughly cycle days 5-22 of a 28-day cycle), but showed improvement in depression in the premenstrual phase (the seven days leading up to the start of the next period) compared to people on a placebo pill (16). At the end of the three-month study, there was no difference in depression scores between the birth control pill and placebo groups (16).
A study of 264,557 women from the UK found that the link between COC use and depression was strongest in the first two years of taking it (32).
Extended or continuous dose birth control pills
Some types of birth control pills can be taken at a continued dose throughout each cycle so that no menstrual bleeding occurs, or bleeding is much lighter. Research on the effects of continuous birth control pills on mood is limited, but they are recommended for people who know that they are sensitive to hormonal changes (33).
The key takeaway: The pill may increase the chance of being diagnosed with or treated for depression, but the specific pill formulation may make a difference. Overall, it appears that COCs do not have a harmful effect on mood for users, but this may vary between individuals.
Hormonal IUD
The hormonal IUD is a progestin-only method containing levonorgestrel (27). In a Danish study, current users of the hormonal IUD were more likely to be diagnosed with depression and prescribed antidepressants for the first time than people who weren't currently using it (1). According to the study, the risk of being diagnosed with depression and prescribed an antidepressant was higher for adolescent hormonal IUD users than in adults (1). A Swedish study also showed an increased risk of being prescribed an antidepressant among people using a levonorgestrel-only birth control method, which included both the hormonal IUD and implant (29).
In contrast, a large Finnish study showed that people using the hormonal IUD were just as likely to have symptoms of depression or anxiety as people not using this method (3). Two studies involving people who received the hormonal IUD to treat heavy periods showed scores on depression surveys either remained the same or improved, but this could be due to an improvement in quality of life when heavy periods become more manageable (34, 35).
The key takeaway: The hormonal IUD may increase the chance of being diagnosed with or treated for depression, but it does not appear to negatively affect mood when hormonal IUD users report symptoms.
Depo-Provera shot
There are several types of birth control shots available. All the studies mentioned in this section focus on the progestin-only shot containing medroxyprogesterone acetate (27). A Danish study showed current users of the shot were more likely to be prescribed antidepressants for the first time than people not using it, although the rate of depression diagnosis among shot users was not reported in the study (1). In a Swedish study, shot users were also more likely to be prescribed an antidepressant (29).
In a study involving 183 people using the shot for up to three years, it was shown that participants were more likely to report depressive symptoms compared to people using another method of birth control or no method at all (15). People who stopped using the shot during the study reported depressive symptoms at higher rates, which subsided after stopping (15). It’s worth noting, however, that these shot users were also more likely to report depressive symptoms before starting the shot (36).
Another study followed almost 400 users of the shot for a year (37). Among the 170 people who continued using the shot for a year, there was a decrease in depressive symptoms from the time they started it (37). Among the 218 people who stopped using Depo during the year-long study, there was no change in depressive symptoms (37).
Adolescents using the shot do not appear to be at increased risk for depression, based on three small studies (38). One two-year study found that shot users were less likely to report mood swings compared to people not using hormonal contraception (15).
The key takeaway: The shot may increase the chance of being treated for depression, but results on mood symptoms are mixed—some people may have improved mood, while others have worsened mood.
The implant
The implant is a progestin-only method of birth control. There are two variations: a single-rod implant containing the progestin etonogestrel and a two-rod implant containing levonorgestrel (27).
In a large Danish study, current users of the implant were more likely to be prescribed antidepressants for the first time than people who weren’t currently using it, but the rate of depression diagnosis among implant users was not reported in the study (1). This study also does not specify which implant people were using.
It was found in a large Swedish study that people, particularly adolescents, using the etonogestrel implant were more likely to be prescribed an antidepressant (29). The same study showed an increased risk for antidepressant prescription among people using levonorgestrel-only methods, which included both the hormonal IUD and implant (29).
In a study of people using the etonogestrel implant for up to two years, 14% reported mood swings and 7% reported depression that was attributed to the implant (14).
The key takeaway: The implant may increase the chance of being treated for depression, but more research is needed to determine whether implant users report mood changes during use.
The patch
The patch is a combined hormonal birth control containing ethinylestradiol/norelgestromin (27). Very few studies on birth control and mental health specifically include the patch.
In a Danish study, current users of the patch were more likely to be diagnosed with depression and prescribed antidepressants for the first time than people who weren't currently using it (27). The risk of being diagnosed with depression and prescribed an antidepressant was higher for adolescent patch users than for adults in the study (1).
A Swedish study showed that people using the patch were more likely to be prescribed an antidepressant than those not using hormonal birth control (29).
The key takeaway: The patch may increase the chance of being diagnosed with or treated for depression, but further studies are needed to determine whether patch users report mood changes during use.
The ring
The ring is a combined hormonal birth control containing ethinylestradiol/etonogestrel (27). Few studies on birth control and mental health specifically include the ring.
In a Danish study, current users of the ring were more likely to be diagnosed with depression and prescribed antidepressants for the first time than people who weren't currently using it (1). The risk of being diagnosed with depression and prescribed an antidepressant was higher for adolescent ring users than for adults in the study (1).
Studies have shown that ring users may be less likely than pill users to report depression, irritability, and mood swings as side effects (18).
The key takeaway: The ring may increase the chance of being diagnosed with or treated for depression, but more research is needed to see if ring users report mood changes during use.
Mini-pills
Mini-pills are progestin-only birth control pills. They may contain norethindrone, desogestrel, drospirenone, lynestrenol, or other forms of progestin (27).
In a Danish study, current users of the mini-pill were more likely to be diagnosed with depression and prescribed antidepressants for the first time than people who weren't currently using it (1). The risk of being diagnosed with depression and prescribed an antidepressant was higher for adolescent mini-pill users than for adults in the study (1).
A Swedish study found that people aged 16–31 taking norethindrone or lynestrenol mini-pills were just as likely as people not taking hormonal birth control to be prescribed an antidepressant, although adolescents (aged 16–19) taking norethindrone mini-pills were more likely to be prescribed antidepressants (29). People taking the progestin-only pill containing desogestrel were also more likely to be prescribed an antidepressant (29).
The key takeaway: The mini-pill may increase the chance of being diagnosed with or treated for depression, but the specific formulation may make a difference. Further research is needed to see if mini-pill users experience changes in their mood while using it.
What is the best birth control method for depression and anxiety?
Whether you are thinking about starting birth control or are already using a method, talk to your healthcare provider about any concerns you have about your mental health, as well as your other menstrual cycle experiences. Your healthcare provider can help you to decide which birth control method is best for you, or if trying a new method might help. Trying a few different types of birth control on your journey can help you find the one that best suits your specific needs.
How to manage your mood changes
Working with both a prescriber and a therapist can help you find the best of what will work for you. There are several treatments for mood swings and mood disorders, and not all involve medication. The first step is to recognize the symptoms and how much they affect your life (16). Tracking your mood and its changes in Clue can provide helpful insights into how you are feeling, which can be shared with your healthcare provider.
Discuss your mood changes with a healthcare provider
Therapy and medications, like antidepressants, may be appropriate treatments for depression and mood changes associated with premenstrual syndrome (16, 39). There are several alternative treatments to improve mood swings, but many of them need further study. Some people find that exercise, yoga, and acupuncture can help improve mood changes (17). Other people report that supplementing calcium and vitamins B1 and B6 are helpful in treating mood swings (17).
Monitor and track mood changes related to birth control
Using Clue to track your feelings when starting a new birth control can help you identify any changes. You can also share your tracking history with your healthcare provider to show how your mood varies across your cycle.
Consider switching to non-hormonal birth control
People who are concerned about mood changes may prefer to use a non-hormonal birth control method. There are 12 non-hormonal birth control methods. Each one has its own pros and cons. A healthcare provider who specializes in contraception can help you understand your options and find one which will work best for you.
FAQs
Which birth control is best for mental health?
Some people are more sensitive to hormonal changes than others, and there is reason to believe that hormonal changes can be linked to mental health in these people. It is important, however, to remember that mental health conditions like depression and anxiety are difficult to study because they are influenced by a variety of factors. It’s easy to blame hormonal birth control for mental health conditions, but the truth is that mental health is complicated. Past trauma, physical or emotional abuse, conflicts with family or friends, social isolation, major events (like moving or losing a job), serious illness or other health challenges, some medications, and substance use are just a few of the things that can play a role in the development or worsening of mental health conditions (5, 19).
That being said, it's also been shown that people who have regular cycles are more likely to have mood disorders after puberty and during perimenopause–both periods of hormonal change. This suggests that hormonal changes may affect mental health. When a person uses hormonal birth control, it can change the natural level of hormones in their body and could possibly affect their mental health.
What is the best birth control option for women with a history of mood disorders?
It’s important to speak with your healthcare provider about any history of mood changes when considering birth control options.
PMS and PMDD
COCs are a recommended treatment for premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) (Reid). Continuous COCs (not having any hormone-free days) may be a particularly good choice for people with PMDD, as they help avoid hormonal fluctuations (41).
Postpartum mood disorders
More research is needed to better understand how hormonal contraception affects the risk of postpartum depression, postpartum anxiety, and other postpartum mood disorders. Breastfeeding may influence the type of hormonal birth control a person is prescribed, as well as their risk for postpartum depression, regardless of birth control use.
A study of more than 16,000 people who birthed two to eight months prior showed no relationship between reporting depressive symptoms and the use of any birth control method (41).
One study showed that people who had birthed in the past 12 months and were using the implant or ring, did not have a higher risk of being diagnosed with depression, but were more likely to be prescribed an antidepressant than people not using hormonal birth control method (42). The use of COCs did not change the risk of a depression diagnosis in the postpartum period (33). Those using the mini-pill containing norethindrone and the hormonal IUD were less likely to have a postpartum depression diagnosis (42).
Two studies of people who received the shot shortly after giving birth showed no increase in depression based on self-reported surveys (43). However, these studies only followed shot users for up to three months after delivery, while postpartum depression can occur up to 12 months after delivery (44).
