What’s the lowdown?
- Hormonal contraception can have a negative impact on your mood, but some people find it beneficial
- Some forms of hormonal contraception could present a higher risk than others
- Your age and medical history can affect your risk of developing low-mood side-effects
- Working with your GP and taking note of the levels and types of hormones in your contraception could help you to find the right fit
Since the birth of the pill, some users have noticed a significant change in their mental health, and for some of us, hormonal contraception seems to make the fluctuations in our mood more noticeable. In fact, one study suggests the most common reason¹ for stopping or changing contraception is because of negative mood side effects.
Of all the potential threats that could be posed to our mood, depression is perhaps the most worrying. Some research² shows that hormonal contraception is associated with the risk of attempted suicide, and while findings like these are definitely alarming, they don’t paint a complete picture. What they do do, is highlight how important it is that we understand how our contraception choices can affect our mental health.
Is there a proven link between hormonal contraception and low mood?
Yes – but it isn’t quite as simple as that. A quick Google search of this question is a bit baffling: for every piece of research showing that low-mood side effects exist, there is another study claiming the opposite³. The problem is that contraception users have been reporting these possible side effects for years, but actual research into this topic has been patchy to say the least. In 2016, a few heroes of the research world looked at all the available evidence⁴ and concluded that it was virtually impossible to say what the low-mood risks were, and who was most likely to suffer.
A Danish study⁵ from 2016 reported that women are more likely to be started on antidepressants for the first time or to be diagnosed with depression for the first time if they are currently using or have recently used hormonal contraception. However the study did not account for possible confounding factors and importantly does not establish a causal link between hormonal contraception and depression.
The Faculty of Sexual and Reproductive Health in the UK have released two statements in recent years in response to studies that look at hormonal contraception and depression. At present they advise healthcare professionals to tell patients that whilst it is recognised that some people report that they experience mood changes associated with hormonal contraception, there is no clear evidence that hormonal contraception causes depression.
How might hormonal contraception influence mood?
Hormonal contraception contains different rates of oestrogen and/or progestin (this article explains a little more about how these hormones work). Research suggests⁶ that oestrogen is linked to feeling anxious and fearful, and progesterone with irritability and depression.
Here’s the particularly bamboozling part: different combined contraceptives (those with both oestrogen and progestin) have markedly different rates of each hormone⁷. You might find that some pills contain high levels of progestin and a small amount of oestrogen, for example, or vice versa. Add to this the fact that there are eleven different types of progestin, and that oestrogen and progestin can counteract or interact with each other in different ways, and we have ourselves a research minefield. Essentially, we have oodles of pills, patches, coils and injections, all with their own unique recipes and potential side-effects.
Are there specific brands that impact mood?
Research conclusions vary, but here’s what the evidence seems to suggest:
- All forms of hormonal contraception are associated with possible mood changes. The Summaries of Product Characteristics (and the info you get in your pill packet) for hormonal contraceptives list mood disorders as potential unwanted effects.
- “Low-dose pills” (those with less than 20mcg of oestrogen, like Loestrin 20) may be more likely to be associated with depressive mood⁸. Check out our blog to find out more about the different types of pills and their hormone levels
- Some types of progestin⁹ may be more likely to be associated with low mood
- Progestogen only contraceptive methods may be linked to higher rates of low mood.
- Non-oral forms of hormonal contraception may be linked with a higher risk of depression (like the hormonal coil, patch and ring).
But if speaking to our friends about hormonal contraception has taught us anything, it’s that how it affects one person can be very different to how it affects another. In fact, who you are might actually be the most pressing thing to consider.
From clinical experience doctors say those who find their mood adversely affected by a specific hormonal contraceptive preparation will not necessarily have the same problem with other hormonal contraceptives.
How can I weigh up my individual risk?
There are several factors that research has found that may mean you are more susceptible to the negative mental health effects of hormonal contraception:
- Your age. A study showed teenagers were more likely to suffer from low mood and depression when using hormonal contraception. It may be that, the older you are, the less likely it is that you’ll experience these effects. However the study did not factor in possible other influences on teenagers’ mental health.
- Your medical history. If you have a history of mood disorder or depression, you might be more susceptible to experiencing low moods when using hormonal contraception.
- Your contraceptive history. If you experienced a negative impact on your mood the first time you tried the combined pill, research shows that you may be more likely to experience these side effects again.
- Just… you. Some people are simply more sensitive to changes in their oestrogen and progesterone levels. We know, we know – this information isn’t exactly stamped on your birth certificate. Only trial and error will tell you if you fall into this category.
What does The Lowdown’s review data say?
As part of our contraception review form, we ask you how your contraception has affected your mood. The table below reflects data taken from reviews at the time of writing, and some methods with less than 100 reviews have been labelled. For more information on each method and specific brands, check out our contraception pages. This table shows how many Lowdown reviewers have found contraception to have either a negative, no change or positive effect on their mood.
As research shows that progestogen-only contraception is more likely to be linked to low-mood side effects, it might be surprising to see the combined pill top the charts here. These results are also contradictory to the idea that non-oral hormonal contraceptives present a higher risk of low mood, and it is interesting to see the hormonal coil (IUS) may have a lower impact than its oral counterparts. As you can see, even reviewers who have the copper coil (IUD), a non-hormonal contraceptive, have also reported negative effects on their mood. This could be down to the fact that the copper coil can commonly cause heavier periods, which may have an indirect effect on mood.
These ‘sad face’ percentages reflect reviewers who have marked their contraception as having a ‘somewhat’ and ‘very’ negative affect on their mood – so this could include low mood, mood swings, anxiety and irritability, for example. Check out the reviews for each method for more detailed experiences.
Does the progestogen-only pill cause mood swings and depression?
It’s important to reiterate that everyone is different, and while one pill may work for someone else, it may not for you. A lot of mini pill users also find that mood related side effects are temporary – lasting for a few weeks or months (not that you should have to put up with them at all!). The Lowdown has over 1,000 reviews for the progestogen-only pill, and the below table shows how many Lowdown reviewers have found the four most popular brands of mini pill to have either a negative, no change or positive effect on their mood.
Here’s a snapshot of what our reviews says about the Desogestrel progestogen-only pill and mood changes…
What information should I look for when choosing hormonal contraception?
As we learned before, facts and figures about the vague concept of ‘the pill’ or other contraceptive methods should be taken with a pinch of salt. What we should really be looking out for robust studies to clarify any association between hormonal contraception and depression. Research into the effects of different types and levels of progestins, different levels of oestrogen and the interaction between these two compounds would also be helpful.
Annoying as it might seem, the take-home message is one that you have probably heard a million times before: try it and see. As the research stands at the minute, the most important factors to consider are your age, medical background and contraceptive history; something which didn’t suit your friend might be a good fit for you, and vice versa.
It is important to remember that not every woman experiences low mood when using hormonal contraception. Some women find no change to their emotional state, and others notice an improvement as some methods of contraception can improve heavy, painful periods, PMS, acne and other bothersome symptoms.
Under the guidance of your GP, keep an eye on the level of oestrogen and types of progestin in your contraception to find the balance that works for you. And if you’re frustrated, remember that the perfect pill doesn’t exist for every woman, but there are lots of other options out there!
Mary Hargreaves is a writer and author with a passion for women’s reproductive health. She has a Masters in Clinical and Health Psychology, and has worked in scientific research across a range of disciplines.