Fact-Checked By : Dr. Tara Scott, OB-GYN
It’s not in your head. Some women experience mental side effects from oral contraceptives. Your allies here at Eve’s Disclosure want you to know that we take the mental health of our community very seriously. Mental health is equally as important as physical wellness.
Do you have a history of ADHD, depression, anxiety, or a personality disorder? Are you on the pill or considering going on it? If so then take heed.
Why The Suffering?
Dr. Margaret Altemus of Cornell’s Weill Medical College notes that “Women have twice the lifetime rates of depression and most anxiety disorders.” This is likely because the very same differences that promote reproductive success and prime women to be responsive mothers also increase vulnerability to mood and anxiety disorders.
For example, women’s innate social skills and empathy are important for the cognitive and social development of offspring. However, these enhanced emotional capacities are also thought to result in women experiencing heightened sensitivity to rejection, criticism, and separation. These are key features of depression and anxiety disorders.
Hormonal life markers like puberty, pregnancy, postpartum, perimenopause, and menopause – while essential for the survival of mankind – are not exactly conducive to perfect emotional health. Our very anatomy and the biochemical impact of ovulation may increase the odds of developing anxiety or depressive disorders.
The onset of these disorders tends to emerge during puberty and early adulthood, a time when girls undergo transformational hormonal changes. It is during this transitional period that many girls opt for hormonal birth control to stymy painful cramps and avoid unwanted pregnancy.
Overall, this is a good concept. Why not use technology to avoid some of the evolutionary burdens inflicted on females? Unfortunately, there can be consequences to fiddling with one’s endocrine system.
Side Effect Knowledge Gap
Concerns about effects on mental health have been dismissively brushed under the rug since the inception of hormonal birth control in the 1960s. Knowledge gaps and misinformation still persist today because of the lack of proactive research on this subject.
For this reason, well-meaning OB-GYNs and psychiatrists are typically not taught to counsel their patients on their mental health risk factors when considering whether or not to go on the pill. Because of this, most girls who begin a regimen of oral contraceptives do so with no prior knowledge of their side effect profiles.
80% of women in their childbearing years' experience PMS (premenstrual syndrome). PMS symptoms can be both physical and mental — although the luckier ones among us may only deal with the physical symptoms.
Weighing the options of going on the pill can be confusing. We want a pill that will help foster mental health instead of making us feel worse. Below you will find a brief guide to the different types of pills and how they may or may not impact mental health
Biphasic pills are a type of combination pill that administer a lower ratio of estrogen/progestin during the first half of the pill cycle and then a higher dose during the second half. The purpose of this is to mimic the feedback loop of increasing and decreasing estrogen and progesterone levels during a regular menstrual cycle.
What many women don’t realize is that these synthetic versions of estrogen and progesterone have the capacity to affect our moods in a similar way to our endogenous hormones. If you are prone to mental PMS symptoms off the pill, note that this type of pill may not alleviate that for some. Examples of biphasic pills include Mircette, Azurette, Amethia Lo, Camrese Lo, Daysee, Kariva, and LoSeasonique.
There is also similar evidence that triphasic pills may also worsen mood swings in some women. Triphasic pills are divided into three phases and each phase releases a different concentration
of estrogen and progestin. If you find your mood swings getting worse on either biphasic or triphasic pills, it is important to tell your OB-GYN. If they don’t believe you then it’s time to find another OB-GYN who will hear you out and work with you to find other solutions. Follow your gut on this! Some examples of triphasic pills are Enpresse, Levonest, Triphasil-28, and Trivora.
Monophasic pills do not mimic our natural hormonal patterns. This type of pill is a good candidate for those wishing to reduce premenstrual negative feelings and even food cravings. This type of oral contraceptive keeps our hormones at the same level, sparing us from the ups and downs. It’s called monophasic because each pill delivers the same concentration of hormones every day. After the cycle is complete you take no pill at all or a placebo for the remaining 7 days.
Every woman’s brain is different so if you do experience sadness, depression, or anxiety it’s a great idea to bring this up with your OB-GYN. This isn’t a complete list by any means but here are some types of monophasic pills: Apri, Cyclessa, Loryna, Yaz, Aviane, Aranelle, and Low-Ogestrel.
Not all pills are the same and not all women will have the same mental health side effects. If you already experience bad PMS symptoms like anxiety, depression, or irritability it may get worse on the pill. Conversely, many women have reported feeling way less moody on their pill of choice. It’s important for us to give credence to our own observations. If you currently experience PMS then you should exercise caution with oral contraceptives.
The results of studies affirm that fluctuations in progesterone may cause depression in adolescent females and that certain types of estrogens may cause anxiety and depression. It can be useful to make a birth control journal to document your mental reactions to whatever pill you are trying out so you can protect yourself from negative side effects.