WTH?! (What The Health?!) is a Scary Mommy series answering health questions relevant to moms and women that we don’t talk about enough. Think: “What is this weird pregnancy symptom? WTF is happening to me postpartum? Are these signs of perimenopause?” Let’s normalize these and other women’s health issues by talking about them more in a relatable, less clinical, and no-BS way.
For some of us, there is no greater gift than hormonal birth control pills: They're reliable, mostly convenient, and can give us shorter, lighter periods and less cramping. They can even reduce symptoms of PMS or PMDD.
But for others, there is no greater thorn in our sides: They can alter moods and make people feel depressed, anxious, irritated, and angry, which, in turn, affects everything from your work to your relationships.
So why is this? Scary Mommy talked to two doctors about why hormonal birth control can have this effect on some and what they can do. The good news: If you do have a bad reaction to it, there are lots of other options for you.
Why does hormonal birth control make some women moody?
Birth control pills consist of synthetic hormones like estrogen and progestin. Both of these hormones can influence brain function and your mood, Dr. Somi Javaid, founder and CMO of HerMD, tells Scary Mommy.
She says that an oral contraceptive works by inhibiting ovulation: "You are interfering with a natural menstrual cycle, so you're altering physiology and biology," she says. "For a lot of patients, it's a great solution … and has other positive impacts like decreasing cramping and controlling bleeding … But for some patients, it's just not a good fit because of the negative impact that [it can] have on mood."
Dr. Suzanne Fenske, founder of TārāMD, explains that birth control in pill form is systemically absorbed, circulates in the bloodstream, and can affect the whole body. Hormonal IUDs (which are inserted into the uterus) were initially thought to only have local effects, but studies show they can also cause systemic side effects, like mood changes. (On average, mood changes were reported in 9.1% of oral contraceptive users compared to 6.4% of hormonal IUD users.)
Mood changes are one of the most common reasons that patients decide to discontinue using oral contraceptive pills, Javaid says. Depression, anxiety, anger, and a decrease in sex drive have been reported as side effects.
Although we don't know for sure why hormonal birth control may affect women differently, there are some theories, according to Fenske.
- Multiple different types of progestins are used in birth control pills, and certain progestins may have more of an impact on mood than others. So, it could be more about the birth control pill that they're using rather than the individual.
- Our natural neurotransmitter levels in the brain (which can impact mood) are affected by the altered hormones, and some of us may have less tolerance for that.
What are your options if you have a bad reaction?
"Just because one hormonal contraceptive didn't work for you doesn't mean that it precludes you from all," Javaid says. "And if you're not a candidate, there are lots and lots of other options that are not [hormonal]."
If you've had an adverse reaction to an oral contraceptive, switching up the type of pill may help since it contains different doses of hormones. You may also tolerate hormonal birth control better if it's in a different form, such as an IUD (like Mirena), vaginal ring (NuvaRing), skin patch (Xulane), injection (Depo-Provera), or implant (Nexplanon), according to the Mayo Clinic.
And if hormonal birth control isn't for you, some of the most popular non-hormonal options are the copper IUD (ParaGard), contraceptive gels (like Phexxi), and barrier methods (like condoms and diaphragms).
How do you know if you should switch your birth control, and when should you see a doctor?
It's common to have side effects when first starting a new birth control, so Fenske recommends giving it three months for your body to get used to it. But since mood side effects can be severe, it's essential to monitor closely.
"If it's something that's persisting, if it's something that's taking over your day-to-day, and you can't get through those three months because your mood is just so different … then you want to switch [sooner]," Fenske says.
When you do make an appointment with your doctor, Javaid recommends having a thorough conversation about your birth control goals. Think: Do you want to have a cycle, or do you want to skip having periods? How long do you want long-term contraception? What method do you prefer (pills, shots, gels, etc.)? How effective do you need it to be?
The bottom line is you do not have to put up with a poor quality of life because of how your birth control is affecting you. Fenske sums it up nicely: "There are so many [birth control] options now on the market … you don't have to suffer through your contraception. It should be something that makes your life better, not worse."