Side effect grips some users of birth control pills - depression

When her period first arrived when she was 12, Hannah LaCroix said her cramps were painful to the point where she struggled to get out of bed. Her menstrual discomfort mostly subsided, she said, once she began taking birth control pills at 13.

But she said her period pain was soon replaced by a pain of another kind: depression.

“I was on birth control for a bit when I first told my parents something was wrong with me because I was always sad,” said LaCroix, who is now 28 and a licensed nurse practitioner at Mount Wachusett Community College. “I had no interest in doing anything. Then I was diagnosed with depression.”

According to a 2020 national survey from the Centers for Disease Control and Prevention, 14% of women 15 to 49 use birth control pills. The pill's primary purpose is contraception, but other health benefits include reduced menstrual pain, lower iron deficiency and lower risk of ovarian cancer, according to Planned Parenthood.

“The pill, if it’s taken every day, is very effective for physical conditions like severely painful periods,” said Dr. Sydney Hartman-Munick, an assistant professor of pediatrics and adolescent medicine at UMass Chan Medical School.

LaCroix said she noticed clear physical benefits of the pill at first, as she no longer suffered from intense menstrual cramps. But these advantages, she said, were offset by the “emotional emptiness” that followed.

According to Hartman-Munick, who specializes in contraceptive management, severe mood changes are a rare occurrence for birth control users. But because the pill operates by modifying natural hormonal levels, it is common for users to experience slight emotional changes, she said.

“Your hormones affect your emotions, so it’s an understandable thing to feel kind of moody when your hormone levels change on the pill,” Hartman-Munick said.

According to Dr. Jonathan Schaffir, a clinical professor of obstetrics and gynecology at Ohio State University, these initial emotional changes are often temporary for birth control users.

“With many patients, there’s sort of a transient effect where they may have an adjustment period to get used to these levels of hormones in their system,” said Schaffir, who specializes in the mood effects of hormonal contraception. “Then, usually within one to two months, those symptoms go away.”

Negative moods persisted for years

For LaCroix, however, negative moods on the pill persisted for years. In cases like hers, Schaffir said, trying out different brands of the pill may help mitigate emotional side effects.

Hannah Lin, 19, said she experienced heavy emotional instability under Larissia, the first birth control brand she tried. She switched to Junel FE a few months later.

“Larissia gave me really bad crying spells and terrible anxiety, and it just made my emotions a wreck,” said Lin, a sophomore at the University of Connecticut. “I definitely feel a lot better on Junel. My emotions have been pretty steady, and I don’t feel as anxious or on edge.”

Research on the relationship between hormonal birth control and depression remains ambiguous. Whereas some studies find that birth control pills have no effect on one’s risk of depressive disorders, others confirm a positive correlation between the pill and depression.

But Schaffir warns against attributing this correlational data to a causal relationship.

“A lot of women use birth control because they’re in sexual relationships or have medical conditions that may cause stress and other adverse effects on their mental health,” Schaffir said. “It may not be the pill itself that’s causing these issues as much as the other things going on in their lives that might trigger them to be using birth control pills.”

Hartman-Munick echoes Schaffir’s reluctance to trace patients’ emotional changes directly to their use of birth control.

“It’s really tough, when I have a patient who tells me the pill is making their mood worse, to tease out if it’s actually the pill or if it’s something else,” said Hartman-Munick, who primarily works with teenage patients. “This is especially uncertain among adolescents, where it’s a critical time for growth and development in a world that’s been a difficult place to live in the past few years.”

Hartman-Munick affirms, however, that the choice ultimately lies with the patient. If they find that their emotions are too unstable on the pill, Hartman-Munick said she always respects their decision.

“Because there are so many different options for birth control like implants and IUDs, stopping the pill and trying something different is almost always an option,” Hartman-Munick said.

Switch to IUD

When LaCroix experienced negative mood changes on the pill, she did just that. At 19, six years after starting birth control, LaCroix said she found it difficult to keep up with the pill’s daily regimen and switched to a hormonal intrauterine device.

“With my IUD, I just felt so much better overall,” LaCroix said. “Everything was great once I stopped the pill. I had so much less fatigue, and I actually wanted to get out of bed in the morning.”

But the IUD eventually gave LaCroix a uterine perforation, prompting her to switch back to the pill at 25. This time, she said the depression hit her much harder; she consistently felt “angry” with “mood swings every single day.”

After three years, LaCroix said her emotional changes were too much. This past March, she opted out of birth control altogether — a decision that has significantly improved her mood, she said.

“I still have period cramps, but it’s not that bad,” LaCroix said. “Even if I do have cramping, it’s two or three days of pain, and I would rather have that passing discomfort than being sad all the time.”

But Schaffir said that for patients with more severe period cramps, the physical benefits of the pill often outweigh the mental toll, if any.

Natalie Benavides, 21, agrees. Though her lethargic moods on birth control sometimes render her “unable to function,” Benavides said the pill has helped regulate her menstrual cycle since age 10.

“I experience depression for a few days leading up to my periods, but I’m no longer cramping constantly outside my period, which I was at the start,” said Benavides, a junior at Northeastern University.

Positive emotional effects

Negative emotional changes are just one side of the story. Dr. Marybeth Lore, an assistant professor of obstetrics and gynecology at Northwestern University, said in certain situations, she prescribes oral birth control to improve patients’ moods.

“For people who have premenstrual syndrome, which usually involves a lot of mood swings, the pill is the main line of treatment because it stabilizes hormone levels so they don’t go up and down during a spontaneous menstrual cycle,” said Lore, who’s been prescribing the pill for over 30 years.

Hartman-Munick said these positive effects are often overlooked, especially in online discourse. On social media platforms like YouTube, content creators have shared anecdotes only about the negative mood changes they’ve encountered on the pill.

“It’s very easy for one individual’s personal negative experience with one aspect of health care to spread like wildfire online,” Hartman-Munick said. “These anecdotes become like facts to audiences, but I think we need to be really critical about making sweeping statements about any category of medication. Make sure you take a minute to think about what you see online, and do your research.”

Melissa Dai, of Northborough, is a sophomore at the Medill School of Journalism at Northwestern University.

This article originally appeared on Telegram & Gazette: Birth control pills could spur depression, users warn