Birth control and depression: How the pill impacts our mental health

“I feel like a different person on the pill”. 

Sound familiar? You’re not alone. Adverse mood changes, like depression and anxiety, are up there as the number one reason people stop using hormonal birth control pills(1).

If that’s the case, why do we also hear so many positive stories about the pill and its mood-boosting benefits?(2) 

Confused by all the contradictions? We hear ya. The links between hormonal birth control and depression (and mental health in general) are, to say the least, contested topics (watch this space, we’ll be fleshing this out in our next editorial). 

Despite the conflicting accounts, there is one thing we know for sure–whether we’re happy or we’re hangry, it’s down to our hormones(3,4). 

The natural rise and fall of our hormones each month, plays a huge role in influencing our mood and mental health–an experience that is completely, irrefutably, individual. But, when we add hormonal birth control pills into the mix, this system–for better or worse–changes(5). 

Whether you are worrying that your birth control pill could be giving you depression, or looking for the best birth control for mood stability, we’re here to help you get some clarity and quash all the confusion. 

So, let’s get to it–what exactly happens to our brains on birth control?

Disrupting the balance 

Hormonal contraceptives change our body’s naturally occurring balance of sex hormones(6). This brings about physical changes which (yep, you guessed it) help prevent pregnancy. 

But, because our natural sex hormones have such a big influence on our moods (again, alllll in the baby-making favor) disrupting this balance can cause changes to our mental health too(7).

For example, most hormonal birth control pills consistently keep estrogen levels low, which prevents ovulation–but this means we also miss out on all of estrogen’s feel-good factors and party-girl presence during the first half of our cycles(5,8,9). 

What’s more, most people don’t realize that hormonal contraceptives don’t contain ‘natural hormones’, they contain synthetic hormones.

These are essentially (wo)man-made versions of the real deal–which, although they mimic the physical effects of their natural counterparts, don’t interact with our brain's neurotransmitters in the same way that our natural sex hormones do(10). 

So, when we change the levels of sex hormones in our systems and replace them with the synthetic hormones in our birth control pills, we’re essentially pressing pause on all of the baby-making bits (bingo) (11), but we’re also blocking some of our natural sex hormones mood-bolstering benefits(12) (bummer).

POPs, COCs and mood drops

Okay, seems simple(ish) enough right? So what’s with all of those contradictory accounts about the emotional side effects of birth control pills?

Well, to start with let’s clear one thing up. We all talk about ‘the pill’ as if it’s one single silver bullet, but there are actually over 243 different types of birth control, all of which contain many different types and amounts of synthetic hormones(13). 

This means their effects on our moods, and brains can be very different (trust us, this is a good thing), and may, in part, explain some of the contradictory accounts that regularly fill our ears.

Let’s take a look at some of the VIPs (very important pills), individually...

Progestin-only pills (POPs)

Progestin-only pills, or ‘mini pills’, contain synthetic forms of our naturally occurring progesterone, called progestins, and are most commonly associated with adverse mood side-effects(14). 

Naturally occurring progesterone has all kinds of calming qualities(15), rising in the luteal phase of our cycles (roughly the two weeks prior to our periods, after ovulation)(16).

Synthetic progestins don’t interact with neurotransmitters in our brain in the same way as naturally occurring progesterone, so can’t induce placid progesterone’s restful, relaxed side effects, which may explain why some people may feel more anxious or irritable when taking POPs(14).

To add more fuel to the fire, having a dominance of progestin keeps estrogen levels very low(13), bringing on (but not always) feelings of depression, vulnerability and fatigue. 

But don’t let this dishearten you! Loads of us get on really well with POPs, and this may be down to them being monophasic–meaning the level of progestin is kept the same throughout the whole of the pill pack. Essentially, no more hormonal ups and downs.

Combined oral contraceptives (COCs) 

COCs contain synthetic versions of both estrogen (estradiol) and progesterone (progestins). CHCs have been known to improve mood swings and to decrease irritability and nervousness in some people, and are sometimes prescribed for those suffering from PMS or PMDD(18). 

These improvements in mood may be seen in those of us particularly sensitive to dropping estrogen levels in the latter half of our natural menstrual cycles(19), or those of us who have a hormonal imbalance between natural levels of progesterone and estrogen. CHCs can bring all of this back into balance–dampening out our premenstrual symptoms(20). 

However, for others, CHCs have been found to cause adverse mood effects, especially in those who have suffered previously with other pills(21).

Finding our fit

Okay, but why do POPs and COCs (and everything in between) affect our individual mental health so differently? 

Because we are all utterly unique, our natural hormone patterns aren’t the same to start with. Some of us may be more sensitive to low levels of estrogen or high levels of progesterone. Some of us may notice big changes to our mental health on birth control, others none at all. When we start taking hormonal birth control pills, our systems all react differently. 

So, how can we find the best birth control for us? One free from adverse mood side-effects? Well, it all starts with our hormones. 

At Tuune, we can help you decipher your unique hormone patterns by building a completely holistic 360° picture of you. We take into account your mental health, your medical history (even your family history), suss out what your natural balance of sex hormones is to begin with and (last but certainly not least) your goals for using birth control. 

The outcome? Birth control that’s completely personalized to you. 

Poor mental health or adverse mood changes are not simply a side-effect of the pill that we should ever, ever, ‘just put up with’. If you are suffering from adverse side-effects like low mood, depression or anxiety and you suspect your birth control pill may be to blame–never, ever, suffer in silence. 

There is a pill out there for you (not to mention 100s of other forms of hormonal and non-hormonal contraception types) and we’re here to help you find your personalized, perfect match. 

Remember, you are wonderfully unique, and so is your mental health. Why shouldn’t your birth control pill be too?

Editor's note: Our mental health is complex, and our hormones can make up just one piece of our individual puzzles. Remember, if you are struggling with your mental health–you’re not alone. There are numerous resources available to help, below are listed just a few: 

1. Mind: https://www.mind.org.uk/ 

2. Samaritans: https://www.samaritans.org/

3. Give us a shout: https://giveusashout.org/

Written by

Annalisa Hayes (she/her)

Copywriter at Tuune, Annalisa has worked for various pioneering health-tech startups and healthcare companies with purpose-led missions. Driven by empowering people to take control of their health, she helps make the science behind hormones accessible for our community, so they can make clued-up choices about their healthcare.

Medically reviewed by

Dr. Arushee Prasad, GP, MBBS (she/her)

Dr Arushee Prasad is a GP for NHS England with an MBBS in Medicine and Surgery, and an MRCGP from the Royal College of General Practitioners. Passionate about digital health and algorithmic medicine, Arushee was previously an Algorithmic Medical Doctor for Docly.