Ask the experts: Can the right birth control improve mental health?

When it comes to birth control and mental health, it can sometimes feel difficult to know what to believe. Maybe you’ve felt terrible on the same contraceptive your friends swore by, or perhaps you’ve been using the same method for years and don’t know whether your low days are down to what you put in your body, or are just ‘you’. 

You’re not alone—a lot of the murkiness is because we’re all unique and will react in our own way to different contraceptive types. During Mental Health Awareness Month, we asked our Physician-Scientist, Alejandra Elder Ontiveros, MD, PHD, some important questions about the link between contraception and mental health. This is what she said. 

What’s the research saying right now about contraception and mental health?

Dr. Ontiveros: "The relationship between hormones, birth control and mental health is quite hard to tackle. Many studies have been carried out, but the results are controversial and there’s a lack of consistency in how researchers decide to measure mental health outcomes which makes it harder to dissect these relationships.

Likewise, mental health encompasses a wide range of disorders that have different degrees of severity and limitations on having a normal day-to-day life. 

Some research suggests that using certain methods of birth control, like the implant, IUD or shot, can increase your chances of being diagnosed with depression or needing antidepressants. 

However, hormones and cycles are unique to each individual person and your relationship with them will vary in different stages of your life and on a month-to-month basis. Some people with cycles report better moods on hormonal birth control whereas others need to try several before finding the right hormonal birth control for them. Therefore, YOU will be the most important person in deciding which birth control method is right for you, and whether or not to continue with it". 

Dr. Ontiveros: "With support and access to in-depth information about your body, you can make informed decisions about your health including your contraceptive choices. 

Unfortunately, because research is so limited at this moment in terms of hormones, birth control and mental health—you may need to try more than one method to find the right one!

This is why we're here–we’re building this research so people with cycles are able to make their own choices based on a deeper understanding of their hormones and their bodies". 

Can birth control pills make you emotional?

Dr. Ontiveros: "Yes, definitely. However, this is one end of the spectrum—some women may report being more emotional, and on the other end, some women say their mood stabilizes and they feel great on hormonal birth control. We’d love to be able to share specifics, but for now, given the evidence we have, working on a case-by-case basis is the best approach".

Do all birth control pills cause depression?

Dr. Ontiveros: "It's possible, although research has found that if you're diagnosed with depression and take the pill, it's unlikely your symptoms will worsen(1). A study of more than 1 million women in Denmark did find an increased risk for the first use of an antidepressant and first diagnosis of depression, with the highest rates among adolescents(2). However, everyone is different and with our body of research, we’re looking beyond averages to understand how birth control affects individuals".

Can birth control pills help with depression?

Dr. Ontiveros: "For some people, yes. Oral contraception can help with premenstrual syndrome (PMS) and/or premenstrual dysphoric disorder (PMDD)-related depression if taken on a continuous regimen (that means you don’t take a hormone-free break).

The root cause of depression is unknown and is likely to vary from person to person. If you’ve been diagnosed with depression and it is exacerbated by the cycling of your hormones, it’s possible that birth control may provide relief from your symptoms. This happens because when you are on hormonal birth control you take the same dose of hormones daily, and this prevents the natural fluctuations that may cause disturbances in your mental health (this is especially true if you take oral contraception on a continuous regimen).

If you are suffering from postpartum depression, it’s also likely that taking hormonal birth control will help you. 

However, the effects of hormonal contraception can vary according to the person, which makes monitoring especially important(1)".

Which is the best contraceptive method if you feel depressed?

Dr. Ontiveros: "This is better tackled on a case-by-case basis. At Tuune, we can help you find the right contraception for you by looking at your genetic and medical history, including factors that are important to you. We reject the one-size-fits-all approach in favor of healthcare that's tailored to you".

How can I tell if my low mood, anxiety, or depression is caused by my birth control or other factors?

Dr. Ontiveros: "I emphatically recommend Dr. Sara E. Hill’s book This is Your Brain on Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences. Her tips include:

• Journaling: If you keep a journal and track your symptoms for a period of time before you start birth control, you will be able to notice subtle patterns and changes in your mood.

• Tell people what’s going on: It’s also important to let someone close to you know you are starting birth control so they can also be aware of any changes in your mood and let you know. They will be able to tell you they find you are having changes in mood that you may not have realized were happening—depression can creep up without us noticing".

What should I do if I feel depressed when on birth control?

Dr. Ontiveros: "Definitely chat to your doctor about this and the possibility of changing the pill or method you are using.

Remember, if you are struggling with your mental health—don’t suffer in silence. You are not alone. There are numerous resources available to help".

Some of the great resources Dr. Ontiveros recommends:

1. Mind: https://www.mind.org.uk/ 

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

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

Should I come off birth control if I have depression?

Dr. Ontiveros: "If you feel that your birth control is causing disturbances in your mood, or it is worsening previously diagnosed depression or another mental health issue you should chat with your doctor about changing the birth control method you are using. There is no reason to suffer through negative side effects when there are so many options out there, and there’s probably a method that is the right fit for you. 

Having depression doesn’t automatically mean you can’t be on birth control. This is a personal decision, i.e. for someone with pre-existing depression, the right birth control might help, but for someone else, birth control could bring about depression. 

If you decide to stop taking your birth control method, it’s important you are aware of the risk of becoming pregnant and therefore start another type of birth control right away (after chatting with your doctor) or use barrier methods like the condom".

How important is it to choose the right birth control for your body?

Dr. Ontiveros: "Super important! It is your body and you get to choose what you are okay living with. If you experience side effects from hormonal birth control that affect your mood in a negative way, there’s no reason for you to have to live with that. It’s 100% okay to chat with your physician and let them know you want to try different methods until you find the best fit for you".

Can picking the right birth control improve your mental health?

Dr. Ontiveros: "Absolutely! But remember that this will be a team effort where YOU are part of the team. Journaling, symptom tracking and keeping your doctor informed about your symptoms will help you get to the right choice for you. 

This process may take time and it is important you are patient when trying to find the best method. However, once you have achieved your goal, you’ll be able to live your best life without having hormonal side effects bogging you down! And if hormonal methods are not the right fit for you—this is totally fine and there are other methods that you can use to prevent pregnancy". 

How can Tuune help you to feel your best? 

Dr. Ontiveros: "Everyone is different – we take the time to really get to know you. With our Tuune 360, we’ll ask you all the questions you’ve probably never been asked about your contraceptive history, hormonal health and wellbeing. We’ll consider all the different types of contraceptives out there and make specific recommendations based on what’s right for you and your body".

Written by

Hermione Wright (she/her)

An NCTJ-qualified journalist, Hermione writes for national and local publications in addition to creating thought leadership for brands with a purpose. Passionate about telling the stories that matter, she helps our community make their own clued-up choices about their healthcare.

Medically reviewed by

Dr. Alejandra Elder Ontiveros, MD, PHD (she/her)

Ale is a PhysicianScientist with a doctoral degree in Development Biology and Embryology and is currently a Postdoctoral Scholar at UCSF. Ale believes that the union of academia and business can lead to transformative discoveries for women’s health.