Ask the experts: What’s the best birth control for mood swings?

Last month, in recognition of Mental Health Awareness Month, we asked you to share your questions about mental health, mood swings, and hormonal contraceptives. 

After all, the link between mental health and female contraceptives is, let's face it, pretty damned confusing. Like, does birth control help mood swings or make them worse?  Is there such a thing as birth control without mood swings? 

We put 4 of your questions to Dr. Arushee Prasad, GP. Listen as she answers below (or read the bullets if you prefer) and shares her tips and advice.

Should I come off birth control if I have depression?

• There’s no reason to stop your birth control pills if you have depression. If you have depression which is currently being managed well with either lifestyle changes, counselling, or medication, then there is no reason to stop your birth control pills. 

• It can be useful to keep a diary to track your mood so you’re aware if there are any changes. 

• If you feel that your birth control pills have potentially triggered or worsened your depression, then it might be that you aren’t on the right pill for you.

• It’s important to remember that there isn’t one ‘right’ or ‘best’ pill—each individual needs to be assessed individually to see which pill they are best suited to.

• If you feel that your pill is worsening your mood, it may be that another contraceptive pill would be better for you.

Is it better to try therapy or hormonal treatment first to help with mental health issues?

• Mental health issues can impact how we feel about ourselves, how we experience our day-to-day lives, and the decisions that we make. 

• Mental health conditions can vary significantly in severity so it’s difficult to talk about mental health treatments as one-size-fits-all. 

• The most important first step is realizing if there’s a problem affecting you and recognizing which factors are triggering the mental health issues. Once you know what the triggers are, you can try to work to improve these. 

• For example, is your mental health really bad just before your period? This is a really common symptom of PMS (premenstrual syndrome). 

• PMS can cause all sorts of symptoms that can impact your mental health—it can cause irritability, feeling angry or upset, lethargy, trouble sleeping, and a whole host of other symptoms.  

• If this is affecting you, then hormonal treatment may help you. If you aren’t sure if there is a trigger to your mood problems, then please speak to your doctor or a therapist to see what would be the best way forward for you.

What does research say about choosing the correct contraception to improve mental health? 

• The research on the use of hormonal contraception can be quite varied, with different studies showing conflicting results.

• Mental health is such an innate part of us, which can be affected by so many different factors—external life factors such as a global pandemic, life-changing events, your personality, your medical history, your family history; and the contraceptive pill is yet another factor. 

• There is no research at present which states which particular hormonal contraceptive pill will improve mental health outcomes for everyone using it.

• However, that being said, if we can thoroughly and individually assess how your hormones may be impacting you, we have a much better chance at prescribing you the most appropriate pill with the least side effects.

• Subsequently, improving how you experience your cycle, your hormones, and your physical and mental health.

My friend became depressed when on birth control—will the same happen to me?

• In a word, ‘no’. Everyone is different, with different life situations, different medical conditions, and different family histories. 

• Just because someone we know has responded to a particular pill, does not mean that we will respond in the same way. Each woman needs to be assessed according to their individual situation and medical history to see which pill would suit them—and hopefully avoid any unwanted side effects at all. 

• Some women, especially those who are suffering with symptoms of PMS may respond really well to a birth control pill, their mood may well improve on it. 

• Traditionally, women have been advised to take the contraceptive pill every day for 3 weeks and then 1 week to go pill-free. This is the week in which women will have a withdrawal bleed and potentially feel more emotional. 

• There is significant evidence to show it is perfectly safe to miss this week out altogether and essentially miss the withdrawal bleed as well as the emotional turmoil we experience in this time.

Guest writer

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.

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.