Last updated 9/8/2023
A recent study based on data from over 260,000 women in the United Kingdom (UK) validates something that I and several of my female patients have experienced, but believed to be idiosyncratic: being on oral contraceptives (OCs) can worsen mental health.
When I was 18, I decided I was done with the unpredictability of my own cycle and went to my gynecologist in search of an OC prescription. I took my first pill on the first day of my next period, hopeful that I would finally get it under control. In the end, my hopes were dashed.
For months, I experienced what I now know to be symptoms of depression: agitation, apathy, low mood, some sleep problems. When I spoke to my gynecologist, she noted that she had seen this in other women and offered to switch me to a different OC. But I decided that I’d rather deal with my unpredictable periods than low mood and poor sleep.
Just a few weeks ago, I met a new patient who mentioned her own experience with OCs during our initial appointment. She was in her early 40s and noted that she had been on birth control pills for as long as she could remember. She also noted that she had been managing anxiety and depression for years and had tried talk therapy, antidepressant medication, lifestyle improvements, and more. But, she said with some incredulity in her voice, that her depression seemed to have improved since discontinuing OCs several weeks prior to our appointment.
My patient and I are just two women with anecdotal experiences. The UK study, on the other hand, is an impressive 264,557 women and a robust collection of questionnaires, interviews, and health record data. And that study published some eyebrow-raising results: There is an increased risk of depression among women who use OCs, particularly in the first two years of use. The risk decreases after discontinuation, except among those who began using OCs as adolescents.
To be honest, these results are both surprising and confusing. OCs have been around since 1950 and are the most commonly prescribed form of contraception in the United States. How are we just now learning about the link between OC use and depression? Further, OCs are actually recommended as a treatment for certain female mood disorders, namely premenstrual dysphoric disorder (PMDD). How can a medication that is associated with worse mental health improve mental health?
I’m no OC expert, but there are a few things to note. First, the UK study included women between the ages of 37 and 71, most of whom began taking OCs in the 1970s and 1980s. The OCs available then were estrogen and progesterone combinations. Today, several more types of OCs exist and may not have a similar effect on women’s mental health. Second, studies look at people in aggregate, even though we are unique individuals. Not all women in the UK study who used OCs experienced depressive symptoms. In fact, even the authors note, “It is important to emphasize that most women tolerate OCs well without experiencing adverse mood effects…”
So, what does this all mean? Well, one, if you are a woman who has or is taking OCs as a method of birth control, please do not panic. OCs have many health benefits. In addition to being an affordable and effective way to prevent pregnancy, OCs have also been shown to help with acne, bone thinning, iron deficiency, serious infections in certain parts of the body, as well as reduce the risk of endometrial and ovarian cancers. And while there may be an increased risk of depression with some OCs, this does not mean you will struggle with depression or that you will be unable to overcome it.
More importantly, what this study tells us is that it’s so important to be empowered in our healthcare decision-making. Whether we are choosing the right birth control option or otherwise, we should take the time to introspect about our individual needs, preferences, and experiences. We should educate ourselves on the available options and think through their pros and cons. We should work with our providers to determine the right course of treatment for ourselves. And we should feel confident in speaking up when we believe the chosen course of treatment is no longer the right one.