Hormonal Contraceptives’ Impact on Mood



Author: Maria Ibrahim

Introduction

Hormonal contraception comes in a variety of forms. Hormonal contraception includes oral birth control pills, hormone-releasing contraceptive coils, the vaginal ring, the skin patch, the three-month injection, and the hormonal birth control implant [1,2]. Each product releases one or multiple hormones into the system and is absorbed differently. The contraceptive coils release levonorgestrel, while the other methods release a combination of estrogen and progestin (excluding the injections and the implants) [1,2]. The methods by which these hormones enter the bloodstream are through the digestive system, the skin, the wall of the vagina, or the lining of the womb [1]. Estrogen prevents the thickening of the uterine lining and ovulation [3]. Progestin inhibits the development of the uterine lining and thickens the cervical mucus [3]. Levonorgestrel suppresses ovulation [3]. According to the Canadian Contraception Survey, oral contraceptives are used by 44% of women aged 15-49 years old [4]. Comparatively, condoms are used by 54% of women, and 12% used the withdrawal method [4].

The term ‘person of female sex’ will be used, when possible, to be inclusive. In instances when the term ‘women/woman’ is used, it was not possible to change the wording because of the references.

Impact of Hormonal Contraceptives on Mood

The use of hormonal contraceptives holds both positives and negatives on the physical and mental wellbeing of the people of the female sex. In this article, the main focus will be how hormonal contraceptives impact the mood of the user. Hormonal contraceptives have been shown to cause mood swings, depression, a decrease of womens’ sexual desire, and anxiety [1-3,5].


Contributing Factors

Age is a controversial possible contributing factor. A systematic review demonstrated that some other contributing factors were underlying mood disorders, the dosage of the contraceptive, the delivery method (choice of contraception), and continuous use [4].


Age

Some studies suggest that adolescents have a higher risk of being diagnosed and treated for depression when starting the use of hormonal contraception [2,3,7], while others have not proven this to be true [4,6].


Underlying Mood Disorders and Dosage

Women with underlying mood disorders, specifically a history of depression, are predisposed to experiencing negative mood side effects while using hormonal contraceptives [3,5]. One study showed that women on a lower dosage (20 μg) of the estrogen pill reported higher negative mood changes than women on a higher dosage (30 μg) [5]. Another study demonstrated that women on the combined oral contraceptive (COC), reported reverse effects on mood changes [5]. Women on the lower dose COC (25 μg) reported that they had an improved premenstrual mood, compared to those on the high-dose COC (35 μg) [5]. It is currently difficult to gauge why these contradicting results exist, because of the low difference in estrogen dosing [5].


Delivery Method

Further studies compared the effects of the use of the vaginal ring, the pill, and the patch [5]. Users of the vaginal ring and the contraceptive patch have both demonstrated better results on mood fluctuations compared to those on the pill [5]. In comparison to COC users, vaginal ring users “reported less irritability, depression and emotional lability” [5]. Women using the patch reported a “greater emotional well-being” than pill users [5]. No significant mood changes were observed between the vaginal ring users and the patch users [5].


Continuous Use

Studies have shown that women who take the pill continuously were noted to have “fewer mood swings and less depression” than women who take the pill on a cyclic method [5]. Cyclic use of COC is when the pill is taken on a cycle of 28 days to get their menstruation [5]. Continuous use of COC is used to avoid menstruation [5]. The evidence provided above suggests that when the hormones from the COC are delivered continuously to the body, they provide fewer emotional side effects [5]. With current evidence, in practice, it is hard to predict who may experience negative mood effects with the use of hormonal contraceptives [3,5].


Conclusion

Hormonal contraceptives are one of many forms of possible contraceptive methods. They exist in a variety of product forms that deliver hormones by different mechanisms to the body. Delivering these hormones into the body have proven to cause negative mood effects on people of the feminine sex. Mood effects observed include depression, low libido, anxiety, and mood swings, among others. Some contributing factors include continuous use of hormonal contraception, the dose of the COC, the method of delivery, and pre-existing mood disorders. Although it is currently difficult to determine in-practice who might be experiencing these negative effects, it is always recommended to discuss with your health care provider any concerns or changes you may experience in order to determine the best healthcare services for your needs.


Editors

Alison MacPhee, Kaz Shuji, Rhea Verma

Designer

Web design by Majd Al-Aarg

Additional Credits

Cover photo provided by Reproductive Health Supplies Coalition on Unsplash

References

  1. Institute for Quality and Efficiency in Health Care. Contraception: Hormonal contraceptives. National Center for Biotechnology Information (NCBI) [Internet]. 2017 June 29 [cited 2021 May 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441576/

  2. Ross RA, Kaiser UB. Reproductive endocrinology: The emotional cost of contraception. Nature Reviews Endocrinology [Internet]. 2016 Dec 08 [cited 2021 May 15];13(1):7-9. Available from: https://doi.org/10.1038/nrendo.2016.194

  3. Robakis T, Williams KE, Nutkiewicz L, Rasgon NL. Contraceptives and mood: Review of the literature and implications for future research. Curr Psychiatry Rep [Internet]. 2019 Jun 06 [cited 2021 May 15]21(7):57 Available from: https://doi.org/10.1007/s11920-019-1034-z

  4. Journal of Obstetrics and Gynecology Canada. Canadian contraception consensus chapter 1: Contraception in Canada. JOGC [Internet]. 2015 Oct 01 [cited 2021 May 15];37(10):S5-S12. Available from: https://doi.org/10.1016/S1701-2163(16)39370-7

  5. Schaffir J, Worky BL, Gur TL. Combined hormonal contraception and its effect on mood: a critical review. The European Journal of Contraception and Reproductive Health Care [Internet]. 2016 Oct [cited 2021 May 15];21(5):347-55. Available from: https://doi.org/10.1080/13625187.2016.1217327

  6. McKetta S, Keyes KM. Oral contraceptive use and depression among adolescents. Annals of Epidemiology [Internet]. 2019 Jan [cited 2021 May 15];29:46–51. Available from: https://doi.org/10.1016/j.annepidem.2018.10.002

  7. Skovlund CW, Morch LS, Kessing LV, Lidegaard O. Association of hormonal contraception with depression. JAMA Psychiatry [Internet]. 2016 Nov 01 [cited 2021 May 15];73(11):1154–1162. Available from: https://doi.org/10.1001/jamapsychiatry.2016.2387


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