Is Your Hormonal Birth Control Making You Moody?

Stigma around women's issues, such as menstruation, menopause and birth control, can limit open conversations about what women are experiencing on a daily basis. One such topic is the use of birth control and the mood swings that can follow.

Around 10.1 million women use oral contraception in the United States alone, according to the Guttmacher Institute, and another few million women use other hormonal birth control options, such as the implant, ring, patch or intrauterine device (IUD).

People continue to use hormonal birth control because it is widely regarded as safe and effective by medical experts, and many peer-reviewed studies from decades of research back up these claims.

However, every person's body is different, and what works for one woman might not work for another. Many people find hormonal birth control regulates their emotions and doesn't cause mood swings. For others, the emotional irregularity that comes with adjusting to hormonal birth control is too much to bear.

Types of birth control pills

There are many types of hormonal contraceptives, but the birth control pill is the most widely used. Hormonal birth control contains either only progestin (the minipill) or progestin and estrogen (the combination pill). Women may take the minipill if they have certain health conditions or have experienced side effects from estrogen, according to Cornell Health.

The combination pill is more effective at preventing pregnancy. It's important to take it at the same time every day to ensure maximum effectiveness.

The connection between birth control and emotions

"Most clinical studies have not shown a definite link between use of hormonal birth control and mood changes, but I have certainly seen many patients who complain about mood changes with birth control or who have experienced them in the past," said Kelly Culwell, M.D., a board-certified OB-GYN and women's health expert in San Diego who goes by Dr. Lady Doctor.

For some women with mood disorders, birth control can actually regulate emotions.

"We don't know a lot about how hormonal contraception impacts mood," Culwell said. "But for some women who experience severe PMS [premenstrual syndrome] or PMDD [premenstrual dysphoric disorder] symptoms, use of hormonal contraception can improve these symptoms due to the stabilization of the natural fluctuations in hormones, particularly just before menses."

Even though it's known there is a connection between hormones and depression, there isn't enough data to say the pill causes depression, said Jen Gunter, M.D., a San Francisco-based OB-GYN and the bestselling author of "The Vagina Bible," in an article on her website.

Gunter also emphasized the importance of weighing the pros and cons. "Everyone considers the mental health consequences of taking the pill, but it's also important to consider the mental health and medical consequences of not taking the pill," she wrote.

'If you have issues with one progestin causing mood changes, you may consider trying a method with a different progestin.'

While more research is needed to definitively connect hormonal birth control and mood changes, experts assume that the increase in hormones just doesn't settle well for some people.

"Instead of relying on your own progesterone and estrogen to control your ovulation and uterine bleeding, you're taking a pill that will override your body's signaling," said Greg Marchand, M.D., an OB-GYN in Mesa, Arizona. "Ideally, this means no ovulation, no pregnancies, and short, regular periods. This can go haywire as many people don't tolerate the exogenous hormones and it creates emotional issues."

Progestin can be found in contraceptive methods such as the shot and implant. There are also combined contraceptives, such as the combined pill, patch and ring, that include both estrogen and progestin.

"If you have issues with one progestin causing mood changes, you may consider trying a method with a different progestin," Culwell advised.

Contraceptives containing less androgenic progestins may have fewer adverse effects on mood.

For many people, side effects improve over time

As with most birth control side effects, mood changes may improve for some women over the first several months, Culwell said. The hormones in birth control can cause other symptoms, such as headaches, nausea, sore breasts and menstrual changes, but all of these often go away after two to three months of regular use.

If you can push through the symptoms, you might find they lessen to an acceptable state. If the side effects are too much for you, that's OK, too. There are plenty of other contraceptive methods that might be a better fit for you.

Nonhormonal contraceptive methods

You don't have to feel anxious or depressed while using contraceptives. If you're experiencing mood swings from your hormonal birth control, there are other methods to consider. Talk to your OB-GYN about your options.

Traditional nonhormonal contraceptive methods include condoms (98 percent effective), tracking your cycle and fertility window (76 percent to 88 percent effective) and the pullout method (78 percent effective). Copper IUDs are the most effective birth control on the market (99 percent) and contain no hormones. Additionally, Phexxi (86 percent effective) is a nonhormonal contraceptive gel approved in 2020 by the Food and Drug Administration.

Sometimes one hormonal birth control may work better than another for you, so if you want to switch your contraceptive method, you have plenty of options.

If you get off the pill and still experience mood swings, you could have an underlying mental health issue that should be addressed by a professional.