Birth Control and Mental Health: Understanding the Connection

Mental health affects roughly 1 in 5 American adults — that's roughly 50 million people. If you're considering hormonal contraception or currently using it, you might wonder how birth control and mental health intersect. The relationship between hormonal contraceptives and mood is complex, with research showing positive and challenging effects for different people.

Understanding this connection helps you make informed choices about your reproductive health while prioritizing your mental wellbeing.

How Hormonal Contraception Can Affect Mood

Hormones are your body's chemical messengers, sending signals throughout your system to regulate everything from your menstrual cycle to your mood. When you use hormonal contraceptives — the pill, patch, ring, or shot — you're introducing synthetic hormones that can influence these natural processes.

Research suggests that hormonal contraceptive use can affect mood in several ways:

During your natural menstrual cycle hormone fluctuations often cause mood changes. Many sexually active women experience premenstrual mood symptoms (PMS) as estrogen and progesterone levels shift. Some people develop premenstrual dysphoric disorder (PMDD), a more severe form of PMS that significantly impacts mental health.

With combined hormonal contraceptives (containing both estrogen and progestin), your body receives steady hormone levels instead of natural fluctuations. For some hormonal contraceptive users, this stabilization reduces mood swings and PMS symptoms. Others may experience mood changes in response to synthetic hormones.

The mechanisms behind these changes aren't fully understood, but research points to how reproductive hormones interact with neurotransmitters in your brain that regulate mood, including serotonin and dopamine.

Which Birth Control Methods Affect Mental Health Most?

Not all contraceptive methods impact mood equally. Understanding the differences can help you make the best choice for your mental health needs.

Combined Hormonal Contraceptives

Birth control pills, patches, and rings containing both estrogen and progestin tend to have the most research around mood effects. Most studies of combined oral contraceptives show mixed results:

• The Harvard Study of Moods and Cycles found that among women with depression history, 61% experienced no mood changes, while 14% actually saw mood improvements
• Some observational studies suggest a slight increased risk of depression diagnosis, particularly in young women and adolescent girls
• Combined oral contraceptive use may help reduce severe premenstrual mood symptoms for many users

Progestin-Only Contraceptives

Methods containing only synthetic progesterone (like certain pills, the shot, or hormonal IUDs) may have different mood effects:

• Some research suggests progestin-only contraceptives might be associated with mood changes in certain people
• The contraceptive shot (Depo-Provera) has been linked to mood symptoms in some users
• Hormonal IUDs typically release lower hormone levels and may have fewer systemic mood effects

Non-Hormonal Options

Copper IUDs and barrier methods don't contain hormones, so they don't directly affect mood through hormonal mechanisms. However, the peace of mind from effective pregnancy prevention can positively impact mental health for many people.

Birth Control Choices for People with Anxiety or Depression

If you have anxiety disorders, major depressive disorder, or other mental health conditions, you might wonder whether hormonal contraception is safe. The good news: current medical guidelines support hormonal contraceptive use for people with mood and anxiety  disorders.

The CDC's Medical Eligibility Criteria doesn't restrict hormonal contraception for people with mood disorders. However, individual responses vary, so working with healthcare providers familiar with both reproductive health and mental health is crucial.

Best options to consider:

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• Combined oral hormonal contraceptives with evidence supporting mood stability
• Methods that help address underlying conditions like PMDD
• Non-hormonal methods if you prefer avoiding synthetic hormones entirely

Birth Control for Acne and Mood Balance

Many people seek birth control that addresses both skin concerns and mood stability. Certain combined oral contraceptives are FDA-approved for acne treatment and may also help with mood-related symptoms.

Options that may help with both:

• Formulations with anti-androgenic properties such as those containing drosperinone. Please note: Drosperinone has been shown to treat PMDD effectively. 
• Continuous cycling pills that reduce hormone fluctuations

Keep in mind that what works for acne might not be the best choice for mood, and vice versa. Your provider can help balance these considerations.

Switching Birth Control Methods Safely Through Telemedicine

If you're experiencing mood side effects from your current method, switching might help. Modern telehealth platforms like Twentyeight Health make this process more accessible than ever.

How to switch pill brands via telehealth:

1. Document your current symptoms and concerns
2. Schedule a virtual appointment with licensed clinicians
3. Discuss your mental health history and current medications
4. Work together to identify better options
5. Receive your new prescription with home delivery

Twentyeight Health providers are  specialized women's health providers who understand the connection between contraception and mental wellbeing and can help you to find the most appropriate option for you. Many virtual women's health providers offer both reproductive health and mental health support.

Twentyeight Health accepts Medicaid and many other major insurers removing financial barriers to help you find the right method.

When to Seek Help: Warning Signs and Reporting Side Effects

While most people can use hormonal contraception safely, certain symptoms warrant immediate attention:

Seek emergent  care if you experience:

• Thoughts of self-harm or suicide

Seek urgent care if you experience:

• Severe depression that interferes with daily life
• Panic attacks or severe anxiety
• Significant personality changes

Report concerning symptoms to your provider:

• Persistent mood changes after starting a new method
• Worsening of existing mental health conditions
• Sleep disturbances or appetite changes
• Difficulty concentrating or memory issues

How to report mood side effects from the pill or other methods involves clear communication with your healthcare team about timing, severity, and impact on your daily life.

Combining Mental Health Support with Reproductive Care

Taking a comprehensive approach to your wellbeing might involve multiple types of support:

• Virtual comprehensive women's care can address both reproductive and mental health needs in one place. Some providers offer integrated care that considers how these aspects of health interact.
  
  
• Women's mental health teletherapy options complement reproductive care by helping you develop coping strategies for mood changes, whether related to hormones or other factors.
  
  
• Tracking mood changes alongside your menstrual cycle and contraceptive use helps identify patterns and provides valuable information for your healthcare team.

Making Informed Decisions About Your Care

The relationship between contraceptive users and mood is highly individual. While systematic reviews and randomized controlled trials provide important population-level data, your personal experience matters most.

Recent research continues expanding our understanding of these connections. However, you don't need to wait for perfect research to prioritize your wellbeing.

Questions to discuss with your provider:

• How might my mental health history influence contraceptive choices?
• What should I monitor when starting a new method?
• How quickly should I expect to see changes?
• What are my options if I experience mood side effects?

Your Mental Health Matters

Whether you're dealing with major depression, anxiety disorders, or simply want to maintain good mental health while preventing pregnancy, you have options. The key is finding providers who take both your reproductive health and mental wellbeing seriously.

Twentyeight Health just so happens to be one of a few online birth control providers, increasingly offering comprehensive care that considers the whole person, not just contraceptive needs. 

So, look for services that:

• Have experience with mental health considerations
• Offer multiple contraceptive methods
• Provide ongoing support, not just initial prescriptions
• Accept your insurance to make care affordable

You deserve care that supports all aspects of your health. Have questions or concerns about your current method? Chat with a Twentyeight Health Provider to see if switching methods is right for you!

Your reproductive choices should enhance your life, not complicate it. With the right support and information, you can find contraceptive methods that work for both your body and your mental health.
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This article was reviewed by Twentyeight Health's clinical team. The information provided in this article is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. This content does not establish a provider-patient relationship. Always consult a licensed healthcare professional regarding any medical concerns.

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