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Birth control plays a critical role in allowing individuals, particularly women, to manage their reproductive health. Beyond its primary function of preventing pregnancy, birth control offers numerous benefits, such as regulating menstrual cycles, reducing the risk of certain cancers, managing symptoms associated with hormonal imbalances, and even addressing conditions like acne and polycystic ovary syndrome (PCOS). 

However, like any medical intervention, birth control is not without its side effects, some of which can significantly impact a woman’s physical and mental well-being.

Birth control works by interfering with the natural processes of the reproductive system to prevent pregnancy. There are several types of birth control:

  1. Barrier methods: Methods like condoms, diaphragms, and cervical caps physically block sperm from reaching the egg. They are less invasive and have fewer side effects than hormonal options. Condoms also protect against STIs. However, these methods require consistent and correct use and generally have lower success rates than hormonal methods.
  2. Hormonal methods: These include birth control pills, patches, injections, and hormonal IUDs. They work primarily by preventing ovulation—the release of an egg from the ovaries. Without an egg, sperm cannot fertilize anything, thus preventing pregnancy. Hormonal birth control also thickens cervical mucus, making it more difficult for sperm to enter the uterus, and alters the uterine lining, making it less likely for a fertilized egg to implant.
  3. Intrauterine devices (IUDs): IUDs come in hormonal and copper forms. Hormonal IUDs release hormones to prevent pregnancy, while copper IUDs create a hostile environment for sperm without using hormones, offering long-term, hormone-free contraception.
  4. Permanent methods: Permanent contraception includes tubal ligation (for women) and vasectomy (for men). These surgical procedures permanently block reproductive pathways, ensuring no future pregnancies.
  5. Emergency contraception: Emergency contraception is used after unprotected sex to prevent pregnancy. It works mainly by delaying ovulation and is most effective when taken promptly.

Yes, birth control can potentially cause anxiety. The use of hormonal contraception (HC) has been linked to a higher risk of future depression and an increased likelihood of using antidepressants, particularly among adolescents. This association suggests that hormonal contraceptives might contribute to depressive symptoms, which can exacerbate anxiety.

Below is a table from a study analyzing the psychological side effects of hormonal contraception among 188 participants. 

CategoryPercentage (%)
Participants reporting mood changes as a side effect of HC43.6%
Participants discontinuing or switching contraception due to side effects48.3%
Participants with a history of psychiatric illness reporting mood changes with HC61.2%
Participants without a history of psychiatric illness reporting mood changes with HC29.5%
Worsening of psychiatric symptoms with HC among those with a history of psychiatric illness38.8%
Improvement of psychiatric symptoms with HC among those with a history of psychiatric illness11.2%

For women who already experience anxiety, hormonal birth control can sometimes make these feelings more pronounced. The body’s natural hormones, particularly estrogen and progesterone, play crucial roles in regulating mood and emotional responses. By altering these hormone levels, birth control can disrupt the delicate balance, leading to mood swings, irritability, and heightened anxiety.

However, if your anxiety is due to PMS, some hormonal contraceptives, particularly those containing drospirenone, may help alleviate symptoms. It’s important to differentiate between general anxiety concerns and those specifically related to birth control.

While hormonal birth control is highly effective in preventing pregnancy, it’s important to be aware of its potential side effects. These can vary widely, affecting mood, mental health, hormone levels, and physical well-being.

Hormonal changes

The primary mechanism of hormonal birth control involves altering the body’s natural hormone levels, which can lead to a variety of effects:

  • Changes in menstrual cycle: Birth control pills maintain steady hormone levels, preventing the uterine lining from thickening as it would in a natural cycle. This often results in lighter periods, reduced menstrual cramps, and sometimes, the complete cessation of menstruation. Continuous-use birth control methods can further eliminate periods altogether, which can be a relief for some women but may feel unnatural to others.
  • Suppression of ovulation: Hormonal contraceptives prevent the natural rise and fall of estrogen and luteinizing hormone (LH) that triggers ovulation. By maintaining consistent hormone levels, birth control tricks the body into thinking it’s already pregnant, thereby preventing the release of an egg. This suppression of ovulation is a key factor in the effectiveness of hormonal birth control.
  • Changes in cervical mucus: Normally, cervical mucus changes consistency throughout the menstrual cycle, becoming thinner and more slippery around ovulation to facilitate sperm movement. Hormonal contraceptives, however, keep cervical mucus thick and sticky, creating a barrier that makes it difficult for sperm to reach an egg.

Mental changes

One of the most significant and often-discussed side effects of hormonal birth control is its impact on mood and mental health. These changes can vary from mild irritability to severe anxiety and depression, depending on the individual’s susceptibility to hormonal fluctuations.

  • Anxiety and depression: The synthetic hormones in birth control can interfere with neurotransmitter regulation, leading to feelings of anxiety, restlessness, or sadness. For some women, these symptoms may be mild and manageable, while others may experience more severe mood disorders. Women with a history of mental health issues are particularly at risk, and these symptoms can sometimes appear shortly after starting a new contraceptive or after several months of use.
  • Panic attacks: Panic attacks are sudden episodes of intense fear or discomfort, often accompanied by physical symptoms like rapid heartbeat, shortness of breath, dizziness, and a sense of impending doom. Hormonal birth control may contribute to the onset of panic attacks by altering the body’s stress response. For women who are already prone to panic attacks, starting hormonal contraception could increase the frequency or severity of these episodes.
  • Emotional blunting: Emotional blunting refers to a dulling of emotional responses, where women on hormonal birth control may feel less intense emotions or a reduced ability to experience pleasure. This state is often described as feeling “numb” or emotionally flat. While emotional blunting can protect against extreme negative emotions, it can also diminish positive feelings, leading to a sense of disconnection from oneself and others. 
  • Mood swings: Hormonal fluctuations caused by birth control can lead to sudden or unpredictable changes in mood. Women may experience irritability, anger, or sadness without a clear reason. These mood swings can be frustrating and may affect daily life, relationships, and overall well-being. The intensity of mood swings can vary, with some women noticing only slight changes, while others may find them more disruptive.
  • Decreased libido: Hormonal birth control can lower levels of testosterone, a hormone that plays a key role in sexual arousal. The synthetic hormones in contraceptives can suppress the natural production of testosterone, leading to a decrease in sexual desire and response. This side effect can be distressing for some women, especially if it affects their intimate relationships. 

Physical changes

In addition to mood and hormonal changes, hormonal birth control can cause various physical side effects:

  • Headaches and migraines: Birth control stabilizes hormone levels, which can either reduce the frequency of migraines or, conversely, exacerbate them, depending on the individual. For some women, the synthetic hormones can trigger migraines, especially during the hormone-free intervals of birth control pills (when placebo pills are taken), leading to what is known as menstrual migraines.
  • Breast tenderness: Hormones may increase fluid retention in the breasts and alter breast tissue, leading to discomfort, fullness, or even a slight increase in breast size. While this side effect often diminishes as the body adjusts to the hormones, it can be uncomfortable and concerning for some women.
  • Weight changes: Some women experience weight gain, which may be due to several factors. For instance, hormonal contraceptives can cause fluid retention, leading to a temporary increase in body weight. Additionally, changes in appetite, influenced by hormone levels, can result in an increased caloric intake, contributing to gradual weight gain. On the other hand, some women might experience weight loss, possibly due to the body’s adjustment to new hormone levels or changes in metabolism.
  • Skin changes: For some women, birth control can help improve skin conditions like acne by reducing the levels of androgens (male hormones like testosterone) that contribute to oil production and acne formation. Certain birth control pills are even prescribed specifically to treat acne. However, in some cases, birth control may worsen skin conditions or cause other skin issues, such as hyperpigmentation or melasma (dark patches on the skin), due to the hormonal influence on melanin production.
  • Increased risk of blood clots: Estrogen can increase the blood’s clotting ability, which, in some women, can lead to the formation of clots in veins (venous thromboembolism) or arteries. These clots can be dangerous if they travel to the lungs (pulmonary embolism) or cause a stroke. The risk of blood clots is higher in women who smoke, are over 35, or have a history of clotting disorders.
  • Nausea: Estrogen, in particular, is known to slow down the emptying of the stomach, which can contribute to feelings of nausea. This side effect is usually temporary and tends to subside after a few weeks as the body acclimates to the new hormone levels.
  • Impact on bone density: Long-term use of certain hormonal contraceptives, particularly those that contain only progestin, such as the Depo-Provera injection, can affect bone density. Hormonal contraceptives that lower estrogen levels can decrease bone density over time, potentially increasing the risk of osteoporosis and fractures later in life. This effect is particularly concerning for young women who are still building bone mass. 

Dealing with the side effects of hormonal birth control can be challenging, but with the right approach, many of these issues can be managed effectively.

Monitor and track symptoms

Keeping a detailed record of your symptoms can help you and your healthcare provider identify patterns and triggers. Note when side effects occur, their severity, and any possible correlations with your diet, stress levels, or menstrual cycle. This information can be valuable in adjusting your birth control method or addressing specific issues, like timing the intake of the pill to minimize nausea.

Consult with a healthcare provider

The first step in managing side effects is to talk with your healthcare provider. They can help you choose a birth control method that best suits your body and lifestyle. If side effects become problematic, they might suggest switching to a different type or dosage of birth control. For instance, if you experience mood swings or anxiety, a lower dose of hormones or a non-hormonal method might be recommended.

Adjust your lifestyle

Certain lifestyle changes can help mitigate side effects. For instance:

  • Diet: Eating a balanced diet rich in calcium and vitamin D can support bone health if you’re using a method that affects bone density.
  • Exercise: Regular physical activity can help manage weight changes and improve mood by releasing endorphins.
  • Hydration: Drinking plenty of water can reduce fluid retention and bloating.

Regular check-ups

Regular medical check-ups are essential to monitor the long-term effects of birth control, especially if you’re using a method that impacts bone density or increases the risk of blood clots. Blood pressure checks, bone density scans, and discussions about any ongoing symptoms should be part of your routine healthcare.

Emotional support

If you experience mood swings, anxiety, or depression, consider talking to a mental health professional. Therapy, stress management techniques, and, in some cases, medication can help manage these side effects.

Consider non-hormonal options

If hormonal side effects are severe or persist despite adjustments, non-hormonal birth control methods like copper IUDs, condoms, or fertility awareness methods might be preferable. These options avoid the hormonal disruptions that cause many side effects.

Consider timing and type

If side effects are tied to hormonal fluctuations during the cycle, such as with traditional birth control pills, you might consider continuous use pills that skip the placebo week or using a different form of hormonal birth control, like an IUD, patch, or ring, which may offer more stable hormone levels.

Not necessarily. Although there is a noted increase in depression and anxiety risk among women using hormonal birth control, the overall incidence remains relatively low. Approximately 2.2% of women using hormonal contraceptives develop depression, compared to 1.7% of those not using them. This suggests that while some individuals may be susceptible to these side effects, the majority are not significantly affected. Therefore, hormonal birth control should not be broadly discontinued but rather prescribed with careful consideration of individual health profiles and potential side effects.

  1. Hormonal contraception and mood disorders – PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9218393/
  2. Population-based cohort study of oral contraceptive use and risk of depression – PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10294242/ 
  3. YAZ and the novel progestin drospirenone. Available at: https://pubmed.ncbi.nlm.nih.gov/18980044/#:~:text=Drospirenone%2F20EE%2D24%2F4%20is%20the%20only%20COC%20with,a%20COC%20for%20birth%20control .
  4. Can hormonal birth control trigger depression? – Harvard Health. Available at: https://www.health.harvard.edu/blog/can-hormonal-birth-control-trigger-depression-201610172517
  5. Can Birth Control Cause Anxiety? — Talkspace. Available at: https://www.talkspace.com/mental-health/conditions/articles/birth-control-and-anxiety/
  6. Association of Hormonal Contraception With Depression. Available at: https://pubmed.ncbi.nlm.nih.gov/27680324/
  7. Is There a Connection Between Hormonal Birth Control and Anxiety? Available at: https://www.healthline.com/health/birth-control/birth-control-anxiety#effects-on-anxiety
  8. Psychological side effects of hormonal contraception: a disconnect between patients and providers – PMC Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9842494/
  9. Menstrual impact of contraception. Available at: https://pubmed.ncbi.nlm.nih.gov/8178900/#:~:text=Hormonal%20contraceptives%20may%20have%202,the%20hormones%20on%20day%2021.
  10. Comparison of cervical mucus of 24/4 vs. 21/7 combined oral contraceptives.Available at: https://pubmed.ncbi.nlm.nih.gov/22682723/
  11. Hormonal contraception and mood disorders. Available at: https://pubmed.ncbi.nlm.nih.gov/35755988/#:~:text=Hormonal%20contraception%20is%20known%20to,progestogen%20contained%20in%20these%20pills.
  12. Perspectives on the side effects of hormonal contraceptives among women of reproductive age in Kitwe district of Zambia: a qualitative explorative study – PMC. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10439553/
  13. Oral Contraceptive Pills – StatPearls – NCBI Bookshelf. Available at: https://www.ncbi.nlm.nih.gov/books/NBK430882/

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