Contraception is something most of us are relatively familiar with but could it be altering our moods?
Whether it’s the pill, the implant or an IUD, around 70 percent of the female population of New Zealand are on some form of contraception. Along with preventing pregnancy, contraception is often used to regulate periods, reduce acne and lower endometriosis-related pain. However, many Kiwi women report contraception negatively affecting their mental health in significant ways.
Possible links between contraception and depression have been discussed for years – and while there has been clinical evidence of contraception influencing some women’s moods, up until recently, there was no research that could prove any link between hormonal contraceptives and depression.
This all changed with a 2016 study that was conducted in Denmark, which evaluated the contraception use of the entire female population of the country (around one million women), and found there was an increased risk for first use of an antidepressant and first diagnosis of depression in women who were using different types of hormonal contraception.
The nationwide study combined data from the National Prescription Register and the Psychiatric Central Research Register in Denmark. All women in Denmark between the ages of 15 to 34 years with no prior depression diagnosis were followed up over the course of 13 years (2000 – 2013), to see what changes occurred.
The study found women on the pill had a higher likelihood of being diagnosed with depression. It also found women using the combined pill were 23 percent more likely to be prescribed antidepressants while women on progesterone-only pills were 34 percent more likely. Hormonal contraception use, especially among teenagers and young adults, was associated with subsequent use of antidepressants and a first diagnosis of depression. This finding suggests that depression could be a potential adverse effect of hormonal contraceptive use.
However, Family Planning National Medical Advisor, Dr. Christine Roke says most studies have shown there is no big difference in frequency between women who are and aren’t using contraceptives, “If you take 1,000 women who aren’t on contraception and 1,000 who are, there is no real difference between the two in terms of frequency – however, if we pick out individuals, it is a different story.”
General Practitioner, Dr. Orna McGinn agrees with Dr. Roke that there isn’t much evidence of a link between depression and contraceptive use. “There’s just not enough background evidence to show that there’s any link at all.”
However Dr. Øjvind Lidegaard, Professor in Obstetrics and Gynecology at the University of Copenhagen who initiated the Danish study says that he absolutely believes there is a link between contraception and depression, “[The study] demonstrates a close and strong association between initiating use of hormonal contraception and depression development. These two circumstances are strong indicators of a casual relationship. A definite proof – no, but close to.” Dr. Lidegaard also mentioned that a recent Swedish study that was published had confirmed the Danish findings.
The bottom line is, at this stage, contraception causing depression cannot be definitively proven and more research is still needed. However, the hormones used in birth control can contribute to changes in mood and mood swings – with mood changes being listed as a possible side effect in contraceptive pamphlets. Whether or not contraception can cause depression, there are many women who believe their mental health has been negatively impacted by it.
We spoke to seven New Zealand women who experienced an onset of depression or anxiety after starting contraception use – here are their stories.
“I started contraception at 14, with the combined pill [Ava30]. During this time, I became depressed, suicidal and had insomnia. I was referred to a psychologist by my doctor who suggested I change contraception. I took that advice and had a break from contraception and in that time, my mood changed and I was given the all clear that I seemed okay and healthy. At 16, I started getting the Depo Provera injection and I had it until I was 18. Unfortunately, after this, my mental health became a downwards spiral of low esteem and depression, and I developed a lot of unhealthy habits. I ended up researching the side-effects of the Depo and decided to come off it as I realised it could be causing my mood swings.
None of the side effects or the possibility of depression were ever explained to me on either occasion of starting contraception. I now use the copper IUD and it was the best choice – I’m happy and healthy. I had to do my own research to understand what contraceptives work well for me. I was a young girl going on it for the first time; it should be standard practice to go through all side-effects, so someone is aware of what they are using.”
“I had the Jadelle implant inserted about two weeks after giving birth to my second child. Not long after I had it put in, I began feeling off – tired, quite down and I didn’t want to leave my house anymore. At first, I just thought it was baby blues but as the months went by, I began to get worse and worse, and I knew that I was seriously depressed and it was far more than baby blues. I went back to the doctor for help and thought, “Okay, well, maybe this is postnatal depression.” I was started on antidepressants. The medication made me ten times worse, so I opted to stop taking them and do six weeks of counselling instead. This [counselling] helped a bit but I still was a long way off being 100 percent.
One day, while I was browsing through Facebook, I came across a thread on a mummy’s page about contraception and while reading through the comments, I noticed several people had commented saying they had become depressed while on the Jadelle implant. So I began to wonder if I was having the same issue. A few days later, I went to the doctor and asked to have it removed, which the doctor agreed to. The following morning, I woke up and felt like a completely different person. I had energy, I was happy and I felt better than I had in over a year! It has been five years now since it was removed and I have had no problems with depression since.”
“I was on the contraceptive pill for two years. When I started, I noticed a lot of changes – weight gain, severe mood swings, loss of energy and depression. I’ve recently come off it and I’ve noticed that I have a lot more energy. I’m more outgoing and confident, and just more happy in general. While I was on the pill, I was less active, I lost all motivation and contact with friends. The only person I spoke to was my boyfriend and my mood swings would bring on massive arguments, which would cause me to fall into a deeper depression.
I was told by my doctor about this being a possible side-effect but I didn’t expect it to hit me so hard. I’m off birth control now but if I went back on, I’d make sure to look into the side-effects before deciding.”
“When I was in my late teens/early twenties, I was on the combined oral contraceptive. I didn’t react well to the high levels of estrogen in those pills. It made me extremely erratic, irritable, angry and just not myself. So I went back to my Doctor and she suggested I go on Noriday (progesterone only pill). I used Noriday for 18 months and for the first 14 months, I had no period. Then after 14 months, I began bleeding heavily for around three months. I went back to my doctor and she suggested I take two tablets per day. This made me hit the wall. I was crying every day, I was irritable, angry and just one extreme to the other.
During the first 14 months, I felt like I was in a constant state of being neither happy nor unhappy – I just felt very deflated. I didn’t realise I was depressed until I came off the Noriday but looking back on the first six to 14 months, I would wake up, get something to eat and then go back to bed, and this went on for days and weeks at a time. I only had to work one day a week because I was at uni, but I just began calling in sick to that one day of work. I’m an extremely active individual and always on the go, so this behaviour was very abnormal for me. I’ve been off birth control for two years now and I feel completely like myself again now.”
“I started taking the Ava 30 when I was 16. I’d never had any problems with my mental health before this time but when I started taking it, I had crazy breakthrough bleeding and at one point, I had my period for six weeks. During this time, I became very moody and emotional – I would go from very intense highs to horrible lows very frequently. It was like I had a very short fuse and the littlest thing would set me off. I would also often get really emotional over things and then half an hour later, I’d be confused as to why I’d reacted in such a way.
I didn’t realise that depression was a potential side-effect before taking the pill but when I spoke to my doctor about my mood changes, he said that it was likely to be from the pill I was taking.
Due to the breakthrough bleeding, I was changed to another pill, which I am still currently on but it’s given me awful anxiety to the point where I end up vomiting due to stress. I think this pill is actually rougher on my mood but it’s hard for me to tell if it’s the pill causing it or whether I’m just getting more emotional as a person.”
“My issues with the Jadelle Implant started probably a month after I had it inserted – I noticed that things that didn’t usually make me very sad, really affected me. I also noticed I wasn’t feeling emotions normally and started experiencing suicidal thoughts. I figured out I was depressed after a couple of months of a really bad depressive episode. It was mentioned in the pamphlet I received that depression was a possible side-effect but I’d been on the Depo Provera prior to the implant, so I’m guessing no one thought it would be a problem.
When I realised I could be feeling depressed because of my implant, I had it removed. This was around November last year and since then, I’ve felt so much better. All my symptoms of depression pretty much went away within a couple of weeks. I’m feeling like I did before I went on contraception now.”
“When I first began taking birth control, I tried a couple of different pills – first, I was on the Ava 30 but it caused me massive headaches, as well as being really upset and moody over nothing all the time. I didn’t think anything of it at first – once I did realise this could be a more serious problem I went to see my doctor and I was put on the Ava 20 pill instead. The Ava 20 screwed with my head even more than the previous pill and brought my mood down so much.
I decided to take myself off it and since then, everyone around me can see a change in my personality almost straight away! I was never told of the side-effects the pill could give me. This has made me learn to be very careful to look up the different medications I take now, as well as checking what possible side-effects there could be.”
Should we be worried?
While it is important to keep an eye on how you’re feeling and any physical or emotional changes you experience when starting a new form of contraception, most women don’t experience such extreme side-effects.
Dr. Roke says some degree of mood swings can happen when first starting on different types of contraceptives, “When the implant or an IUD is inserted, it lets out a larger dose of hormones at the beginning, so within the first couple of weeks, you may experience some mood changes but for the most part, they subside after this. The pill is a little different as it releases the same amount of hormones in every dose.”
One worry Dr. Roke has is that young women will be scared to try contraception because they think it will make them depressed, “There is such a small possibility of contraception causing depression or mood swings that it’s not something most women need to worry about. If you are concerned about your contraception, see your doctor.”
It can be confusing figuring out what contraception is the one for you and while one person may have problems with a certain form, it doesn’t mean you’ll have the same issue. So all in all, if you feel good on your method of contraception – stick with it. If you have any concerns, talk to your doctor or a Family Planning nurse about what other options there are out there.