As women, we all have a decision to make when it comes to birth control. There are various options, from the oral pill to the implant to condoms to injections—but the one overarching worry I know my friends and I always have at the back of our minds when choosing contraception is how it will affect our mental health.
But now there's a new study to put us "at ease." Researchers at The Ohio State University Wexner Medical Center claim that there is no evidence to support a link between progestin-only hormonal birth control and depression. Brett Worly, MD, the lead author of the study, claims that "depression is a concern for a lot of women when they're starting hormonal contraception, particularly when they're using specific types that have progesterone. But based on our findings, this side effect shouldn't be a concern for most women, and they should feel comfortable knowing they're making a safe choice."
The investigation reviewed thousands of studies on the mental effects of contraceptives, including the pill, the implant and the injection. They reviewed studies examining the effects of hormonal birth control on adolescents, women with a history of depression and postpartum women and concluded that there is insufficient evidence to prove a link between birth control and depression.
But in 2016 researchers at the University of Copenhagen studied the health records of more than a million Danish women aged between 15 and 34. They discovered that those on the combined pill (which combines artificial versions of the hormones estrogen and progesterone) were 23% more likely to be prescribed an antidepressant than those not on hormonal contraception. They also found that those on the progestin-only pill were 34% more likely to be prescribed antidepressants.
So something about this new research just doesn't add up to me.
I've been in a relationship for five and a half years, and during that time I've only been on the pill for the last three months (purely because my skin is having a major freak out and my doctor recommended it). Why I haven't chosen a more "responsible" approach to contraception? Well, for my mental health.
I was on Microgynon between the ages of 16 and 19 and felt fine. Everything was peachy, and I didn't experience any pressing side effects. Switch to 2009 and I changed pills. Microgynon had started to make me break out (or so I thought), so my doctor suggested I tried Yasmin.
Yasmin and I did not get on, and I spent the next year with severe anxiety one minute and rage the next, unable to understand what was happening to my mind or my body. I'd never felt so self-conscious and had no clue at the time that the pill played a huge part in this. It wasn't until I stopped taking it all together that I felt like me again. Clearer, brighter and without extreme mood swings. I hadn't touched hormonal contraception since, until about three months ago when I started taking a combined pill again for my skin. I lasted about three weeks before my mind was all over the shop once more. But still, I'm told by Worly that he was unable to find a link between this pill and depression? It's also worth noting that while this new study looks into the link between progestin-only hormonal birth control, Worly has previously looked into the link between the combined pill and depression and claims to have found no link.
My colleague, Maria, told me that when taking the mini pill, or Cerazette (a progestin-only pill), she was always on edge, would cry for no reason and felt like she was going mad. When she eventually decided to stop, she felt clearer in days. Being a naturally anxious person, she just thought that was who she was, but now she's on the nonhormonal coil, she's never felt happier.
Another friend of mine who has just recently started to take the mini pill has started to notice a pattern in her mood swings on the same two days in her cycle in a month. On those two days, she feels more emotional and anxious. The link between her cycle and her moods is clearly hormonal, especially as she's not normally one to experience mood swings or anxious tendencies.
While Worly's study does take a closer look into the direct link (or lack thereof) and could put women at ease, I'm still left wondering why so many women experience mood swings when taking hormonal contraception. According to a survey of over 1000 women conducted by The Debrief, the majority of users "who have reported adverse mental health side effects to their doctor don't feel they were taken seriously." Which is what worries me. Even if there is no "direct link" between the pill and depression, we live in a society where we're told from an alarmingly young age to take hormonal birth control to control our bodies, our skin and prevent unwanted pregnancies. But what if that belief that our body is a force that needs controlling is what is perpetuating our anxieties?
If you take a scroll through the NHS website, it lists "mood swings" as a side effect of both the combined pill and the progestin-only pill, but nowhere does it state depression. We're left feeling like we're not normal when we experience bouts of anxiety or mood swings and are then told that there's no link between depression and the pill. These mood swings are still valid, and having a "minimal association" between progestin-only birth control and depression is still an unexplained association that needs to be examined at length.
Worly does feel it's really important for women to work with their doctors, as we're all different and can experience different side effects. So if something doesn't feel right when you're on birth control, speak up and talk to your doctor.
Worly BL, Gur TL, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018;97(6):478-489. doi:10.1016/j.contraception.2018.01.010
Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of hormonal contraception with depression. JAMA Psychiatry. 2016;73(11):1154-1162. doi:10.1001/jamapsychiatry.2016.2387