Birth Control Linked To Depression – So Why Don’t More Doctors Care?

birth-control-depressionYou’ve probably seen some back and forth in the news this past week over a recent study that found a link between hormonal contraception and depression.

These are the facts:

  • A Danish study found that women taking a combined (progesterone and estrogen) birth control pill had a 23% increased chance of being diagnosed with depression
  • Women on progestin-only birth control, or the mini pill, were found to have a 34% greater chance of being diagnosed with depression by the same study
  • Teens were found to have the largest increase in depression risk, with an 80% greater chance of receiving a depression diagnosis while taking hormonal contraception, according to the study
  • The study also found that women using other methods of hormonal birth control (including the IUD and implant) had a greater risk of receiving a diagnosis of depression
  • While the study did not test for causation, it did find a correlation between hormonal contraception use and depression
  • Following the study’s release, a number of doctors have publically expressed their view that women should not to be concerned about the study’s findings
  • Nobody should be surprised by this (Ok, maybe that’s not a fact).

Here’s why nobody should be surprised:

To start, there is a lot of anecdotal evidence for a link between depression (in extreme cases) or changes in mood (in more mild cases), and hormonal contraception. Mood changes is one of the most commonly cited reasons by women who discontinue hormonal contraceptive use within the first year. Mood swings are also listed as one of the primary side effects of most oral contraceptives.

Holly Grigg-Spall, author of the book Sweetening the Pill, has been very public with her own story of pill-related depression. Her personal experience with the pill led her to years of research and of interviewing other women who had had similar experiences with hormonal birth control. (By the way, Holly has a great must-read article on this most recent study.)

I had no major issues while on the pill for about ten years, but I know and have worked with women who have. Speaking for myself, I can say since coming off of the pill that I feel happier, lighter, clearer, and also slightly more emotional. I cry more quickly at sad things, and feel more moved by happy occurrences. It’s not quantifiable, but I know my emotions and emotional state are different. I’ve heard this from client after client as they transition away from the pill and return to their natural hormone patterns.

Secondly, it makes sense. I am not a physician, nor am I a researcher. (Let’s just get that out of the way now.) But I am a practitioner who spends a lot of time reading medical journals and studies on hormonal contraception and women’s cycle health. I’ll further preface this section by stating that in some cases there are contradictory studies, and in most cases, more studies need to be done.

That said, it is well established that the steroid hormones produced by the ovaries (estrogen, progesterone, testosterone) have an effect on neurotransmitters like dopamine, GABA, and serotonin, all of which are essential for mood stability and health. Furthermore, these hormones interact with many parts of the brain that deal with functions outside of the reproductive system. Parts of the brain, such as the amygdala and hippocampus, that deal with emotion and cognition have a large amount of estrogen and progesterone receptors.

Additionally, neuroimaging has shown that the hormones progesterone and estrogen alter the actual structure, as well as functional capability, of adult women’s brains.

At this point it is important to note that a natural cycle contains a delicate interplay between the primary hormones of progesterone and estrogen. Hormonal birth control disrupts this natural cycle by introducing exogenous hormones into the system. Furthermore, the progesterone and estrogen introduced to the system via birth control methods are synthetic variants of our bodies’ natural hormones.

In an effort to metabolize the large amounts of synthetic hormones (primarily estrogen depending on the type of birth control) in hormonal contraception, the liver uses large amounts of certain vitamins and minerals, causing a deficiency. Since at least the 1980s, it has been known that the pill causes specific nutrient deficiencies. In particular, B vitamins and magnesium are often depleted. This is of extreme importance because both of these are essential for maintaining a healthy stress-response and emotional stability. In fact, B vitamins are often recommended as holistic treatment for mild cases of depression.

Thirdly, doctors have been telling women that hormonal birth control is perfectly safe for over 30 years now despite evidence to the contrary. I was not told by one doctor in my ten years of being on hormonal contraception that it was considered to increase my risk of certain cancers, deplete important nutrients, or could very likely cause a dark spot (adenoma) to appear on my liver. (And this is just the tip of the iceberg.)

The World Health Organization has characterized the oral contraceptive pill as a ‘class one carcinogen’ since 1999. This is the highest classification of cancer-causing agent, and it has remained on the WHO’s carcinogen list as a class one offender despite periodic reviews of newer low-dose pills and new delivery methods.

A 2014 study showed an increased risk of multiple sclerosis amongst pill users. And all of this does not even get into the misappropriated use of the pill for the treatment of disorders such as PCOS and endometriosis, or its effect on future fertility. Yes, much of this is not 100% scientifically proven, and I understand that many physicians believe the benefits outweigh the costs, but I believe this information does merit a conversation in the very least.

I do not think doctors are bad people. In fact, one of the doctors who prescribed me birth control during my ten years on it was my father. He absolutely has my best interest at heart, and probably thought that he was doing nothing more than saving me a trip to my gynecologist. It’s just that oral contraceptives are so standardly accepted that their use has become pervasive.

This says so much more about how our culture devalues women and the female reproductive system, than it does about our medical system.

Again, I refer you to Holly Grigg-Spall’s article, which speaks to how women’s experiences are overwritten, and why a male birth control pill has remained elusive. I am sad to note that I do not think this study would be viewed with quite as much triviality if a medication taken solely by men showed an increase in as serious of a disorder as depression.

All of this is not to say that doctors should stop making hormonal contraception available to women, by any means. I am, however, strongly advocating that doctors make all of the information available to women when they are assessing their options and choosing a method of birth control.

I can only hope that more studies on oral contraceptives, in general, are conducted and that doctors acknowledge the potential consequences illustrated by such studies as they are released.

Kara DeDonato is a fertility health expert who works with women to troubleshoot their monthly cycles and digestion so that they can feel their best and be their best selves. Read her full bio here

See more articles by Kara DeDonato

Continued reading…

2 Comments

  1. Hi Kara, As you point out, there are probably several mechanisms by which hormonal birth control causes depression, including the fact that hormonal birth control alters the intestinal microbiome. But the main MECHANISM is that steroid hormones affect the brain, and that synthetic progestins affect it in a vastly different way compared to real progesterone. It is the PROGESTIN part of birth control that causes depression. The estrogen part is ok for mood.

  2. Hi Dr. Briden, thank you for providing this clarification regarding progestin and mood, and the additional emphasis on the primary mechanism. The point about estrogen was mainly referring to the breakdown of estrogen by the liver, but I can see where this could have confused the issue with the progestins in the pill in an article primarily focused on this most recent depression study. Thanks for reading – I love your work!

2 Trackbacks & Pingbacks

  1. Birth Control Pill Linked to Depression | Libera Wellness
  2. Choosing Your Birth Control Method After Baby |

Leave a comment

Your email address will not be published.


*