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The Little-Known Link between Birth Control Pills and Depression


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Do you use the pill or some other form of hormonal contraception? Recent studies suggest that it may increase your risk of developing depression. Read on to learn how these contraceptives change your body, the association between hormones and depression, and natural alternatives to hormonal birth control.

birth control pills and depression
Recent studies have shown a link between hormonal contraceptives and risk of depression. istock.com/KatarzynaBialasiewicz

Depression is the leading cause of disability worldwide, and antidepressant use has risen dramatically in recent years (1). Depression also happens to be one of several commonly reported side-effects of hormonal contraceptives, and mood symptoms are a known reason for stopping hormonal birth control treatment (2, 3).

I’ve written previously about depression as an inflammatory condition. In this article, I will specifically focus on the associations between hormonal birth control and depression.

The Natural Hormone Cycle

The hormones estrogen and progesterone fluctuate over the menstrual cycle in a predictable pattern that is repeated every month. Estrogen and progesterone levels begin very low at the beginning of the cycle (the follicular phase), signaling the pituitary gland to produce follicle-stimulating hormone (FSH). FSH begins the process of maturing about 15 to 20 follicles, the fluid filled sacs in the ovaries that each contain an egg. The follicle produces estrogen to prepare the body and uterus for pregnancy.

Approaching ovulation (about midway through the cycle), high estrogen levels trigger the release of luteinizing hormone (LH) from the pituitary gland, causing the release of a single egg from the follicle (the ovulatory phase). The ruptured follicle (corpus luteum) begins to secrete progesterone and estrogen to continue to prepare the uterus for pregnancy (the luteal phase). If the egg is not fertilized, estrogen and progesterone levels drop and menses begins as the uterine lining is shed along with the unfertilized egg.

A basic knowledge of this natural hormone cycle and the rise and fall that occurs will help us to better understand the various types of hormonal contraceptives and how they alter this cycle to prevent ovulation.

Types of Hormonal Contraceptives and How They Work

The primary types of hormonal contraception (HC) include the combined pill, progestin-only pill, IUD, implant, injection, vaginal ring, and transdermal patch. Hormonal contraceptives contain either synthetic estrogen and progestin (combination) or progestin only. Most HCs work by providing the body with synthetic hormones, keeping progesterone (and estrogen) levels consistently high. In the case of oral contraceptives, there is a sharp spike in hormones each day of the cycle that falls before the next day. (This is why oral contraceptives have to be taken daily to prevent pregnancy.)

The high levels of synthetic estrogen and progesterone “fool” the body into thinking it’s pregnant, inhibiting the secretion of LH and FSH and thus effectively blocking follicular development and ovulation. Progestin-only contraceptives also inhibit sperm penetration through the cervix by decreasing the amount and increasing the viscosity of cervical mucus (4).

The takeaway here is that hormonal contraceptives suppress the natural hormone pattern that occurs over the course of the menstrual cycle. We’ll see in the next few sections how these hormones are associated with mood and depression.

Sex Hormones, Mood, and Depression

Hormonal differences between the two sexes have a tremendous effect on mood. Studies have shown that the lifetime prevalence of depression is approximately twice as high in women as in men across different populations (5, 6), whereas before puberty, the frequency of depression is equally distributed between girls and boys (7). Because of these and other studies, the two primary female sex hormones, estrogen and progesterone, have been hypothesized to play a role in the symptoms of depression (8, 9).

A review by Toffoletto and colleagues found evidence that steroid sex hormones have an influence on cortical and subcortical brain regions involved in emotional and cognitive processing (10). Changes in estrogen levels may trigger depressive episodes in women at risk for depression, and adding progesterone to hormone therapy has been shown to adversely affect mood in women (11). Progesterone metabolites can mimic the neurotransmitter GABA, the major inhibitory system in the central nervous system (12). External progestins also increase levels of monoamine oxidase, an enzyme that degrades serotonin. It may do this more potently than endogenous progesterone (13).

Furthermore, a double-blind, randomized controlled trial recently found that women given a goserelin (a stimulator of gonadotropin-releasing hormone) implant had significantly greater subclinical depressive symptoms than those receiving a placebo implant. Depressive symptoms were positively correlated with a decrease in estrogen (14).

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The Association of Depression and Contraceptive Use

Several studies have now studied the association between low-dose HC use and risk for depression. Two studies found that teens taking progestin-only contraceptives tended to be more frequent antidepressant users (15, 16). Another study found that use of combined oral contraceptives among women who previously experienced adverse emotional effects resulted in deterioration of mood and changes in emotional brain reactivity (17). A 2014 case report describes two female patients who developed depressive symptoms after starting hormonal contraception use (18). On the other hand, one study found no association between mood and oral contraceptive use (19), while three studies suggested that HC use was actually associated with better mood (20, 21, 22).

This type of birth control doubles your risk of depression

The most robust study, however, was published just last month and provides strong evidence for an association between HC and depression (23). The researchers designed a prospective cohort study, where patients are followed forward in time and outcomes are observed. The entire female population of Denmark between ages 15 and 34 was studied, thanks to extensive national registry data. Of the more than 1 million women studied, 55.5 percent were current or recent users of hormonal contraception.

So what did they find? Compared to non-hormonal contraceptive users, the chance of needing your first antidepressant was:

  • 1.2-fold higher if you used a combined oral contraceptive
  • 1.3-fold higher if you used a progestin-only pill or transdermal patch
  • 2.0-fold higher if you used a vaginal ring
  • 2.1-fold higher if you used an implant

Use of all types of hormonal contraceptives was also positively associated with subsequent diagnosis of depression. These risks were even higher for adolescents and for those who had been using hormonal contraception for a longer period of time.

Alternatives to Hormonal Contraception

Evidently, hormonal contraception is not as harmless as it is often made out to be.

If you are a current or past consumer of HCs and are concerned about the health implications of your HC use, I’ve talked extensively on my podcast about how to recover from “post-birth control syndrome” and the associated nutrient deficiencies, gut dysbiosis, detoxification issues, and adrenal fatigue.

I also know that women use HC for a number of reasons, not just preventing pregnancy.  Fortunately, there are natural alternatives to HC:

  • For PMS symptoms or painful periods: this is likely a sign that your hormones are out of balance. Check out this blog article and podcast for tips on how to fix your menstrual cycle and rebalance hormones naturally.
  • For contraceptive purposes: one of the most effective non-hormonal options is the Fertility Awareness Method (FAM). FAM is a natural method of preventing or achieving pregnancy by tracking and charting the body’s cued responses to hormone fluctuations over the menstrual cycle. Due to the combined maximum survival time of an unfertilized egg (1 day) and sperm (5 days), there is only a small portion of a woman’s cycle where she can actually get pregnant. This method uses basal body temperature, cervical fluid, and cervical position to effectively predict ovulation so that you can choose to avoid unprotected sex during the fertile time around ovulation.

While there has not been a ton of research in this area (it’s not anywhere near as profitable to study cycle charting as it is to study a birth control pill), a review of robust clinical trials found that the FAM symptothermal method for contraception has about 98 percent effectiveness for typical use and about 99.5 percent efficacy for correct use (24). In comparison: condoms are 98 percent effective when used properly, and birth control pills are between 91 and 99 percent effective. However, it should be noted that FAM does not protect against STDs.

For more information on FAM, I highly recommend the book Taking Charge of Your Fertility, by Toni Weschler.

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Join the conversation

  1. Hi Chris, Do you have any further information on treating irregular, extremely painful periods along with ovarian cysts in a functional manner? My 16 year old has suffered from cysts and debilitating periods that were coming every 10 days with heavy bleeding. I held out as long as I could, but the only option for relief seemed to be the birth control pill. She is in her 2nd month, and still having extreme pain (without the bleeding) and now having intense emotional swings. We have been to a traditional OBGYN (who prescribed the pill), Functional Dr, and just had our first appt. with a pediatric endocronologist who is doing several blood tests for PCOS and insulin resistance. Her health history is complicated and began with a severe concussion 3 yrs ago. Any thoughts on the pill for the painful periods?

  2. Just like the article states:
    “Use of all types of hormonal contraceptives was also positively associated with subsequent diagnosis of depression. These risks were even higher for adolescents and for those who had been using hormonal contraception for a longer period of time.”
    I believe my diagnosis of depression and anxiety are due to continued use of birth control pills from the age of 16 for about 17 years.
    I deeply regret believing the doctors that it was a simple fix to my heavy and painful periods. I had severe post partum depression, and I’m still struggling now, especially with gut issues and recurring anxiety. Even while I’m eating clean with no sugar!
    I won’t allow my daughter to be fed the same lies from a doctor about birth control.

  3. I experienced depression throughout my 20, after going onto the pill. The likelihood of depression being a side effect of the pill was never mentioned by my doctor. I never mentioned the depression to my doctor, because I was young and didn’t recognise it as a condition – I was just terribly, terribly sad and my life stopped.
    These horrible drugs blighted my 20s, and my life beyond. It is shocking that young people can be put on these things without regular monitoring by a doctor.
    I finally connected the depression with the pill in my mid-30s – what a waste!

  4. After having gone through three rounds of IVF, there is no doubt in my mind that the severe depression and anxiety that I am now experiencing as a 47 year-old peri-menopausal woman is the direct result of hormone injections I received during my treatments. In addition, after my second child was born, I was instructed by my OB-GYN to use a form of birth control. I chose ParaGard and found that after 3 months of use, I had to have it removed as the side effects were less than pleasant.

  5. I would just like to clarify that the Fertility Awareness Method does NOT predict ovulation; it merely helps a woman confirm when she has ALREADY ovulated based on her temperature change + cervical fluid and is therefore safe to have unprotected sex.

    Also, Fertility Awareness is NOT the Rhythm Method, as erroneously stated in the comments. The Rhythm Method assumes women ovulate on the 14th day of their cycle every month, while FAM makes no such assumption. Only by tracking temperature and cervical fluid can a woman confirm whether she has ovulated (it can be different every month!).

    The book Taking Charge of Your Fertility by Toni Weschler is required reading for anyone thinking of using this method. I started using it after getting my Mirena IUD taken out and have never had a pregnancy scare.

    Chris, thank you for recommending women look into FAM as a form of birth control. While it is best for women in monogamous relationships, I do wish more women received the kind of education about their cycles and bodies that FAM provides.

  6. There is another natural family planning tool available that folks should know about. A Clear Blue fertility moniter can be used each morning to determine your hormonal state regarding the possibility of fertilization and pregnancy that day. It was developed for women trying to get pregnant, but can also be used to prevent pregnancy. It’s easier than all that charting your cycle and taking the basal body temp. It does, however, still require abstinace on days that are fertile.

    • Can you talk a bit more about this? I did a little googling and found a reusable machine – is that it? The device that says whether you have low, high or peak fertility? If yes, would you avoid sex on high and peak days?

      • Lauren, sorry I didn’t respons intil now. I just saw your question
        I don’t use the Clear Blue fertility monitor myself, but my adult daughter does. She ordered it online and yes the device is reusable like a blood glucose monior. You buy the strips and use one daily with your first morning urination. You are correct that you would avoid sex on high and peak days.

  7. Any man who has lived with a woman on BC knows this by experience. Add various other Rx meds and its a witches brew of emotional turmoil. Yikes!

    FAM…I seem to recall that was once called Vatican Roulette! As being deligent enough to record all these things and refrain from sex, is akin to gambling with nearly the same odds and risks!

    Use a condom, or PTFO!!!

  8. Copper IUD’s can lead to copper toxicity (as does the OCP) and that is not a good thing. Copper will combine with xenoestrogens and impact on the liver. If the woman gets pregnant after using the IUD the existing copper toxicity can affect a baby and cause ADHD as well as other symptoms. It will cause a relative deficiency of zinc which is also not good.

    • Sylvia – I would love to see some references supporting the information about copper toxicity

      • Copper toxicity is real! I used a copper iud for 5 months. Two weeks after it was inserted my hair started falling. I didn’t make the connection between copper toxicity and my hair loss until after spending months going to doctors and getting tested for many ailments. The doctors could not find anything wrong with me. One dermatologist even told me that I had alopecia. I said to him, ” How is that possible as I am a 38 year old woman, and besides there is new hair growth?” I wound up losing 50% of my hair before having the copper iud removed. My hair stopped falling two weeks after the removal. It was like something out of a horror movie!

  9. I’ve been using FAM since last November after being on HC for about 9 years. It’s the best decision I’ve probably made my entire adult life. My mind is clearer. I feel more emotionally. My sex drive is way higher. I feel like my old self in general, and the scary thing is that I really didn’t notice how bad it was until I got off of them. Love your page and this article. Thanks for your work!

    • Hi Tracie,

      The symptoms you list perfectly line up with what I think I am experiencing now (have taken Levlen ED for 2 years, since I was 19)… Whilst I’m not experiencing anything ‘concrete’ that could be diagnosed, I am highly suspicious that the pill is causing things like emotional confusion (sort of like an emotional numbness…a detached feeling, even from my wonderful boyfriend!), low sex drive, generally more difficult to feel happy, crying and not knowing why (I’m not a crier at all! Occasionally I find myself in front of my boyfriend, laughing and telling him that I have no idea why I’m crying)… I feel like all of these things might line up with when I started taking the pill…. I don’t really feel like myself!

      I was wondering if those sort of ‘symptoms’ sound familiar to you, and how you differentiated between knowing which things are just you and part of your life, and which things were caused by the pill? It’s very hard to work out if my behaviour is just ‘me’ and a reflection of my every day life and stresses etc., or if it could be the pill messing with me. I would go off it in a heartbeat if contraception were the only reason I was on it… there are plenty of better options for contraception. It’s actually just the convenience of skipping periods since I’m in the army and can’t afford the ‘inconvenience’! I’ looking at hormone-free alternatives, but none prevent periods.

      I should add that I have always been an extremely resilient, confident and happy person, and have never even come close to any sort of mental illness such as depression and the like, whatsoever.

      Any sort of feedback and/or guidance would be welcomed!

      • I didn’t realize that BC had gutted my sex drive and taken my emotional and mental life hostage until I went off of it.

        Within a month or two I had gone from 125 to 115lb without any other lifestyle changes. My sex drive corrected after several years of being veryyyy low. And my mood got back to what is within my normal range.

        I didn’t realize BC was causing all of this havoc – just went off because I wasn’t having sex (see: low sex drive). With my sex drive back to normal, I went on the Paragard IUD, which I’ve been happy with.

        Your symptoms sound suspect to me, and I cannot recommend stopping the pill highly enough. Try Paragard, condoms, FAM, the diaphragm, or some combination. I hope it helps! Would love to hear an update…

        • I would definitely look at trying to get off of the hormones. That sounds eerily familiar to my life while on the pill – what really made me realise what it was doing was when the generic I was on was no longer available, the pharmacy gave me another generic that was supposed to be the same, but I was CRAZY on it. Crying out of nowhere, snapping at my husband, it was ridiculous. I’d gone online to search about that specific generic because I knew that was the only thing I changed in my life and I found a forum with women having the same exact issues. I didn’t have as strong of a reaction with the generic I was on previously, but that really opened my eyes and I started thinking, if this pill was supposed to be the same thing, who knows, maybe it was just slightly altering me, and I really was being affected more than I could even tell. Looking back at my life, now being hormone free, I’d have never gotten on them to begin with if I knew how easy it is to use FAM in conjunction with using condoms in my fertile window.

          I’m not sure what you could do about getting your period. I’d look into using menstrual cups. I’ve been using them for over three years, and they are much more convenient and cheaper (one time cost) than pads/tampons. Hormonal contraceptives are the only things that could delay or make a period not show up besides hysterectomy, which I’m also completely against.

          Also, just wanted to say thank you so much for your service!!

  10. I have been on oral contraceptives since age 17 when I had my first ovarian cyst removed and was diagnosed with endometriosis. I’ve had 5 lapscopes and 1 laparotomy since. I have tried going off oral contraceptives a few times in my twenties and early thirties, but everytime I do, I am back on the operating table within a few months to clear out my endometriosis and have ovarian cysts removed. For the last 5 years I have been advised to skip the inactive pills to skip my period completely and have so far been symptom-free.
    At age 37 I am now trying to finally go off antidepressants for good and would like to stop taking my Pill to take any contributing factors to my depression out of the way.
    I am worried about my symptoms returning if I stop my Pill, but on the other hand also very concerned about the long term effects on my mind and body by taking the Pill for such a long time and also not having normal periods?
    My gynae believes that being on the Pill and not having regular menses is very healthy for a woman in the long run?
    Apart from the depression-link, I am also concerned about whether taking oral contraceptives cause more damage to a female’s body or does surpressing the reproductive hormones hold any real benefit in the long run as advocatef by my gynae?
    Would love to hear your thoughts on this matter.
    PS: I have been single out of choice for 5.5 years and have never had children.

  11. Great article Chris! We have been married for 11 years and have used the Fertility Awareness Method, along with ecological breastfeeding, with wonderful results. No unwanted side effects! It always amazes me that everyone is all for “going green / organic” on everything under the sun, EXCEPT the pill. For more info. Go to ccli.org

  12. I’ve used FAM (we call it “NFP” though–Natural Family Planning–same thing) for almost 14 years. It has worked perfectly for us: achieving pregnancy when we wanted to and avoiding it when necessary as well. It’s NOT the same thing as your grandmother’s “rhythm method” and does work for women with irregular cycles. It does boast a very high user effectiveness rate (in the mid to high 90’s I believe) and 99% method effectiveness rate. I wish more women who are concerned about hormones in their food would at least give NFP/FAM a chance. Thanks for mentioning it, Chris. Unlike artificial contraception, there’s no money to be made by promoting NFP/FAM so I appreciate your mentioning it here!

  13. The primary reason I took birth control pills from when I was 16 years old until 37 years old, and then switched to Nuvaring through now (mid-40s), was to have normal periods and not have to worry about that aspect of my life. That is an important reason to take hormonal contraceptives if many of your hormones have always been and could always be, severely imbalanced. It’s also a karma/soul issue. Also, keep in mind that not everyone is constantly or regularly sexually active by choice or b/c a suitable partner is not in their life, and female hormonal meds may not always be used for actual contraception. A few times I took a break from the hormones and I either had a period every 14 days or every 50-60 days and I got very embarrassed from the highly unpredictable blood stains on my clothes and chairs at work and school. In my younger years I could not afford to spend thousands of dollars on naturopaths, acupuncture, taking on a lower-paying job with less stress, etc, to more naturally try to correct the problem with the likelihood of results happening on a limited basis only after many years of hard work. My body probably does not have the ability to have normal periods ever b/c of the rather challenging life I’ve had and the genetic misfortune I was born with. I accept this and I am at peace with it. I eat well, exercise, and I incorporate many holistic practices into my life but I will not give up the Nuvaring just yet, even with the side effects.

  14. Well done , Chris. It amazes me that so many people who are extremely health conscious give hormonal birth control a free pass! These are powerful drugs that have a myriad of adverse health consequences. It’s time, especially for women, to stop being Guinea pigs and take a more holistic approach to reproduction.

  15. Just to put the results of the 2016 Skovlund study into perspective 1) correlation is not causation 2) the absolute risk is low:
    in those NOT taking hormonal contraceptives:
    1.7% take an antidepressant, 0.2% have a psych diagnosis
    in those who DO take hormonal contraceptives:
    2.2% take an antidepressant, 0.3% have a psych diagnosis.
    Interestingly, in this study, depression rates peaked 6 months after starting a hormonal method, then at 4 years were actually LOWER than in women not using hormonal methods. Maybe this reflects an increased contact with the health care system after starting a new hormonal method and so the increased diagnosis of depression is simply from a higher rate of diagnosis.
    That being said, Fertility Awareness Methods are an excellent option for many.

    • I second the comment that correlation is not causation. Actually I second everything Cynthia says! And not just because I am a fellow midwife.

      I would also just like to put out there that the rate of depression for women finding themselves with an unwanted pregnancy is not inconsequential. Add to that the incident of Post Partum Depression, and I think that for many women, the potential risk of hormonal contraceptives is outweighed by need to not be pregnant. Especially given the current climate regarding reproductive health in the US.

      • Amen to that! All of the alternative health folks are condemning the pill etc. nowadays, but whoaaaaaaa there. Just think about how many people do just fine (or better) with it — and for whom it is WAY, WAY more important to avoid unwanted pregnancies. I think if you are having issues that haven’t been resolved by other means, or are very clearly linked to hormonal contraception, sure try going without. But if it works well for you, I wouldn’t fret about it!!

  16. I used a diaphragm with spermicide jelly successfully my entire adult life, combining it with the rhythm method which Chris mentioned –I used the diaphragm during the middle of the month during a ten to 14 day period when I would be ovulating — and loved it! I avoided BC pills because couldn’t tolerate the side effects and, even though the diaphragm is a little messy, it worked like a charm. I recommend it…learning how to use it isn’t that much trouble and well worth it. I never got pregnant.

    • Agreed Kathryn, I too used the diaphragm for many years with total success. I used to be sensitive to the chemical spermicides unfortunately but now there is at least one natural spermicide brand I know of that I’d consider using instead of the chemical versions.

      I don’t think using the ‘rhythm method’ is for everyone and I’m surprised Chris rates it so highly. It has a track record of failure. I became pregnant with my daughter at a so-called ‘safe time’ in my cycle when not using any other form of contraception. My sister also became pregnant during her ‘safe time’.

      There are surely more reliable non hormonal methods out there to promote first e.g. diaphragm, copper IUD & condoms, all that I have had total success with.

      • The rhythm method is not the same as the fertility awareness method. FAM incorporates temperature charting, cervical mucus analysis, predictor kits, cervical height, and other aspects. It is a highly studied and successful method for those that understand it.

      • Thank you for sharing your experience with the rhythm method, but just to clarify, Chris did not rate the rhythm method highly. I was originally under the impression too that these methods were one and the same. He is speaking of a different method, Fertility awareness. The rhythm method is more like a one size fits, whereas the fertility awareness method is highly individualized. You are tracking several different body signs to determine your personal fertility. I think that is why the rhythm method is less successful. If practiced correctly, research has shown FAM to be highly affective. I have recently started using this method and have learned so much about my body and my fertility. Thank you Chris for bringing attention to this method.

      • Chris absolutely did not recommend the rhythm method, as almost anyone with any idea of how the female would not. FAM is a completely different process and is increasingly effective. Please research it and abandon any thoughts if the rhythm method.

      • FAM isn’t the same as the rhythm method. It’s not relying solely on counting days on a calendar. It is based on actual symptoms being tracked – temperature and cervical fluid, some add cervical position as well. The book he mentions explains this all a lot more scientifically, but it is nothing like blindly trusting the rhythm method. There is actual science backing up the decisions regarding whether or not to go protected or unprotected. Not everyone ovulates on day 14 of their cycle, that is just complete nonsense that becomes very clear once you learn the FAM method. If you’re curious and don’t want to spend money on the book, Kindara has a brief explanation on their website of what it entails. Fertility Friday also has great info on her website and she has a podcast as well.

      • Please do not confuse the “rhythm method” with Fertility Awareness, they are 100% NOT the same thing!!!!!!!! The rhythm method is based on total guesswork and is just playing russian roulette with possible pregnancy. FAM, as Chris did mention, involves taking your waking temperature daily, checking your cervical fluid throughout the day, and optionally checking the position of your cervix. These fertility signs paint a clear picture of where you are in your cycle and whether or not you are fertile on any given day. I’ve been using this method successfully for over a year and it really is as effective as studies have reported. It’s the most liberating, inexpensive, healthy birth control option in existence, and I really wish all women knew about it!!!

  17. How is it that this article doesn’t at least mention the paragard (non-hormonal, copper) IUD? It’s not a perfect option, but I am incredibly grateful for mine. My periods were heavier for a the first year or two, but have evened out over time so that 5 years in, they are actually lighter than they were previously (getting diagnosed and treated for ureaplasma really did a lot to help the excessive spotting I was having, which I always attributed to my IUD).

    Paragard is a particularly strong option if:
    – your cycle is irregular (making FAM more difficult to use)
    – you don’t want to put in the time/effort that FAM requires (an IUD is 10+ years of mindless contraception)
    – you live in a location where it is difficult to terminate a pregnancy
    – you are morally opposed to terminating a pregnancy but do not want a child

    I cannot wait for vasalgel to come to market in the US so my partner can take over the contraceptive burden, but until then, I love my paragard.

    And for anyone with spotting who writes it off as a necessary part of having paragard, ask your doctor to do a culture for ureaplasma / genetical mycoplasma. A 30 day course of doxy for me and my partner completely eliminated routine UTIs and insane patterns of spotting and irregular periods.

    • My osteopath got uterine cancer which was probably caused by her copper IUD. They are not without risks. Not everyone is prone to cancer from copper overload but some people are (genetically) and she is one of those people.