The Impacts of Hormonal Contraceptives on Mental Health

2023-07-04

The development and extensive use of contraceptives has been one of the most important steps in promoting gender equality.  It presented women with the possibility of control over their reproductive lives. Significant strides of women in the professional area coincide directly with the legalization of contraceptives. For this article, we will discuss the use of hormonal contraceptives and any potential impact they could have on mental health.

Why Access to Contraceptives Matter 

Education

Legal access to birth control pills before age 21 is the most important factor in enabling women in college to stay in college. Women who had legal access to the pill obtained about one year more of education before age 30 and had a 35% lower dropout rate than those who did not have access. Access to the pill also led to a 2.3% increase in the number of women who were college graduates. 

Economic Growth

In terms of economic growth, access to oral contraceptives is a primary driver for women. One-third of the wage gains women have made since the 1960s are attributed to access to birth control. It also played a significant role in narrowing the wage gap between men and women.

 Child Spacing

Access to contraception has been an absolute game-changer for women. It meant we can make choices about when to start a family and as a result, it opens up a world of opportunities for women to pursue their education, careers, and other life goals.  While contraceptives have undeniably been useful for women, it is still an under-researched topic, just like many issues concerning women’s reproductive health.  

Understanding Hormonal Contraceptives

Hormonal contraceptives have been a popular method of birth control for many years. They work by releasing synthetic hormones similar to the ones produced by the body to prevent ovulation, which is the release of an egg from the ovary. They are widely known to be effective in preventing pregnancy and provide many other benefits, such as regulating menstrual cycles and reducing the risk of certain cancers.

Types of Hormonal Contraceptives

There are several types of hormonal contraceptives available including:

  • Combined oral contraceptives (COCs): COCs contain both estrogen and progestin (reproductive hormones) and are usually taken daily.
  • Progestin-only contraceptives: Progestin-only contraceptives come in different forms and can be taken orally, injected, or implanted under the skin.
  • Hormonal Intrauterine devices (IUDs): IUDs are small, T-shaped devices that are inserted into the uterus. They can contain either copper or progestin. Copper IUDs don’t contain hormones and are not of interest to this article.
  • Hormonal patches: Hormonal patches are placed on the skin and release hormones into the body.

Oral forms of contraceptives are the most widely used forms of contraceptives, making up a quarter of the prescribed contraceptives.

Hormonal Contraceptives and The Brain 

Hormonal contraceptives work by altering the body's innate level of the reproductive hormones, estrogen and progesterone. These hormones, however, affect the brain in ways that are still not completely elucidated.  In her book  ‘This Is Your Brain On Birth Control: The Surprising Science Of Women, Hormones, And The Law Of Unintended Consequences’ evolutionary psychologist Dr. Sarah E.Hill delves into the science of hormonal birth control as well as its effects on women's bodies and brains. 

The book reveals that sex hormones impact various bodily functions, including attraction, stress, mood, and learning, and so hormonal birth control alters how women's brains function, ultimately making them a different version of themselves than when they are off it. The book argues that these changes can have significant implications for women's lives and society as a whole, and calls for more research to help women make informed decisions about their health.

As mentioned, sex hormones play a role in mood regulation, and the exact mechanisms and extent of this are still being investigated. The use of hormonal contraceptives alters the levels of these hormones, which may lead to changes in mood and behavior. The science on the implications of this on mental health so far is contradicting.  Several studies have analyzed the potential link between hormonal contraceptives and mental health. Some studies have found that hormonal contraceptives may increase the risk of depression, anxiety, and other mood disorders, while others have found no significant link.

One review of 14 clinical trials that included 5833 participants of age range: 16.8–32.4 years) found that oral contraceptive use didn’t cause an increase in depressive symptoms in adult women. However, another Densih study followed around 1 million women for 13 years and concluded when compared to non-users, women, especially adolescents, on hormonal contraceptives had an increased risk of depression diagnosis. 

A paper indicated that this adverse effect is mainly attributed to the amount and type of progestogen within the contraceptives (either oral contraceptives or IUDs). One thing worthy of mention is whether these contraceptives could have an impact on sexual function. One review assessed exactly this. It concluded that while the use of hormonal contraceptives wasn’t associated with female sexual dysfunction, it could significantly impair sexual desire.

The potential impact of hormonal contraceptives on mental health is complex and may vary depending on several factors, such as the type of contraceptive, the dosage, and the individual's hormonal and psychological profile. The current scientific evidence on the relationship between hormonal contraceptive use and mental health is inconclusive or contradictory. Hence, it is paramount for women to be proactive and take charge of their well-being.  Here are some tips to help you do just that.

Tips for Women to Take Charge of Their Reproductive Well-Being

Be Aware of the Potential Side Effects

Before starting hormonal contraceptives, you have to be aware of the potential side effects. These are different for different people, so it is good to consider them and see if you have any of the possible side effects.

Keep Track of Your Mood

If you are on hormonal contraceptives, it is important to keep track of your mood. This will help you stay aware of your emotional well-being and allow you to address them early on if you notice problems. There are different options for doing this. Consider keeping a mood journal or using a mood-tracking app.

Talk to Your Doctor

If you are experiencing changes in your mental health after starting hormonal contraceptives, don’t hesitate to talk to your doctor. Your doctor can help you determine if the changes are related to the contraceptives and may suggest alternative options if necessary.

Consider Switching to Non-Hormonal Contraceptives Temporarily

A considerable number of women start these pills during their teenage years, so they may have no awareness of these possible effects since they will be their new normal. You might want to switch to a non-hormonal option for some time and see how it affects you. If you notice that you are experiencing effects on your mental health from hormonal contraceptives, you may want to consider non-hormonal options. These can include condoms and copper IUDs.

In conclusion, while hormonal contraceptives are generally a safe and effective birth control method for most women, they may carry some risks.  It's vital to be aware of the potential side effects and know how to deal with them.

By: Salem Temesgen Alemu M.D.

 

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