(Photo illustration by Gabby Lopez)
Thousand Oaks High School

Contraception, symptom relief and depression: the overlooked side effect of hormonal birth control

When a Thousand Oaks 16-year-old started taking birth control pills, she hoped it would relieve her symptoms of endometriosis. The pill provided some relief, but the severe effects it had on her mood were staggering.

“I almost felt completely different. Happiness was extremely hard to achieve, and I didn’t realize how bad it had become until I [stopped the pill and] stopped crying every single day,” the 16-year-old who requested to remain anonymous due to privacy concerns said.

According to the Centers for Disease Control and Prevention, about 65% of American women between the ages of 15 and 49 are using contraception. Of that 65%, about 37% are teenagers between the ages of 15 and 19 who are using a form of hormonal birth control. 

Oral contraceptives mainly come in two forms: The combination pill combines synthetic estrogen and progesterone to prevent ovulation and thin uterine lining and cervical mucus, and the mini-pill contains synthetic progesterone that thins the uterine lining and cervical mucus, and some brands also prevent ovulation. Other forms of hormonal birth control include the patch, ring, implant, shot and hormonal Intrauterine Device, known as the IUD.

These work similarly to the birth control pill, but they are not taken orally. The ring and hormonal IUD release hormones locally. 

Doctors prescribe hormonal birth control to teenage girls for a variety of reasons: Contraception, symptom relief for various health conditions, severe menstrual cramps, heavy menstrual periods, severe premenstrual syndrome and acne. 

“We often prescribe the pill for relief of menstrual issues and acne even for young women who are not sexually active,” said Dr. Leena Nathan, an obstetrician-gynecologist at UCLA Health, “Hormonal birth control pills are effective for treating painful periods, acne and mood swings related to premenstrual syndrome.”

Despite these synthetic hormones being scientifically proven to influence neurotransmitters and brain function, the effects they have on one’s mood are often dismissed. Side effects of hormonal birth control can include migraines, weight fluctuation and depression.

Many studies regarding depression as a side effect of hormonal contraceptives have either been inconclusive or have shown no link between the two. However, many of these studies proved to not be credible due to lack of participation and reliance on subjects self-reporting their symptoms, according to a post by Dr. Monique Tello on Harvard Health’s blog.

A 2016 study of over a million Danish women over the age of 14 suggested a strong link between depression and all types of hormonal contraception. This study used diagnosis codes, prescription records, Denmark’s nationalized collection of prescription and diagnosis data and excluded patients with pre-existing psychiatric conditions, allowing for a more accurate analysis of patients’ symptoms and their causes. 

The study showed a 70% higher rate of depression diagnoses in 15-19-year-old females using combination birth control pills compared to those who weren’t.

(Image by Natalie Venable / JAMA Psychiatry)

The patch, vaginal rings and hormonal IUDs nearly tripled diagnoses of depression and antidepressant use among younger participants in the study. Despite these results, healthcare providers are still trained to assure their patients that localized hormones in the IUD are incredibly unlikely to enter their bloodstream, let alone influence their mood.

For example, when asked about the hormonal IUD, Nathan said, “The IUD has fewer side effects because it works mainly locally at the level of the uterus.”

In addition, a more recent study shows that young women are at three times the risk of committing or attempting suicide than those who have never used hormonal birth control.

(Image by Natalie Venable / JAMA Psychiatry)

The discrepancy between the increased risk of depression newer studies are showing and what information doctors are telling their patients is largely due to what medical schools are teaching, according to Dr. Jolene Brighten, an expert in women’s medicine who is leading the exploration into the deeper effects of hormonal birth control.

“They are relying on the research they are being presented in their continuing education. While I value the research, I think it’s equally important to listen and really hear the story of the woman who is sitting in front of me,” Brighten wrote in her article, “Birth Control and Mood Swings.” “If she’s telling me that her mood has changed since beginning a hormonal contraceptive, then that is valuable data that should be considered in her care.”

Brighten advocates for more thorough screening and counseling when it comes to hormonal birth control.

“I believe in a woman’s right to prevent pregnancy, as much as I believe in her right to have a true informed consent.” Brighten said in her article, “Birth Control and Depression – Is there a link?” “Knowing the risks, along with the signs to look out for and how to protect yourself is important to maintaining your health.”

Brighten also acknowledges some physicians’ beliefs that the risk of pregnancy far outweighs any side effects that birth control can have.

“In my mind, we shouldn’t need to suffer. Birth control and depression do not need to be the way of things.” Brighten said in her article, “We shouldn’t become dependent on antidepressants just to ensure we don’t have a baby.”

(Image by Natalie Venable / JAMA Psychiatry)

As with any medication, hormonal birth control affects everyone differently. If you are experiencing depression and think your birth control may be a contributing factor, talk to your doctor or visit your local Planned Parenthood to discuss a solution.