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Woman hands opening birth control pills in hand. eating Contraceptive pill. Contraception reduces childbirth and pregnancy concept.

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By Andrea Cannas

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November 10, 2023

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Are oral contraceptives making you depressed?

Understanding hormonal contraception: Before drawing conclusions

This blog theme is not meant to deter women from the use of hormonal contraception or refute its long-standing benefits for the prevention of unwanted pregnancies.

The oral contraceptive pill (OCP), otherwise ‘the pill’, is artificially formulated with synthetic versions of the female hormones oestrogen and progesterone, which women produce naturally in their ovaries.

Most women start using contraception during a period in life when they experience hormonal changes caused by puberty and mature into adult women. This is a difficult period in life for most women.

Many women tolerate OCP well without experiencing side effects and notice benefits on other aspects of their health such as improved skin health. However, a subset of women that use OCs can experience side effects such as mood-related problems, breast tenderness and headaches that are often dismissed and not addressed.

What did the study show?

A recent study in 2023 conducted on a large population of 265,000 women from the UK Biobank showed that women who used contraceptive pill as teenagers are 130% more likely to be depressed as adults compared to never-users. Individuals who started an OC as an adult had a lower depression risk at 92%. 

To clarify, in this study they were looking at the combined OCs that contain a combination of both oestrogen and progesterone.

20% of young white women using combined contraceptives remain at an increased risk of depression, even after stopping using the pill

The likelihood of developing birth control pill-induced depression was highest within the first two years of starting the contraceptive. Depression in adult women fell after about two years of routinely taking an OC. However, that similar incidence remained high among teens even after they stopped taking it. Specifically, 1 in 5 teenage girls up to 20 years of age, who started using combined OCs, remained at a heightened lifetime depression risk, even after they discontinued it.

The above associations remained unchanged after adjusting for relative’s exposure, indicating a cause-and-effect relationship between OC use and depression risk. 

What were the strengths of the study?

The evidence looking at the association between birth control and depression is conflicting which may be explained by the fact that the existing studies did not consider healthy user bias. A strength of this study is that the authors accounted for this bias by looking at both ‘new’ and ‘current’ users. As explained by the authors, this is important as looking at current users may not reflect affected women who were not willing to participate in those studies and lead to underestimation of effects. Undoubtedly, there are inherent limitations of inferring causality from observational studies. However, the authors also accounted for familial factors to determine causality. Nonetheless, more research is required to investigate this possible side-effect of the pill. 

How can the pill affect mood in young adults and adults?

The mood effects of OCs can lead to discontinuations and is a contraindication for their use. Indeed, this may result in decreased compliance to treatment in young women due to perceived side effects. The increase in lifetime risk in teens may be due to hormonal changes occuring during critical developmental periods that affect brain function. Studies have suggested raised progesterone levels in particular may lower mood. 

It is known that oral contraceptives disrupt the body’s biochemistry, either by interfering with nutrient metabolism, absorption and distribution, increasing oxidative stress or directly influencing the reproductive and stress hormone cycles. 

What can I take into account to support my mood while on birth control?

  1. Assessing nutritional status and nutrient intake

A woman’s nutritional needs change when using an OCP, whether high or low-dosage, and unfortunately not many are aware of this. Studies have long shown OC may deplete key nutrients such as folic acid, vitamins B2,B6, B1, vitamin C and E and the minerals magnesium, selenium and zinc. Many of these nutrients are vital to the function, development and maintenance of our brain, nervous system, behaviour and cognitive performance. Moreover, deficiencies in these nutrients can cause frequently encountered side effects ranging from headaches and mood fluctuations to specific risks like pernicious anaemia and increased risk of thrombosis. Hyperhomocysteinemia can also occur as a result of B12 and folic acid deficiencies which promotes neurodegeneration and increase risks of neurological and psychiatric disorders.

In hindsight, medical nutrition therapy is warranted to correct these deficiencies. For instance, cardiovascular risks induced by medication can be mitigated with vitamin C and vitamin E therapy. 

Finally, it is worth emphasising that the severity of deficiencies is likely to increase with the duration of OC use. From an integrative perspective, you may require stronger therapeutic support if you also eat poorly, adopt unhealthy habits or have underlying malabsorption issues due to an existing pathology.

  1. Undergoing biochemical testing

Other than causing nutrient deficiencies, long-term use of birth control can change white and red blood cell count. Monitor your complete blood count by undergoing private blood screening before you start an OC and throughout its course. 

  1. Undergoing a functional heavy metals test

One of the key reasons why many women on birth control experience anxiety and depression is due to an increase in copper levels. Taking a combined OCP that contains oestrogen can cause issues with metabolising excess oestrogen which in turn increases the turnover and uptake of copper in the brain.

Copper is a potent monoamine oxidase inhibitor – that’s the enzyme that is responsible for breaking down your catecholamine neurotransmitters, i.e dopamine, noradrenaline and serotonin. This means it inhibits dopamine and serotonin metabolism and it can also speed up the conversion of dopamine to noradrenaline.

  1. Introducing zinc or herbs with calming properties

In addition to elevating copper levels, oral contraceptive pills have been reported to induce hormone fluctuations by reducing zinc levels. Zinc plays a crucial role in mental health, particularly in the production of GABA- the neurotransmitter that helps maintain a calm and relaxed mental state. Broadly speaking, zinc deficiency has been observed in individuals experiencing conditions such as anxiety, depression, panic disorders, and OCD.

  1. Fluid retention

A combined oral contraceptive triggers physiologiacl changes in sex hormones, specifically progesterone and oestrogen, leading to fluid retention. This can manifest as symptoms like oedema and weight gain, significantly impacting a young woman’s confidence and mood. However, a holistic approach involving dietary adjustments, nutraceuticals, and lifestyle changes can collectively contribute to reducing fluid retention.

  1. Pre-existing mental health illness

Hormone imbalances can have a profound effect on brain function. Therefore, teenage girls or women with a history of mental health illness seeking birth control methods should seek the advice of a suitable care provider. If that is not the best solution for you at the moment, you can also seek the advice of a nutrition practitioner to support hormone metabolism and mental health through diet, nutraceuticals and lifestyle.


Summary

Literature data starting from the 1970s clearly show that OCs deplete nutritional status which is likely to contribute to several common side effects. Hence, the prevention of vitamin and mineral deficiencies using appropriate nutraceuticals should be considered as a first line approach by clinicians. The ideal dietary supplement should contain vitamins of the B complex together with folic acid, vitamin E and C as well as minerals such as magnesium, zinc and selenium.

Stopping the pill without a suitable alternative increases the risk of unintended pregnancy. It is important that women are fully supported, provided with information, and offered alternative forms of contraception with minimal perceived side effects if necessary.

 

Disclaimer

The combined pill is not suitable for women over 35 who smoke, or women with certain medical conditions.

No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Please note this advice is not a replacement for women who have a medical indication for medical treatment such as those with dysmenorrhea, endometriosis and PCOS. Medication should always be discussed with your doctor and you may benefit from nutrition counselling to optimise your medical treatment.

References

Johansson, T., Vinther Larsen, S., Bui, M., Ek, W., Karlsson, T., & Johansson, Å. (2023). Population-based cohort study of oral contraceptive use and risk of depression. Epidemiology and Psychiatric Sciences, 32, E39. doi:10.1017/S2045796023000525

Kopp Kallner H, Thunell L, Brynhildsen J, Lindeberg M, Gemzell Danielsson K. Use of Contraception and Attitudes towards Contraceptive Use in Swedish Women–A Nationwide Survey. PLoS One. 2015 May 20;10(5):e0125990. doi: 10.1371/journal.pone.0125990. PMID: 25992901; PMCID: PMC4439158.

Palmery, A. Saraceno, A. Vaiarelli, G. Carlomagno. (2013) Oral contraceptives and changes in nutritional requirements.Eur Rev Med Pharmacol Sci 17(13): 1804-1813

Gedfie S, Getawa S, Kassahun W, Gashaye KT, Melku M. Hematological parameters of reproductive-age women using hormonal contraceptives at University of Gondar Comprehensive Specialized Referral Hospital, Northwest Ethiopia: A comparative cross-sectional study. PLoS One. 2022 Nov 8;17(11):e0277254. doi: 10.1371/journal.pone.0277254. PMID: 36346804; PMCID: PMC9642895.

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