A 2017 census reported that roughly 64% of the U.S. female population (about 46.9 million women) uses some sort of contraception, whether that is female sterilization, the pill, an IUD, or male condoms. Another report showed that 10.7 million U.S. women use hormonal birth control pills. Given those numbers alone, chances are that either you or someone you know uses hormonal birth control. Therefore, the following discussion is critical to engage in and share with women around you.
The Link Between Hormonal Birth Control and Depression
Can hormonal birth control cause depression? It’s complicated. Like nearly everything in medicine, there is no simple A causes B trajectory when it comes to birth control and depression. So far, research has shown that there are moderate to strong correlations between birth control and depression, but there’s not yet enough evidence to claim causation.
As is the case with many comorbidities, some doctors caution young women against taking hormonal birth control if they are prone to major depressive disorder because it is believed to heighten the chances that a woman develops depression. According to Stanford Medicine, risk factors for depression include genetics, sexual abuse, emotional and physical neglect, and other severe “life stressors.” While you may be comforting yourself by thinking, well, none of those risk factors apply to me, so I have nothing to worry about, think again.
The Prevalence of Depression Among Women
Roughly 12 million U.S. women suffer from clinical depression every year. This means that about 1 in every 8 women, or 12.5% of the U.S. female population, can expect to experience depression at some point in their lifetime. But these are only the numbers that we know. Studies have highlighted that depression is misdiagnosed in women 30-50% of the time, causing researchers to believe that thousands, even millions, more women suffer from depression than are shown in the numbers. But, without a solid estimate of how many, these women are left out of the data.
Women are twice as likely to experience depression as men.
If that didn’t convince you that the prevalence of depression is alarmingly high in women, maybe the following fact will: Women are twice as likely to experience depression as men. According to Mental Health America, “developmental, reproductive, hormonal, and genetic differences” are cited as reasons why women are more predisposed to depression than their male counterparts. In addition to these, social factors like work, family, and financial stress, as well as sexual discrimination, are possible explanations for why women experience higher rates of depression. Even girls 14-18 years old have “consistently higher” rates of depression than boys the same age.
Interestingly, the ages of women most commonly affected by depression range from 25 to 44. Suicide is one of the leading causes of death for Americans in their twenties, next to accidents and violence. Coincidentally or not, this age group is also more likely to use contraception (as well as undergo childbirth, miscarriages, fertility challenges, PMS, perimenopause, etc.) compared to women of any other age group.
Depression Is the #1 Reason Why Women Ditch the Pill
According to a study investigating the correlation between depression and oral birth control, symptoms of depression are the main reason why women stop using the pill. This is a significant finding that should not be ignored. There are dozens of reasons why women could and do stop using the pill, but for severely decreased mood to be the top reason is profound. In this study, the researched group of women using oral contraceptives were “significantly more depressed” than the control group. However, researchers still say that more research needs to be conducted. “There are surprisingly few large studies investigating depression related to oral contraceptive use,” says Jayashri Kulkarni, the author of the study and director of the Alfred Psychiatry Research Centre in Victoria, Australia.
Let’s dive into what exactly happens inside your brain when you take hormonal birth control. Research has shown that taking the pill causes structural and chemical changes in the brain. Oral contraceptives contain synthetic hormones, like progestin and ethinyl estradiol, and these compounds do not bind to receptors in the brain the same way that natural hormones do. Instead, they alter neurotransmitter function and disrupt mood regulation. This means that if you take hormonal birth control, the hormone levels in your brain are imbalanced, causing you to have mood swings and, in more serious cases, depression.
Convincing Studies and Their Evidence
A few convincing studies point to strong evidence that hormonal birth control like the pill can lead to higher rates of depression. One study found that the relative risk rates for women who take the combination pill were 10% for developing depression and 20% for starting an antidepressant. A relative risk does not mean that 10% of all oral contraceptive users have depression and 20% take an antidepressant. Rather, it means that if you take hormonal birth control, you are 10% more likely to experience depression and 20% more likely to start using an antidepressant.
Progestin-only pills, as opposed to combination pills, pose the highest risk for severe mood imbalances.
Another study claimed that the type of progestin (synthetic progesterone) present in the pill would determine the risk for depression. Progestin-only pills, as opposed to combination pills, pose the highest risk for severe mood imbalances due to the way that the synthetic hormone interacts with the human brain.
According to a Danish study conducted from 2000 through 2013 with women aged 15 to 34, all forms of hormonal birth control were associated with a heightened susceptibility to depression and similar mood disorders. This study echoed the notion that progesterone-only forms of contraception, including most IUDs, came with increased risk. This is a highly interesting discovery because, traditionally, doctors have been taught that contraception options like the ring, patch, bar, and IUD come with less risky side effects because of locally concentrated hormones. The last significant conclusion that researchers noted was that teenage girls aged 15-19 were at increased risk for depression due to their already-changing hormone levels as they undergo puberty.
These few studies only scratch the surface of the research being conducted on this pressing question. And please note that other studies have come out contradicting the conclusions drawn in all of the before-mentioned studies; so, at the moment, it’s difficult to pin down a clear answer for whether birth control can truly lead to depression in some women. However, the evidence in these studies makes a convincing argument that we should at least be aware of the possibility of the correlation between hormonal birth control and depression.
The Pill’s Long-Lasting Impact
Young women who used oral contraceptives were found to be susceptible to a higher risk of depression even after stopping the pill. According to a UK study, adolescent usage of oral contraceptives showed a 130% higher incidence of symptoms of depression in womanhood, while adult usage showed a 92% increase. Because these long-lasting impacts were not found to have the same severity in adult women, this suggests that adolescent usage of oral birth control is even riskier and more dangerous.
This body of research is one that needs a lot more effort thrown into it, but the medical field is largely ignoring the problem. If you’re on hormonal birth control and feel that you could be suffering from any of the signs or symptoms of depression, please see your healthcare professional immediately.
Each woman’s experience with birth control is vastly different. Listen to your body (even over your doctor) and continue to educate yourself about the effects of the things you put into your body.
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