MENTAL EFFECTS OF CONTRACEPTION 1

The Mental Side Effects of Female Contraception

Sydney Matteotti, Madyson Pickett, Paige Strobel, and Amber Wilson

Department of Nursing, Youngstown State University

NURS 3749: Nursing Research

Mrs. Danielle Class

April 5, 2022
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Introduction

Many women take contraception to prevent pregnancy. More than 150 million women

use oral contraceptives in the United States (Le Guen et al., 2021). The oral contraceptive

quickly became a “lifestyle drug” for many women after its release. This pill promised to help

with acne, menstruation, and pregnancy 99% of the time. Side effects of these contraceptives

have not been as evident until recently. Depression, anxiety, and suicide risks have been reported

to increase from the use of different contraceptives. More studies have been conducted to gather

significant data to confirm these reported side effects. Some of these studies focus on just the

commonly reported effects, while others try to identify brain function being changed to cause

them.

Search Strategies

The purpose of this literature review is to look at studies that were conducted on the

adverse effects of contraception on females’ mental health. The PICO question used for this

review was, “in females, what is the effect of birth control use on their mental health compared

to women that do not use birth control.” Following the development of this PICO question,

searches for relevant studies began. We used CINAHL and Medline as research databases. An

example of a search strategy used is (birth control) OR (contraceptive*) effects AND anxiety OR

depression OR (mental health).

Review of Literature

Many women use hormonal contraception, such as birth control, for reasons such as

decreasing the risk of pregnancy or regulating a menstrual cycle. Eight research articles were

reviewed and cited within this research paper. These articles prove our PICO question to be true
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that hormonal contraceptives have negative adverse effects on the mental health of its users. This

research paper includes three themes which are: the fear of contraception, depression, anxiety,

and suicide risks, and influence on brain function.

The Fear of Contraception

Women often begin to fear pharmaceutical contraceptives because of the many women

that have spoken out about their adverse effects and the speed at which the companies shut down

their statements. Women and men have voiced their preferences for more natural types of

contraceptives rather than chemicals. Anderl et al. (2022) stated, “[women] felt that they should

use hormonal contraception if they wanted to prevent pregnancy, but the discomfort associated

with use made them reluctant to continue” (p.333). It is a common misconception that hormonal

contraception is the only true way to prevent pregnancy. But as technology and medicine

advance there are many more options for pregnancy prevention being released but it is not

something that is always shared by the healthcare provider.

Fear in Healthcare

Healthcare is important for the well-being of all people, especially women. One

important problem in healthcare is that “women’s fears about the side effects of hormonal

contraceptives seem to be rooted in the fact that they feel that healthcare professionals do not

inform them sufficiently” (Anderl et al., 2022, p.334). Doctors and nurses in healthcare do not

always include women in the decision making process and often overlook fears, complaints, and

side effects about the hormones in their birth control. Women should not have to fear what they

are putting inside their bodies. It is crucial in healthcare that as providers, the patients are being
MENTAL EFFECTS OF CONTRACEPTION 4

cared for in the best way possible. As stated in the article, “Reasons for Rejecting Hormonal

Birth Control in Western Countries”,

“The fact that side effects, experienced or feared, are a major reason for rejecting

hormonal contraception should therefore invite us to explore further the provider-patient

relationship, which could be a cornerstone in helping women and men to choose the

contraceptive that best fits their present needs, constraints, experiences, and values”

(Anderl et al., 2022, p.334)

Some of the most common side effects women experience from hormonal contraception

include depression, anxiety, fear, fertility issues, physical appearance changes, weight gain,

decreased libido, etc. (Le Guen et al., 2021, p.1). These side effects can alter the mental health of

women, especially adolescents. Half of the women that use oral contraceptives use them in their

teenage years, but panic and anxiety are more prevalent in adolescent users than in non-users.

(Le Guen et al., 2021).

Fear of Side Effects

Birth control can also have an effect on physical health, which in turn affects the mental

health of women. There are many reasons women reject hormonal birth control. It is partly based

on the fears their family, friends, and neighbors have related to infertility, decreased libido, and

“side effects that indirectly affect sexuality such as mastodynia, vaginal dryness, mental health,

or weight gain that alters body representation” (Le Guen et al., 2021, p.1). Experiences of these

side effects, either personal or those of relatives, may lead some women to interpret hormone

intake as disturbing the natural female body balance.

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Depression, Anxiety, and Suicide Risks

The National Institute of Mental Health (2018) defines depression as a mood disorder

that affects how humans think, act, and feel (par.1). Women are already more likely to

experience mental health issues compared to the male population; taking hormonal contraception

increases the number of hormones in their bodies. These hormones are commonly estrogen, and

progesterone and they stop ovulation. Creating a higher level of hormones in the body can

increase stress levels. Synthetic progesterone does not replicate the natural progesterone

response. Natural progesterone breaks down to allopregnanolone and downregulates the stress

response. Concluding women get none of the anti-anxiety benefits (Siddall et al., 2021). This

puts more women at risk for developing potential issues regarding their mental health and their

ability to cope with stressful situations.

Depression

The England Health Survey conducted a study of 4,428 women who are on hormonal

contraceptives (Siddall et al., 2021). This cross-sectional survey compares women who are on

oral contraception and women who are not, as well as the symptoms they are experiencing.

Women using oral contraceptives reported 29.15 % having depression, 10.34 % attempting self-

harm, and 9.72% with anxiety (Siddall et al., 2021). These results show that women are more

vulnerable to developing mental health issues such as depression and thoughts of suicide on oral

contraceptives.

Women are more likely to develop depression due to the alteration in their reproductive

hormones throughout their life periods. Many studies suggest that the alteration is more common

in younger women around the puberty age and that mixing it with contraception worsens the
MENTAL EFFECTS OF CONTRACEPTION 6

symptoms. Because of the harsh mental side effects, women seek help from other providers to

provide prescriptions for psychotropic drugs such as sedatives, antidepressants, hypnotics, and

anxiolytics. Research in Sweden produced results comparing women twelve to twenty and

women twenty-one to thirty, both using oral contraceptives to see if there were psychological

health outcomes and if they were modified by age (Zettermark et al., 2018). The study found the

strongest result in adolescent girls and its link to the need for psychotropic drugs during the use

of oral contraception. For the older female population, there were no significant results on the

link between them and psychotropic drugs, concluding that oral contraceptives mainly target the

younger population of women.

Antidepressant Use

A study was conducted in Sweden with women aged sixteen to thirty-one years old; there

were a total of 917,993 women included (Foldemo et al., 2010). Of those women, 58.9% of them

were hormonal contraceptive users and 8.5% of them were antidepressant users. There were two

types of contraceptives involved which were progestin-only and combined hormonal

contraceptives. The findings concluded that the largest difference was found in those sixteen to

nineteen years old. The progestin-only users in this age range had a 67% higher antidepressant

use than users on a combined hormonal contraceptive. Both of these studies concluded that the

age group at high risk was adolescents.

Suicide

A study was conducted on 457,802 women in Denmark with no psychiatric history or any

antidepressant use (Skovlund et al., 2017). This study was conducted to assess if hormonal

contraceptive use was directly associated with depression and suicide in users. The results were
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clear that there was a correlation between the use of hormonal contraceptives and depression, as

well as suicide. With the use of these contraceptives, the risk for depression was 70% higher than

nonusers, suicide attempts doubled, and suicide overall tripled. Also, this study proved there

were 6,999 first suicide attempts and 71 suicides. The timing of these suicides peaked just after 2

months of hormonal contraceptive use. Strikingly, the population that experienced the highest

risk was adolescents. Not only are the users at high risk at the current point in time, but the risk

can continue for some time after the cessation of the contraceptive.

This is very significant in today's society because many women go on contraception at a

young age for various reasons such as sexual maturity to decrease the side effects of period

symptoms. Females of a younger age are already more susceptible to alteration in hormones due

to menstruation creating an imbalance. Oral contraceptives have shown an increase in an

imbalance leading to more younger women having increased reactions to stress and not having

many ways to cope. So they turned to psychotropic drugs because the side effects were so severe

for them. This has encouraged studies globally to find better ways to cope with the side effects of

birth control or potentially change the chemical components of oral contraceptives.

Influence on Brain Function

Out of the many side effects that hormonal contraception has, the chief complaint among

most women, especially adolescents, are these adverse mood-related effects. This has become a

common reason that many women discontinue taking their contraception. Complaints of these

effects have led to the process of in-depth studies on why they are occurring. Some researchers

have been looking into the brain to understand what processes are being affected while women

are using hormonal contraceptives.

MENTAL EFFECTS OF CONTRACEPTION 8

Emotional Changes

Mood processing has become a big focus on brain function for contraception users due to

mental side effects. One of the main categories that had many differences between hormonal

contraceptive users and non-users was emotion recognition. When conversing with a person or

people, nonverbal communication is almost as important as verbal communication. Reading a

person’s body language can be an important indicator of how that person is feeling and their

perception of the topic of conversation. A study done by Current Psychiatry Reports found that

many hormonal contraceptive users were more accurate when identifying fearful or saddened

facial expressions but were less accurate when it came to identifying angry faces. Not only did

they have differences in identifying the expression, but they also took longer to react to the

negative emotions (Lewis et al., 2019).

With emotional recognition having differences, there were also some differences in

emotional reactivity (Lewis et al., 2019). Actively taking contraceptives seems to be linked to

enhanced positive or negative emotional reactivity. It was shown that female contraceptive users

react more intensely and can recall emotional actions, images, or scenarios better than women

who are not using contraception. One of the emotions seen with a difference between the two

categories of women was fear. When using contraception women had an enhanced activation of

their fear network.

Stress Response

Even more differentiated results came from the emotion of stress and the women’s

responses. This is because many hormonal contraceptives contain estradiol. The study done by

Lewis et al. (2019) also found that estradiol has been linked to blunted cortisol responses in
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women, which means they may not react to stress as much as a woman that is not on estradiol

contraceptives. This blunted response can be almost protective to the body when it comes to

stress for the woman. But with a chronic amount of estradiol coming into the body via

contraception, the body is going to be having this response blunted chronically as well. The

chronic use of estradiol not only affects the woman’s response to stress but their reactivity as

well. Sharma et al. (2020) stated that “there may be long-term effects of prolonged OC use

during puberty on stress reactivity, which could involve a variety of mechanisms.” (p. 8)

Structural Differences

Some structures of female brains have been seen to change throughout the use of

contraception. Sharma et al. (2020) did a study on the brain with MRI to examine the structure

and function of female brains on contraception versus women that do not use contraception. It

was seen that women using contraception had regions of the brain with both increased and

decreased gray matter volume. They also had increased white matter volume and integrity. With

these increases in the matter, there was also evidence of increased cortical thickness, which can

be linked to cognitive impairments.

Many of these differences in the brain’s function and structure that are seen in women

taking hormonal contraception can be linked to mood-related adverse effects being experienced.

Depression and stress-related disorders can be caused by having a blunted response and change

in reactivity to stress. This can lead to adolescents on contraception being more vulnerable to

depression in their adolescence or later on in adulthood. Evidence also shows that women on

contraception tend to focus their attention more on negative emotions, some of which increase

their brain activity.

MENTAL EFFECTS OF CONTRACEPTION 10

Recommendations for Practice

As females and medical professionals are looking into contraception, mental health

history needs to be considered. Contraception has been shown to cause adverse mental health

effects for patients that are using them. Putting females on certain contraception can increase

their risk of developing depressive disorders or thoughts of suicide. These effects are heightened

for patients that have a history of mental diagnoses.

Conclusion

Many females worldwide are using contraception for different reasons. However, there is

a pattern for the reasons why they discontinue taking contraception or not take it all. Women fear

contraception because of the side effects it can have on their bodies physically and emotionally.

Specific reasons women fear birth control include depression, anxiety, suicide, fear, fertility

issues, physical appearance changes, weight gain, decreased libido, etc. Certain contraceptives

have a higher association with these mood-related feelings, mostly higher estradiol doses and

progesterone-only contraception. After the many studies conducted, there was significant data

confirming females’ reasoning patterns for quitting usage of contraception. Looking deeper into

the symptoms, there are changes to the brain that can cause mood-related side effects. All the

data is heightened in females that have a mental health-related diagnosis before using

contraception. Adolescents are more susceptible to these negative hormonal contraceptive effects

including depression and suicide. Overall, these hormonal contraceptives being prescribed to

many women proved to have negative impacts on them.

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Reference Page

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between adolescent oral contraceptive use and future major depressive disorder: a

prospective cohort study. Journal of Child Psychology & Psychiatry, 63(3), 333–341.

https://doi.org/10.1111/jcpp.13476

Foldemo, A., Josefsson, A., Lindberg, M.,Wiréhn, A. (2010). Use of hormonal

contraceptives in relation to antidepressant therapy: A nationwide population-based

study, The European Journal of Contraception & Reproductive Health Care, 15:1, 41-47,

https://doi.org/10.3109/13625181003587004

“Depression.” National Institute of Mental Health, U.S. Department of Health and Human

Services, 2018, https://www.nimh.nih.gov/health/topics/depression

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MENTAL EFFECTS OF CONTRACEPTION 12

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