Social media users bring closer attention to effects of hormonal birth control on mental health

With the rise of social media, specifically, TikTok, more women and young girls are sharing their experiences about how being on hormonal birth control has affected their mental health, causing depression and anxiety.

But is there a documented link?

Emily Thomas, a TikToker with over 150,000 followers, made a video about how she thinks her hormonal birth control, in her case an IUD, has been causing “borderline debilitating anxiety.” She said it started about four months after being on her second IUD and has lasted almost eight months.

Thomas said she wouldn’t know for sure until she could have it removed, which she said was a month away at the time of the interview.

“There were so many people in the comment section of my video that said, ‘I had the same experience,'” added Thomas. “I see it so often, and I hope that by more and more people sharing their story, young girls realize that there are other options, not just for contraceptives.”

OB-GYN and contraceptive expert Dr. Ashley Waddington says she has patients who have heard the same concerns surrounding depression and mental health linked to hormonal birth control from what they’ve heard on social media.

Dr. Waddington, who is also an assistant professor at Queen’s University and the director of the Contraception Advice, Research and Education fellowship, said women should be coming directly to their doctor for advice on what birth control might be best for them, not relying on social media reviews.

“While we don’t want to discount the experience of people who are going on, instead of mentioning issues that they’ve had with a birth control method or things that haven’t worked well for them, we also need to put that in the context of the fact that many people have probably also used that method and found it perfectly satisfactory, but weren’t so passionate about it, that they would go to the effort of kind of seeing anything online or making a video about it or anything like that,” said Dr. Waddington.

Dr. Waddington said prescribing birth control can sometimes be a trial-and-error process. “Hopefully, no significant harm comes to somebody during that trial-and-error process, and hopefully side effects are relatively manageable, and eventually they find the thing that works.”

She adds health care providers need to “take seriously when people come back and have concerns about a part of it. Be prepared to help them to navigate that, whether it’s to continue on the same method but maybe mitigate some of the side effects they’re experiencing or switch to a different method.”

In 2019, Health Canada reviewed the potential risk of suicidal thoughts and behaviours connected to hormonal birth control. Still, it found there was not enough evidence at the time to support a link. They also discovered that current labelling on hormonal birth control products contained the necessary warning statements about the risk of depression and mood changes.

This review was prompted by a study from the European Medical Agency (EMA). The EMA says it was recognized that “depressed mood and depression are known to occur in association with the use of hormonal contraceptives.” Pharmaceutical companies were then required to adjust product information to include a warning that depression can sometimes lead to suicidal thoughts.

It’s important to note that each country has its own individual medication approvals standards.

Hormonal birth control effects now being researched around the world

A pilot study conducted in Australia in 2007 noted the link between the oral contraceptive pill and depression, but its author says not much more research or acknowledgement of the connection has come since then.

Researcher and psychiatrist Jayashri Kulkarni said they have attempted further studies but have never been able to receive the funding.

“It’s not seen as a priority area, not only in Australia, but internationally, it has not received the attention. It should. And this is an example of why there hasn’t been funding put into a lot of this research, and we must research the impact of the different types of available pills,” said Kulkarni.

Depression or mood swings are listed as a “serious side effect” on many birth control labels. As Kulkarni explains, this type of depression isn’t something you would feel immediately once you start taking it. She refers to it as “insidious.”

“It’s not the immediately apparent crashing immobilizing, can’t eat, can’t get out of bed, can’t do anything type of depression. It sneaks up on women by presenting as difficulties with just the enjoyment of life or irritability, hostility, falling out of love, you know, not having that very joyful experience,” said Kulkarni.

The most intensive study completed on a link between depression and the birth control pill happened in Denmark in 2016. The investigation, published in the Journal of American Medicine Association, followed more than 1 million women living in Denmark.

“An increased risk for the first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents,” read the findings. The study found the risk decreased with increasing age.

Dr. Sarah Hill published a book on the connection between birth control on the brain.

“The idea that you can take a hormone and not have it influence the way that you experience the world around you is Koo-Koo.”

In her findings, Dr. Hill said there had been an uptick in awareness of the harmful effects of birth control. She adds it’s always been a discussion amongst women and their friends, but it’s become more common to discuss it openly with the rise of social media.

“I think that the younger generations of women are a lot more skeptical of hormonal birth control and are more willing to discontinue if they’re unhappy with the way that it’s making them feel.”

All three doctors CityNews spoke to agree that more research should be happening on the side effects of birth control. Still, Dr. Waddington said it could be tricky to get a convincing conclusion out, and she is wary of any studies that say they have conclusively found a link between hormonal birth control and depression.

“One of the major reasons for that is that the use of contraception is widespread, in particular in young women. And the diagnosis of depression is pretty common as well. And so there will always be situations where those two things are going to overlap,” explained Dr. Waddington.

“I wouldn’t caution people that they’re likely to experience a depressive or anxiety diagnosis because they’re on a contraceptive method, but if it happens to them, that should be taken seriously, and it shouldn’t be dismissed,” she added.

“More information is always better. But I think even when we have information, it’s very reassuring. [But] it still doesn’t negate the experience of somebody if they’ve had a side effect and it’s affecting them,” said Dr. Waddington. “So it’s nice to be able to put numbers to things, but it doesn’t solve the problem, even if it’s a small number of people who are affected by something.”

Thomas said she tried to research when she first started experiencing anxiety but couldn’t find anything.

“There’s no scientific papers or anything online about it. You try to find a medical journal or a medical article about it, and they don’t exist. I think the medical community, just in general, doesn’t look closely enough at issues surrounding women, and it’s disappointing when you try to look at this stuff online when you try to google the negative effects of birth control on mental health. Not a lot of scientific medical journals come up,” said Thomas.

“As someone who loves science and someone who dives deep in the research, it would be nice to see more research on this stuff.”

Birth control not an ‘optional’ medication for many women

Hormonal birth control isn’t just used to prevent pregnancy. It’s prescribed for various other reasons, including controlling painful periods and acne. All the doctors CityNews spoke with focused on the idea that birth control is seen as an optional medication when, for many women, it is not.

“Sometimes we talk about it as an optional thing, and you can either choose to use birth control or not, but actually if getting pregnant is going to be a problem for you. That’s not a benign outcome either. And so we always have to keep that in context when we’re having these conversations,” said Dr. Waddington.

“Because sometimes the alternative methods that are not hormonal are often less effective. If people are unwilling to accept the risk of unwanted pregnancy, they’d have to use birth control methods and come to terms with that.”

Dr. Hill added that understanding that birth control can affect the brain doesn’t mean we should abandon the idea altogether.

“The fact of the matter is, women don’t have a lot of really safe, easy to use, effective options and controlling our fertility to allow us to make plans is one of the biggest things that we can sort of do to forward our progress in society,” said Dr. Hill. “But instead, this is all about making sure that women are well aware of the risks so that way they know if they’re making that trade-off and what the trade-offs are that they’re making.”

Dr. Waddington says the focus should remain on patients being empowered to speak to their health care provider if they have any concerns about the prescription medicine they are taking.

“If your healthcare provider has recommended something to you and it’s not working, please don’t feel that you can’t go back to them and explain what the concern is and revisit some of the other potential options that might help you.”