How common is mood side effect on hormonal birth control?

March 15, 2011 9:53 AM

I saw a gyno today in hopes of finding the right hormonal birth control, as I've had mood problems on it in the past. He told me that mood issues with HBC is uncommon; that he sees maybe 2 patients a year that complain of mood side effects on HBC. He even went as far as to say that he saw one woman last week who complained of it, and I'm the second patient this year, so I've met his quota for the year of women who complain about this.

Details about me:
-During my teen years I took the pill with no problems. I don't remember what it was called-- probably some Ortho tri cyclen variety.
-Many years later, I went on Yasmin for a few days before quitting it-- I was crying in the middle of work, and I knew it was related to the pill.
-I was on Nuvaring for a year before it caused some mood problems and killed my sex drive, so I stopped.

Before this gyno, my then-doctor told me that the Nuvaring could not cause low sex drive or depression. I dumped her because I thought that was bad advice. Now this gyno is telling me the same thing-- that depressive mood is not a common side effect. I'm beginning to see that HBC is not for me, but seeing that so many women complain about the same issues I have, can I trust what these doctors are saying? Do I have confirmation bias?

posted by elif to Health & Fitness (29 answers total)

Of the two female roommates I've had who I've been close enough to to discuss their birth control/mood swing happenings, both have reported mood problems after starting HBC. One of them extremely severe. The other not as severe, but on Nuvaring. So I guess I've met my quota, too.

Find another doctor. If you're in Chicago, I have a wonderful one, just memail me.
posted by phunniemee at 10:01 AM on March 15, 2011 [3 favorites]

You may be an out-lier statistically, but you know your body better than anyone. If your doctor was being a condescending prick, switch gynos.

My question to you is: If HBC messes with your mental health and makes you unhappy why would you continue using it?
posted by JimmyJames at 10:02 AM on March 15, 2011 [1 favorite]

Ooh, doctors like this drive me crazy. Did it ever occur to them that there might be many more women in their practice who do have mood side effects from HBC but just don't say anything for fear of being dismissed? Do they actively read any research on the issue to see if there might be a link? We all know at least one friend who cannot be on HBCs because of this very problem.

On the question of whether or not HBC is causing YOU problems, the authority is YOU. If you know that HBCs do this to you, do not take no for answer when a doctor tells you its impossible. Find another doctor.
posted by Leezie at 10:03 AM on March 15, 2011 [9 favorites]

Listen to your own experience. (FWIW, I have met/known lots of women with depression who report worse depression with HBC and that was my experience as well.)
posted by ClaudiaCenter at 10:03 AM on March 15, 2011 [1 favorite]

In matters of mood, things like confirmation bias and placebo effect are extremely powerful. If you think these pills are affecting your mood, they certainly are. It might just be because you think they're affecting your mood, but the placebo effect is still a legitimate effect. It might also be because the hormones are messing with your brain. It doesn't really matter why. You already know HBC is not for you.
posted by yeolcoatl at 10:04 AM on March 15, 2011

I am sympathetic to people who anecdotally report mood, weight, and sex drive side effects from the pill. The problem is that scientific studies do show that these side effects are uncommonly caused by HBC (this DOESN'T mean that HBC doesn't cause these side effects in a particular patient - just that in general they are rare). When it comes to anecdotes, I think they are complicated by the fact that HBC methods are NOT the only things that affect our hormones.

For example, when I was 23-24, I experienced such "stereotypical birth control" weight, mood, and sex drive changes that, had I actually been on HBC at the time, I would absolutely have stopped taking it.

This all being said, you do not have to put up with a dismissive doctor. If you don't think hormonal birth control is right for you, then there are other options.
posted by muddgirl at 10:06 AM on March 15, 2011 [5 favorites]

I took Ortho Evra when it first came out, and I would have a crying jag each time I put a new patch on. I would burst into tears for no reason at all. I stopped taking it pretty quickly, and for what it's worth, I've not had the same problem with any other type of HBC.
posted by crankylex at 10:29 AM on March 15, 2011

As a data point, I was on Ortho Tri-Cyclen Lo until I turned 30. I'd been on it or regular Ortho Tri-Cyclen (I went to the Lo version when it became available in my 20s) since I was 16. I switched pills because I noticed that over the course of a year, I started having severe mood swings once a month, the week before my period. I was inexplicably angry and would cry at the drop of a hat. When I asked my gyno, she said it was possible that the pill was the culprit and had interacted with natural hormonal changes associated with aging. I switched to Lutera and the problem vanished immediately. Maybe it was a placebo effect, maybe not, but going to a different hormonal formulation did help in my case.
posted by Fuego at 10:30 AM on March 15, 2011

Hormonal birth control does indeed cause mood changes, it did for me and it has for most of my friends. Some have stayed on it and their moods eventually evened out, and others switched to a non hormonal BC like the IUD. As someone else said, don't put up with a condescending OBGYN.
posted by katypickle at 10:32 AM on March 15, 2011 [2 favorites]

How can a doctor claim hormones have no effect on mood?! Stymies me, really.

To find the right HBC for me, I went to an endocrinologist (a hormone doctor). He put me on straight hormones, without birth control, and made quick tweaks to the dosages and proportions until he found the hormonal balance that was right for me. This experimentation took less than a month (though it was a hell of a month!). Then he simply looked for the birth control pill with the closest approximation to that balance. Worked like a charm.

Good luck!
posted by nadise at 10:39 AM on March 15, 2011 [1 favorite]

WHAT THE WHAT

No, you get you (another) new doctor.

I thought "HBC can equal mood swings" was common knowledge. How could your doctor not say so?

I have plenty of girlfriends who have had the same response to various kinds, and need keep trying repeatedly to find the right one for their own chemistry. I, personally, can't take any form of HBC without turning into a different, much sadder and more anxious person. :-/
posted by functionequalsform at 10:47 AM on March 15, 2011 [2 favorites]

Wow, that is completely nuts. I, too, have heard many many anecdotes about HBC causing mood issues. And when I tried it myself last year, I swung into a tremendous depression that lasted four months. I went off the HBC in January.

New doctor time!

(FWIW, I am 30 years old, and my current doctor is the only doctor I've ever had who seems to respect me. I had a couple of bad experiences in a row when I was a teenager and it put me off going to the doctor for years. There are MANY doctors with shitty manner out there, and the only thing to do is keep shopping around until you find a good one.)
posted by marginaliana at 10:55 AM on March 15, 2011

The wrong birth control can be sheer misery -- the Nuvaring almost put me over the edge. The right birth control can be a breeze, maybe even an improvement. I would not be comfortable with any doctor taking a one-size-fits-all approach to something that can affect your well-being so deeply.
posted by bunji at 10:56 AM on March 15, 2011

For every friend I have whose cycle was regulated and life really, genuinely helped by the Pill, I know two like me whose moods basically spiraled out of control. I think even just a quick scroll through old AskMe threads is pretty revealing - there sure are a lot of us "outliers" complaining about the same kinds of side effects!
I know my body. My mood changes when my hormones fluctuate naturally, so OF COURSE it would change when I muck around with my natural hormone production. Once I got off the Pill, it was like I was myself again. Trust your body.
If you're in the NY area, I have an OBGYN whom I love and would be happy to recommend.
posted by bookgirl18 at 10:59 AM on March 15, 2011

Anecdata, but I was also on Nuvaring for a year with no problems until it started causing mood swings and a decrease in sex drive, so I stopped taking it. Timeline fits too. My doctor thought that was a pretty common side effect and agreed with me on my decision to stop taking it.
posted by lydhre at 11:00 AM on March 15, 2011

No matter what the actual stats, your doctor is being a jerk.
posted by radioamy at 11:01 AM on March 15, 2011 [5 favorites]

Even if mood swings are an "uncommon" side effect, it's still a side effect that's happening to you. Just because it's "uncommon" doesn't mean you still can't get it. Find a doctor who will take you and your individual health -- and wishes -- seriously.

I mean, hell, cancer is uncommon compared to the flu, but you don't see doctors turning their patients away and saying "feh, I've already had my quota of cancer this year, clearly this means you've just got a cold!"
posted by EmpressCallipygos at 11:12 AM on March 15, 2011 [3 favorites]

Agree, agree, agree. Do what is best for your body, and do what is best for your comfort level with a clinician.

I am reminded of an exchange between a friend and a server manufacturer.
Server tech: "That problem doesn't happen. Not possible."
Friend: "IT'S HAPPENING NOW."

On the flipside, I'd still suggest you consider Mirena or a nonhormonal IUD. Mirena truly, truly has such a low dose that it shouldn't mess with your moods. Every single person I've known who has had it -- and most, including me, have had some variation on mood disorders such as anxiety or depression -- has reported no mood disruption at all, and just enough hormones to clear up their skin.

I've had issues with multiple types of oral BCPs and mood swings, but this was a magical godsend (until it expelled -- painlessly -- after my checkup, which is pretty rare). Bonus: if you don't like it, just take it out and you'll be good to go.
posted by Madamina at 11:17 AM on March 15, 2011

Wow, I'm surprised he didn't diagnose you with hysteria *roll eyes*

You need another doctor, one who will take you seriously and not dismiss how you're feeling.

My own data points:

- Took BC pills for 10 yrs. Tried many different types, monophasic, triphasic etc... All caused some sort of mood instability which led me to get a non-hormonal IUD. IUD = no mood swings, but ridiculously long periods.
- Been using the NuvaRing for the past 2yrs. Started noticing increased irrational anger. I took it out earlier this week and will spend the next month w/out it to see if the anger subsides.

Our own natural hormone fluctuations effect us each and every month. It's ludicrous to believe that the hormones in BC wouldn't do the same.
posted by Constant Reader at 11:20 AM on March 15, 2011

Response by poster: It's difficult to reconcile the number of people with complaints with the statistics saying these side effects are uncommon. I realize that those satisfied with HBC aren't likely to go on message boards and post how happy they are on the pill, but I, too, thought it was common knowledge that the pill can mess with you.

I'll keep looking for better doctors. Many thanks to everyone for their input.
posted by elif at 11:53 AM on March 15, 2011 [1 favorite]

The pill of course can mess with you. Different pills may mess with you differently (or if you're lucky enough to find one, not at all). What works for me (yay nuvaring) may not work for everyone (see several posters above who've had mood issues with it). For me it was Ortho tri-cyclen that caused severe mood swings after a few years.

Definitely will take time to settle in on a new pill/other HBC method; could be a year or even several before a bad mood effect is apparent. You know your own body best, if you aren't happy with the method you have, consider one of the (many many) others. If your doc doesn't respect your reporting of symptoms, you have the wrong doc.
posted by nat at 12:14 PM on March 15, 2011

I think there is room for research: Women's Brains on Steroids

I personally had horrible mood swings while taking HBC, so I'm off it.
posted by starfyr at 12:56 PM on March 15, 2011

I too had mood swings when on HBC. Try Planned Parenthood. They worked with me to find a better solution than what my then OB/GYN insisted was the right BC method. Sorry you're going through this but I hope you are taking confidence in knowing your own body better than any doctor from what everyone has said above. Good luck!
posted by Lynsey at 2:11 PM on March 15, 2011

Thank goodness for my copper, non-hormonal IUD. Nuvaring and all the others I tried were horrible for me, mood-wise.

It's common enough there's a research paper floating around about the effect of HBC on sex drive (I've read it on AskMe before).
posted by bookdragoness at 2:36 PM on March 15, 2011

Dude. What? I have been on various types of HBC, including the Nuvaring, and they have made me varying degrees of batshit crazy. Some make me a crazy bitch, some make me crazy depressed, but they all make me crazy, crazy, crazy. So yes, here is another point of anecdata supporting your position.

If you want to go HBC-free I highly recommend Natural Family Planning and the book Taking Charge of Your Fertility. (Am on my phone and can't link.) It is not the rhythm method. It is very effective and just plain interesting to know how your body works. I have been doing it for almost 4 years and have remained baby free.
posted by apricot at 4:14 PM on March 15, 2011

Your doctor is WRONG. HBC use is RIFE with hormonally-induced mood problems. Definitely get a different doctor.
posted by patronuscharms at 5:43 PM on March 15, 2011

STOMP STOMP STOMP.

If you got hit by lightning and came into his office to show him your char marks, would he stand there talking about what an unlikely event it was? Find another doctor.
posted by hungrytiger at 1:31 AM on March 16, 2011 [1 favorite]

Wow. Sad that they don't see a correlation. How do they explain PMDD? PMS? Post Partum Depression? All are hormonal changes causing mood issues. The birth control pill causing mood changes is absolutely true for some people.

Time for a new doctor. You may also want to ask a psych doc too. I always had wicket PMDD, got better with birth control, had a baby + got back on pill = really bad PMDD/depression/anxiety. Staying on the pill (medical reasons) and taking Prozac. So there are work arounds.
posted by stormpooper at 8:36 AM on March 16, 2011

OK, it took me awhile to find actual results from a scientific study.

In the overall sample, 107 women (16.3%) noted worsening of their mood on oral contraceptive, 81 (12.3%) experienced mood improvement, and 470 (71.4%) had no change in their mood.

Negative mood effects are certainly not as rare as the OP's dismissive doctor, but not 50 out of 52. The rest of the research is also enlightening.

They noted that women who reported PMS and severe menstrual pain as a teenager were more likely to experience premenstrual mood improvement on the pill than those without these symptoms. Women with a history of depression were more likely to experience premenstrual mood worsening on the pill than those with no history of depression.

I had PMS and severe menstrual pain as a teenager (passing out in English woot woot) and I would be a "positive mood improvement person".

How do they explain PMDD? PMS? Post Partum Depression? All are hormonal changes causing mood issues.

Of course hormones affect mood - no one is claiming that they don't. The issue is that HBC is supposed to mimic natural hormonal cycles - the effects of HBC shouldn't be much different than the normal cyclic affects of our menstrual cycle. However, since every woman has different base hormonal functions, every different formulation is going to affect every woman differently.

While it's certainly been shown that a significant majority of women do not report mood changes while on the pill, it's ridiculous for the OP's doctor to state that it's so rare he only sees it twice a year.
posted by muddgirl at 9:12 AM on March 16, 2011 [1 favorite]