Does it make me fat AND happy?

June 19, 2006 2:52 PM

Can hormonal birth control have positive side effects on mental health?

I'm considering switching from NuvaRing to an IUD, mostly because of a bit of weight gain and slightly decreased libido. However, since I've been on hormonal birth control, I've been happier, less manic, and less anxious. I've been off-and-on the pill and the ring a few times over the past eight years, and I remember feeling markedly better while on it. (I have a panic disorder, periodic deep depression, and a tendency towards reckless behavior when I'm upset or bored. I take Lexapro, which does help.) Could the "smoothing out" of once-fluctuating hormone levels be helping my emotional problems, or is it more likely a coincidence? I haven't had much luck finding professional or even anecdotal discussion of this theory on the internet, so I'd love to hear about any links, articles, or personal experiences.

posted by juniper to health (20 comments total)

Completely isolated anecdotes are OK? I know one person who did use the NuvaRing, and did experience less mood-swinginess as a result. OTOH, she also ended up being sad all the time, so she stopped using it.

I have a vague impression that some mood effects are pretty common from any kind of hormonal treatment, and that they're pretty idiosyncratic.
posted by hattifattener at 3:11 PM on June 19, 2006

Intuitively, and from observation of others, it makes sense that hormonal contraception can cause both positive and negative mood changes by the "smoothing out" you talk about - it's just that we hear more about the negative side effects and try to get more information about them in trials. It would definitely make sense in the case of a woman with severe PMS or painful periods who is affected by these symptoms, since hormonal contraceptives can definitely help decrease PMS and menstrual cramps.

I am also interested in your problems with weight gain, since weight gain on the pill is relatively rare (I am basing this on what I have read in Contraceptive Technology, the major text out there on contraception. You could try a switch to another formulation of oral contraceptives (lower levels of estrogen and progestin, or just lower the level of progestin) and see if that helps, or maybe try Yasmin, as that formulation contains a diuretic. The libido issue can be harder to treat by changing pills, since any formulation can cause it, and also being depressed increases your risk for problems with libido as well.

(I am not a doctor, but I worked for five years as a family planning counselor and did a lot of education and counseling on contraception). It can take some time to find what works for you. You could always try the IUD and take it out early if it doesn't work for you and go back to something else.
posted by tuff at 3:16 PM on June 19, 2006

Also, I was doing some reading recently about menstrual migraine and found that estrogen levels are connected to circulating peripheral serotonin levels. Serotonin decreases when migraine occurs, and it is thought that women experience menstrual migraine during the second phase of the menstrual cycle when estrogen is decreased. So, in this theory, decreased estrogen leads to decreased serotonin which leads to migraine. Mood disorders have also been linked to dysfunction with serotonin production, reuptake, etc. It would make sense, if you connect these dots, that fluctuating estrogen could cause fluctuating serotonin, and that could lead to mood destabilization - which maybe hormones could counteract by providing supplementation or stabilization of hormone levels. Just a guess.
posted by tuff at 3:30 PM on June 19, 2006

Speaking as a guy, I obviously have no first hand knowledge here, but I can tell you what my girlfriend has experienced, and that is that she recently started taking medication to even out her horomone flows and has found that she no longer needs to take her mental health meds (She was taking Celexa, as Lexapro didn't work at all for her). It's not 100%, she still has bad days and getting back on the celexa is something she thinks about, but it's been about five months now without any psych meds and there haven't been any 'breaks' or whatever you want to call them.

HOWEVER! I want to make abundantly clear, depression and that whole fun filled banquet you describe, is not the only health issue she is working with. Specifically, she has been diagnosed with PCOS (Polycystic Ovary Syndrome) which is a horomone disorder, and in addition to taking birth control pills, she also takes a diabetes medication to regulate her insulin. There is some thought in the medical community that PCOS often *causes* depression (rather than being a symptom), so her doctor isn't too suprised that her mental health is improving along with her physical.

What I'm trying to say is that while my girlfriend has definitely noticed an improvement to her mental health since she began taking birth control pills, she has a specific, diagnosed-by-a-doctor condition that may or may not the causitive factor here. I'm not a doctor, but I would agree with the above poster that regulating the horomone flow could easily provide additional beneficial effects to mental health. At the risk of sounding like a nanny, I would say that you should talk to your doctor about this. Unlike a lot of nannies though, I have a seriously hard-ass attitude about treating mental health. Far too few people take it seriously, and those that are left often take it way too seriously. Getting treatment that works for *you* can be a full time job and requires steady attention even after you get things going right. If your doctor isn't going to be a fully active and supportive partner in this process, kick them to the curb and get another one!
posted by schwap23 at 3:36 PM on June 19, 2006

Which IUD are you considering? The copper one, or a hormonal one? Supposedly the hormonal IUDs have lower doses of the hormones vs. other hormonal birth control methods because they are delivered at the site, so you may (emphasis on may) experience milder side effects compared to other hormonal birth control methods.

That could translate into reducing or eliminating the side effects you don't like OR the side effects you do (or none at all, of course). Pretty hard to know without trying it yourself.

My source: information from my doctor @ Planned Parenthood, both verbal & 'material' (pamphlets) from the manufacurers when I was considering getting an IUD*.

Possible downside to experimenting with the hormonal IUDs: they're relatively expensive. It's worth it if you're going to use it for the full life of the device, but possibly prohibitive if it's just going to end up in the garbage in 6 months time. YMMV depending on your financial means and if you've got health insurance to pay for it.

* Which I got. And I love.
posted by raedyn at 3:41 PM on June 19, 2006

Purely anecdotal comment: I had the exact opposite reaction on the pill. My depression (which was medicated) became worse and I had to discontinue use of the pill, whereupon my depression eased considerably. This was on a combination pill, of which depression is a side effect.

Nuvaring is also a combination method but if you go for the hormonal IUD, it contains just progestin (not estrogen) and this may be the thing that is facilitating your better mood. Worth discussing with your doctor - maybe s/he can provide some info here.
posted by meerkatty at 3:56 PM on June 19, 2006

I'm sure that it's totally possible that the NuvaRing is making you both fat and happy. If I've learned anything from talking to my doctor about birth control, it's that the effects are somewhat predictable, but the one thing that is 100% is that the side effects are also completely idiosyncratic. On the subject of Yasmin, all I can say is that I hear more women tell me that Yasmin made them bonkers than I hear women say they like it. This is clearly antecdotal, but thought I'd throw that out there.

I have the hormonal IUD and I LOVE IT. I am totally fine. I'm 26, never had kids, and after the first two weeks, I've not even so much as thought of looking back. My body seems to really like the progestin. It's a commitment, and it's a lot of trouble if you end up hating it but I'd seriously consider it if you're having weight gain issues. If your doctor won't talk with you about it seriously, then find one who will.
posted by Medieval Maven at 4:28 PM on June 19, 2006

Hrmm...great, and fast, answers from everyone. I do have that fear that I'll go through the expense and insertion trouble of getting an IUD (which I'd have to go to Planned Parenthood for, as well, since I haven't had kids and my otherwise-great GYN is a weenie about inserting them in uh...unstretched cervixes) and then have to have it removed because I feel like hell.

I've also read that the Mirena IUD's hormones work only locally, so if I am getting hormone benefits from the ring, I wouldn't if I switched.

The weight gain I've experienced could be contraceptive-related, or could have just occured because I'm twenty-six now and my metabolism has changed. Definite breast growth, though, which is another welcome, happy side effect. So many factors, silly and serious, to consider.
posted by juniper at 4:29 PM on June 19, 2006

If it were me, I would stay on the ring. IUDs have their own potential side-effects (bad cramps, nasty periods). The weight gain is probably a combination of a little bloating (boobs getting bigger) and a little metabolism slowing down (or lifestyle slowing down). And it makes your moods better? Man, you hit the holy grail there.
posted by ch1x0r at 4:45 PM on June 19, 2006

The hormonal IUD actually makes your periods lighter, or stops them entirely. With the copper IUD, I've had immense luck with ibuprofen (2 pills, three times a day) for reducing the increased flow (if that makes any sense...)

Juniper, from the research I've done, it seems that your gyn's skill in inserting the IUD is a major factor in whether it will be expelled, so it might not be a horrible thing that you're forced to go to the "experts."
posted by occhiblu at 4:56 PM on June 19, 2006

Purely anecdotal - Nuvaring made me extremely moody and unhappy, I quit after 2 months. Yasmin was great, no noticeable side-effects at all. It seems likely that if the pill can alter mood levels in terms of "grumpiness" for me then it could alter your anxiety positively too.
posted by Joh at 5:28 PM on June 19, 2006

My mother and sister are (were) outrageous PMSers. My daughter was having major troubles with PMS until she went on the pill, which helped a lot. I guess its pretty common.
posted by RussHy at 6:08 PM on June 19, 2006

Just a followup -- Mirena is the hormonal IUD and it does, indeed, have the blessed side-effect of at least lightening or at best ELIMINATING your period. Having done Seasonale (which I liked for about 9 months) and having had issues with dryness and whatnot, I'm not seeing that with the IUD.

If your doctor is being a dick about inserting an IUD, seriously, look for a more flexible doctor. You shouldn't be forced to go to Planned Parenthood (no matter how much I love and applaud what they do) if you don't want to. I have never had kids, and I was duly warned that it would be a pain in the ass, but it wasn't anything I couldn't handle, and it's been the best birth control method by far for me. I've read about the ring, and it seems to me that the delivery method for the hormones isn't really very different, but I'm no expert.
posted by Medieval Maven at 6:42 PM on June 19, 2006

Because the conversation is veering a bit this way:

For me, my PMS has almost always been a sign that something else in my life is off. That I'm swallowing too much stress without doing anything to alleviate it, that I'm eating food that's not good for me, that I'm not getting enough exercise, that I'm letting the people around me dictate too much of my life. The worst PMS I've ever had was when I was living with my ex-boyfriend. The stress that came from putting up with his behavior, and his blaming me for that behavior, would tend to explode once a month when my estrogen dipped; my lack of exercise and my overeating of fried foods showed up in major cramping. It magically went away when he and I broke up -- it seemed to be entirely environmental.

There are, of course, many women who do have major problems with PMS that need to be controlled with pills. Many of us, however, can make lifestyle changes to alleviate most of the problem.

Statements that somehow imply women who get PMS just need to go on the pill, rather than examine their lifestyles and see if things need to change, worry me. We often act like woman are the only humans who have hormone fluctuations, and like those fluctuations (or the hormones themselves) are flaws.

With anything going on in one's body, diet and exercise and medicine and mood and stress will affect it. The pills may be keeping your hormones "in check," but there are probably other ways of doing that if you decide the side effects of hormonal birth control are too much. Hopefully your doctor and psychiatrist might have more information (but unfortunately I think there's not been enough real academic attention paid to women's health and experiences in this arena).
posted by occhiblu at 6:58 PM on June 19, 2006 [1 favorite]

Maybe the birth control is improving the quality / quantity of your sleep, which of course has a huge impact on mood and mental health. Hormonal therapy improving sleep is common for menopausal women - you don't say how old you are but some people think it helps with sleep in perimenopausal (pre-menopause) women as well. And everybody's mileage varies. Even if you're not within shouting distance of menopause, you might be a person who gets better sleep with some extra estrogen.
posted by selfmedicating at 7:43 PM on June 19, 2006

I found this Women's Health Discussion Forum when looking for information regarding hormonal contraceptives and depression about a year ago. It is mostly anecdotal; I found it interesting to read various women's observations and reactions. Hormonal contraceptives are also linked to low libido for some women, definitely something to consider as you evaluate your experiences with them.

Personally speaking, I can second occhiblu's post. I have been successful and much happier taking a more holistic approach to my hormones and leaving the pharmaceuticals out of it.
posted by FuzzyVerde at 7:43 PM on June 19, 2006

Me again. Well, I do get PMS, mostly the anxious and irritable variety, but I always have, and my lifestyle is ridiculously healthy, except that I should get more exercise. I am getting better at recognizing and releasing stress and other emotions, but I can feel it as soon as the "week before" comes. My problem (not to discount your posts or the slight topic shift) is more day-to-day anxiety and depression.

The fakey hormones do squelch my libido a bit, but I am orgasmic and interested, at the risk of delivering TMI, and reckless sex was a big part of the mania I dealt with in my early 20's, so it's nice to be able to regularly think about topics other than sex for the first time since puberty. Again, it's something that could have just as much to do with age as with contraceptives.

Whee! Juniper's life has been fraught with a few issues!

But everyone's comments, again, are helpful and thought-provoking.
posted by juniper at 8:16 PM on June 19, 2006

From personal experience...

I recently went off of depo provera shots after being on them for 12+ years. I started having mood swings and hot flashes. I was agitated and a real pain to be around--I didn't even like being around me!

So, I went to the doctor to find out if I was either pregnant or entering menopause...or just going completely crazy! LOL! Well, it was neither. He determined that the lack of hormones in my system were causing the problem because my body was so used to a certain level of hormones and then they were gone.

He put me on the Yaz BC pills for the next few months until my cycle gets regulated. I noticed an almost immediate change in my symptoms. I have been a much happier person (with a much happier family) since taking the pills.

Personally, being on depo provera was wonderful for me--my cycles were completely put on hold, so there was no mood flux or PMS at all. So far, so good with the pills.

I know everyone has a different opinion on the various BC methods and I'm not trying to incite a riot (LOL!). If you aren't familiar with how the different methods work, you might want to investigate them. For instance, BC pills and many other hormonal forms make the body think it's already pregnant, thus, not releasing an egg that can be fertilized. IUDs and some other methods aren't "preventative" in the same way. The egg can still be released and fertilized, but not implanted in the uterine wall, thus being "abortive". If you are pro-life at all, this may be a determining factor for you. Just saying...do your homework if this is important to you.
posted by Mrs. Smith at 8:14 AM on June 20, 2006

I understand what you're saying, Mrs. Smith, but the official medical definition of pregnancy begins at implantation, not fertilization, so every medical professional would disagree with your definition of "abortive" there. In addition, such events with IUDs are thought to be rare, as the device also tends to make the uterus hostile to sperm, making fertilization difficult.
posted by occhiblu at 8:30 AM on June 20, 2006

I've been diagnosed with PMDD (severe PMS, basically) and I've found that most low dose monophasic birth control pills help even me out. I did have trouble with high doses of progesterone in the triphasics (like OrthoTricyclen) and have found that most women who have mood problems tend to be set off by progesterone rather than estrogen. I'm on the nuva ring now, and it's working very well for me. I wanted to try the Mirena IUD, but my gyn was concerned that the progesterone in it would exacerbate my PMDD.
http://www.vaginapagina.com/ has lots of first hand accounts and research on different methods of birth control.
posted by blueskiesinside at 11:58 AM on June 20, 2006