Should I take hormonal birth control if I am anxiety prone?
November 12, 2014 12:17 PM   Subscribe

Help me sort out my options.

I recently went through a round of CBT for anxiety and got a prescription for 5mg/day of Lexapro and am a very good place in my life mental health wise. I would say I have had a life long, low grade struggle with anxiety and sometimes depression, with bright spots interspersed. Anyway, I am very happy with how things are going and the way my current medications are affecting me.

I am in a relationship with a man I care about deeply. He has some erectile dysfunction issues and I'd like to be able to not use condoms, both for comfort's sake and because I think the ability to be more spontaneous would help him as well. I have talked to him about this (possibility of birth control or IUD) and he said that would be good for him.

I have been considering birth control options and there are a few complicating factors. I am nervous about adding hormones to the mix of medications I am taking because I'm afraid of upsetting the balance of my brain chemicals basically. I've considered an IUD, but I have some serious-ish medical anxiety that I manage with medication when I have doctor's appointments/procedures. I'm not sure whether or not I could handle the procedure to get it inserted. I went to the OBGYN and she gave me a prescription for Nuvaring but I've been getting slightly worked up reading people's accounts here and elsewhere on mood/mental functioning.

1. If you are anxiety or depression prone, how did Nuvaring affect you?

2. What other options should I be looking at? Requirements are high success rate, minimal effect on mental health and not condoms. (We're using condoms in the meantime.)
posted by anonymous to Health & Fitness (32 answers total) 3 users marked this as a favorite
I was on the pill, not nuvaring, but it was AMAZING for my anxiety and depression. I'm actually having a lot of trouble now that I'm off of it (because I don't currently want to control birth) with keeping my mood stable. It is basically a wonderdrug for my anxiety. My brain chemicals are naturally messed up; adding constant, managed hormones smooths them out.

I know it isn't that way for everyone, but give it a try, enlist your boyfriend to help monitor your mood (I didn't see the connection until my husband pointed it out) and give it a few weeks. And different pills affect people in different ways, so if you're willing to use a pill instead of the ring it might be worth trying a version of the pill if the nuvaring doesn't work for you.
posted by brainmouse at 12:21 PM on November 12, 2014 [2 favorites]

I have an IUD, but I would personally not recommend it for someone whose anxiety sounds as serious as yours. Even after the insertion procedure, you sound like you would probably continue to worry about possible issues like expulsion, etc. with the IUD. The other side of it though is that once you've had it for a while, you forget it's there and you never have to think about it. If you think you can get through the initial few months of adjustment and uncertainty, it might actually be better.

Everyone reacts differently to hormonal birth control. The good thing about it is, if you have bad reactions to it, you can always stop using it. For me, the pill actually reduced my PMS symptoms for a couple years (and then they came back to the same levels that they were before so I decided to give up on hormones forever). Some people have the opposite reaction. Others continue to find that PMS symptoms are reduced while they are on the pill. Others have no mood/anxiety/depression symptoms at all while on hormonal birth control. The only way to know for sure is to try.

Other than IUD, there aren't many non-hormonal birth control options that have a high success rate. There is lots of good information about birth control options here.
posted by Librarypt at 12:26 PM on November 12, 2014 [1 favorite]

I have pretty awful anxiety that developed during my pregnancy and never quite went away. (Most say it never will - a mother's curse!) but I have done both the pills AND nuvaring in recent years and would recommend the nuvaring to pretty much anyone, especially if you're concerned about dosing yourself with extra hormones.

I had absolutely NO side effects from the nuvaring and it was relatively easy to take in and out. You can ask your physician with a sample - most offices will provide a 1 month sample for you to try to see how you and your significant other like it.
posted by Sara_NOT_Sarah at 12:35 PM on November 12, 2014

I've been getting slightly worked up reading people's accounts here and elsewhere on mood/mental functioning.

Also, maybe don't read so many personal accounts of individual experiences on the internet. People are more likely to report negative reactions on the internet. And as I said, everyone reacts differently.
posted by Librarypt at 12:37 PM on November 12, 2014 [7 favorites]

Every body is different, and every person reacts differently to different forms of BC. You and your doctor together are probably much more likely to find the right solution for YOU than any of us here internet types.

That said, I don't see it mentioned as often, but I love my Nexplanon implant. It's not as long term as an IUD (2-3 years depending on the brand), but I switched from a low dose pill that was affecting my mood, and honestly one of the big draws for me was that the removal procedure is so much faster (literally, just cut and pop it out) that I knew if I were to have a serious hormonal reaction, I could literally get it out that day as a walk-in. The insertion involves a numbing agent to the forearm, then a big syringe I choose not to watch thanks very much, but nowhere near as anxiety inducing as even a normal gyno appointment. Had a cool bruise for about two weeks. I have not had any emotional issues with this particular dose of hormone, YMMV

Of course, I ruled out the copper IUD because I have severe cramps, but if you're looking for non-hormonal options, that's where is at as far as many of my friends are concerned (including one who did very badly on Nuvaring).
posted by theweasel at 12:41 PM on November 12, 2014 [1 favorite]

I got a hormonal IUD (Mirena). I'm nulliparous and it didn't hurt a bit beyond the initial pinch and a bit of cramping. But apparently that's not the norm and your worries about insertion are well founded. As far as anxiety goes though, I have had no side effects from the Mirena (which I have had for 3+ years) and I love it and will be getting another one when this one runs its course. But my insurance covers it, so I'm not out $350 if it doesn't work. Maybe worth trying for you if you are covered. Good luck.
posted by futureisunwritten at 1:01 PM on November 12, 2014 [1 favorite]

One of the things to remember about the insertion is that it happens once every seven to ten YEARS. Even if it's pretty unpleasant, you get a lot of birth control bang for that buck.
posted by KathrynT at 1:05 PM on November 12, 2014 [1 favorite]

My anxiety is no worse or better for my birth control pills (generic version of Mircette).
posted by cecic at 1:11 PM on November 12, 2014

Any kind of hormonal birth control I tried either made me super sad or took away my sex drive. The annoying thing is that you have to try it out to see what a specific B.C. will do to your individual mix of tendencies and hormones.

After a few failed pill prescriptions, I tried Mirena, the hormonal IUD. The first insertion, at my local Planned Parenthood, was pretty painful - the person doing it was some sort of intern, not a full doctor, and they just couldn't get it in. God, that sucked. However when I went back to PP to have an actual doctor do it, there was a tweak of pain -- it feels kind of like a bad menstrual cramp -- and then I was fine! So I think the horrendous experience was due to the inexperienced person, not my body or the IUD. (I don't know for sure, though.)

Mirena took away my sex drive so I switched to Paragard (copper IUD) which I'm still on. Paragard's nice because I feel like my emotions are my emotions, y'know? I don't have to second-guess my feelings. But, yes, cramps increase, my periods are longer and heavier, and I've had more yeast infections/BV.

Still, it seems like the best non-hormonal option for me. Good luck.
posted by rogerrogerwhatsyourrvectorvicto at 1:14 PM on November 12, 2014

I use Nuvaring, and have gone on and off it over the past 10 or so years at various points in my dating life. Have never had any symptoms/side effects, mental health-related or otherwise.
posted by rainbowbrite at 1:14 PM on November 12, 2014

I have a copper IUD but took birth control for about 10 years before I got it. I have always been a bit of an anxious person so I didn't even think of a connection between it and my birth control, however now I'm synthetic hormone free my anxiety (social anxiety) is a lot better. I think it varies quite a lot between people and I had to try a few different pills before I found one that worked for me, so if you do try the pill give it a couple months before deciding if it works or not and don't give up if the first few you try don't agree with you. Whether the IUD would be worth the medical anxiety is a complete guess as well, it really agrees with me but I know a lot of people can't tolerate it. Maybe try the pill first and monitor carefully to see if your anxiety is affected, its much easier to stop taking pills than to go through the anxiety of having the IUD removed when you are already stressed about it!

Also try not to read too much medical stuff online, it very rarely leads to anything good!
posted by Peetree at 1:20 PM on November 12, 2014 [1 favorite]

To add another anecdote to the mix:

I'm someone who deals with anxiety and depression issues as well. I've tried two different types of birth control pills (not NuvaRing). Both of them increased my anxiety by a lot. They also killed my sex drive, and made me feel overall kind of crazy and not myself. It didn't even out for me after several months of trying to be on them. The only awesome thing they did for me was completely remove all period pain.

However, I have friends that do not have these issues at all and they've been on BC pills a long time.

This is the kind of thing you just have to try and see how your body reacts. You also are supposed to give it a few months so you get through the adjustment period and then see how your body does.

My sister has the copper IUD, she was anxious about getting it inserted, and now she doesn't really think about it much. It did increase the pain during her periods and also it made her flow much more, but again, that varies from woman to woman.

If I were in your shoes, I'd try the NuvaRing or other BC pill first, and see what happens. Who knows, it may work amazing for you. We are all so very chemically different, you know?
posted by FireFountain at 2:04 PM on November 12, 2014 [1 favorite]

For me, hormonal birth control has always been a very strong magnifier of my existing problems with depression and anxiety. So I can easily live through the 30 second pain of the insertion of a copper IUD. I do get stronger periods and some very slight pain during those periods, but compared to the darkness I experienced even with "mini" pills, it is nothing.

Honestly, you need to find out what works for you. I've found that while I am not shy of sharing my experience, it is my experience. For others, the effect may be the complete reverse.
posted by mumimor at 2:08 PM on November 12, 2014 [2 favorites]

I have Mirena, and have only good things to say. I love it for the lack of side effects (and periods.) If you can get your hands on a couple Vicodin or muscle relaxers, it helps immensely with the insertion. Your doc may even be willing to proscribe them, or anxiety meds just for the procedure. The insertion is also very quick, so any discomfort only lasts a few seconds. There may be some cramping afterward, but no worse than a period, and managed fine with some ibuprofen.

I had the same reservations about hormonal birth control, and I haven't had any mood changes with Mirena. The small amount of hormones stay localized.

Please don't use Nuvaring. The risk of blood clots is very serious, and way too many healthy young women without risk factors have died suddenly while on it. You can google the stories. I believe there are a number of lawsuits trying to get it off the market, and I agree, with the number of deaths reported, it is unsafe.

I'd also recommend against Depo Provera (don't even know how common this is anymore) simply because if you do react badly, and there are many horror stories, all you can do is wait it out.

If you do go with the pill it is likely to be a trial and error process until you find the right one. Personally, I really think IUDs are the best choice for the majority of women, which the rest of the world, aside from the US has also realized.
posted by catatethebird at 2:31 PM on November 12, 2014

I have a history of depression and anxiety (not on any medication, though), and have taken hormonal birth control to no ill effect. The one time I did experience mood altering symptoms while on birth control, there were factors in my life that were much more likely sources of the depression and anxiety.

I had great results with NuvaRing. It's the best birth control I've ever used. A+, would ring again.

If you have serious concerns based on actual science and not just hearsay or assumptions, talk to your doctor(s) about it before they prescribe you anything. This is why birth control is not over the counter, and why IUDs require a consult with your doctor. Because you talk to them about this stuff beforehand.

I personally wouldn't get a hormone-releasing IUD inserted if you've never been on any hormonal birth control before and have reason to think it might affect you negatively, but TBH that may be coming from my personal ambivalence about the IUD hype. You should talk to your doctor, not some stranger on the internet.
posted by Sara C. at 2:32 PM on November 12, 2014

I'm on Celexa and I take HRT, and I'm very mellow and cool.

This is all anecdotal, everyone is different. My mother needs MASSIVE amounts of hormones to keep her from being a King Kamehameha Beyotch.

They could help, they might do nothing (except prevent pregnancy) or they might make things worse.

Give it a try, if it works for you, great, if not, you can easily stop.
posted by Ruthless Bunny at 2:33 PM on November 12, 2014 [2 favorites]

Another vote for the copper IUD. I chose to come off the Pill because I wanted my hormones to be my own, so to speak. The first insertion of the IUD gave me a sharp pain but it passed quickly, and the second insertion five years later was fine. As both appointments took about fifteen minutes, that means I have spent a grand total of about half an hour thinking about my BC in the last 8 years. I also have never experienced heavier periods or bad cramping as a result though I may just be lucky.

I have bouts of anxiety and can be disorganised, so one problem with the pill was sometimes forgetting to take it and then panicking about accidentally getting pregnant, so the IUD means I actually have less Things To Be Anxious About. I'd definitely recommend it for the stress-free aspect.
posted by billiebee at 3:11 PM on November 12, 2014

I have severe anxiety, now managed with medication (Lexapro and Lamictal). I also have the Mirena, which I LOVE like whoa and has no side effects on my mood. The insertion was easy, if slightly pinchy and crampy, and if you have general anxiety around doctors, you can get some stronger anti-anxiety meds for the appointment.

I will say, though, that I had cramps on and off for about 2-3 months after insertion, and I spotted almost constantly for about 6 months. In hindsight, these things were totally worth it (no periods! spontaneous, condom-free sex!), BUT I was anxious about expulsion/migration and possibly needing to get the Mirena taken out if the spotting didn't stop. I also visited my gyno 2-3 times in those 6 months, just to have her check that everything was okay, which seems like it might be a source of anxiety for you.

tl;dr -- I have medically-managed anxiety, and I love my Mirena, but I don't have anxiety about medical appointments, so YMMV.
posted by Ragini at 3:45 PM on November 12, 2014 [1 favorite]

As someone with mild unmedicated depression, Nuvaring was pretty much terrible for my mood, causing extreme irritability and inexplicable rage . Same deal with the pill I took. But you know what? It was so not a big deal in either case because I stopped taking them and things went back to normal in a couple days. As long as you are reasonably stable and know that hormones can mess with your moods, I don't think it's a huge risk to give HBC a shot.
posted by noxperpetua at 3:52 PM on November 12, 2014 [1 favorite]

Just get a hormone-free copper IUD. Ask for a Valium prescription for the insertion. Once you get your IUD, start taking an iron supplement just in case.
posted by Jacqueline at 4:22 PM on November 12, 2014

The ring is always recommended to me by doctors because the low hormones make it seem like a good option for me. But I think that it being a monophasic form of HBC wasn't good for my moods (I had a better experience with a low dose, triphasic pill). The Nuvaring made me really anxious. But a friend of mine, who has struggled with quite severe anxiety (/a panic disorder, I think), absolutely swears by it. The only way to know how it will affect you is to try it. Discuss your options with your doctor, if you haven't already. I'm not sure whether there's any kind of interaction with Lexapro or anything else that you'll need to know.

When I tried the Nuvaring, I had only just started dating someone and my anxiety did not do great things for that relationship. But since you're in a supportive relationship, have a talk with with your partner about how HBC might affect you and what you might need from him while you're trying it out. You really need him to be supportive of you during this time and to understand that if you're a bit moodier than usual, it's because of the ring. Sometimes side effects can even out over a few months of use, but it will be up to you to decide whether it's worth waiting it out or whether you're better off stopping. But you possibly won't get any or many side effects at all. After all, Nuvaring has a really low dose of hormones. It might work out really well for you and actually help with your mood. I think that go into it hoping for the best, but do remember that you can stop using it if you experience negative side effects.
posted by kinddieserzeit at 4:26 PM on November 12, 2014 [1 favorite]

Yeah, nuvaring was terrible for me too. I also had terrible mood issues with pregnancy and I get notably disphoric during certain portions of my cycle, although not every cycle. If you have similar noticeable reactions I'd be much more careful. If not, it might not be such a big worry.

Yes, this is me, too. The only hormonal birth control that didn't make me labile, edgy, and anxious instead made me dysthemic. I suspect it's higher levels of estrogen that impact me, specifically (while nursing, which suppresses estrogen, I have felt very, very even-keeled, to an extent I haven't since puberty).

There's no telling how you will personally react to a specific cocktail of hormones. I kind of wish I hadn't gone down the hormonal birth control route--I lost most of my twenties to birth-control induced mood swings, not to mention the fact that it killed my libido and vaginal lubrication. But your mileage may vary; not worrying about getting pregnant, at least, is very nice.
posted by PhoBWanKenobi at 5:09 PM on November 12, 2014

The ring is always recommended to me by doctors because the low hormones make it seem like a good option for me. But I think that it being a monophasic form of HBC wasn't good for my moods (I had a better experience with a low dose, triphasic pill).

Substitute "Nuvaring" with "Mirena" and you have my recent (if qualitative) experience. A couple ob/gyns I've talked to are wary of giving low dose continuous progestin-only BC to people with depression, but I don't know what the take on anxiety is. Reading anecdotes on birth control sometimes makes me many people's hormones are their own unique balance, each more or less prone to going askew when pushed from different directions.
posted by deludingmyself at 5:27 PM on November 12, 2014

Nuvaring worked great for about a year -- but then things took a big-time nosedive. Unfortunately, it took many awful months to figure out why, and I still don't know what changed, but the good news is that most of the symptoms began to lift pretty quickly after taking it out.
posted by bunji at 5:47 PM on November 12, 2014

I've used both Nuvaring and Mirena and loved both, and did not have any mental health side effects with either one.

I have been off hormonal birth control for about 4 years while I've been having kids, and I miss it so much and can't wait to go back on it (it helps my skin, regulates periods, and other positive side effects for me).

Regarding the blood clot risk mentioned above, it's estimated at 8 to 11 per 10,000 woman-years (meaning that if 10,000 women used Nuvaring for a year, 8 to 11 would have a blood clot during that time - keep in mind the majority of blood clots are treatable and do not kill people, so the risk of death is far lower than this). That's similar to the risk of other birth control options, but far less than the risk of blood clots with pregnancy - yet I've never heard someone tell another person not to get pregnant because the risk of blood clot is too high, and I think it's unlikely that all birth control is going to be taken off the market given that the condition it prevents is more dangerous than taking it is.
posted by treehorn+bunny at 5:57 PM on November 12, 2014 [3 favorites]

I meant to include these links: "8 to 11 per 10,000 women years" and "similar to the risk of other birth control options" (the second article discusses a more recent study that showed a risk higher than other birth control options, but also talks about why that study was flawed compared to the previous ones).
posted by treehorn+bunny at 5:59 PM on November 12, 2014

I have medically managed anxiety and have never had an issue with birth control -- I've taken a million methods, and I've rocked 'em all. Three or four pills, nuvaring for years, two different IUDs. You could get lucky, you never know.
posted by chesty_a_arthur at 6:10 PM on November 12, 2014 [1 favorite]

I have depression/anxiety issues. I went on nuvaring for one month and felt emotionally numb then when the 3 week cycle was over, I crashed emotionally had to leave a party because I was so inexplicitly upset (no one else knew I was just very upset). I went home and sobbed for 3 hours. Then the next day I was totally fine.

This is not to scare you. Actually the opposite because basically I did not react well to it, but the side effects were gone within 12 hours. No lasting effects. It didn't trigger any serious depression. Once I stopped using it, I had one bad crying session, went to sleep and woke up feeling like myself again.

I would consider trying it again to see if the effects wore off over time. It was unpleasant, but not so horrible that I'm like no never again. I would give it a try and see if it agrees with you.
posted by whoaali at 6:15 PM on November 12, 2014

I'm a very anxious person. So anxious, in fact, that I recently started taking medication for my anxiety (which is a topic for a different Ask, but has really improved my life).

Anyhow, I talked over my medical anxiety specifically with my doctor before choosing a copper IUD (Paraguard). She gave me a lot of Xananx for the appointment. It helped but I was still pretty emotionally freaked out. The actual insertion went fine but I was scared.

But after about three days I was singing the praises of the IUD and I haven't stopped. It was hard and a bit scary but really really worth it for me. No hormones and no worrying about potential pregnancies is a HUGE load off my mind. It reduced my overall anxiety a fair amount to be honest, because I was no longer worrying about pregnancy and condoms and feeling bad from hormonal birth control (which not only exacerbates my anxiety but really messes with my emotional balance in general).

I have to say: one thing I've learned about my medical anxiety is that I have a bit of control over it. My appointments are so much worse when I work myself into a lather with my anxiety. I am not saying I just choose to not get anxious, but I do choose not to cry and hold my breath and whimper. That's what I used to do and it made things worse. I have practiced breathing techniques and imagining being in a safe place and counting backwards from 100 and that makes doctors appointments - even things like root canals - a lot easier. Well, that and benzodiazepines.

Good luck and take care. Anxiety is hard. The Lexapro will probably help make a dent in your anxiety too.
posted by sockermom at 6:31 PM on November 12, 2014 [2 favorites]

Just to toss a positive anecdote into the mix - I'm medicated both for anxiety and depression, I use NuvaRing, and I don't notice any effect of Nuvaring on my levels anxiety or depression at all, either for better or for worse. I think this is one of those things with highly individual reactions.
posted by pemberkins at 6:35 PM on November 12, 2014

2. What other options should I be looking at? Requirements are high success rate, minimal effect on mental health and not condoms. (We're using condoms in the meantime.)

It's hardly used these days, but according to the CDC, the diaphragm has a 12% failure rate (vs. 9% for the pill and 18% for condoms [and apparently 20% for withdrawal? Better than I thought]).

I have anxiety issues and did not - at all - enjoy the effects of one BCP on my mental state. I chose not to experiment further. ymmv, of course.
posted by cotton dress sock at 11:59 PM on November 12, 2014

I can't speak to any effects on anxiety as I just received it, but you could ask about Skyla, which is like a smaller Mirena IUD. I just had it placed three days ago, and I was freaking out beforehand due to all the horror stories I read.

On the advice of my NP, I took 400 mg of ibuprofen, maybe 5mg of Valium, and she put a paracervical block in first (Lidocaine). It hurt to dilate my cervix and there was another cramp upon insertion, but it was SO much less painful than I had anticipated. Seriously, just a few cramps that were like bad period cramps, and done. I had someone drive me home, laid on a couch for two hours, and have had slight cramping since that I've managed with ibuprofen.

Just wanted to add a counterpoint to all the IUD horror stories that freaked me out before insertion.
posted by queens86 at 8:08 AM on November 13, 2014

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