Is birth control suitable for individuals with mood fluctuations?

Birth Control for Mood Fluctuations

Birth control is generally not recommended as a primary treatment for mood fluctuations, as hormonal contraceptives can both improve and worsen mood symptoms depending on the individual. 1

Effects of Hormonal Contraceptives on Mood

Hormonal contraceptives can have variable effects on mood:

• Potential negative effects:

  • Combined oral contraceptives (COCs) may cause mood swings, depression, depressed mood, and affect lability in approximately 2.2% of users 2
  • Some women experience increased anxiety, irritability, and mood swings during the intermenstrual phase 3
  • Women with previous history of COC-induced adverse mood are more likely to experience mood deterioration when restarting COCs 4

• Potential positive effects:

  • Some women experience premenstrual improvement in depression symptoms with COC use 3
  • Continuous COC use (without hormone-free intervals) may provide mood-stabilizing effects 5

Risk Factors for Negative Mood Effects

Certain factors increase the risk of experiencing negative mood effects with hormonal contraceptives:

• Previous history of adverse mood reactions to hormonal contraception 3, 4
• Pre-existing depression or mood disorders 5
• Age (younger women may be more susceptible) 6

Clinical Approach

1. Assessment:

   • Evaluate pre-existing mood disorders or history of mood fluctuations
   • Document any previous experiences with hormonal contraceptives
   • Consider the temporal relationship between contraceptive use and mood changes 7

2. Contraceptive options for women with mood concerns:

   • First-line options:

     • Non-hormonal methods (copper IUD) if mood stability is the priority
     • Levonorgestrel IUD (LNG-IUD) which provides highly localized hormone effects with minimal systemic absorption 1

   • If hormonal contraception is preferred:

     • Consider newer formulations with 17β-estradiol rather than ethinyl estradiol 1
     • Drospirenone-containing COCs may be beneficial for some women with premenstrual symptoms 1
     • Consider continuous or extended-cycle regimens to avoid hormone fluctuations during pill-free intervals 5

Important Considerations

• The U.S. Medical Eligibility Criteria for Contraceptive Use classifies depressive disorders as Category 1 (no restriction) for all progestin-only contraceptives, indicating they do not increase depressive symptoms in women with depression 8

• For women using fertility awareness-based methods, mood-altering drugs may affect cycle regularity or fertility signs, requiring careful evaluation and possibly a barrier method until effects are determined 8

• Monitor for mood changes after initiating contraception, particularly during the first 1-3 months 8

• If mood deterioration occurs with COC use, consider:

  1. Switching to a different formulation
  2. Changing to a non-hormonal or progestin-only method
  3. Trying continuous dosing to eliminate hormone-free intervals 5

Pitfalls and Caveats

• Avoid assuming that all mood fluctuations in women using hormonal contraceptives are caused by the contraceptive
• Do not overlook the potential for hormonal contraceptives to worsen pre-existing mood disorders
• Remember that approximately 24% of women on COCs may experience clinically relevant mood deterioration, though this is not significantly different from placebo (17%) 3
• The pill-free interval in COC regimens is associated with increased negative affect, anxiety, and mental health symptoms in some women 5