What can be done to alleviate increased emotional changes prior to menstrual cycle in individuals taking birth control (Contraceptives)?

Managing Emotional Changes Prior to Menstrual Cycle While on Birth Control

For women experiencing increased emotional changes prior to their menstrual cycle while on hormonal contraceptives, a hormone-free interval of 3-4 days can be recommended to alleviate symptoms, though this should not be done during the first 21 days of using continuous or extended combined hormonal contraceptives or more than once per month. 1

Understanding Emotional Changes on Birth Control

Emotional changes before menstruation while on birth control are common and can be addressed through several evidence-based approaches:

Causes of Emotional Changes

• Women with ongoing or past self-reported adverse mood effects from combined oral contraceptives (COCs) have a significantly increased prevalence of mood disorders 2
• Some research suggests emotional side effects may be related to both pharmacological properties of hormones and psychological responses to contraception 3
• Hormonal contraceptive users can experience higher rates of depression, anxiety, fatigue, and neurotic symptoms compared to non-users 3

Differences Between Contraceptive Methods

• Combined oral contraceptive (COC) users report fewer mood shifts between depression and elation in the mid-luteal phase compared to naturally cycling women 4
• OC users have shown decreased affect variability, indicating a potential emotional stabilizing effect 4
• Different hormonal contraceptives affect emotion regulation differently - oral contraceptive users show different neurophysiological patterns during emotion processing compared to women with natural cycles 5

Management Strategies

1. Hormonal Management

• For unscheduled bleeding or emotional changes with extended/continuous combined hormonal contraceptives:
  • Discontinue combined hormonal contraceptive use for 3-4 consecutive days (hormone-free interval) 1
  • Do not implement a hormone-free interval during the first 21 days of using continuous or extended combined hormonal contraceptives 1
  • Do not use a hormone-free interval more than once per month as contraceptive effectiveness might be reduced 1

2. Contraceptive Adjustment Options

• If emotional symptoms persist and are unacceptable:
  • Consider switching to a different contraceptive method 1
  • Progestin-only pills may be appropriate for women who have contraindications to estrogen or experience significant mood effects with combined hormonal contraceptives 6

3. Adherence Strategies

• Ensure correct and consistent use of the contraceptive method:
  • Follow recommendations for missed pills, patch detachment, or ring removal to maintain hormonal stability 1
  • Inconsistent use can lead to hormonal fluctuations that may worsen mood symptoms 1

4. Coping Strategies

• Women with premenstrual symptoms may benefit from situational redefinition as a coping process during the premenstrual phase 7
• Address perceptual and coping processes that may influence the manifestation of premenstrual symptoms 7

When to Consider Changing Methods

Consider switching contraceptive methods if:

• Emotional changes persist despite the above interventions 1
• Symptoms significantly impact quality of life 1
• The woman finds the symptoms unacceptable 1

Important Caveats and Considerations

• Blood pressure should be measured before initiating any hormonal contraceptive method 1, 6
• Women with severe hypertension (≥160/100 mmHg) or vascular disease should not use combined hormonal contraceptives 6
• Emotional side effects are one of the major reasons for discontinuation of combined oral contraceptive pills 2
• Counseling about expected side effects, including emotional changes, should be provided before initiating contraceptives 1
• Enhanced counseling about expected patterns and reassurance that irregularities are generally not harmful has been shown to reduce method discontinuation 1

Remember that contraceptive choice is a personal healthcare decision, and respecting a woman's autonomy in making reproductive choices is essential 6. Regular follow-up to assess efficacy and side effects is recommended to ensure the chosen method continues to meet the woman's needs.