Can oral contraceptive pills (OCPs) decrease libido in women?

Oral Contraceptive Pills Can Decrease Libido in Women

Yes, oral contraceptive pills (OCPs) can decrease libido in women, with approximately 15% of women experiencing reduced sexual desire while using combined oral contraceptives. 1

Mechanisms of OCP Effects on Libido

• Synthetic progestins in OCPs may have varying effects on androgen receptors, potentially enhancing libido-reducing effects through off-target effects on both androgen and estrogen receptors 2
• OCPs increase sex hormone binding globulin (SHBG) levels, which reduces free testosterone availability - a hormone important for female sexual desire 1
• Combined OCPs containing ethinylestradiol and drospirenone have been associated with decreased libido, reduced frequency of sexual intercourse, and diminished orgasm 3
• Physical changes including decreased labia minora thickness and vaginal introitus area may contribute to increased pain during intercourse, further reducing sexual desire 3

Variations in OCP Effects on Libido

• The majority (85%) of women using combined OCPs report either no change (64%) or an increase (21%) in libido 1
• Estrogen dosage appears to influence libido effects - OCPs with 20-35 μg ethinylestradiol showed no significant difference in sexual desire, while those containing 15 μg ethinylestradiol were associated with decreased libido 1
• Different progestin types in OCPs may have varying impacts on sexual function 4
• Women with pre-existing depression, neuroticism, or history of premenstrual mood changes may be more susceptible to libido reduction while using OCPs 5

Alternative Contraceptive Options for Women Experiencing Decreased Libido

• Progestin-only pills (POPs) are not associated with the same degree of SHBG elevation and may have less impact on libido than combined OCPs 2
• Women experiencing decreased libido on combined OCPs might benefit from switching to progestin-only methods 2
• For women who need to avoid estrogen-containing contraceptives (such as those with risk factors for cardiovascular disease), progestin-only options may be preferable 6

Clinical Considerations

• When prescribing OCPs, healthcare providers should discuss potential sexual side effects with patients 4
• For women experiencing decreased libido on OCPs, consider:
  • Switching to a different OCP formulation with different estrogen/progestin balance 2
  • Trying progestin-only contraceptives 2
  • Evaluating for other contributing factors to decreased libido (relationship issues, stress, depression) 4
• Women with a history of depression or mood disorders should be monitored more closely for sexual side effects when starting OCPs 5
• Sexual side effects may be a significant reason for discontinuation of OCPs, potentially leading to unintended pregnancy if alternative contraception is not used 5

Limitations in Current Evidence

• The sexual side effects of hormonal contraceptives are not well studied, particularly regarding impact on libido 4
• Most studies show mixed effects, with individual responses varying significantly 7
• Better-designed studies are needed to establish the independent, causal effects of OCPs on libido 7