Which Birth Control Causes the Most Anxiety? A Pharmacological Review

A large-scale study of over one million women in Denmark identified an increased risk of depression and antidepressant use among those on hormonal birth control, especially adolescents. This raises the critical question for many users: Which birth control causes the most anxiety? Research and anecdotal evidence point toward specific hormonal components as potential culprits behind mood fluctuations.

Quick Summary

Hormonal birth control, particularly progestin-only methods and hormonal IUDs, is linked to a higher risk of anxiety and mood changes in some individuals, with effects varying widely. Progestins can negatively impact mood-regulating neurotransmitters, though combined pills may offer some protection for some users.

Key Points

• Progestin is a Key Factor: Synthetic progestin is more often linked to mood side effects like anxiety and depression than synthetic estrogen, which can be neuroprotective.

• Progestin-Only Methods Pose Higher Risk: Methods containing only progestin, such as the mini-pill, hormonal IUDs, and the contraceptive shot, are more frequently associated with increased anxiety.

• Combined Pills Have Variable Effects: Combined oral contraceptives can also affect mood, but the estrogen component may reduce the risk for some; effects are most common during the first couple of years.

• Risk is Higher for Sensitive Individuals: Those with a history of anxiety or depression are more susceptible to experiencing mood changes on hormonal birth control.

• Response is Highly Individual: The effect of any birth control method on anxiety varies significantly from person to person, making a 'trial and error' approach sometimes necessary.

• Non-Hormonal Options are Available: Non-hormonal methods like the copper IUD or condoms offer effective contraception without the risk of hormonal mood fluctuations.

• Communication with a Doctor is Critical: Openly discussing your mental health history and any mood changes with a healthcare provider is essential for finding the right contraceptive.

Understanding the Hormonal Link to Mood

Hormonal contraceptives work by introducing synthetic versions of estrogen and progestin into the body. These hormones influence the brain's neurotransmitter systems, such as those involving serotonin and gamma-aminobutyric acid (GABA), which are key for regulating mood. The way a person's brain chemistry responds to these synthetic hormones, particularly the progestin component, is what can lead to mental health side effects like anxiety.

The Role of Progestins

Unlike estrogen, which can have neuroprotective effects, progestins have been shown in some studies to potentially worsen mood symptoms. Some progestins, like those used in progestin-only pills (mini-pills) and high-dose hormonal IUDs, can increase monoamine oxidase, which leads to decreased serotonin concentrations—a key factor in mood regulation. This disruption is a primary reason why progestin-heavy methods are most often flagged in relation to mood-related side effects.

Combination Pills and the Estrogen Factor

Combined oral contraceptives (COCs) contain both synthetic estrogen and progestin. For some individuals, the presence of estrogen may help balance the progestin's effects on mood, leading to more stable emotional states or even improvement in pre-existing mood issues related to their natural cycle. However, a subgroup of users remains susceptible to negative mood effects, especially during the first few years of use.

Methods With the Highest Anxiety Correlation

Based on clinical research and user reports, certain types of hormonal birth control appear to have a stronger association with anxiety and other mood disturbances. These include:

• Progestin-Only Pills (Mini-Pill): For women sensitive to hormonal shifts, the constant, low dose of progestin can trigger mood swings and anxiety. This is in contrast to the combined pill, which includes estrogen that might mitigate these effects.
• Hormonal Intrauterine Devices (IUDs) (e.g., Levonorgestrel): Studies have shown a positive association between the use of levonorgestrel-containing IUDs and the onset or worsening of anxiety and depression. This is significant because it challenges the long-held belief that hormonal IUDs only have localized effects.
• The Contraceptive Injection (Depo-Provera): The injectable progestogen (medroxyprogesterone acetate) has been linked to greater depressive symptoms in users compared to non-users. The sustained, high dose of hormone can have a more pronounced effect on mood.
• The Vaginal Ring (e.g., NuvaRing): While some studies suggest less mood impact than the pill, certain users still report emotional side effects.

Noteworthy Progestin: Drospirenone

The progestin drospirenone is particularly interesting because it has both progestogenic and anti-androgenic effects. While formulations containing drospirenone are used to treat premenstrual dysphoric disorder (PMDD), some users report experiencing increased anxiety while on it. The dual potential for both negative and positive mood effects highlights the deeply personal nature of hormonal response.

Who is Most at Risk?

Several factors can increase an individual's susceptibility to birth control-induced anxiety:

• History of Mental Health Conditions: Those with a pre-existing history of anxiety, depression, or other psychiatric conditions are significantly more likely to experience worsening mood symptoms on hormonal contraception.
• Adolescents: Teenagers, whose brains are still developing, appear to be more susceptible to mood-related side effects, according to some studies.
• High Hormone Sensitivity: Some individuals are simply more sensitive to hormonal fluctuations, making them more vulnerable to the psychological effects of hormonal birth control.
• The First Few Months: The adjustment period is critical. Mood changes are most likely to occur in the first few months and years of starting a new hormonal method.

Comparison of Birth Control Methods and Anxiety Risk

Method	Hormonal Composition	Potential for Anxiety	Notes
Combined Pill	Estrogen & Progestin	Moderate	Variable; estrogen may offset progestin, but risk exists, especially early on. Lower-dose pills may be better tolerated.
Progestin-Only Pill	Progestin	Higher	More frequently linked to negative mood changes and anxiety in susceptible individuals.
Hormonal IUD	Levonorgestrel (Progestin)	Moderate to Higher	Research shows a link to anxiety and depression, challenging previous assumptions about localized effects.
Contraceptive Shot	Progestin (High Dose)	Higher	Associated with greater depressive symptoms in some users.
Vaginal Ring	Estrogen & Progestin	Moderate	Side effects vary, with some suggesting less mood impact than the pill, though not risk-free.
Non-Hormonal IUD	Copper	Lowest (None)	Contains no hormones, so it has no direct effect on neurotransmitters or mood.

Managing Birth Control-Related Anxiety

If you believe your birth control is contributing to anxiety, it's crucial to act. Here are some steps you can take:

• Track Your Symptoms: Keeping a diary of your mood, anxiety levels, and other symptoms can provide valuable information for your healthcare provider.
• Consult Your Healthcare Provider: Have an open and honest conversation with your doctor about your concerns. They can help you explore alternative options, including different hormonal formulations or non-hormonal methods.
• Consider a Non-Hormonal Method: For those who are highly sensitive to hormones or have a history of mental health struggles, a copper IUD or barrier methods like condoms are excellent alternatives that eliminate hormonal mood effects.
• Explore Lifestyle Modifications: Techniques such as mindfulness, deep breathing exercises, regular physical activity, and a balanced diet can help manage stress and anxiety, regardless of your contraceptive choice.
• Consider Mental Health Support: A mental health therapist can provide coping strategies and support, particularly if you have an underlying anxiety disorder that may be exacerbated by hormonal changes.

Conclusion

While no single birth control method is guaranteed to cause the most anxiety in all users due to highly individual responses, evidence suggests that progestin-only and high-progestin methods, such as the mini-pill, hormonal IUDs, and the injection, pose a higher risk for some individuals. Combined pills may offer a more balanced profile for certain people, but can still trigger anxiety, especially in the first couple of years. The best approach is a personalized one, where individuals discuss their mental health history and concerns with a healthcare provider to find the most suitable contraceptive. Your experience is valid and should be taken seriously when making a decision about your reproductive health.

For more detailed clinical information on the mental health effects of contraceptives, see the NIH resource here: Hormonal contraception and mood disorders - PMC.

Frequently Asked Questions

Can hormonal birth control cause or worsen anxiety?

Yes, hormonal birth control can cause or worsen anxiety for some individuals. The synthetic hormones, particularly progestins, can affect neurotransmitters in the brain that regulate mood, such as serotonin.

Which specific types of birth control are most likely to cause anxiety?

Progestin-only methods like the mini-pill, hormonal IUDs (containing levonorgestrel), and the contraceptive injection (Depo-Provera) have been most strongly associated with increased anxiety and depressive symptoms in studies and user reports.

Does anxiety from birth control go away?

For many, mood changes and anxiety are most pronounced during the first few months of starting a new hormonal method while the body adjusts. However, if symptoms persist, it's a sign that the medication may not be the right fit for your body.

Are there non-hormonal birth control options that don't cause anxiety?

Yes, non-hormonal methods such as the copper IUD and barrier methods like condoms do not introduce synthetic hormones into the body and therefore do not cause mood-related side effects like anxiety.

How can I tell if my anxiety is caused by birth control?

You can track your symptoms in a diary, noting any changes in your mood, worry, or irritability since starting your contraception. If there's a clear temporal link, discuss this with your doctor. Remember that other factors can also influence mood.

What should I do if I think my birth control is causing anxiety?

Consult a healthcare provider to discuss your symptoms and explore alternative birth control options. They can help you decide whether switching to a different hormonal formulation or a non-hormonal method is the best course of action.

Can birth control be used to treat anxiety or mood issues?

In some cases, particularly for those with conditions like PMDD, some hormonal birth control (such as specific combined pills containing drospirenone) can help stabilize hormones and alleviate mood symptoms. However, this is not a universal effect and depends on the individual.