by Dr Sophie Genoni of Femma
It is well known that hormones can affect a woman’s mood and mental health. The complex changes and fluctuations in hormone levels throughout a woman’s menstrual cycle can have both positive and negative impacts on mood. Understandably, women may be concerned about the impact of the different contraceptives on their hormones, and how this might affect their mood.
Combined oral contraceptive pills
The combined oral contraceptive pills (also known as ‘the Pill’) contain oestrogen and progestogen hormones. Oestrogen and progesterone are hormones involved in the menstrual cycle, and naturally fluctuate throughout a woman’s cycle which can cause mood changes.
There is no clear evidence that taking the Pill worsens mood and mental health, including those suffering from mental health disorders such as depression and bipolar disorder. Taking the Pill provides more stable hormonal levels across the month compared to a woman’s natural hormonal fluctuations, which may result in less noticeable mood changes for some women.
Majority of women experience pre-menstrual symptoms (PMS) leading up to their period, including mood changes. Some women experience more prominent mood changes at this time, and a small percentage of women have severe mood symptoms called pre-menstrual dysphoric disorder (PMDD). Most of the Pills have not been shown to improve PMS and PMDD symptoms when taken in the traditional cyclical way. The exception to this is the Pill containing the progestogen drospirenone, which has been shown to improve mood symptoms and function in the pre-menstrual time. Another option for women who experience PMS or PMDD is to take the Pill in an extended use regimen, or ‘skipping periods’. This provides more stable hormonal levels and avoids the rise and drop in progesterone that occurs prior to a woman’s period. It has been shown that skipping periods is safe for women to do, and does not impact future fertility.
Progestogen only pills
The progestogen only pills are a suitable option for women who cannot take oestrogen due to medical conditions, medications or other factors. There are several different progestogens available, however they all work by thickening the cervical mucous so that sperm cannot travel into the uterus. Mood changes can unfortunately be a relatively common hormonal side effect with progestogens given on their own. However, because the hormones from tablets do not last long in our systems after stopping, these mood changes should not last if the progestogen only pill is stopped.
The contraceptive injection is a long acting injection of a progestogen hormone, that lasts for 12 weeks.It works by thickening the cervical mucous, thinning the uterus lining, and in some women it can prevent ovulation. Like the progestogen only pills, mood changes can be a common side effect. Because the injection last for 12 weeks, any troublesome mood changes are likely to also persist for this time. For this reason, it may not be the most suitable choice for women who have experienced troublesome mood changes as a side effect of progestogens before, or with a history of moderate or severe mental health conditions.
The contraceptive rod is a device that is inserted under the skin and contains the progestogen etonogestrel. The hormone is slowly released over 3 years, and works by inhibiting ovulation and thickening cervical mucous. There is some suggestion that etonogestrel has more impact on mood than other progestogens, although there is no clear evidence to support this. However, mood changes is a common side effect reported with use of the contraceptive rod. For women who experience troublesome mood changes on the rod and wish to have it removed for this reason, the effect of the etonogestrel will resolve within weeks of removal.
Progestogen containing IUD
Progestogen intra-uterine devices (IUD) contain a hormone called levonorgestrel. This progestogen acts locally on the lining of the uterus to make it unsuitable for implantation of an embryo, and also inhibits movement of the sperm and egg. In some women it can inhibit ovulation, but this is less common. Whilst most women do not experience systemic absorption of the progestogen, some women may have a small amount of systemic absorption accompanied by hormonal side effects including mood changes.
An alternative choice for women who would prefer to avoid this small chance of hormonal side effects would be to consider the new lower dose progestogen containing IUD, as this would have an even smaller risk of causing mood changes. The standard progestogen containing IUD has 52 milligrams of levonorgestrel, whereas the lower dose option contains 12.5 milligrams.
The copper IUD is an option for women who are not suitable for hormonal contraceptives, or who desire a contraception that contains no hormones. Copper IUDs work by preventing sperm from fertilising the egg, and making the lining of the uterus unsuitable for implantation of an embryo. It has no effect on a woman’s reproductive hormones or mood.
Women with pre-existing mental health conditions may find that their mood symptoms iimpact their ability to remember to take a contraceptive. They may find that a longer acting contraception is preferable to a contraceptive that requires daily dosing.
It is also important to consider that women who are sexually active may worry about the possibility of an unplanned pregnancy, and this stress can impact their mood. Using effective contraception to prevent an unplanned pregnancy can relieve stress and empower women to take control of their contraceptive choices.
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Australian Medicines Handbook. 2022. Etonogestrel (Accessed: https://amhonline.amh.net.au/auth)
Australian Medicines Handbook. 2022. Progestogens (Accessed: https://amhonline.amh.net.au/auth)
Family Planning NSW. 2022. Copper IUD (Accessed: https://www.fpnsw.org.au/health-information/individuals/contraception/copper-iud)
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