KEY INSIGHTS

• Hormonal birth control (hormonal IUD, oral contraceptive pill, vaginal ring, hormonal contraceptive injection, and hormonal contraceptive implant) can have impacts on a woman’s mood, mental health, and overall well-being.

• Choosing the right contraceptive is important and requires that women and their healthcare providers weigh benefits against side effects and select the best option on an individual basis.

• Many women who experience mood issues with hormonal contraceptives may benefit from using a low-dose hormonal (i.e. progestogen-only) IUD or a non-hormonal (i.e. copper) IUD.

• Gynaecology Centres Australia (GCA) is a leading private women’s health clinic in NSW with clinics in Greater Sydney, Newcastle, Gosford, and Wollongong. We perform IUD insertions under IV sedation.

Can Contraception Affect Your Mental Health?

Unquestionably, having control of one’s own body and access to a reliable form of contraception gives a woman definite peace of mind, knowing that the risk of an unintended pregnancy occurring is mitigated as much as possible.

Hormonal contraceptives have proven to be highly effective when used properly and consistently. These include both combined (oestrogen and progestogen) and progestogen-only options:

• Oral Contraceptive Pill (combined)
• Vaginal Ring (combined)
• Contraceptive injection
• Contraceptive Implant (progestogen only)
• Mini-Pill (progestogen only)
• Hormonal IUD (progestogen only)

Combined oral contraceptive pills are the most common form of contraception used by women of reproductive age.

These birth control methods can have numerous positive or therapeutic effects on the body as well as preventing pregnancy from occurring. They include:

• Reducing symptoms of premenstrual syndrome/premenstrual dysphoric disorder
• Reduced menstrual pain and lighter bleeding
• Regulating menstrual cycles
• Endometriosis management
• Management of Polycystic Ovarian Syndrome or PCOS (now called Polyendocrine Metabolic Ovarian Syndrome or PMOS)
• May prevent/alleviate menstrual migraines in some women (though in others, these can become worse. Many women who experience migraines should not use hormonal contraceptives at all – please check with your doctor)
• Reduce the risk of developing some cancers (e.g. uterine and ovarian cancer)

Like for any other medicine, there are hormonal contraception side effects, and these medicines are known to precipitate or perpetuate mood disorders in some women. You need to understand the link between contraception and mood, and what impact your choice of birth control can have on mental health.

Hormones and Brain Chemistry

Hormones work with brain chemistry as a complex communication system for the body. These include “feel-good” hormones like serotonin, dopamine, endorphins, and oxytocin; metabolic and steroid hormones like cortisol and thyroid hormones; and countless others.

Hormonal contraceptives use synthetic (man-made) forms of the hormones oestrogen and progesterone. Both of these influence neurotransmitters and the functioning of the brain, including suppressing the production of certain hormones by the pituitary gland and modulating neural function and stress response. They can also, in up to at least 10% of women, trigger symptoms of anxiety or depression.

Women who use hormonal contraceptives commonly report experiencing irritability, mood fluctuations, and even anxiety, depression, or other negative mood issues during their use. Mood changes or depression are also among the most common reasons women stop using hormonal contraceptives.

Conversely, some women find that using OCPs offers relief from mood issues associated with their menstrual cycle, as they help to stabilise brain chemistry. For these women, using a combined OCP (or vaginal ring) without the 7-day placebo period can have an overall antidepressant effect.

What the Research Says: Studies on Mood and Depression

Many researchers have explored the associationbetween hormonal birth control and mood disorders, and mounting evidence demonstrates a significant link between taking OCPs and low mood, depression, and other mood issues.

A Monash University study, for example, which considered and ranked hormonal contraceptives from best to worst in terms of mental health effects, found that there are very few OCPs on the market that do not cause depression in women who are vulnerable to it. Some women experienced mental health issues for the first time after commencing OCP use, while others who had existing depression found it became uncontrollable once they added an OCP to the mix.

This study identified the synthetic progestogen progestin as the culprit, whereas oestrogen appeared to have a generally positive impact on mood and mental well-being. These researchers concluded that oestrogen is good for mental health, while progestin (a synthetic progestogen) is generally not.

(The exception was a single pill on the market that has estradiol and nomegestrol, which is considered to be a “good” progestin.)

Using other types of combined hormonal contraceptives (vaginal ring) may have lower mental health impacts, as the dose of hormones is lower, their release into the bloodstream is continuous, and they are a gentler way of taking the hormones into the body than the systemic highs and lows that taking pills delivers.

Progestogen-only contraceptives should be used with caution in women with a history of depression or another mood disorder. The best contraceptive option for these women may be using a low-dose IUD or a non-hormonal IUD.

Choosing a Contraceptive That Works for You

A lot of older oral contraceptive pills (OCPs) are associated with severe mood issues, due to their use of the potent synthetic form of oestrogen, ethinylestradiol.

Newer formulations of OCPs contain more natural, physiological forms of oestrogen, which carry fewer side effects. They tend to be better tolerated, and their link to mood disorders is shown to be markedly weaker.

Some women may find the vaginal ring to be a more favourable option.

For women who can’t tolerate oestrogen, or who want a long-term contraceptive solution, an IUD can be an effective, reliable, and cost-efficient option lasting up to five to eight years. There are hormonal IUDs and non-hormonal IUDs, and your healthcare provider can help you determine which is right for you.

*There are no oestrogen-only forms of birth control.* This is because oestrogen can not be used without progestogen in a woman with a uterus; oestrogen on its own causes unpredictable bleeding and thickens the uterine lining (endometrium), which increases the risk of developing endometrial (uterine) cancer. The only time oestrogen can be used alone is as menopausal hormonal therapy or MHT (previously called HRT or hormone replacement therapy) in women who have had a hysterectomy (surgical procedure where uterus is removed).

Contraceptive Choice: IUD Insertion at Gynaecology Centres Australia

GCA is a private NSW women’s health provider. We offer hormonal and non-hormonal IUD insertions using IV sedation.

Maximising the comfort and well-being of the women in our care is our priority. Using IV sedation is standard practice for all IUD procedures at GCA, and we provide this sedation at no extra cost to clients for those with a Medicare card. This part of the procedure is “bulk billed” but there is a fee for the insertion. This makes us unique from other providers, many of whom offer no sedation and little pain relief at all for what can unquestionably be, at best, an uncomfortable procedure.

While some other providers do offer Penthrox™ “Green Whistle” pain management, this may be inadequate for many women’s comfort and well-being during IUD placement.

We have four NSW clinic locations:

• Sydney 02 9585 9599
• Newcastle 02 4962 4999
• Gosford 02 4324 5176
• Wollongong 02 4227 4100

To discuss your IUD options or book an appointment with us for IUD insertion under IV sedation, contact us online or call your nearest convenient clinic on the number above.