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The conversation around the side effects of hormonal birth control and contraceptive pills on mental health has been around for a while: you may have heard women recounting their negative experiences with heightened depression symptoms, or mood swings, when switching contraceptive methods. Though personal experiences are not medical research, they do warrant attention.

In 2016 a Danish study of more than 1 million women, which focused on analyzing nationwide health records, showed that women using hormonal birth control were more likely to be treated for depression. On the other side, studies conducted in the US and Finland have showed that hormonal birth control users report less symptoms of anxiety and depression. Though just what effect hormonal birth control can have on mental health differs, one thing is for sure: it does affect it.

Hormones and Mental Health

Though there are no mental health risks directly associated with the use of contraception, we do know hormones—and hormone imbalances—can have an impact on mental health. To start with, women are twice as likely as men to suffer from depression: this is a difference that starts in adolescence due to the changing levels of estrogen.

During the follicular phase, which is the time between the start of a period and ovulation, estrogen levels are high. However, individuals with depression demonstrate lower levels of estrogen at that time. Hormonal birth control is likely to affect the natural levels of hormones in someone’s body, and therefore cause mental health changes.

Types of Hormonal Contraception and their Effects

Implant

There are two types of implants: one containing the progestin etonogestrel and another containing the progestin levonorgestrel. Results of the Danish study concluded that use of the etonogestrel implant led to higher use of antidepressants, especially for teens. People using that for two years have also reported mood swings and depression attributed to the implant. The risk for depression seems to heighten with the etonogestrel implant, but studies remain somewhat inconclusive.

Hormonal IUD

The Danish study on hormonal IUD showed that adolescent IUD users were more likely to be treated for depression than adult IUD users. However, a Finnish study suggested that women using this method were just as likely to showcase symptoms of anxiety and depression as women who were not using it. Like the implant, there is some evidence that IUD increases chances of depression but no direct conclusion.

Pills

Combined Oral Contraceptives (COCc) contain both synthetic estrogen and progestin. Though the Danish study found that users of COCs aged 16-31 were more likely to be prescribed an antidepressant, several other studies have shown that birth control users are not more likely to have symptoms of depression. However, people using COCs for reasons other than birth control have been found more likely to have depression.

There are several other hormonal contraceptive methods that can potentially affect mental health, but the three examined above are the most commonly used. Results may remain inconclusive, but if you are taking a hormonal contraceptive method and you experience unusual symptoms, you may consider consulting your doctor or healthcare provider.