My nightmare on the pill

Millions of women rely on the contraceptive pill and many are happy with it – but some find it has a devastating effect on their mental health. Here Vicky Spratt, deputy editor of The Debrief, describes years of depression, anxiety and panic as she tried one version of the pill after another.

I sat in the GP’s office with my mum and told her that I’d been having my period for three weeks. She told me that the contraceptive pill might help. She warned that it wouldn’t protect me from sexually transmitted infections and told me that if I had unprotected sex I could get cervical cancer, so I’d best use it wisely. She had to say that, though I was 14 and sex was very much not on the agenda.

My prescription was printed in reception. And then, a three-month supply of the combined pill was mine. Picking up the green foil-covered packets full of tiny yellow pills felt like a rite of passage – I was a woman now. In the plastic pockets was the sugar-coated distillation of feminism, of women’s liberation, of medical innovation.

Image copyright Vicky Spratt

This is where it all began, 14 years ago. I then played what I call pill roulette for more than a decade, trying different brands with varying degrees of success and disaster. It was around this time that I also developed anxiety, depression and serious mood swings which, on and off, have affected me throughout my adult life.

Relationships have ended and I had to take a year out from university – I thought that was just “who I was”, a person ill-equipped for life, lacking self-confidence and unhappy. It wouldn’t be until my early 20s, after graduating from university – when my mental health problems and behaviour could no longer be dismissed as those of a “moody teenager” – that I would seriously question whether it was linked to my use of the pill.

Image copyright Thinkstock

Pill varieties

  • There are two main kinds of pill: the combined pill – which combines oestrogen and progestogen (a synthetic form of progesterone) – and the progestogen-only pill (POP) or mini-pill
  • There are many brands of the combined pill – the dose may differ, and the relative amounts of oestrogen and progestogen
  • There are also different types of the progestogen-only pill, making use of different progestogens, such as norethistorone or desogestrel
  • Women who have problems with one pill may find another has no side effects

One day in the early hours, sitting at my laptop, unable to sleep because of a panic attack which had lasted overnight, I began to Google. I had started taking a new pill, a progestogen-only pill (POP) which had been prescribed because I was suffering from migraines, and the combined pill is not safe for people who suffer from migraines with aura.

I tapped the name of the pill + depression/anxiety into the search engine and the internet did the rest. There it was: forum threads and blog posts from people who were experiencing the same symptoms as me.

At this point I had already seen my GP several times, following the sudden onset of debilitating panic attacks, which I had never experienced before. At no point had my contraceptive pill come up in conversation, despite the fact that the attacks had started when I switched to the new contraceptive. Instead, I was prescribed a high dose of beta blockers, used to treat anxiety, and it was recommended that I should undergo cognitive behavioural therapy (CBT).

I lived like this for somewhere between six and eight months – I can’t tell you exactly because that year of my life is a blur, recorded by my mind in fast-forward because of the constant sense of urgency and impending doom that coursed through my veins.

Media playback is unsupported on your device Media captionListen to Vicky Spratt on Woman’s Hour

Find out more

The Debrief carried out an investigation, surveying 1,022 readers, aged 18-30

  • 93% had taken or were taking the pill
  • Of these, 45% had experienced anxiety and 45% had experienced depression
  • 46% said taking the pill had decreased their sex drive
  • 58% believed that the pill had a negative impact on their mental health – 4% believed it had a positive effect

The Debrief’s investigation in full

I wish, wholeheartedly, that I could look back on this and laugh. That’s how all good stories end, isn’t it? But there was then, and is now, nothing funny about what I went through. It was terrifying. I was scared. I didn’t recognise myself, I didn’t like myself and I couldn’t live my life. I didn’t know what to do, who to turn to or whether it would ever end. I was not only anxious but lethargic, I felt completely useless. I blamed myself.

At the time, convinced that I had lost my mind and feeling as though I was having an out-of-body experience, I explained to my GP that “I felt like someone else”, as though my brain “had gone off and gone mouldy”.

“Do you think this could have anything to do with my new pill?” I asked. I remember the look on her face, an attempt to look blank which barely concealed a desire to tell me I was ridiculous. I explained to her that I had felt awful on every single one of the six or seven pills I’d taken up until that point, with the exception of one high-oestrogen combined pill which made me feel like superwoman for a year, before it was taken away from me (partly because of the migraines and partly because of an increased risk of thrombosis with continued use).

She told me, categorically, that my new pill was not the problem.

But, disobeying both her and my therapist, I stopped taking the progestogen-only pill.

I can only describe what happened next as the gradual and creeping return of my sense of self. After three or four weeks I also stopped taking the beta blockers. To this day, I still carry them with me. They’re in every handbag I own, a safety net should I fall off the enormous cliff of my own mind again. In three-and-a-half years I have never had to take them.

My problems didn’t disappear overnight, of course, but I did stop having panic attacks. I haven’t had one since. I feel low from time to time, anxious and stressed but it’s nowhere near on the same scale as what I experienced while taking the progestogen-only pill. I felt joy again, my libido returned and I stopped feeling terrified of absolutely everything and everyone.

Image copyright Vicky Spratt

A year after the panic attacks subsided I sat on a faraway beach, after taking a solo long-haul flight halfway round the world. This would have been unthinkable the previous year. As I sat there, underneath a tropical electrical storm, I cried with relief. Relief that I was myself again, relief that I had control of my own mind once more and relief that I hadn’t been wrong, that I knew myself better than doctors had made me feel I did.

Now 28, I no longer use hormonal contraception and with the exception of mild mood swings in the 48 hours before my period I am, touch wood, free of anxiety, depression and panic attacks.

In the years that have passed since I lost myself on the progestogen-only pill and found myself again on a South Asian beach, this issue has been gradually receiving more and more attention. Holly Grigg Spall’s book, Sweetening The Pill, published in 2013, put the effects of hormonal contraception on women’s mental health firmly on the agenda.

Since then a study, overseen by Prof Ojvind Lidegaard at the University of Copenhagen, found that women taking the pill – either the combined pill or the progestogen-only pill – were more likely to be prescribed an antidepressant than those not on hormonal contraception. The difference was particularly noticeable for young women aged between 15 and 19 on the combined pill.

Lidegaard was able to conduct this research because he had access to medical records for more than a million Danish women aged 15-34.

Following the publication of Prof Lidegaard’s study I sent a freedom of information request to the NHS, in my capacity as a journalist at The Debrief. I knew, from the number of our readers who write to us on a near-daily basis about this issue, that significant numbers of women were suffering. I asked the NHS whether they knew how many women were taking antidepressants or beta blockers concurrently. They told me that their systems do not yet allow them to collect this data.

The pill and depression

Prof Helen Stokes-Lampard, Chair of the Royal College of GPs, says: “There is an established link between hormones and mood, both positive and negative, but for the vast majority of women, the benefits of reliable contraception and regulation of their menstrual cycle outweigh any side effects, and many women report that taking hormones actually boosts their mood.

“If a woman believes her contraception might be adversely affecting her mood, she should discuss it with a healthcare professional at her next routine appointment.”

See also: How risky is the contraceptive pill?

Depression is listed as a known but rare side effect of the hormonal contraceptive pill, it’s there in the small but hefty leaflet you get in the packet. The NHS website lists “mood swings” and “mood changes” but not explicitly depression, anxiety or panic attacks.

We shouldn’t throw our pill packets away but neither should we accept negative side effects which impinge on our day-to-day lives. We can’t make informed choices without information. We need better research into how hormonal contraception can affect women’s mental health, better ways of monitoring reactions in patients, more awareness and support for those who do experience serious side effects. No woman should feel dismissed or ignored.

Vicky Spratt is deputy editor of The Debrief, a website for women in their 20s. Its investigation, Mad About The Pill, launched on Wednesday.

Listen to the discussion on BBC Radio 4’s Woman’s Hour

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The oral contraceptive pill is a popular choice among women, with about 100 million individuals worldwide using it. There’s no denying it revolutionised female sexual health, and while the health effects (both good and bad) associated with the birth-control pill are well documented – reduced risk of ovarian cancer, improvement in skin health, an increased chance of breast cancer, etc – there has been limited research into its connection to anxiety.

So, if you’re questioning why symptoms of anxiety now plague your day, read on.

Does the pill cause anxiety?

A study published in Human Brain Mapping found a link between the pill and your mental state. Scientists at the University of California, Los Angeles, studied 90 women – 44 of whom were on the pill. The researchers compared the thickness of different areas of the brain between the two groups.

They found that two specific regions of the brain – the lateral orbitofrontal cortex and the posterior cingulate cortex – appeared to be thinner in those on the pill, compared with those on their natural cycles. A bit of background: the lateral orbitofrontal cortex is what helps us regulate emotions in response to external stimuli, while the posterior cingulate cortex helps us to evaluate our internal state of mind.

And given that sex hormones strongly influence the brain and the nervous system, it makes sense that the pill could be the reason some women experience symptoms of anxiety and depression.

The study is far from conclusive, so don’t throw out your pill packet just yet.

However, Dr Geetha Venkat of Harley Street Fertility Clinic agrees that there could be an indirect link: ‘Common side effects of the pill include mood swings. However, in women who are prone to anxiety, depression, panic attacks or other mental symptoms, the Pill may amplify these symptoms and increase their severity.’

Can the pill affect your mood?

The Debrief* launched their own investigation into the link between the pill and mental health. They surveyed 1,022 readers, aged 18-30. They found:

  • 93% had taken or were taking the pill
  • Of these, 45% had experienced anxiety and 45% had experienced depression
  • 46% said taking the pill had decreased their sex drive
  • 58% believed that the pill had a negative impact on their mental health – 4% believed it had a positive effect

A study at the University of Copenhagen seemingly backs up their findings. They discovered that women taking the pill – either the combined pill or the progestogen-only pill – were more likely to be prescribed an antidepressant than those not on hormonal contraception.

But promotion to bin pills this is not. Rather, it’s essential coverage of a conversation that needs more voices. For instance, look inside your pill packet and you’ll notice ‘depression’ is listed as a side effect of the pill on the pamphlet. But click over to the NHS website and the repercussions of popping the pill are played down (“mood swings” and “mood changes” are what they refer to).

Period Power amazon.co.uk £9.17

So if you have experienced (or have a family history of) anxiety or depression, do speak to your GP. You are not alone and you might find the new forms of non-hormonal contraception such as period trackers might suit you better.

* The Debrief closed in 2018.

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6 Surprising Causes of Anxiety and Anxiety Disorders

February 12, 2019

Common causes of anxiety include financial hardship, public speaking, and stress at home, work, or school. Experiencing some anxiety every now and then is normal and happens to everyone. However, anxiety that lasts longer than 6 months can indicate the presence of one or more anxiety disorders, which can be caused by a range of factors outside of everyday stressors.

If you’ve been suffering from symptoms of anxiety for longer than 6 months, it’s possible there may be a more serious underlying problem contributing to your disorder. Here are 6 surprising causes of anxiety and anxiety disorders that may be driving your symptoms.

1. Caffeine

Caffeine is a stimulant that increases blood pressure and the body’s production of the fight-or-flight hormones cortisol, epinephrine, and norepinephrine. Even those who consume caffeine sporadically can experience these effects and suffer worsened anxiety and panic attacks. If you have anxiety and consume caffeine products such as coffee, tea, sodas, energy drinks, or caffeine pills, try cutting back on your intake to see if symptoms improve.

2. Weight Loss Supplements

Many ingredients in weight loss supplements have been found to contribute to anxiety. For instance, guarana and green tea extracts are common ingredients in weight loss supplements that contain high amounts of caffeine; while Saint John’s wort produces side effects including fatigue, sexual dysfunction, and anxiety. Before purchasing any weight loss supplement, read the ingredients label and do some research to determine whether any of the ingredients can trigger or worsen anxiety.

3. Prescription Medications

Certain medications interact with the body in ways that can trigger anxiety. For instance, ADHD medications that contain amphetamine work as stimulants to improve concentration and make you feel more alert, but can also cause side effects of restlessness and anxiety. Birth control pills contain synthetic hormones that cause imbalances in brain chemicals like serotonin, dopamine, and GABA that play a role in anxiety.

Decongestants, antibiotics, and NSAIDs are other commonly used medications that can cause anxiety. If you’re taking any medicines that list anxiety as a side effect, ask your doctor about options for other treatments.

4. Heart Problems

An estimated 30 percent of people who experience a major cardiac event suffer elevated levels of anxiety for up to one year following the event. Many studies reveal that anxiety is significantly linked to poor cardiac outcomes, including death and recurring cardiac events like a heart attack. At the same time, those who suffer anxiety are at increased risk for heart problems because anxiety can cause related symptoms of chest pain, rapid heart rate, and heart palpitations. If you suffer anxiety and/or heart problems, see a cardiologist immediately so you can improve and reduce your risk for one or both conditions.

5. Poor Nutrition

People who suffer mood disorders like depression and anxiety are shown to practice poor nutritional habits and eat diets high in fat and sugar. High-sugar diets can cause imbalances in a range of hormones including insulin, leptin, serotonin, and dopamine to trigger anxiety and anxiety disorders. Increase your intake of healthy foods like fruits and vegetables and cut back on fried foods, desserts, and other foods high in fat and sugar.

6. Substance Abuse

People who suffer from substance abuse disorders are roughly twice as likely to also suffer from anxiety and anxiety disorders. Long-term use of drugs and alcohol can upset the brain’s production of neurotransmitters like GABA, dopamine, and serotonin — increasing the risk of anxiety. If you need help recovering from substance abuse, ask your doctor about treatment programs that can also treat your anxiety disorder.

Healthcare Associates of Texas offers a range of mental health services that can help you overcome anxiety, depression, and substance abuse disorders. Request an appointment today or contact us at (972) 258-7499 to begin the treatment process.

Posted in: Uncategorized

Premenstrual Syndrome (PMS)

Medically reviewed by Drugs.com. Last updated on May 31, 2019.

  • Health Guide
  • Disease Reference
  • Care Notes
  • Medication List
  • Q & A

What Is It?

Premenstrual syndrome (PMS) is a collection of symptoms that many women experience during the one to two weeks before a menstrual period. These symptoms may be physical, psychological and emotional. They disappear soon after the start of menstrual bleeding.

Researchers are not certain what causes PMS. The most popular explanation is that PMS symptoms are related to cyclic changes in:

  • Female sex hormones

  • Pituitary hormones

  • Prostaglandins

  • Certain brain chemicals (neurotransmitters)

There is some evidence that magnesium deficiency could play a role.

Lifestyle may play a significant role in PMS. PMS symptoms appear to be most troubling in women who:

  • Smoke

  • Lead stressful lives

  • Rarely exercise

  • Sleep too little

  • Have a diet high in:

    • Caffeine

    • Alcohol

    • Salt

    • Red meat

    • Sugary foods

However, it’s not clear whether these factors increase your risk of PMS or if PMS accounts for these differences in lifestyle. For example, it is more likely that PMS causes stress rather than that stress causes PMS.

Medications may exaggerate the symptoms of PMS. Oral contraceptives cause symptoms of PMS in some women. However, in some women, symptoms improve or disappear while using birth control pills.

There is some controversy in the medical community about the difference between premenstrual discomfort and true PMS. Premenstrual discomfort is fairly common among women of childbearing age. It affects about three-quarters of all menstruating women.

However, fewer than one in ten women have symptoms that are severe enough to disrupt their personal relationships or interfere with their work and home responsibilities. Some doctors feel that only women who have such severe symptoms have true PMS.

Other doctors use a less stringent definition for PMS. Their definition includes mild to moderate symptoms.

Severe mood symptoms are sometimes named premenstrual dysphoric disorder (PMDD).

Symptoms

Symptoms of PMS fall into two general categories:

Physical symptoms

  • Bloating

  • Breast tenderness

  • Swelling of feet and ankles

  • Fluid retention and weight gain

  • Painful uterine cramps just before and during the first few days of menstruation

  • Headaches

  • Food cravings (especially for salty or sweet foods)

  • Acne breakout

  • Low energy or fatigue

  • Palpitations

  • Dizziness

  • Backaches or muscle pain

Psychological and emotional symptoms

  • Fatigue

  • Mood swings

  • Irritability

  • Depression

  • Aggressiveness or hostility

  • Crying spells

  • Difficulty concentrating

  • Increased appetite

  • Forgetfulness

  • Changes in sexual desire

The specific symptoms of PMS vary from woman to woman. But the top three complaints are irritability, fatigue, and bloating.

Diagnosis

Your doctor will ask you about:

  • Your PMS symptoms

  • The timing of these symptoms in relation to your menstrual period

  • The regularity of symptoms (every month, every other month, etc.)

Your doctor also will ask about the general quality of your life. Questions may include:

  • Are you feeling sad, tense, or anxious lately?

  • Do you notice mood swings? Fatigue? Difficulty concentrating?

  • Are you having difficulties with your spouse, family members or coworkers?

  • Are you so rushed that you sleep poorly and skip meals?

  • Do you live a sedentary life with little exercise?

  • Do you smoke cigarettes?

  • Do you drink alcohol or caffeinated beverages?

  • Is your diet high in red meat, salty foods or sugar?

Next, your doctor will review your medical history. He or she will ask about any medications that you are taking.

Then, your doctor will examine you. He or she will do a pelvic exam with a Pap smear.

No single physical finding can confirm the diagnosis of PMS. But a thorough physical exam can check for other medical problems. These may include hypothyroidism or a tumor of the breast, brain or ovary.

Similarly, no single laboratory test can confirm that you have PMS. But blood tests can rule out medical disorders. These may include hypoglycemia, hypothyroidism or other hormonal problems that may be causing your symptoms.

If there are no physical findings and your laboratory test results are normal, then your doctor may ask you to keep a daily record of your PMS symptoms. You will do this for two or three months. This record will include:

  • Type of symptoms

  • Severity of symptoms

  • Timing of your menstrual periods

  • A description of any special stresses that have affected your life

Once this record is complete, your doctor will review the information. If your symptoms follow a pattern that is consistent with PMS, then this will help to establish the diagnosis.

Generally, premenstrual symptoms must be absent for about two weeks to qualify for the diagnosis of PMS. Symptoms will be absent from shortly after the start of menstruation until the next ovulation.

Expected Duration

PMS can be a long-term condition. In some women, symptoms of PMS flare up before every menstrual period. This pattern continues until menopause. Menopause is the age-related end to menstrual cycles.

In other women, PMS symptoms seem to decrease after age 35.

Prevention

Because doctors are not exactly sure what causes PMS, there is no way to prevent it. However, you may be able to alleviate some PMS symptoms by leading a healthier lifestyle.

Treatment

The treatment of PMS depends on:

  • The severity and type of symptoms

  • How bothersome they are

For example, your symptoms may be mild. They may not interfere with your daily life or personal relationships. In this case, your doctor may suggest that you try one or more of the following lifestyle changes:

  • Exercise regularly, aim for at least 30 minutes most days of the week.

  • Do not skip meals. Follow a regular meal schedule to maintain a more stable blood sugar level.

  • Eat a balanced diet that is low in refined sugars.

  • Try to get a good night’s sleep. Avoid staying up all night.

  • If you smoke, quit.

  • Cut down on caffeine, alcohol, red meat and salty foods.

  • Practice stress reduction techniques. Take a nice long bath. Or, try meditation or biofeedback.

Your doctor also may suggest taking supplements of vitamin B6, calcium or magnesium. Always follow the dosage recommended by your doctor. Do not take more than 100 milligrams per day of vitamin B6. Nerve damage has been associated with vitamin B6 at high doses.

If your symptoms are moderate to severe, your doctor probably will prescribe medications. These medications are aimed at relieving specific symptoms.

For example, if you are troubled by bloating and weight gain, your doctor may prescribe a diuretic. This will help your body eliminate the excess water. Oral contraceptives, especially those that contain both estrogen and progestin, may minimize the severity of cramps and the length of your period.

Your doctor may suggest that you try an antidepressant medication. This is likely if you have symptoms that interfere with your work or home responsibilities or your personal relationships. These symptoms may include irritability, social withdrawal, angry outbursts or depression.

The most effective antidepressants for relieving PMS are selective serotonin reuptake inhibitors (SSRIs). Examples of SSRIs include:

  • Fluoxetine (Prozac, generic versions)

  • Sertraline (Zoloft, generic versions)

  • Citalopram (Celexa, generic versions)

Other antidepressants include nefazodone (Serzone) and venlafaxine (Effexor). These can be taken for two weeks prior to each period or can be taken every day.

Less commonly, your doctor may prescribe a medication that causes the ovaries to stop producing estrogen, so that ovulation stops. This is usually reserved for very severe symptoms, or when other medications fail. Danocrine (Danazol) is a synthetic androgen. It suppresses the hormones in the brain that trigger ovulation. Gonadotropin-releasing hormone (GRNH) agonists, such as leuprolide (Lupron), create a temporary menopausal state. They do this by suppressing hormones that control the production of ovarian hormones and ovulation.

These medications are generally used for short periods of time. They commonly lead to hot flashes and other symptoms of menopause. If therapy needs to continue for more than six months, you will also have to take estrogen to prevent bone loss.

Whether your symptoms are mild or severe, it always helps to have your family’s understanding and support while you are being treated for PMS. Your doctor will encourage you to speak frankly with family members about your symptoms and your PMS treatment.

When To Call A Professional

Call your doctor if your premenstrual symptoms:

  • Cause you significant distress or discomfort

  • Make it hard for you to function in daily life

  • Interfere with your personal relationships

If you think you are in danger of causing harm to yourself or others, call your doctor for an emergency appointment.

Prognosis

In most women, PMS symptoms begin to subside after age 35. They end at menopause. Women who have PMS or PMDD are at greater risk of developing depression.

Learn more about Premenstrual Syndrome (PMS)

Associated drugs

  • Premenstrual Syndrome

IBM Watson Micromedex

  • Premenstrual Syndrome

External resources

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer

Can you still get PMS if you’re on the birth control pill?

“Some women report that birth control actually exacerbates PMS symptoms, while other women get relief from PMS symptoms who are on birth control,”

Dr. Wider goes on to completely school us on the A-Zs of birth control, explaining why it can eliminate symptoms of PMS for some.

“The luteal phase of your cycle prepares the body to bleed. It begins right after ovulation and ends when your period starts,” Dr. Wider tells us.

Your body produces high levels of progesterone and estrogen during the luteal phase, but then there’s a drop of hormones when you actually start to bleed. This is exactly when PMS kicks in—you deal with cramps, you’re bloated, you can’t sleep well, your breasts are tender, and you have headaches (just to name a few).

“These hormonal changes and drop in levels of hormones don’t occur if you’re taking the birth control pill—so for some women, this lack of change and drop results in less or no PMS for many women,” Dr. Wider says.

Because hormonal birth control uses synthetic hormones (estrogen, progesterone, and testosterone), which prevent a woman from ovulating, it prevents the natural hormonal drop that causes PMS from occurring. This is if you’re not menstruating (skipping placebos, which is totally okay to do).

Even if you are getting your period while on the pill, you’re actually having what’s called withdrawal bleeding, which still allows for a reduction in PMS symptoms due to your body’s change in hormones. Dr. Wider warns that this “period” can still cause PMS. “It’s actually the body’s reaction to a lack of hormones being given—this can also result in PMS symptoms in some women,” she informs HG.

Simply put, because the synthetic hormones trick your body into thinking that you don’t need to ovulate, the uterine lining is kept thin and periods on are typically lighter than a natural hormonal cycle’s period.

If severe PMS or PMDD is a problem for you, you might want to speak to a doctor about using birth control to alleviate your symptoms. However, hormonal contraceptives like the pill are frequently linked to causing depression.

If you notice yourself skipping the monthly cramps but still feeling down in the dumps while on the pill, you might want to discuss other options with your doctor.

  • By Angelica Florio

“Some women report that birth control actually exacerbates PMS symptoms, while other women get relief from PMS symptoms who are on birth control,”

Dr. Wider goes on to completely school us on the A-Zs of birth control, explaining why it can eliminate symptoms of PMS for some.

“The luteal phase of your cycle prepares the body to bleed. It begins right after ovulation and ends when your period starts,” Dr. Wider tells us.

Your body produces high levels of progesterone and estrogen during the luteal phase, but then there’s a drop of hormones when you actually start to bleed. This is exactly when PMS kicks in—you deal with cramps, you’re bloated, you can’t sleep well, your breasts are tender, and you have headaches (just to name a few).

“These hormonal changes and drop in levels of hormones don’t occur if you’re taking the birth control pill—so for some women, this lack of change and drop results in less or no PMS for many women,” Dr. Wider says.

Because hormonal birth control uses synthetic hormones (estrogen, progesterone, and testosterone), which prevent a woman from ovulating, it prevents the natural hormonal drop that causes PMS from occurring. This is if you’re not menstruating (skipping placebos, which is totally okay to do).

Even if you are getting your period while on the pill, you’re actually having what’s called withdrawal bleeding, which still allows for a reduction in PMS symptoms due to your body’s change in hormones. Dr. Wider warns that this “period” can still cause PMS. “It’s actually the body’s reaction to a lack of hormones being given—this can also result in PMS symptoms in some women,” she informs HG.

Simply put, because the synthetic hormones trick your body into thinking that you don’t need to ovulate, the uterine lining is kept thin and periods on are typically lighter than a natural hormonal cycle’s period.

If severe PMS or PMDD is a problem for you, you might want to speak to a doctor about using birth control to alleviate your symptoms. However, hormonal contraceptives like the pill are frequently linked to causing depression.

If you notice yourself skipping the monthly cramps but still feeling down in the dumps while on the pill, you might want to discuss other options with your doctor.

In This Section

  • Birth Control Pill
  • How effective is the pill?
  • How safe is the pill?
  • How do I use the pill?
  • How do I get the pill?
  • What are the benefits of the pill?
  • What are the disadvantages of the pill?

Remembering to take a pill every day can be hard. And some people get side effects that bother them (but they usually go away in a few months).

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You have to take the pill every day.

It’s really important to take your birth control pill every day, or you might not be protected from pregnancy. Using our birth control reminder app, setting an alarm, or keeping your pill pack next to things you use every day (like your toothbrush or phone charger) can help you remember to take your pills.

If you have a really busy life and think you might not remember your pill every day, check out other birth control methods like IUDs or the implant that are super low-maintenance and almost impossible to mess up. Take our quiz to help find the birth control method that’s best for you.

There can be negative side effects.

Like all medications, birth control pills can have side effects. But most usually go away after 2 or 3 months. Many people use the pill with no problems at all. You can keep track of any side effects with our app.

The hormones in the pill can change your level of sexual desire. You may also notice spotting or bleeding between periods (this is more common with progestin-only pills), sore breasts, nausea, or headaches. These side effects usually go away after 2 or 3 months, and they don’t happen to everyone who takes the pill.

Birth control shouldn’t make you feel sick or uncomfortable. Luckily, there are many different types of birth control, so you’ve got options. If you keep having side effects that bother you after using the pill for 3 months, talk with your nurse or doctor about trying another brand of pill or another birth control method. But don’t stop taking the pill without starting a new method, or you won’t be protected from pregnancy.

There can be some rare but serious risks.

Serious problems from taking the birth control pill are very rare. People using birth control that has estrogen, like combination pills, have a slightly higher chance of having a few rare but dangerous problems than people who don’t use birth control with hormones. Read more about birth control pill safety.

For more information about side effects, talk with your nurse or doctor or read the package insert that came with your pills.

What are the side effects of stopping birth control pills?

The side effects of stopping birth control pills are different for each person, just like the side effects of using them.

The hormones in the pill leave your body in a few days. That means any side effects you experienced while using it will go away pretty quickly. Yes, this includes the positive ones like clearer skin and lighter periods. However, it can take a few weeks to several months for your regular menstrual cycle to return.

Here are some side effects you might experience:

  • PMS symptoms come back

  • Mood changes, including a change in sex drive

  • Changes in vaginal discharge

  • Change in your periods

  • Skin changes, like more acne if you had that before taking the pill

Your ability to get pregnant returns as soon as you stop the pill, so if you don’t want to get pregnant right away, keep using your birth control (or use a different method like condoms) until you can get to a doctor or nurse. They can help you make a plan for switching to a new method.

Your periods might be irregular for a while. If you don’t get your period within 3 months after stopping birth control pills, check in with your doctor or nurse to rule out any problems.

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7 Common Birth Control Side Effects

If the Pill makes you woozy, try the ring or the patch.MasterfileHormone-based birth control often comes with side effects that can range from slightly annoying to bad enough to make you switch. You may not know what you can tolerate until you’ve given a couple of them a try. But here are some solutions for the most common problems. (View 7 Common Birth Control Side Effect as as a gallery)

Headache, dizziness, breast tenderness
Be patient. “These side effects seem to go away after you’ve been taking the Pill for a while,” says Hilda Hutcherson, MD, an ob-gyn professor at Columbia University. If they don’t, switching brands may help.

Nausea
It will probably go away in a couple of months. If not, and you’re taking oral contraceptives, try taking it with food. If you’re taking the ring or the patch, you might need to switch methods.

Breakthrough bleeding
“I think this is the side effect that drives women crazier than any other side effect,” says Dr. Hutcherson, mostly because it’s so unpredictable. Taking the Pill at precisely the same time every day may help. Especially with shots, the mini-Pill, and the implant—the progestin-only methods—the lining of the uterus is so thin that it sometimes sloughs off a little bit. (On the upside, this also makes your periods lighter and sometimes makes them disappear entirely.)

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Talk to your doctor if you’re concerned about spotting, because there may be a solution. “You can sometimes add an anti-inflammatory such as ibuprofen, or occasionally you can add a little estrogen,” says Anne Foster-Rosales, MD, chief medical officer for Planned Parenthood Golden Gate and a professor at the University of California, San Francisco.

Decreased libido
Try another formulation. “Some women, if you change the Pill to one that’s more androgenic , the libido comes back,” says Dr. Hutcherson. Otherwise, find another method completely.

Mood swings
If it’s really the birth control and not some other factor that’s bringing you down, you may need to find a nonhormonal method. “In my experience, if a woman has depression with one pill, switching usually doesn’t help,” says Dr. Hutcherson. All hormonal methods are likely to cause the same problem. For some patients who really want to stay on the Pill, Dr. Hutcherson sometimes prescribes an antidepressant as well, with good success.

Acne. Spider veins. Ceaseless nausea. Mood swings. Anxiety. Depression. Read the #MyPillStory hashtag on Twitter and oral contraceptives may seem like the biggest disaster to hit women’s health since the thalidomide crisis during your mom’s early childhood. Adverse effects of the Pill are a legitimate concern for women on all iterations of estrogen and progesterone replacements. But the recent buzz on social media may distract from the Pill’s many upsides.

I rounded up the research and spoke with Sherry Ross, MD, ob-gyn, and women’s health expert at Providence Saint John’s Health Center in Santa Monica, California, to get the DL on what actually happens when you go on the Pill.

Here are 19 known side effects of going on birth control pills — the bad, the good, and the bizarre.

The Bad

1. Nausea. Though expected to last only up to three months, some women feel queasy when they start the Pill, Ross says. Taking your pill with a meal can help reduce how icky you feel during the time your body needs to adjust to new levels of estrogen and progesterone.

2. Breast tenderness. Alas, this downside of oral contraceptives can apparently last for up to 18 months on the Pill, according to a report by the American Family Physician. Sorry.

3. Bloating. Changes in the ups and downs of your body’s sex hormones can lead to water retention and bloating. These effects may be particularly strong for women suffering from irritable bowel syndrome and other gastrointestinal tract disorders. That being said, many women feel better six months into a new pill regimen.

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4. Headaches. A 2005 study published in the American Journal of Obstetrics and Gynecology found that approximately 10 percent of women feel headachy within a month of starting the pill. Once the body acclimates to a new oral contraceptive, however, the study authors conclude most reports of headaches go away.

5. Increased appetite. Perhaps you recall from ever having PMS that hormones can make you super hungry. Same goes when you alter your estrogen and progesterone levels via birth control. But an increased appetite doesn’t always lead to packing on pounds, Ross points out. In fact, she says, “there’s still no definitive proof that birth control directly causes weight gain.”

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6. Yeast infections. Some women may need to invest in a few more Monostat packs after they go on the pill. Ross says this is likely due to changes in the use of tampons and new patterns of bleeding induced by the Pill.

7. Mood swings — and other emotional issues. This issue is complicated. While some women with a history of mood issues — depression, anxiety, even insomnia — tend to see an increase in their symptoms’ severity once they go on some birth control pills, others report that going on the Pill improves their psychological turmoil. (More on this below.)

8. Blood clots. Newer versions of birth control pills (like Yasmin) appear to put some women at an elevated risk of blood clots compared to “first-generation” pills, whose progesterone has a different chemical makeup. So long as gynecologists and patients monitor side effects, this can be kept under control. But be sure to bring this up with your doctor, just to be safe.

9. Brown spots on your face. Oral contraceptives have been found to increase women’s risk of a skin condition called melasma, which can make your face break out in some brown-colored splotches. Research shows, however, that this is more likely to occur in women who have a family history of the skin issue. Switching from the pill to an IUD may be able to resolve this, several case studies suggest.

10. Lower sex drive. Some women report decreases in their libido once they begin the Pill, Ross says. But she points out that much of this may be due to birth control’s shorter-term side effects — think: bloating, breast pain. (Who wants to be sexual when everything hurts and you feel like there’s a balloon in your belly?)

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That said, many women report that their sex drive picks back up again — or even gets stronger than pre-Pill levels — about nine months into their new hormone regimen.

The Good

11. Reduced risk of certain cancers. A 2011 review of studies examining the link between birth control and cancer risk found that incidences of endometrial and ovarian cancers dropped by 30 to 50 percent among women without a history of HIV or HPV.

12. Fewer cramps. With a more regulated regimen of estrogen and progesterone entering your body, your periods get on a more predictable schedule. Often, once you get adjusted to the Pill, Ross says, “your periods may become lighter, which can mean less painful menstrual cramping.”

13. Clearer skin. Because acne is largely influenced by high levels of male hormones, like androgen, balancing it out with female hormones (estrogen and progesterone) can help scale back the prevalence of pimples on your face.

14. Mood improvements. Yes, some women with a history of emotional issues have found the Pill worsens their symptoms. But others claim it’s offered a boost to their psychological well-being. Evidence suggests the Pill can, for many women, decrease depression.

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15. Stronger ligaments (maybe). Apparently birth control pills are linked with lower incidences of knee injuries. The researchers who found this correlation peg it to birth control’s regulation of estrogen, which — if too high — may weaken young women’s ligaments.

16. Fewer complications from anemia. Studies suggest a link between oral contraceptive use and fewer incidences of anemia. Likely, researchers believe, because the Pill can boost iron levels and the protein molecule hemoglobin in the bloodstream, both of which are lowered in cases of anemia.

17. Less pain during sex. In some cases, going on the Pill can increase a woman’s vaginal lubrication and, as a result, make intercourse a heck of a lot less painful — especially if she experienced it as such prior to going on the Pill.

18. Greatly reduced chance of pregnancy. Remember that one? It’s kind of why birth control was created. In case you needed a reminder.

The Random

19. Changes in mate preference. Studies have also found a fascinating link between the use of oral contraceptives and women’s preference for certain traits in their partners. Going on birth control can, according to some evidence, make women more inclined to choose nurturing men over sexually exciting ones, while going off birth control may influence how attractive we consider our significant others — and not for the better.

All this goes to show that, like any medication, the Pill’s got its own ups and downs. The trick, Ross says, is to find the right combination of hormones for you and allow about three months for your body to make that call.

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Progesterone Only Contraceptives

All the progestin only contraceptives are approved for patients at higher risk of deep venous thrombosis and pulmonary embolism (DVT/PE), such as patient with malignancies. They are not associated with an increased risk of high blood pressure and cardiovascular disease. An added benefit is menstrual lightening or suppression, which differs according to each one of them. The only absolute contra-indications to progestins are pregnancy and a personal history of hormone dependent breast cancer. Progestin-only contraception may be provided as an oral medication, injectable form, or an implant. Their mechanisms of action for contraception are: increasing viscosity of cervical mucus, ovulatory suppression and endometrial thinning.

Progestin-only Pills

Progesterone only pills must be taken at the same time every day. Its efficacy relies on compliance with a typical use failure rate of 8-9%. (10) Up to 10% of users will develop amenorrhea after one year of use. Side effects may include breakthrough bleeding, headaches, nausea, acne and breast tenderness. Its risks are minimal. (8)

Injectable Contraceptive (Depot Medroxyprogesterone Acetate)

DMPA is given as an intramuscular injection, which is administered every 12 weeks. Its efficacy relies on compliance with a typical use failure rate of 3 to 6% and perfect use of 0.3%. (10) Up to 60-90% of users will develop amenorrhea after 1 year of use. Side effects include initial breakthrough bleeding, weight gain, headaches, nausea, breast tenderness, acne and mood disorder.

In 2004, the FDA issued a black box warning stating that prolonged us of DMPA may result in significant loss of bone mineral density (BMD). Following this event, the WHO collected experts reviews concluding that DMPA is associated with a risk of reversible BMD reduction during treatment, which has not been proven to increase fracture risk. (11) On average, patients on DMPA have a weight gain of less than 2 kg per year. (12) However it has also been shown that certain populations, such as those that are obese or more sedentary, are more at risk for weight gain with DMPA. (13, 14).

Long-acting reversible contraception (LARC)

LARC methods are the most effective birth control methods with a failure rate of < 1%. In September 2014, AAP (American Academy of Pediatrics) published a new recommendation stating that the first-line contraceptive choice for adolescents who choose not to be abstinent should be a LARC method. Their safety and efficacy in adolescents has been well demonstrated and are recommended for teenagers. (15)

LARCs include the intrauterine device (IUD) and the birth control implant. In the Contraceptive CHOICE project, all contraceptive options were provided to participants at no cost for the duration of the 2-3 year project. Seventy-five percent of participants in the CHOICE project chose LARC methods; this is astounding compared to the national average of 8.5% at the time. (16) Adolescents chose LARC at similar rates (69-71%); however the younger adolescent population appeared to favor the LNG implant system. (17) A recent analysis of the CHOICE project evaluated contraception continuation in teenagers and young women and demonstrated high rates of continuation and satisfaction with LARC similar to that in the older adult population. (18, 19) It has also been shown that adolescents are more likely to continue LARC than non-LARC contraceptive methods. (20) The continuation rate of LARC methods in teenagers and young women has been studied at 81%. (19)

Contraceptive Implants

The subdermal rod, marketed as the Nexplanon, measures 4cm by 2 mm, and constantly releases Etonogestrel. It is currently approved for contraception at three-year duration. The device is inserted superficially in the upper arm during a simple office procedure by a trained physician or midlevel provider, requiring only local anesthesia. (21) The risks of the procedure are rare, but include, bleeding, hematoma formation and infection. The main side effects are irregular, unpredictable vaginal bleeding (50%), acne (12%), headaches (16%), weight gain (12%) and mood disturbance (6%). About 11% of patients become amenorrheic after 1 year of use. (22) Removal requires a second small office procedure with local anesthetic and a small incision and similar risks. Removal can be challenging due to an inability to palpate the rod, a breakage of the implant, or growth of adhesions around the device.

Continuation rates have been shown to be higher than 80% after 1 year of use in one study. (19) Other studies have found higher discontinuation rates with an average of 35%, and the most frequent reason for discontinuation was persistent bleeding irregularities. (22)

Levonorgestrel IUDs

This device, marketed as the Mirena, is T-shaped and contains a barrel with 52mg of Levonorgestrel. It is inserted inside the uterine cavity, through the cervix using a speculum and indicated instruments. This is a simple office procedure in most instances. Levonorgestrel is released at an initial rate of 20mcg/day that decreases to 10-14 mcg per day over its currently approved five year duration of use. (8) The main risks are uterine perforation (1/1000) (23), IUD expulsion (6%) (19), and slight increase in PID in the 20 days following insertion (1%). (24) It is important to clarify that overall, IUD use in teenagers is encouraged and that it does not increase risk of PID, STI and infertility. Cervical screening for Chlamydia and Gonorrhea should be done on all women at high risk for STIs, therefore all adolescents. Side effects are minimal but include limited irregular vaginal bleeding, acne, headaches and mood disturbance. Other benefits include menstrual lightening (up to 90% of flow) or suppression (in 50% at 24 months of use), alleviation of dysmenorrhea and pelvic pain, and reduction of risk of endometrial cancer. There is limited evidence for or against IUD use in cancer related immunocompromised women, however the CDC and WHO both support its use and are reassuring about its safety based on other types of immunocompromised patient data. (10)

A lower dose levonorgestrel IUD became available on the market in the United States in 2013, marketed as Skyla. This IUD contains 13.5 mg of levonorgestrel, that is initial released at a rate of 14 mcg/day that decreases to 5 mcg/day overs its approved three year duration of use. It has a slightly smaller size and diameter, which theoretically may make it more suitable for placement in certain populations with a small uterine cavity or cervical stenosis. The low dose levonorgestrel IUD is not currently approved for the treatment of menorrhagia and has a lower likelihood of amenorrhea (13% vs 24%) compared with the higher dose IUD. (25)

Overall, the levonorgestrel IUDs have been proven to be a highly effective birth control method that is both beneficial and safe. Non-sexually active teenagers and young adults usually tolerate insertion very well. In patients who are unable to tolerate in-office placement, such as those with special needs, the IUD can be placed under general anesthesia. It is best to attempt to combined placement with a previously scheduled procedure, such as a line placement or biopsy, however they can also be scheduled independently.

Effects of progestin-only birth control on weight

Progestin-only contraceptives (POCs) can be used by women who cannot or should not take the hormone estrogen. Many POCs are long acting, cost less than some other methods, and work well to prevent pregnancy. Some people worry that weight gain is a side effect of these birth control methods. Concern about weight gain can keep women from using these methods. Further, some women may stop using birth control early, which can lead to unplanned pregnancy. We looked at studies of POCs and changes in body weight.
Until 4 August 2016, we did computer searches for studies of a POC compared with another birth control method or no contraceptive. For the initial review, we wrote to investigators to find other trials. The focus was on change in body weight or other body measure of lean or fat mass.
With six new studies in this update, we have 22 studies that included 11,450 women. The groups compared did not differ much for weight change or other body measures in 15 studies. Five studies with moderate or low quality results showed a difference between study groups. Three studies showed differences for users of the injectable ‘depo’ versus no hormonal method. Depo users had a greater weight gain in two studies. In the third study, adolescents had a greater increase in body fat (%) and decrease in lean body mass (%). Two studies showed a greater increase in body fat (%) for users of hormonal intrauterine contraception versus women not using a hormonal method. One also showed a similar difference with a progestin-only pill. Both studies showed a greater decrease in lean body mass with POC use.
We found little evidence of weight gain when using POCs. Mean weight gain at 6 or 12 months was less than 2 kg (4.4 lb) for most studies. The groups using other birth control methods had about the same weight gain. Good counseling about typical weight gain may help women continue using birth control.

Birth control causes anxiety

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