What You Need to Know
As a psychiatric nurse practitioner, I fully embrace the role that combined oral contraceptives (COCs) can play in women’s health. For many of my patients, COCs offer significant benefits—improved hormonal regulation, reduced menstrual pain, clearer skin, and even a better mood. However, I also see patients who experience unexpected and troubling side effects like depression, decreased libido, and vaginal dryness. In many cases, these patients have already voiced their concerns to their primary care providers or OB/GYNs, only to be dismissed with reassurances that it’s “all in their head.” For those patients, I want to offer validation and a deeper understanding of how synthetic hormones can impact mental health and hormonal balance.
The Complex Relationship Between COCs and Mental Health
Combined oral contraceptives contain synthetic forms of estrogen and progestin that prevent pregnancy by suppressing ovulation. While these hormones are highly effective for birth control, they can also influence neurotransmitter function and hormonal pathways in ways that aren’t always predictable.
Why Some Women Feel Depressed on COCs
- Neurotransmitter Imbalance – Progestins in COCs can alter serotonin and dopamine activity, which may lead to mood disturbances in susceptible individuals.
- Elevated Cortisol Response – For some women, COCs can increase cortisol levels, contributing to heightened stress and anxiety.
- Nutrient Depletion – COCs are known to deplete essential nutrients like vitamin B6, magnesium, and zinc—all of which are crucial for mood stability.
But Not All Experiences Are Negative
It’s important to recognize that not all women have adverse reactions to COCs. In fact, some of my patients report significant mood improvements after starting birth control. For women with conditions like premenstrual dysphoric disorder (PMDD), COCs can offer relief from severe mood swings and hormone-related irritability. The key is understanding that every woman’s experience is unique, and there is no one-size-fits-all solution.
Sexual Health and Libido: What You Should Know
One of the most commonly overlooked side effects of COCs is decreased libido. Testosterone, often thought of as a “male hormone,” plays a crucial role in female sexual desire and energy levels. COCs can suppress testosterone production and increase levels of sex hormone-binding globulin (SHBG), which binds free testosterone and reduces its availability.
Why Libido Declines on COCs
- Reduced Testosterone Levels – Lower testosterone means less sexual desire and reduced arousal.
- Elevated SHBG – Even after discontinuing COCs, SHBG levels can remain elevated, leading to prolonged sexual dysfunction.
- Mood and Fatigue – Depression and fatigue caused by COCs can further diminish sexual interest.
Vaginal Dryness and Estrogen Suppression
Another side effect that rarely gets enough attention is vaginal dryness. The synthetic estrogen in COCs can suppress the body’s natural estrogen production, leading to decreased vaginal lubrication and discomfort during intercourse. For some women, this can severely impact intimacy and quality of life.
Supporting Vaginal Health
- Use water-based or silicone-based lubricants for immediate relief.
- Vaginal moisturizers and low-dose vaginal estrogen (prescribed by a healthcare provider) can help restore tissue health.
Practical Steps and Personal Advocacy
If you suspect your birth control is affecting your mental health or sexual well-being, you’re not alone. Many women have felt dismissed by their healthcare providers when they raised concerns about these side effects. Advocating for yourself and seeking a second opinion can be empowering.
Steps to Take
- Track Your Symptoms – Keep a journal of your mood, energy levels, and sexual health. This can provide valuable data for your healthcare provider.
- Explore Alternative Birth Control Options – Non-hormonal options like the copper IUD or barrier methods may be worth considering if you’re sensitive to synthetic hormones.
- Support Your Body with Nutrients – Supplement with vitamin B6, magnesium, zinc, and omega-3 fatty acids to counteract nutrient depletion.
A Balanced Perspective on COCs
My stance is always this: there is no “right” or “wrong” choice when it comes to birth control. The best choice is the one that works for you, with the fewest side effects and the greatest benefits for your health and lifestyle. For some women, that means sticking with COCs. For others, it means exploring other options. What matters most is that you feel supported, informed, and heard. If you’re struggling with unexpected side effects and not sure where to turn, know that there are answers and options. You don’t have to go it alone.
References
- Sabatini, R. (2022). Side effects of hormonal contraceptives on mental and sexual health. Journal of Clinical Studies.
- Goldstein, A. (2023). The impact of oral contraceptives on libido and mood regulation. Sexual Health Journal.
