Birth Control Access Is Also About Mental Health

Hillary Weeks never wanted to be on medication, let alone birth control pills.

Throughout the years, they’ve relied on a combination of condoms and partners who’ve had vasectomies to avoid unwanted pregnancies. But for the past two years, Weeks has taken hormonal birth control consistently, and it’s helped them regain control of their life. Weeks, 45, has suffered from severe depression, anxiety, and migraines related to their menstrual cycle for the better part of 30 years. They’ve missed work because of the intense mental fog and exhaustion that comes during menstruation. They’ve cut out sugar, caffeine, saw acupuncturists, chiropractors, massage therapists (even shamans), and went vegan for 18 years, all in attempts to improve their mental health. But for Weeks, birth control is the only option that’s quieted their debilitating symptoms. 

“I’ve tried everything in the natural and modern world [to relieve my period pain],” says Weeks. Birth control is the only thing that has provided some relief.

With the Supreme Court draft opinion that would overturn Roe v. Wade, experts fear taking away the right to abortion could put similar freedoms in jeopardy, such as access to contraception. Politicians in states such as Louisiana and Mississippi have already signaled their willingness to curtail access to birth control in the wake of the leaked decision. 

The research on the menstrual cycle’s impact on the body and the brain is still in a nascent stage. “We’re really just now trying to get a handle on what does it mean for the brain to have these rhythmic fluctuations in sex hormones across the menstrual cycle, and we’ve really only begun to scratch the surface,” says Dr. Caitlin Taylor, Ph.D., a neuroscientist who studies the effect of oral contraception on the brain.  

Taylor says sex hormones have long been thought of as “female” and too variable, especially during the menstrual cycle due to hormone fluctuation. Researchers wrongly assumed including female participants in their studies wouldn’t result in any reliable data. These biases still persist. Today about 30 percent of neuroscience studies include exclusively male participants. “To understand the female body is to understand the human body, and it’s equally as worthy to study females as it is to study males,” Taylor says.  

While there’s a lot left for scientists to discover, Taylor and her colleagues are doing the work. In one of their studies, they tested one woman every day for 30 days and found that day-to-day changes in hormones influence how efficiently the brain’s networks communicate with one another. For example, they found that brain networks may communicate more efficiently during ovulation.

However, Taylor says, it’s important to understand that hormone fluctuations don’t completely change how the brain functions. Rather, there are likely subtle but real effects on what may feel easier or harder for someone, depending on where they are in their menstrual cycle. “Just as hormone levels can vary widely both between people and within an individual at different time points, people’s cognitive and emotional experiences across a menstrual cycle or with hormonal contraceptive use also vary widely,” Taylor says.

Weeks is one illustrative example of how menstrual cycles can affect people differently. Before birth control, their cycles controlled their life.

One hot day, about a decade ago, when Weeks worked on a farm, their period began—and the pain. “I started to get really dizzy… I had to crawl to the edge of the field,” Weeks says. “I couldn’t stand up. I was sitting in the shade and my boss came over, very angry at me, [and said] ‘What are you doing? Why aren’t you working?’”

During that episode, Weeks couldn’t talk, let alone explain why they were on the ground, incapacitated. “I’m sure it looked bad. I’m sure my employer definitely didn’t understand what was going on,” Weeks says. “It also makes you feel bad as a person when you know there’s nothing you could do about it.”

Looking back, Weeks wishes they knew as a teenager that contraception could alleviate their mental and physical suffering. While it’s not a panacea, Weeks says their symptoms are much better but haven’t completely disappeared, birth control has not only transformed their life but those of the people closest to them. 

“I’m doing it [taking birth control] for my daughter because I’d become a very unfunctional person. That’s very scary [for] a kid to be around someone who’s yelling or curled up in a ball, totally depressed or in pain,” Weeks says.

Choosing the right birth control is often a process of trial and error because contraception isn’t one-size fits all. There are many options to choose from, including birth control pills, arm implants, intrauterine devices (IUDs), injections, vaginal rings, tubal ligation, and more. Another barrier is the actual cost of birth control, which can range from free to thousands of dollars. 

Birth control methods like the IUDs are known as “set it and forget it” contraception methods because, unlike pills, people don’t have to do anything to make them effective. Yet, despite their ease, only about 14 percent of people have IUDs, according to 2015-2017 data.

“Early in the IUD’s history, the Dalkon Shield [an IUD invented in the 1970s], there were horror stories. There were horrible side effects, infections, and deaths. I think that to some extent, though IUDs are incredibly more well tolerated now, that those difficulties of the past are in the memories of a lot of older women are potentially advising daughters…” says Dr. Katherine L. Wisner, M.D., Norman and Helen Asher Professor of Psychiatry and Obstetrics and Gynecology at Northwestern University.  

While many birth control users complain about adverse mental health symptoms, like depression, while on contraception, the scientific literature largely doesn’t support those claims. As one recent example, a 2020 study (Wisner was an author) published in The American Journal of Psychiatry found hormonal contraceptives (including the IUD) don’t cause depression. In fact, the study also found that “clinical studies and randomized placebo-controlled trials of women with psychiatric disorders have generally reported similar or lower rates of mood symptoms in hormonal contraceptive users compared with nonusers.” It’s also important to keep in mind, Wisner says, that unintended pregnancies can contribute to worse mental health, especially postpartum depression.

Birth control not only helps people delay or completely prevent pregnancy but it also gives people control over their own bodies in other ways.

When Aster, whose name has been changed to protect their privacy, got on birth control they found it helped alleviate their gender dysphoria. People can experience this distress when their assigned sex at birth doesn’t line up with their gender identity. Suicidality and depression rates go up when people with gender dysphoria don’t receive gender-affirming care, like hormone replacement therapy, surgery, and mental health care.  

For Aster, who’s transgender, their gender dysphoria manifests mainly because of their period. Before they first menstruated, Aster had a fantasy it wouldn’t happen. 

“It [my period] feels like something my body isn’t supposed to be doing,” Aster says. “Maybe part of it subconsciously is the messaging in the public discourse about when you start your period ‘you’re becoming a woman now…’”

While Aster doesn’t only feel dysphoric about their period, they feel like they have less control over it than other aspects of their body. It’s easier to mold themselves to look more traditionally masculine, like with intense exercise to achieve broad shoulders. Taking birth control has helped Aster feel more agency over themself, thus leading to a more stable level of mental wellness. They’ve experimented with different types of oral birth control over the years but, today, Aster has a hormonal IUD. 

“It’s [their hormonal IUD] super duper reliable because I don’t have to take a pill at the same time every day. It just goes in there and then I don’t have to worry about it for years because there’s not the human error element [like with taking a pill],” Aster says. 

But not everyone who is trans is uncomfortable with their period. Leo, whose name was changed to protect their privacy, feels indifferent about their period. But they felt pressure to fit into the “very specific trans narrative” that periods cause gender dysphoria so they opted to get on birth control. “It was almost like ‘as a trans masc person I’m supposed to HATE my period,’ but that wasn’t the case for me,” Leo said. 

“Everyone has different dysphoria that they may or may not ever experience. Some people don’t have dysphoria. Many trans individuals have gender euphoria around certain aspects of their body,” says Dr. Kaitlyn Kunstman, M.D., a fourth-year psychiatry resident at Northwestern Memorial Hospital whose expertise includes LGBTQ+ mental health.   

Despite not hating their period, Leo’s menstrual cycles are no picnic. Typically, Leo’s periods have been very painful, and they’ve felt very emotional during them. Leo’s also experienced suicidal thoughts, but they didn’t know for sure if these symptoms were related to their period. Things got worse when they started testosterone five years ago. Leo’s endocrinologist put them on the highest dose to stop their period completely. But that never happened.

While for many transgender masculine people, testosterone therapy helps affirm their identity, it wreaked havoc on Leo’s mental health. While on testosterone, Leo’s depression got worse, they suffered from debilitating migraines, and their ADHD worsened. Their suicidal ideation got to the point where Leo strategized specific ways to carry out a suicide attempt. This thought pattern scared them because it was a drastic departure from their normal self. 

“I would get these thoughts that were like ‘I should just kill myself.’ Which sounds super dramatic, and I think that’s part of why it was so upsetting! Because I was like…WTF? Where is this thought even coming from?” Leo said.  

In just one year, Leo went through three in-patient psychiatric hospitalizations because of intense suicidality. Leo couldn’t ignore the timing: all three hospitalizations occurred right before their period. 

“During my last admission, I kind of put all the pieces together and with my gynecologist decided to stop taking the testosterone. After I stopped it, and began taking the progesterone birth control pill consistently, I began to notice a shift in my mental health,” Leo said.

Within about two months, Leo’s mood stabilized and they didn’t experience those feelings of crisis that led them to be hospitalized originally.

“All three providers have pointed towards birth control as a key player in stabilizing my mental health because of its ability to keep my estrogen levels relatively consistent throughout the month,” Leo wrote to DAME.  

It’s important to note that not everyone has the same experience as Leo did. Not everyone can afford to see a specialist, or many, have access to mental health care. Health insurance plans also vary so experimenting with different birth control methods isn’t always feasible. Still, for many, the benefits of birth control vastly outweigh the hoops people may have to jump through to access it in the first place. For Leo, birth control saved their life. Without it, or even just regulating access to birth control further, the future of potentially millions of people’s mental health could be in jeopardy.