Do hormonal contraceptives increase the chance of depression? A neuroscientist explains how they affect mood, positively or negatively

More than 85% of girls – And greater than 300 million people worldwide at any time – use hormonal contraceptives for at the very least five years. Although they’re primarily used for contraception, many individuals also use hormonal contraceptives for treat quite a lot of symptoms related to menstruation, from cramps and pimples to mood swings.

For as much as 10% of girlsnevertheless, hormonal contraceptives may increase their risk of depression. Hormones, including estrogen and progesterone, are vital to brain health. So how does the alteration of hormone levels attributable to hormonal contraceptives affect mental health?

I’m a Researcher studying neuroscience of stress and emotion-related processes. I also study gender differences in vulnerability and resilience to mental disorders. Understanding how hormonal contraception affects mood will help researchers predict who will experience positive or negative effects.

How do hormonal contraceptives work?

In the USA and other Western countries most typical type of hormonal contraception Is “the pill“” – a mix of synthetic estrogen and artificial progesterone, two hormones involved in regulating the menstrual cycle, ovulation, and pregnancy. Estrogen coordinates the timed release of other hormones, and progesterone maintains a pregnancy.

This could seem contradictory – why do naturally occurring hormones which might be essential for pregnancy also prevent pregnancy? And why does taking a hormone reduce the degrees of that very same hormone?

Line graph showing the rise in estrogen levels, which peak on the first day of the menstrual cycle and then decline, and progesterone levels, which peak on the eighth day and then decline
When estrogen and progesterone reach a certain threshold, the body reduces their production.
Dharani Kalidasan/RI McLachlan et al. 1987 via Wikimedia Commons, CC BY-SA

Hormonal cycles are tightly controlled by the hormones themselves. When progesterone levels rise, this prompts processes in cells that prevent the production of more progesterone. This known as negative feedback loop.

Estrogen and progesterone from the every day pill or other common contraceptives equivalent to implants or vaginal rings cause the body to diminish the production of those hormones, lowering them to levels seen outside the fertile window of the cycle. This disrupts the tightly orchestrated hormonal cycle required for ovulation, menstruation and pregnancy.

Effects of hormonal contraceptives on the brain

Hormonal contraceptives don’t only affect the ovaries and uterus.

The brain, particularly an area called the hypothalamus, controls the synchronization of ovarian hormone levels. Although they’re called “ovarian hormones”, estrogen And progesterone Receptors are also present throughout the brain.

Estrogen and progesterone have a broad impact on neurons and cellular processes that don’t have anything to do with reproduction. For example, estrogen plays a task in processes that Memory formation and brain protection from damage. Progesterone helps Regulating emotions.

By changing the degrees of those hormones within the brain and body, hormonal contraceptives can modulate mood – for higher or for worse.

Hormonal contraceptives interact with stress

Estrogen and progesterone also regulate the stress response – the body’s “fight-or-flight” response to physical or psychological challenges.

The important hormone involved within the stress response – cortisol in humans and corticosterone in rodents, each abbreviated as CORT – is primarily a metabolic hormone, meaning that a rise in blood levels of those hormones under stressful conditions results in more energy being mobilized from fat reserves. The interplay between stress systems and reproductive hormones is an important link between mood and hormonal contraception, as Energy regulation is amazingly necessary while pregnant.

So what happens to the stress response of an individual taking hormonal contraceptives?

When faced with a light stressor – for instance, putting your arm in cold water or giving a public speech – women who use hormonal contraceptives show a lower increase in CORT than in individuals who don’t take hormonal contraceptives.

Stressed person looking at laptop, resting elbows on surface and holding hands in front of mouth
Chronic stress can worsen mood.
Vera Livchak/Moment via Getty Images

The researchers observed the identical effect in Rats and mice – When treated every day with a mix of hormones just like the pill, female rats and mice also show suppression of the stress response.

Hormonal contraceptives and depression

Do hormonal contraception increase the chance of depression? The short answer is that it varies from individual to individual. But for most individuals, it's probably not the case.

It is very important to notice that neither increased nor decreased stress reactions are directly related to Risk for or resilience to depressionBut stress is closely linked to mood, and chronic stress increases significantly Risk of depression. By modifying stress responses, hormonal contraceptives increase the chance of depression following stress, leading to “protection” against depression in many individuals but “increased risk” in a minority. More than 9 out of 10 people Women who use hormonal contraceptives don’t experience mood swings or depression, and plenty of even experience improvement of their mood.

However, researchers don’t yet know who can be at increased risk. Genetic aspects and former stress increase the chance of depression, and evidently similar aspects contribute to mood swings related to hormonal contraception.

Currently, hormonal contraceptives are often prescribed by trying – If one type causes negative effects in a patient, one other with a distinct dose, delivery method, or formulation may be higher. But the strategy of “trying things out” is inefficient and frustrating, and plenty of people surrender relatively than switch to another choice. Identifying the particular aspects that increase the chance of depression and higher communicating the advantages of hormonal contraception beyond contraception may also help patients make more informed decisions about their health care.

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