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Part Four // Mental Health

Perceptions of Birth Control: A collection of stories and themes that emerged from interviews with undergraduates using birth control at the University of Vermont

This series of blog posts is excerpts (at times edited so its not so academic) of writing from my undergrad research in 2021

One of the things that I was most curious about going into this work and as it evolved though interviewing people was perceptions of mental health while using birth control. It was my experience before this research and even during it that people have really strong opinions about how birth control affects their mental health either positively or negatively. How can it be that ‘the same’ medication can affect people so differently? Gemma shared her story of how she did a self experiment of sorts. She described how she had heard that birth control could affect mood and so she wanted to see if that would be the case for herself. Gemma had had an Nexplanon and was experiencing some mood issues and so wanted to see if it may be related to her birth control. 

“So I thought, let me just give it like a year to see if, because there was a lot of stuff I don't, I don't know what I was, what media I was consuming that time. Something about how like birth control was impacting mood. So I was like, okay, let me try just to go off birth control. I didn't have a partner. I didn't really need it at the time. Um, so I tried that and I went like a year without any hormonal birth control. And I did not think it changed my mood very much at all to be on or off of it. It didn't seem to help, um, or really make anything worse.”

What I found so striking about Gemma’s comment is that she was very self aware in this exploration of mental health. She was able to make a decision that felt right for her based on her own explorations. Though Gemma did not experience any change in her emotions while on or off the hormonal contraception, Elizabeth and Casey reported using their birth control as a mental health medication. They both described using birth control as a way to manage depression and anxiety on a more physiological level. 

Elizabeth talked about how her body and mind respond to being off of birth control for short amounts of time. She was the first person I interviewed to label her birth control as a mental health medication and then I started to see that pattern arise in other peoples’ stories. She talked about how she does not currently use it for pregnancy prevention, but chooses to stay on it because:

“I definitely, like, notice a difference just like mentally when I'm off it, I can get, like, a little bit manic. So it almost acts as, like, a mental health medication for me.”

When I asked Casey how she felt her birth control impacted her mental health she responded, 

“It’s so much better. Yeah. Yeah. My friends are like ‘girls will get an IUD before they go to therapy’ and I was like, okay, fair criticism. I'll take it.” She added, “And definitely like, I feel, like, kind of similar to the way that people describe, like, antidepressants, um, or anxiolytics, like maybe everything is a little bit more muted, you know? Like I don't feel like that really intense joy, although some of that might be just that I'm older, you know? But I feel like it's so much, it's very much worth it.” 

I wish that I had either used a demographic survey or asked more follow up questions to know whether or not either of these interviewees had ever been diagnosed with depression or anxiety and if they were taking any medications in addition to birth control. As Hill writes, “The pill changes the brain. Brain scans of women who are on the pill show structural and functional differences when compared to those of women who are off the pill” (Hill 7). Some of these changes she describes at length in her include changes to the HPA axis which shape one's ability to respond to stress; other changes relate to personality and mood as described by Casey and Elizabeth.  

An important question to ask as this data emerges is why is birth control being used as a mental health medication? Casey’s quote, “girls will get an IUD before they go to therapy” highlights to me a certain stigma around talk therapy and seeking support from mental health professionals. Or perhaps it could be a more practical reason - birth control is often covered by insurance whereas therapy is not always covered in the same way. I have so many questions about this application of birth control that I would love to explore in more depth in future research.

Unlike using hormonal birth control as a mental health medication, Kylie was one of the interviewees who used fertility awareness as birth control and she commented about how that form of birth control made her mental health symptoms more manageable because they were more predictable.  While not exactly the same as a mental health medication, what Kylie highlighted is that by understanding her body she is better able to understand her cyclical mental health. As she learned her cyclical patterns and biomarkers she started to notice how they correlate to her mood and mental health. 

“Um, I compared to, before I used this birth control, um, I feel better about my body than I did before, but I don't think, I think that's more about time than it is about actually like the birth control method. Although it does feel really good when I'm not liking the way my body looks and I'm like, oh, it's because I'm about to have my period. So like, it makes it, it gives me justification for why I feel a certain way. Yes. It is very effective in helping me mentally. I am able to understand better why I feel a certain way, um, at any time.”

While these stories highlight people who were able to support their mental health with birth control, there were other interviewees who felt very differently. An equal number of interviewees had notable experiences that were detrimental to their mental health. Franchesca reported a revelation of sorts that occurred when she read a book that affirmed her experience of the onset of her depression once starting to use hormonal contraception.  

“I'm like, whoa, 30% of women who go on birth control end up getting antidepressants. I was like, you know, like all these things that happened to me and what I thought, I thought I was alone, like just full on education, right in a book. So then I got off kilena on August 1st. Like the first week of August I went home and then I'm like, okay, I'm going to sync to my cycle, whatever. I don't actually do it too much, but I'm just, like, good about my health and then started therapy like in the middle of August, because it was hard to, like, reach out the network here is so overloaded. So. It was hard to find someone available, but she's been amazing. So now I'm getting regular periods, regular cycle healing. My panic attacks are less. My stomach is still a little messed up again. Just whatever , I think, I don't know, but, um, and stress is still there and like there are lingering effects. Yeah. I hate birth control so much.”

Peoples’ experiences are more often than not shared with others. As Sarah Hill writes, “The general attitude with women's health has long been that if what a woman is feeling isn't written in a medical textbook or a package insert, it’s not real. But our bodies sometimes do things that aren't yet fully understood by medicine” (Hill 167). This attitude has been detrimental for so many people who have felt the very real ways that birth control impacted their brain. Even in the initial phases of research on the pill some people did complain of mood changes when using the pill and Pincus (the primary person who created the pill) was extremely quick in dismissing the concerns saying that the complaints were psychosomatic (Pendergrass). We know now that these complaints are certainly not only psychosomatic because the pill does quite literally change a user's brain. But also, even if these complaints were only psychosomatic shouldn’t that warrant concern and/or further investigation? Mental health needs to be taken seriously.  Similar to Francesca, Parker reported feeling much more distant from herself while using the pill. 

“I think just generally, like, I just felt more unstable, like, like any small thing was more triggering or like… I just felt more sad for, like, smaller things. So I think it was just, like, really made, not more dramatic, but just like yeah. More sensitive to life.  Talking about both on and off. Yeah, I think on it, I definitely felt pretty out of touch because I could never figure out if, like, the things that were happening internally or my reactions to things were like…..actually me or if they were the birth control, um, like my periods were. Well, they're not real periods, but my bleeding was pretty non-existent which in the beginning I was like, oh, this is great. But after a little bit, I was like, okay, this is weird. Like, um, so yeah, I think just when I was, when I was on it, just feeling, like, super out of, out of touch with myself as like. Now I know that, um, If I am feeling, like, sad or upset, then I can, like, really try to find the reason internally and not just sort of attribute it to the birth control.”

What is notable about both of these peoples’ experiences is that they noticed a change and then decided to stop using which then confirmed the change they had experienced. People know their bodies really well and I hope that as more research about birth control comes out, people can feel more in control of their choice and the options available to them.

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