As a physician, you may have heard complaints like this in your office from patients on birth control: "I'm gaining weight, and my emotions are all over the place." Or even, "I feel like I'm going crazy." Because of birth control's benefits, many are willing to accept some side effects. However, there are some negative side effects of birth control that are concerning for many women, especially younger females.
Only limited research has been done into the emotional effects of birth control, and there's still no consensus in the medical community about whether taking it leads to weight gain. Still, listen to patients when they talk about body image, emotions and weight gain to help them navigate these aspects of birth control.
Does Birth Control Cause Weight Gain?
Weight gain may contribute to a negative body image for many women, but taking birth control is a bit of a chicken-and-egg scenario. Is the birth control causing weight gain, which is causing negative emotions? Or, are there negative emotions present that are leading to more weight gain? In that case, is birth control causing negative emotions?
It is as frustrating for your patients to wade through these questions as it is for you. Studies do suggest that modest weight gain for some patients may be possible. One in Gynecological Endocrinology found that women using a vaginal ring experienced slight weight gain and a small increase in body mass index. A review published in Informed Health Online concluded that weight gain from hormonal birth control is unlikely; however, the authors noted that it's possible some women may experience additional weight gain. It's difficult to separate weight gain caused by birth control from typical weight gain as women age.
Another recent review that looked at progestin-only contraception published in the Cochrane Database of Systemic Reviews also concluded that minor weight gain may be possible with birth control. The mean weight gain for all studies at six to 12 months was about 4 pounds. Looking at some individual studies within this review, one found that teens had a greater increase in body fat percentage, and a few more studies found an increase for all women.
Does Birth Control Affect Mood?
As with weight gain, it is not easy to directly attribute mood changes to hormonal contraception, and very little research has looked at behavioral health related to birth control use. Although a few studies have not shown birth control to have much of an effect on depression, multiple studies have shown a decrease in measures of quality of life for women. Consider this quick review:
- The vaginal ring did not have a significant effect on depression scores or body figure ratings. However, women using it had lower scores on a self-reported female sexuality scale, according to the study in Gynecological Endocrinology.
- Women had more symptoms of borderline personality disorder while on hormonal contraception, especially those who already had the condition before starting birth control, according to research in Evolutionary Psychology.
- Women reported lower quality of life, mood and physical well-being after taking a birth control pill with ethinylestradiol and levonorgestrel compared to placebo, reported a study in Fertility and Sterility.
- The minipill increased women's risk of being treated for depression 20 percent, and teens were at much higher risk, according to research in JAMA Psychiatry.
What Does This Mean for Your Patients?
Birth control will affect your patients differently. It seems possible that hormonal contraception can lead to modest weight gain and mood changes, all of which can cause a negative body image. Even if the changes directly caused by birth control are minor, they can set off a downward spiral that worsens mood, body image and weight gain.
First, listen to your patients' concerns about weight. Although weight gain is often dismissed as age-related or tied to factors other than birth control, it's theoretically possible that if birth control increases body fat and decreases lean muscle mass, your patient may gain weight easier than she's used to. Hear what she says about weight and offer suggestions, such as increasing strength training to maintain muscle mass or ensuring she's following a healthy eating pattern.
Address any concerns about mood. Whether it's related to birth control or not, your patients will have emotional fluctuations at times, all of which can lead to them discontinuing birth control. Encourage them to try different contraception options until they find one that feels best for them. They should pay attention to any worsening depression, borderline personality disorder or anxiety. For women who may be at risk or already have behavioral health struggles before birth control, keep a close eye on them during follow-up visits and offer treatment or counseling to manage their mental health as well.
Healthcare providers should pay special attention to teens and young adults. Teens are likely already experiencing many emotional changes and may be inherently at higher risk of a negative body image. The reality is that there can be negative side effects of birth control, so be cautious when recommending hormonal contraception and encourage those patients to try options that may be less likely to affect their mental health.
Your patients will experience birth control and any side effects differently. Luckily, they have a wide range of options to try, including many low-dose options. Be empathetic when listening to their concerns about how they respond, and provide tailored solutions based on what will give them the best quality of life.
