By Naya Lunney
Art by Sam Paisley
cw: discusses depression, mentions of suicide
Retracing My Steps back to Joy
It’s hard finding your way back to something you don’t remember losing. Tediously picking through memories, searching for the moment when it silently disappeared. The shocking discovery that you’re missing a part of yourself which you thought was integral to your very being.
take a step back
The last Sunday of February, 2023. That was the day I realized I’d lost my joy. I remember because I was on the phone with my parents. It wasn’t the first time I’d broken down over the phone to them that term. It was the first time they’d asked me if I would consider talking to a psychiatrist. Something about mood stabilizers. A second passed… two… three… I forced the stale air out of my lungs.
How had I missed it? How did my parents half a world away recognize the change in me which I had been ignoring for so long? What possibly could have changed things so drastically?
another step back
The mood swings didn’t appear out of nowhere. They crept up slowly from behind, encroaching upon my periphery until my entire vision was blurred. I couldn’t see. Clearly.
another step
The first wave of uncertainty. An upheaval. Blunt. I knew this part was coming. They said it would. It’s normal. It will pass. Probably.
another
December 19, 2021. The day I started taking oral contraceptives.
***
2. The Reclaiming
Let’s be clear. This story is not anti-contraceptive. It is a reminder for anyone choosing to take oral contraceptives to pay close attention to the ways their medication affects their mental and physical wellbeing, whether that occurs in a positive or negative way. Everyone uses and responds to contraception differently, which is why we need to stop sweeping this conversation under the rug and instead work on dismantling common perceptions of what it means to be on “the pill.”
My own experience with oral contraceptives has been turbulent to say the least. It takes time to figure out which medication meshes with your body the best, or rather which one has the lowest impact on you. It is incredibly frustrating when you spend months coming to terms with your specific reactions to new medication, but you end up having to switch to a new prescription due to uncomfortable or intolerable side effects and the process of adjustment begins again. The first three months on a new pill is always the hardest for me. With different levels of estrogen and progesterone being flung through my body at new intervals, it takes a while to figure out what my new “normal” will feel like. I bled for two months straight when I first started using the medication I’m on now. While that was physically noticeable, the mental and emotional effects of changing hormone levels can be more difficult to peg.
Medication-induced mental health changes become even harder to recognize in environments of ever-changing conditions. Living as a college student, for example. Am I feeling crappy because I switched to new meds a couple weeks ago, or is it because my course load is a lot heavier this term than it was last? Am I in a funk because my cortisol response has been blunted or because it’s winter and I’m also facing seasonal depression? Am I having a meltdown because my hormone levels are shifting or because I’m homesick? It becomes impossible to separate the everyday life stressors from the hormones.
What most concerns me, though, is that we still don’t have a complete understanding of the physiological and psychological effects oral contraceptives have on our bodies. Oral contraceptives have been approved for sale in the United States by the Food and Drug Administration since 1960, and yet more than 60 years later there are still alarming gaps in our knowledge about women’s contraceptive health.[1] We know very little about the neurological impact hormonal contraceptives have on women’s brains, and we’ve accumulated even less knowledge on their psychological consequences. However, research has recently begun expanding to include mental health issues in literature focused on oral contraception.
A 2016 study from Denmark provides compelling evidence for increased rates of depression and anxiety in women taking oral contraceptives.[2] Basically, Denmark keeps track of its citizens’ individual social behavior and health through a series of social registers. With this data, researchers tracked the mental wellness of all Danish women and adolescents aged 15 to 34 years old, who had no prior documentation of depression diagnoses, over a timespan of 19 years (Jan. 1995–Dec. 2013). What they found was that women on hormonal contraceptives were 50% more likely to be diagnosed with depression and be prescribed antidepressants than women who were not on hormonal contraceptives. Women on hormonal contraceptives were also twice as likely to have attempted suicide than women who were not, with the number of fatal suicide attempts rising higher in women on hormonal contraception — triple that of their counterparts who did not use hormonal contraception.
Of course, this is only one study and we cannot claim that these correlations equal causation. Hormonal contraception is just one of the many factors that may have contributed to these women’s experiences with depression. Nevertheless, these statistics should raise red flags. I understand that studies like this one can be hard to swallow. Not only are its statistical results and conclusions difficult to process emotionally, but I find it extremely counterintuitive to criticize contraceptive options.
Take away birth control and you take away a woman’s freedom. It is that simple. Her right to choose how she lives her life depends on her ability to decide if, when, and with whom she wants to get pregnant. While contraceptives may negatively impact mental health, the benefits of having contraceptive options at all arguably outweighs the risk. The ability to live independently, plan for pregnancy, and avoid unwanted pregnancies has been shown to greatly reduce stress and anxiety for women who are not ready, for whatever reason, to take on the responsibility of raising a child.[3] This has an immensely positive effect on women’s mental health which should not be discounted.
‘The pill’ was a huge step towards women’s liberation. It is because of birth control that we no longer have to view pregnancy as the biological binding which men have historically used to restrain us to domesticity. We can decide whether or not bearing children is a joy we want to embrace. It is only with this choice, when women are able to have sex and not face the consequence of pregnancy like men, that the two can be deemed “equal.” I get it: it’s completely reasonable to feel protective of contraceptives, but that doesn’t mean we should hold them beyond reproach.
Anyone who has used oral contraceptives knows that potential side effects can be concerning and often contradictory. Weight gain is a common fear among oral contraceptive users, but depending on the prescription it could just as easily cause noticeable weight loss. Some might bleed excessively after starting medication while others won’t bleed at all. One person might be thrown into overwhelming anxiety by their meds, while another uses the same contraceptive for the purpose of treating PMDD (Premenstrual Dysphoric Disorder) symptoms including anxiety and depression.[4] At this point, it feels like we’re pulling numbers from a hat. So, how are we supposed to negotiate these conflicting risk factors?
I can’t say I know the answer to that question. What I do know is that we need the knowledge to protect ourselves and make informed decisions, and for that to be possible we need a more comprehensive understanding of what oral contraceptives do to our bodies, especially to our brains. Until then, we need to take care of ourselves and each other. If you’re starting a new medication (contraceptive or otherwise) that has the potential to impact your mental health, consider asking someone close to you to pay attention. They may notice changes in your mood or behavior which you might not have discerned. Alternatively, keep a journal to help track your mood alongside your new medication routine. What’s important is that you are in touch with subtle, gradual shifts — that way it’s harder to be overwhelmed by seemingly sudden transformations.
There is no one-size-fits-all when it comes to birth control. Every person’s journey with contraception is unique and deeply personal. While no one should feel obligated to talk about their private experiences, we should be working harder to destigmatize discussions about contraceptive effects on women’s mental and physical well-being. We need to initiate these conversations by making information about oral contraceptives and their potential effects more accessible, creating a supportive environment for people to share their own experiences. Otherwise the relentless cycle of shame, silence, pain and isolation will continue for those who fear no one will listen to their story. It is up to each individual to choose what they do with their own body, but it is up to us to provide a framework of compassion to ensure open dialogue is not just allowed but considered the norm.
[1] The Birth Control Pill a History - Planned Parenthood, (Planned Parenthood Federation of America, 2015). https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf.
[2] Charlotte W Skovlund, Lina S Mørch, Lars V Kessing, and Øjvind Lidegaard, Association of Hormonal Contraception With Depression, (JAMA Psychiatry, 2017).
[3] Kelli S Hall, Julia R Steinberg, Carrie A Cwiak, Rebecca H Allen, and Sheila M Marcus, Contraception and Mental Health: A Commentary on the Evidence and Principles for Practice, (Am J Obstet Gynecol, 2014).
[4] Cerner Multum, Nikki Uses, Side Effects & Warnings, (Drugs.com, 2023). https://www.drugs.com/mtm/nikki.html.