Understanding how hormonal birth control affects mood is directly relevant to anyone living with PMDD. This 2025 review from UCLA researchers examines what is known about the relationship between hormonal contraceptive use and mood disorders, including depression and premenstrual disorders like PMDD.
The review finds that the relationship between hormonal contraceptives and mood is not straightforward — it depends on the type of contraceptive, the person using it, and their individual biology. Some hormonal contraceptives, particularly oral contraceptive pills containing the progestin drospirenone, can actually help reduce PMDD and PMS symptoms by stabilizing hormone fluctuations across the menstrual cycle. At the same time, other types of hormonal contraceptives may increase depression risk in certain people, especially those who start using them during adolescence or who have a history of mental health challenges.
The researchers highlight two possible ways hormonal contraceptives might affect mood: first, by suppressing the natural mid-cycle rise in estrogen that normally accompanies more positive moods, and second, by altering how the body responds to stress through changes in cortisol (a stress hormone) and inflammation. Both pathways could help explain why some people feel worse on hormonal birth control while others feel better.
An important takeaway from this review is the call for more personalized prescribing. The authors recommend that healthcare providers conduct thorough assessments before prescribing, monitor mood for at least the first few months of use, and be willing to switch methods if unwanted mood changes occur. There are hundreds of contraceptive options available, and what works well for one person may not work for another. For those with PMDD specifically, certain hormonal contraceptives may be a helpful treatment option, but the decision should be made carefully with a provider who listens and takes mood-related concerns seriously.
Key findings
- The highest-quality evidence suggests some types of hormonal contraceptives increase depression risk for some women, while others may decrease risk, particularly for those with premenstrual disorders
- Key risk factors for depression following hormonal contraceptive use include younger age/adolescent onset of use, shorter duration of use (first 2 months to 2 years), and pre-existing mental health history or susceptibility
- A large UK Biobank study (N=264,557) with sibling analysis of 7,354 sister pairs found evidence that oral contraceptive use has causal effects on developing depression, especially during the first two years of use and with adolescent onset
- A Danish population study (N>1,000,000) found hormonal contraceptive use associated with first-onset depression and antidepressant use, with risks highest for adolescents, peaking around six months after first use, and higher for non-oral and progestin-only options
- Oral contraceptives containing drospirenone and ethinyl estradiol can provide beneficial outcomes for women with premenstrual disorders, though effect sizes are often small and placebo responses are common
- Two proposed mechanistic pathways linking hormonal contraceptive use to depression risk are: (1) reduction in mid-cycle positive affect due to suppression of cyclical estradiol rises, and (2) alterations in cortisol levels and stress reactivity that may impair coping with stressors
Methods, briefly
Narrative review of literature published between 2014-2024, searched using keywords including 'hormonal contraceptives', 'birth control', 'depression', 'PMDD', 'PMS', and 'mood disorders' in Google Scholar and PubMed. The review synthesizes findings from RCTs, population-based cohort studies, cross-sectional studies, and epidemiological registry studies, and applies the Social Signal Transduction Theory of Depression as a theoretical framework for interpreting mixed findings.
Limitations to keep in mind
- This is a narrative review, not a systematic review or meta-analysis, so study selection and emphasis may reflect author perspectives
- Most high-quality RCTs reviewed had intervention periods of only 3-6 months, which may be insufficient to capture effects that take longer to emerge
- The reviewed literature suffers from pervasive methodological issues including survivorship bias, self-selection bias, lumping of different hormonal contraceptive types, and lack of randomization in most studies
- Many reviewed studies controlled for variables as covariates rather than treating them as moderators or mediators, potentially misrepresenting the strength of associations
- Political and social implications of findings may influence research funding and framing of results in the reviewed literature
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