When a woman or girl walks into her OB/GYN’s office because she’s experiencing mood swings, depression, or anxiety that flare up around her period, it’s likely that she’ll be offered hormonal birth control (HBC) to address these symptoms, despite growing evidence that HBC actually worsens such conditions. Countless stories and an increasing amount of scientific research confirm that birth control affects women’s mental health for the worse, and that teens in particular suffer from far higher rates of depression when taking HBC.
I experienced HBC’s psychological effects for myself when I was prescribed the pill after missing my period for several months in college. I suddenly started having mood swings and extreme emotional reactions that were totally out of the ordinary for me. For example, one weekend approaching finals, I had stashed a pint of ice cream in the dorm fridge. When I went looking for my sweet study boost late Sunday afternoon, it was gone, no doubt taken by some other stressed and hungry student who couldn’t resist. I was enraged. I typed out a message berating the thief to the entire dorm group chat—thankfully, my reason prevailed and I never hit send. Even as I fumed, I remember thinking, I am way too upset about this. Even though my symptoms were relatively mild compared to what many women go through on the pill, I couldn’t stand my emotional unpredictability on HBC, and I quit taking it three months after I started.
A recent study looking at close to 200 participants at Rice University and from the greater Houston area adds a new twist to what we know about HBC and mental health. Birth control might be affecting not only emotions but also memory [1]. Specifically, HBC was linked to remembering fewer details of negative experiences. In news reports covering the study, the lead researcher suggested that “reduced memory for unpleasant experiences may actually be protective.”
My guard was immediately up against this interpretation: in my experience, memory itself has often been a protective force, either by preventing me from repeating mistakes or by helping me evaluate situations with more clarity later on. But I decided to look more closely at the study to see if hormonal birth control really had been found to have some positive psychological influence. The data told a different story than what the reports suggest.
How did researchers study birth control and memory?
The study conducted at Rice University sought to further understand how HBC affects women’s psychology and mental health, including their emotional reactions, responsiveness to emotional regulation techniques, and memory.
Of the 179 female participants, ages 18-35, about half were taking hormonal birth control and the other half were cycling naturally.
The participants were assigned to one of three groups. Two of these groups learned emotional regulation techniques for processing both negative and positive emotions. For negative emotions, one group learned distancing, or taking the stance of an impartial observer towards the situation pictured; the other group learned reinterpretation, or looking for alternative meanings of the image. For positive emotions, both groups learned a technique called immersion, which involves imaginatively engaging with the images to make the events feel more real. A third group, the control, did not learn any emotional regulation techniques.
Each participant was then shown a series of positive, negative, and neutral images, and reported their emotional responses toward the images. After a short delay, participants were given a memory test to see how well they could recall the images they had seen.
Recall differences found between participants using HBC vs those who were cycling naturally
The researchers found a constellation of results differentiating the participants using hormonal birth control from those who were cycling naturally. Birth control users had a stronger emotional reaction to all of the images, but especially towards the negative ones, compared to naturally cycling participants. They also had more success reducing those negative emotions when using emotional regulation techniques, distancing more so than reinterpretation. Finally, the participants using birth control had lower recall of the negative images they had been shown once they applied the emotional regulation techniques.
To summarize, the participants on birth control had intensified emotional reactions when shown negative images; emotional regulation techniques reduced the negative response but also reduced their ability to recall the original image.
To summarize, the participants on birth control had intensified emotional reactions when shown negative images; emotional regulation techniques reduced the negative response but also reduced their ability to recall the original image.
These findings support previous research showing that birth control affects emotional reactivity. They also suggest that birth control alters the way memories are retained and even formed in the first place.
The link between hormones and memory
The role of hormones on brain function, including memory, has been the subject of research using brain imaging technology in recent decades. For example, at least one study has indicated that estrogen has a positive effect on cognition and memory [2].
The study at Rice University collected data that aligns with these findings. They recorded which phase the naturally cycling participants were in, and found that those in the follicular phase—when estrogen is rising and progesterone is relatively low—had better success reducing negative emotions using distancing than those in the luteal phase.
Was HBC really “protective?”
As I mentioned earlier in this article, the lead researcher proposed that having fewer negative memories, as observed in HBC users, may be a positive, “protective” psychological outcome.
The interplay between memory and emotions highlighted by the study calls this interpretation into question. The reduced memory experienced by the participants taking HBC still came with significantly heightened emotional reactions—especially negative reactions.
By contrast, those in the control group (not using emotional regulation techniques) who were naturally cycling had similar levels of negative emotions as those using HBC who employed distancing. In other words, the most effective emotional regulation technique applied by HBC users produced comparable results to the unaided emotional response level of the naturally cycling group.
Moreover, the naturally cycling group also experienced reduced negative emotions when they applied the distancing technique, yet their memory was not affected.
In other words, the most effective emotional regulation technique applied by HBC users produced comparable results to the unaided emotional response level of the naturally cycling group. Moreover, the naturally cycling group also experienced reduced negative emotions when they applied the distancing technique, yet their memory was not affected.
… Or were emotional regulation techniques simply mitigating a problem created by HBC in the first place?
It is misleading to suggest that HBC is in any way protecting women psychologically. The reality supported by this study among many others is that HBC heightens negative emotional responses. The emotional regulation techniques were effective, but they only partially mitigated a problem created by HBC in the first place.
Heightened emotional responses are not simply a result of the way HBC alters brain structure and function. Strong negative emotions can also drive harmful behaviors and damage relationships, and it’s not hard to imagine that a reduced capacity to remember and process negative experiences could further expose women to destructive situations.
A 2010 study published in the British Medical Journal found that long-term use of HBC leads to a 116% increased risk of violent or accidental death [3]. The increased rate of suicide among HBC users is a major contributor, and it’s thought that the higher rates of depression associated with contraception use explains this link. In the study at Rice University, nearly 22% of the participants taking birth control were also taking antidepressants, compared to fewer than 9% of the naturally cycling participants.
Birth control still viewed as a necessity
The authors of the study express their hopes that these findings will contribute to the development of “emotion regulation training programs tailored for [HBC] users.” The idea that emotional regulation training will be provided for birth control users is far-fetched. Many users have trouble getting their doctors to take them seriously when they report their side effects. Meanwhile, the push to make HBC ever more widely available without even a doctor’s prescription runs contrary to implementing measures to help users manage symptoms brought on by HBC.
It’s disappointing that, in the researchers’ view, birth control is a foregone conclusion. No matter how much evidence surfaces that HBC is creating adverse effects for women’s health, it never seems to be enough to suggest that women stop or even exercise caution taking it. Instead of putting forth emotional regulation techniques as a band-aid for adverse effects of HBC, why not call its use into question, especially for women who are already experiencing mental health challenges?
Some good news: Memory effects of HBC appear short-term
One detail that stood out to me from the study as a positive was that participants only had to have been taking or not taking birth control for three months to be included in the contracepting or naturally cycling groups, respectively. This is cited as giving enough time for birth control to fully take effect or for cycles to resume their natural pattern (though we know that suppressing ovulation has long-lasting effects in many areas).
In light of this, I think the significant difference found between the groups is encouraging, as it suggests that the psychological effects of HBC are not permanent. I certainly found that my psychological symptoms disappeared once I was off HBC (granted, I was only taking it for a short time).
The bottom line on emotions, memory, and our hormones
Reading the results of this study drove home for me that our bodies and our minds are made for ovulation. HBC has far-reaching consequences that are continually being uncovered but not widely disclosed. Those who see birth control as empowering and necessary for women may choose to interpret its effects positively, but the fact remains that altering memory and emotional regulation is an unintended side effect.
At the very least, women and girls deserve to know the effects of putting synthetic hormones into their bodies in order to have informed consent, especially amidst a mounting mental health crisis. Even better, they deserve access to education and tools like fertility awareness methods that will help them understand their bodies and their cycles without putting their minds and bodies at risk.
