Is my birth control making me crazy? And other questions about side effects

You’ve been feeling depressed. You’ve gained some weight. Your acne keeps flaring up. And you’ve been on birth control for years. Is your contraceptive to blame, or are your symptoms unrelated? It can be tricky to sort out whether your birth control is causing unwanted side effects, especially since different contraceptive methods can have such different effects on different people.

It’s easier to blame your birth control if you’ve just started a new option and you’re suddenly seeing new symptoms — like if you never had migraines before, and now you do. But other side effects can be more subtle (like making existing depression worse) or even invisible, like increasing your risk of blood clots down the line. Sometimes, your birth control might not be causing a symptom per se, but you might be missing an opportunity to use birth control to make it better — some people find that birth control actually helps with health issues like depression, acne, or migraines.

It can be tricky to sort out whether your birth control is causing unwanted side effects, especially since different contraceptive methods can have such different effects on different people.

Either way, if something feels wrong with your body, it’s important to get to the bottom of it. Unfortunately, the only sure-fire way to see if your birth control is causing a side effect is to go off it for a while, though that requires some careful additional protection against pregnancy, like diligent condom use. Still, there’s evidence that certain forms of birth control are more likely to cause certain side effects, so knowing what the research says can help inform your decisions. Here’s our advice on some of the most common birth control side effects.

Is my birth control making me gain weight?

One of the most common questions people ask about their birth control is whether it’s making them gain weight. In fact, it’s a big reason people report going off contraceptives or switching methods.

That said, there’s not good evidence that hormonal contraceptives cause weight gain.¹ Some studies point to increased fluid retention as a potential source of weight gain, and there’s evidence that estradiol and progesterone, two key ingredients in many forms of birth control, could have some effect on the body’s water balance.² Still, studies that have looked for weight gain on contraceptives tend to come up short.

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The birth control shot (Depo-Provera) is the only method that’s had any concrete links to weight gain, especially for people who are already overweight.³ But even there, evidence is fairly limited.

Another simple explanation could be that people tend to gain weight gradually over time as they age. For example, in 2008, American females had gained, on average, 1.5 pounds per year over the past decade — so 15 pounds total.⁴ And that’s just an average, which means for every person who gained less than that, someone else gained more.

Is my birth control making me crazy?

If you think your birth control is making you crazy, first, let’s take a breath and cut ourselves some slack. In fact, we’d encourage you to not use “crazy” to describe yourself, or others, who might be acting emotional, overwhelmed, or experiencing any number of other perfectly normal feelings!

We do know that estrogen can definitely impact your mood, especially when it comes to emotions related to stress.⁵ There’s even some evidence that higher levels of ethinyl estradiol (the estrogen in some hormonal birth controls) might be associated with higher levels of (self-reported) jealousy.⁶

On the flip side, there’s no association between contraceptive use and lower relationship quality — one study that looked into it found starting or stopping birth control had no effect on relationships.⁷ Many people even find that hormonal birth control has a leveling effect on their mood, for instance reducing mood-related symptoms of PMS and PMDD. This has been confirmed by researchers, with some even suggesting it increases relationship satisfaction.⁸

Hormonal birth control isn’t going to “make you crazy,” but hormones can affect your mood.

Still, if you’re worried your birth control is making you emotional, talk to your doctor. Hormonal birth control isn’t going to “make you crazy,” but hormones can affect your mood. Your doctor might suggest a progestin-only hormonal birth control or a non-hormonal option like a copper IUD if hormones are really hurting your mood.

Is my birth control making me depressed?

First, we need to be clear about what we mean when we talk about depression. Depression is a complex disease, and clinical depression is diagnosed with strict criteria. This means that people may experience depressive symptoms that are disabling, but don’t cross the threshold for a diagnosis of clinical depression.⁹

Here, specifically, we’re talking about both clinical depression and experiencing depressive symptoms. So now that we’ve clarified that, we can rephrase our original question: Is my birth control causing me to experience depressive symptoms?  It’s complicated! There’s evidence that people experience both increases and decreases in depressive symptoms while on hormonal contraceptives.

In 2013, researchers from Columbia University looked at over 6,600 women 25-34 years old and found that those using hormonal birth control were less likely to have experienced depressive symptoms or to report a suicide attempt.⁹ It’s an idea that’s been around for a while: In a 2001 report, researchers recommend hormonal contraceptives as a mood stabilizer for postpartum, premenstrual, perimenopausal, or postmenopausal people.¹⁰

But different birth controls may have different effects, and studies don’t always agree. A 2012 study looking at 498 women between 20 and 50 years old found that people taking progestin-only forms of birth control were more likely to have a mood disorder, while those on a combined form (that is, one with both estrogen and progestin) were less likely to have a mood disorder than non-users.¹¹ But a 2016 study looked at over one million women in Denmark and found all forms of hormonal contraceptives at least somewhat increased the chances people would go on antidepressants.¹² Meanwhile a 2020 review that looked at a number of different studies on hormonal contraceptives and mood concluded that there was no real effect, though adolescents might be more vulnerable than adults.¹³

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Depression is a complex disease that has multiple causes, and our unique bodies can react differently to different methods and doses of hormonal contraception. In general, researchers seem to acknowledge that this topic is a major research gap, and more study is seriously needed.¹⁴ If you think your birth control is making you depressed, talk to your doctor.

Is my birth control making me sick?

Nausea is almost always listed as a possible birth control side effect,¹⁵ but research-based evidence on the topic is extremely lacking. There are studies that link estrogen with nausea, but nearly all of them are related to pregnancy¹⁶ or emergency contraceptives,¹⁷ not to the pill or other forms of hormonal contraceptives.

If you’ve just started a new contraceptive and are feeling nauseous, experts suggest waiting it out — many initial side effects, including nausea, often go away after 2-3 months.¹⁵ But if your nausea is severe, that might be too long to wait. Ask your doctor right away if switching methods is a better option for you.

Is my birth control giving me acne?

If you’re wondering whether your birth control is making you break out, the answer is, yet again… maybe. (When we say that birth control side effects are under-researched, this is what we mean!)

Sex hormones called androgens can increase the production of oil called sebum in the skin, which contributes to acne.^18-19 Estrogen and progesterone affect androgen production, which is why hormonal birth control can impact acne.

Here’s where it gets tricky: Estrogen decreases androgen production, but progestins can increase it, depending on the type of progestin.²⁰ That means that some types of hormonal birth controls make acne better, but others can make it worse. Typically, progestin-only pills are more likely to cause acne trouble, but there’s been little research into this.

If you’re experiencing unwanted acne, regardless of whether your current contraceptive is causing it, evidence suggests combined hormonal pills are your best bet.^21-22 That especially goes for ones with later-generation progestins. Three are approved by the FDA to actually be used to treat acne: Estrostep FE, Ortho Tri-Cyclen, Beyaz, and Yaz.

Learn more about birth control and acne.

Is my birth control giving me yeast infections?

Finally, an easier one! No, your birth control is likely not to blame for your yeast infections. In fact, using contraceptives may actually promote a healthy vaginal microbiome, which prevents infection.²³ The one exception can be the vaginal ring, because they can provide a place for vaginal yeasts to grow, which can potentially facilitate infections.²⁴ This can be avoided with proper cleaning whenever you take out the ring – with warm, soapy water and drying before storage.²⁵ But other insertables like IUDs don’t have the same problem²⁶ – though there is a slight possibility that an existing vaginal infection could be spread to your uterus during the insertion process.²⁷

By the way: If you’re having yeast problems, it’s more likely a gel, sanitizer, or moisturizer you’re using. A survey of over 1,400 vagina owners revealed that people who had used any vaginal or genital products were over three times more likely to have adverse vaginal health outcomes, including yeast infections.²⁸ Why? One reason may be that products like these can mess up your vaginal microbiome, making it more susceptible to infections.

How do I know if I’m having birth control side effects?

It can be tricky to know if a symptom you’re feeling is a side effect of your contraceptive, especially if it’s hormonal birth control, or if it’s just a natural part of being [insert your age here]. But if you’re not feeling your best, it’s worth it to try to figure out the cause and find a solution. There are so many birth control options out there, and each one can affect each person slightly differently. What works for your friend might not work for you – something adyn’s founder noticed in her own experience with birth control that ultimately sparked her idea for The Birth Control Test.

Don’t be afraid to talk to your doctor about how you’re feeling, or to try switching to a different method — you’re worth it!