Birth Control and Mood: When Hormones Change How You Feel and How Your Meds Work

Birth control can shift mood and impact psych med effectiveness. Learn common side effects, warning symptoms, and what to ask before you switch.

Christine, 27, starts a new birth control pill because her periods are brutal. Three weeks later, she is crying in the grocery store. Her sleep has become fragmented. She feels jumpy all day and flat at night. Her chest stays tight, as if she is bracing for bad news. She tells herself it must be stress, and her clinician increases her antidepressant dose.

No one asks the simplest question: Did anything else change right before you started feeling worse?

For some women, hormonal birth control is mood-neutral or even stabilizing. For others, it can quietly push anxiety, irritability, or depression in the wrong direction. And there is a second layer that gets missed even more often: birth control can change blood levels of certain psychiatric medications, so you can feel worse even if your diagnosis is the same and you are “doing everything right.”¹,²

When this article uses the term “birth control,” it refers to hormone-based methods: combined hormonal contraception (estrogen + progestin, like the pill, patch, or ring) and progestin-only methods (such as the mini-pill, injection, implant, and some IUDs). Estrogen and progestin are not just reproductive hormones; they influence brain signaling, stress response, and sleep. That is why the same method can feel completely fine for one woman and destabilizing for another.¹

What mood changes can look like

When hormones affect mood, they often show up as a cluster of symptoms rather than a single change:

• New or increased anxiety, or feeling “wired but tired”

• Irritability and a shorter fuse

• Low mood, tearfulness, or emotional numbness

• Sleep disruption, such as difficulty falling asleep or early awakening

• A flare of PMDD symptoms, including worsening of premenstrual mood changes

Timing matters. A classic pattern is a noticeable shift within 2–8 weeks of starting or switching a method, sometimes sooner.¹ If you felt good for months and then gradually worsened with no contraception change, that is a different pattern and deserves a broader look.

Who is more likely to notice mood effects

There’s no sure way to predict who will be affected, but mood changes are more commonly reported by:

• People with a history of PMDD (severe premenstrual mood symptoms)¹

• Those who have noticed mood changes during other hormonal shifts, such as after pregnancy or during perimenopause³

• Teens and people who start hormonal birth control at a younger age (“early starters”). Population studies suggest this group reports mood effects more often, though many do not experience problems¹,⁴

• An active anxiety disorder or recurrent depression (because a small push can feel big)¹

Population data can show an “average” increased risk, but your experience is individual. Some women stop using a method early because they feel worse, which can make study results look inconsistent when those experiences drop out of the data.¹

“Adjustment” vs “this is not working for me”

Some side effects improve over time. But you do not need to white-knuckle emotional suffering to prove you are resilient.

A practical way to tell the difference is to look at three signals together:

1) Timing: Did symptoms start soon after you began or switched the method?

2) Intensity: Are they interfering with sleep, work, or relationships?

3) Self-recognition: Do you feel like a distorted version of yourself rather than just “a bit off”?

If all three are present, it is more likely the method is not a good fit.

Other red flags that should prompt faster action:

• Symptoms are new, severe, and persistent after starting or switching

• Your sleep is breaking down (sleep loss amplifies anxiety and depression)

• You have intrusive thoughts (unwanted thoughts you cannot dismiss) or hopelessness

• You are using coping skills and support, and things are still escalating

If you have any suicidal thoughts, seek urgent help immediately.

A note about progestin-only methods

Many women who feel worse on estrogen-containing birth control are told to switch to progestin-only options as a “mood-safer” alternative. Some do feel better after that switch. Others do not. Progestin can still affect mood in sensitive individuals, and there is no method that is universally neutral for mental health. If you switch methods because of mood symptoms, it helps to plan a specific follow-up window (for example, 3–6 weeks) to reassess rather than assuming the new method will automatically solve the problem.¹

The part most women never get told: birth control can change how your psych meds behave

1) The lamotrigine issue (the big one)

Lamictal (lamotrigine) is used for bipolar mood stabilization and sometimes as an add-on for depression (augmentation). Estrogen-containing birth control can lower lamotrigine levels, sometimes substantially, because it speeds up how your liver clears the medication.²

What this can look like:

• More mood swings, depression, or irritability after starting combined hormonal contraception - CHC (birth control that contains both estrogen and progestin).

• Feeling “unstable” even though nothing else changed

If you later stop CHC, lamotrigine levels can rise again, which can increase side effects.²

The clinical takeaway is simple: **if you are on lamotrigine, contraception choices and dose planning should be linked, not separate conversations.²,⁵

2) “Enzyme inducers” can reduce contraceptive reliability

Some medications speed up the liver’s filter (enzyme inducers), lowering hormone levels and making some contraception less reliable. This is discussed more often in epilepsy care, but it also matters in psychiatry when these meds are used for mood stabilization. U.S. medical guidelines recognize these interactions and recommend taking them into account when choosing birth control.⁵,⁶

If you take a medication known to be an inducer, you can ask specifically:

• “Could this lower birth control hormone levels?”

• “Should I use a method that bypasses this interaction (like an IUD), or add backup contraception?”

3) Symptoms can be misread as “relapse”

If birth control is lowering a med level (such as lamotrigine), you can look like you are “relapsing” when the real problem is dosing context.² That distinction matters because the fix may be a contraception choice, a dose adjustment plan, or both.

What to do if you think birth control is affecting your mood

Step 1: Name the pattern

Write down:

• Start date (or switch date) of the method

• Method and dose (if you know it)

• The first day you noticed mood or sleep changes

• Any medication changes in the same window

This gives your clinician a clear, usable timeline.

Step 2: Decide what to change first

A practical decision framework:

• If symptoms are severe or escalating: change the contraception plan promptly rather than waiting months “to see.”

• If you are on lamotrigine and started estrogen-containing contraception: assume there may be an interaction until proven otherwise and discuss a coordinated plan.²

• If the method is otherwise ideal (bleeding control, acne, contraception goals): consider a formulation or route change rather than abandoning hormones altogether.

Step 3: Avoid a medication pile-on

A common trap is adding sedatives, raising antidepressants, and layering medications before anyone revisits the hormone change. Sometimes that is necessary, but often it is not.

The patient-centered question to keep repeating is: “What changed right before I changed?”

A screenshot-friendly checklist for your next visit

Bring this list and ask your prescriber to answer directly:

• “Could this birth control method worsen anxiety or depression in some women?”

• “Given my history (PMDD, postpartum, perimenopause, anxiety), what should we watch for?”

• “If I feel worse, what is our plan: switch method, adjust dose, or both?”

• “Do any of my psychiatric meds change how well this birth control works?”⁵,⁶

• “If I take lamotrigine, how will we handle the interaction if I start or stop estrogen?”²,⁵

• “Which symptoms mean I should contact you right away?”

The bottom line

If birth control changes your mood, it is not a character flaw, and it is not “just in your head.” For many women, it is a solvable mismatch: the wrong formulation, the wrong timing, or an interaction plan that never got made.

You deserve contraception that protects your body and supports your mental health.

FAQs

Which birth control is “best for mood”?

There is no universal best option. Your best choice depends on your personal hormone sensitivity, PMDD history, and what happened on past methods. If you have a clear pattern of mood worsening after estrogen-containing methods, discuss non-estrogen options or a different formulation with your clinician.¹

How long should I wait before deciding it is not working?

If you feel mildly off but still functional, a short trial window (often a few weeks) can be reasonable. If your mood, anxiety, or sleep is clearly deteriorating, you do not need to wait it out, and earlier action is especially important if you have a history of depression.

Can an IUD cause mood changes?

Some women report mood effects with hormonal IUDs, while others feel no change. If you develop new symptoms soon after placement, treat the timing as a useful signal and discuss options rather than assuming it is unrelated.¹

If my clinician says “birth control doesn’t affect mood,” what can I say?

You might try: “I am not saying it affects everyone. I am saying my symptoms started after a hormone change, and I would like a plan that takes that timing seriously.” You can also ask for a monitored trial switch.¹

Does postpartum timing matter?

Yes. The postpartum period is already a high-risk time for mood symptoms, and a large cohort study found that postpartum hormonal contraceptive initiation was associated with a higher subsequent depression risk compared with no hormonal contraception.³ This is a place where individualized timing and close monitoring matter.

References

1. Ciarcia J, Huckins LM. Oral Contraceptives and the Risk of Psychiatric Side Effects: A Review. Complex Psychiatry. 2024.

2. Iqbal A, et al. Lamotrigine, Contraceptives, and Psychiatry: A Narrative Review. Cureus. 2025.

3. Larsen SV, et al. Postpartum Hormonal Contraceptive Use and Risk of Depression. JAMA Network Open. 2025.

4. Larsen SV, et al. Depression Associated With Hormonal Contraceptive Use as a Risk Indicator for Postpartum Depression. JAMA Psychiatry. 2023.

5. Nguyen AT, Curtis KM, Tepper NK, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep. 2024.

6. Curtis KM, et al. U.S. Selected Practice Recommendations for Contraceptive Use, 2024. MMWR Recomm Rep. 2024.

Authorship

Frederic Kass, MD — Professor Emeritus of Psychiatry, Columbia University Medical Center; former Clinical Vice Chair, Department of Psychiatry Profile: Medical News Today

Erica Gettenberg, MD — Board-Certified in Adult, Child, and Adolescent Psychiatry; expertise in mood and anxiety disorders and ADHD. LinkedIn: Erica Gettenberg, MD

All vignettes are fictional and for educational purposes only. This is not a substitute for professional medical advice.