Hormonal birth control and mood: what is known

You started a pill, injection, implant or hormonal coil, and a few weeks later something feels off. You are more tearful, more on edge, or just flat. Or perhaps you are only thinking of starting one, and a friend has told you it 'ruined her mood'. It is a fair worry, and the honest answer is that the research does not give a simple yes or no.

This article explains what studies have found, what they cannot tell us, and what you can do. It does not tell you to start or stop any method. That is a decision to make with a doctor or nurse who knows your health.

What the large Danish study found

In 2016, Skovlund and colleagues published a study in JAMA Psychiatry using national registers in Denmark. It followed 1,061,997 women and girls aged 15 to 34, with no earlier depression diagnosis or antidepressant use, from 2000 to 2013. Compared with people not using hormonal contraception, those using a combined pill had a higher rate of first antidepressant use (rate ratio 1.23). The ratios were 1.34 for progestogen-only pills, 1.6 for a vaginal ring, 2.0 for a patch and 1.4 for a hormonal coil. Findings for depression diagnoses at a psychiatric hospital were similar or slightly lower. The ratios were generally higher in teenagers (for example 1.8 for combined pills in girls aged 15 to 19) and tended to fall with increasing age.

The authors concluded that hormonal contraception, especially among adolescents, was associated with later antidepressant use and depression diagnoses, suggesting depression as a possible side effect.

What randomised trials and other studies add

A 2021 systematic review and network meta-analysis in BJPsych Open pooled 12 randomised trials with 5,833 participants. Compared with placebo, hormonal contraceptive use did not worsen depressive symptoms, and the authors concluded it does not increase depressive symptoms in adult women. They said future studies should include first-time users to confirm the result in young women.

A different 2017 trial in Fertility and Sterility gave 340 healthy women aged 18 to 35 either a combined pill or a placebo for three months. The pill group reported a small but statistically significant drop in general well-being, particularly in vitality and self-control, but no significant change in depressive symptoms. A 2025 registry study in Finland looked at about 23,500 new depression diagnoses and found that some combined methods were linked with a lower risk of depression, and that progestogen-only methods were not linked with depression, including in teenagers.

A 2012 review by Poromaa and Segebladh noted that, in prospective trials, between 4 and 10% of people on combined pills report worse mood or emotional well-being. They also said precise estimates are not available because placebo-controlled trials are lacking, and that the causal link in these figures is probably overestimated. So in these trials a minority, not most people, reported worse mood. This rests on one review, so treat the numbers as rough.

A 2025 review in the Open Access Journal of Contraception (Mengelkoch and colleagues) sums it up this way: the highest-quality evidence suggests that some types of contraceptives increase depression risk for some women, while some appear to lower it in some cases. Age when starting and mental health history seem to matter. The authors call for more research and funding.

What is not known

• Whether a particular type of hormone is more likely to affect mood. Studies disagree, and most compare groups rather than individuals.
• Who is most likely to be affected. Teenagers and first-time users are mentioned in several reviews, but this needs better research.
• How much of what people notice is caused by the method, and how much by other changes in life, stress or the underlying cycle.

If your mood changes after starting a method

The NHS lists mood changes among the side effects some people report with the combined pill. It says that if side effects are still a problem after three months, you should speak to a pharmacist or doctor, and that changing to a different pill may help. For the injection, the NHS says there is not enough evidence to say whether it causes mood changes, and advises speaking to a doctor or nurse if mood changes are a problem.

A doctor or nurse can talk through what might be going on, and whether another pill, another method or a non-hormonal method might suit you better. Some methods are easier to undo than others. According to an NHS regional resource, an implant or hormonal coil can be removed if side effects are a problem, while the effects of an injection can last for the length of the injection, and possibly longer.

What to say at the appointment

You do not need medical words. You could say, 'I started this method on this date, and since then my mood has changed in this way.' Mention any earlier depression, anxiety or bad premenstrual mood, any medicine you take, and whether pregnancy is something you need to avoid right now. Ask what your options are, and what to expect if you switch. A good clinician will take your experience seriously, even though the research is still unsettled.

Tracking: a simple way to see the pattern

It is hard to remember how you felt weeks ago. For a month or two, note the date you started or changed a method, your mood on a scale of 1 to 10, sleep, your period or bleeding, and big stresses. This can help you and your doctor see whether changes line up with the method, with your cycle or with something else. It is not a test, and you do not need to be perfect.

If you already have a mood or anxiety condition, or PMDD

Many people worry that they should avoid hormonal methods if they have had depression or anxiety. The 2024 US Medical Eligibility Criteria rate depressive disorders as category 1 (no restriction) for every method in the summary table, including the hormonal coil, implant, injection, progestogen-only pill and combined methods, with a clarifying note. A 2026 rapid review of 10 studies in people with existing anxiety or mood disorders found that hormonal contraception did not consistently worsen symptoms: combined pills were largely neutral, progestogen-only methods and hormonal coils were associated with stable or improved symptoms, and side effects were reported more often with combined pills, especially in teenagers and first-time users. That is a small body of evidence, so individual advice matters.

Mengelkoch and colleagues note that hormonal contraceptives can be used to treat depression in some women whose symptoms swing across the cycle, which may point to a premenstrual disorder such as PMDD. This is a medical decision. If your mood is worst before your period, our articles on PMDD explain more, and a doctor can help you choose a method with your history in mind. If you are taking medicine for a mood condition, do not change it without speaking to your prescriber.

A note for Indian readers

Questions about contraception can feel awkward to ask, especially if you are unmarried, or if a partner or family member has strong views. You deserve private, respectful advice. A gynaecologist, a family planning clinic or a trained nurse can discuss methods without judgment, including non-hormonal options such as the copper coil and condoms.