*Trigger warning for depression and suicidal thoughts*
Two years ago around this time of year I realized that my mental health issues were more than just seasonal blues. Since then, there have been millions of questions I’ve asked, blame I’ve thrown at myself and others, and choices made to better understand and work with my illness. Hormonal contraceptives are one suspected factor of my anxiety and depression that I simply cannot stop analyzing. These are my own complicated experiences with hormonal birth control, so please remember that everyone is unique, and because of that my experiences will vastly differ from those of someone else. This is not a guide or a “birth control: exposed!”, but a personal reflection.
Four years ago I started having penis-in-vagina sex. I had never had prior sex-ed, but after doing some of my own research (thus beginning a passion for all things sex-ed) to teach myself how to masturbate, I knew the basics of protection from STIs and pregnancy. At the time, the only options I knew of for this purpose were condoms and the hormonal pill. I fondly remember my first time using a condom, messing up two of them before we could figure out how to work it. For a high schooler, condoms are difficult to come by, as well as expensive. Afraid and embarrassed to purchase them, I started campaigning my mother to allow me to go on the pill*. I touted it as a solution to my cramps, as well as a treatment for my teenage acne. Of course I wasn’t using it for sex, mom. Despite this (obviously false) reasoning, she voiced a persistent no. I still carry a slight grudge against her over this argument. I understand that it’s scary to see your child growing up and uncomfortable talking to them about sex; however, if you know they’re doing it, wouldn’t you want them to be safe? After a few months of this argument, I discovered I didn’t need her permission anyway and demanded she be absent from my next yearly physical. I was terrified of what that appointment might look like. Would I have to be naked? Would they look at my vagina? Pry me open with cold metal tools? None of these worries were true. Instead, I nervously answered questions about my family health history, and was told about the possible side effects of nausea, mood swings, and lower sex drive. I received a prescription for the Ortho-Tri-Cyclen, the classic combination pill pack of three weeks of white “active” pills, and one week of blue sugar pills.
I was on this pill for about three years. During that time, I slowly developed anxiety and depression. I couldn’t tell you when exactly this happened, just that it crept over me until suddenly it was all I could feel and think about. After about a year of dealing with the daily struggle of constant nervousness and gloom, I started wondering if my birth control had anything to do with it. I decided to try a different hormonal method. I switched to the nuvaring, a ring shaped piece of plastic inserted into the vagina and left for three weeks, then taken out for menstruation. I used it for a few months, but after a while decided to try going off of hormonal contraception altogether to see if it was enhancing my depression as I expected. I consulted my doctor before this, letting her know my suspicions about the hormone’s effect on my mental health. She scoffed at my claims, saying there was no correlation and that it was impossible for birth control to conflict with my mental health. I was embarrassed for suggesting it, so I politely nodded and allowed her to refill my prescription. I decided not to put the ring in regardless of what she said.
As I returned for my sophomore semester of college, I decided to give the nuvaring another chance. I hadn’t been on any hormones for about two months, and had seen no difference in mood. I was discouraged that my suspicions were false and I was still left with no explanation for my depression. Within two days of inserting the ring, I plunged into one of the worst downswings of depression I had ever experienced. The weather was beautiful, I was back at school and free from responsibilities during syllabus week, but instead of seeing friends and socializing outdoors in the sunshine I laid in bed feeling numb, distant, and dead. I was apathetic, lost, confused, and guilty for these feelings. This lasted only a few days before I broke.
There are a few moments in the course of my tangle of anxiety and depression that I don’t think I will ever forget. One was driving down the highway desperately longing to jerk the wheel and smash my car head on onto the oncoming traffic. One is a particular anxiety attack at the pool I worked at. But the clearest, most painful event I can remember happened about a week into school. My roommate and soon-to-be-partner were respectively out and about somewhere and I was in my dorm. I can clearly picture the darkened room and the look of my toes peeping out of the blanket. I was cradled in the rainbow hammock I had strung up under my lofted bed. I still find it hard to look back at the juxtaposition of such a dark dismal me wrapped in so many vibrant colors. I lay there for around an hour feeling somehow nothing but also everything. Filled with anger, embarrassment, guilt, sorrow, loneliness, self-pity, and self-hatred, my thoughts drifted and interwove and it wasn’t until I heard the door open that I realized exactly what those thoughts were. The phrase “burst into tears” could be used to describe what it may have looked like from an outside perspective. To me, however, it was a total breakdown. I felt destroyed. I sobbed and screamed and let all of the horrible emotions pour out as I told my roommate and partner everything I had been thinking. I realized I had spent the last hour lying in bed in the dark figuring out the best possible way to take my own life without disturbing my roommate and close friend’s life. I had been debating where the least bothersome place would be, and contemplating the method of destruction least offensive to whomever would find my body. I had been planning in detail, completely absorbed in those thoughts. My friends listened and held me. They cried with me, and they told me they’d do their best to help me. Once everything had subsided to silence, sniffles, and heavy breathing, I remembered the nuvaring. I knew. I knew that this had something to do with it. I took it out as soon as possible and it was one of the best decisions I’ve ever made.
The next day I felt immensely better. I felt as if I had been at the bottom of the ocean and had just come up for air. Gone were thoughts of ending my life. Gone were the heavy feelings of apathy, uselessness, and exhaustion. Yes, I was still depressed, but the extent to which my mood had improved was incredible. Hope returned. Relief ensued. I felt triumphant because I knew I had been right, that hormonal birth control was somehow exacerbating my depression.
I returned to the doctor for another physical, this time determined to make strides in improving my mental health. I kept my mouth shut about birth control, and instead simply told her how I was feeling. She asked me more questions, and drew her own conclusion that I needed medication. I protested, saying I wanted to try therapy first before starting any kind of pill, as I know exploring medication can be a long journey to find what works for you. She told me that in my condition, it was heavily recommended I take the medication. I once again timidly agreed, nodding my head and accepting the prescription she pushed into my hands. This was the second time she pressured me into accepting her choices about my mental and physical health rather than my own.
Eight months since the “hammock incident” as I have come to call it, I have since changed doctors. I now use condoms as my pregnancy prevention method of choice, and will soon be looking into getting a copper IUD. Anxiety and depression are still very potent and very real to me: worse since my days on the pill, but far better (for the most part at least) than those few days on the ring. I am still unsure if those little pills had a hand in contributing to my depression, but I do know that the ring caused me to contemplate suicide after only a few days of use. Depression and other mental illnesses are rarely caused by one thing. It takes a combination of genetics, brain chemistry, external events, and your reactions to those events. I do wonder if the pill caused slight mood changes, paving way for habitual negative thoughts that contributed to my depression. Maybe my mental illness has nothing to do with birth control at all. Correlation does not necessarily mean causation I suppose. While some research shows similarities to my experience, other research shows the opposite effect, that hormonal contraceptives actually prevent depression.
My story is in no way meant to persuade you away from hormonal birth control. Both the pill and the ring (and I’m sure implants, hormonal IUDs and shots as well) are great methods that work wonderfully for so many people. I suppose what I learned from this whole experience, and the resulting advice I have to give you, is to trust and stand up for yourself. Trust your body, mind, and gut. Listen to them, take note of what they say, and don’t let anyone (even a doctor!) tell you you’re wrong about what you’re feeling. This can be with both mental and physical health issues, as well as relationships of all forms. Your body and mind are yours. Pay attention to them and give them the love and care they need.
*At the time, I figured since I had never been sexually active, I must be free of STIs. This isn’t true! Always get tested before having sex, and especially before deciding to forgo a barrier method.
All links for different forms of contraception lead to bedsider.org, one of my favorite resources for birth control methods. Check out the linked page to find a method that works for you!