Shortly after Catherine Girard began taking oral contraceptives, she felt like there was a “grey cloud” hanging over her head.
At 17-years-old, Girard was prescribed birth control pills – commonly called “the pill” – as a means of contraception. Her doctor recommended the popular brand, Alesse, which like other forms of hormonal birth control, is often marketed as a do-it-all lifestyle drug for young women. Not only would the pill help to prevent pregnancy, but it might also clear up acne, quell painful menstrual symptoms and reduce risks of osteoporosis.
Without question, Girard was sold. She took the medication continuously for five years.
But while taking the medication, Girard, who is now 25, says she felt like she was “crazy.” She experienced bouts of sadness, irritability and “dark thoughts” on a daily basis.
“Even if my day was good, it just wasn’t, for no reason,” she describes.
For a while, Girard figured this was just the angsty, teenage experience. But when she shed her teen years, and not the depressive symptoms, she worried there was another problem.
In 2020, as the COVID-19 pandemic forced people into isolation, Girard chose to stop taking the pill altogether — against the recommendation of her doctor.
“My mood stabilised so quickly,” Girard says. “Almost instantly, I felt better.”
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Girard has no intention of ever returning to the pill, and she’s not alone either.
There appears to be a growing trend that sees some women opting out of the pill on their own volition. Many, like Girard, will say they felt intense melancholy while taking the hormonal medication, then speak of the clarity they feel once they stop.
Between 2002 and 2017, there was a nine per cent decrease in the use of the pill among American women. On the home front, statistics on women’s preferred contraceptive methods are lacking, but the 2015 Canadian Contraception Survey found that 44 per cent of sexually active women using contraception preferred the pill over other means.
Even though many young women and their mothers once used the familiar little pills, a fast-approaching, dynamic shift may be on the horizon. Be it because of adverse side effects, more contraceptive options or a personal desire to experience the world without hormonal medication, more and more women appear to be ditching the pill.
That’s not to say, however, that oral contraceptives aren’t a net-win. Many of those shelving their birth control packets would argue the same. But if you tune in to ongoing conversations about the pill on social media, you’ll hear legions of young women discuss the “clarity” they feel after abandoning their medication.
But there just simply isn’t enough science readily available to confidently say why hormonal contraceptives may influence a person’s cognition or mood.
Nevertheless, women like Girard are adamant the pill is a detriment to their health — and they’re encouraging other people to stop taking the pill, too.
What’s the real truth?
Moodiness is one of the most common side effects reported by those taking the pill, and though the supporting evidence is mounting, scientific literature can’t confidently say why. Many hormonal birth control manufacturers will list depression and moodiness as a possible side effect of the drug, anyway.
“There’s no clear-cut understanding of the effect of hormonal medication on mental health,” says Dr. Sari Kives, a gynecological physician at Toronto’s SickKids Hospital and an associate professor at the University of Toronto. “We don’t really know about mood yet.”
Estrogen and progesterone levels naturally fluctuate during the menstrual cycle, which can influence mood. The pill is intended to stabilize these hormones throughout the month, and for many women, it works.
Similarly, some complain they feel “numb” or “in a daze” while taking hormonal contraceptives – another area where explanation is lacking, so far.
According to Kives, there’s a reason for this knowledge gap — studies into cognition and mood are especially difficult (and costly) to complete. To create a viable study, researchers need a large, cooperative population that’s willing to be studied over a long period of time. Scientific discussion about mood would require diligent documentation of one’s emotions, likely over the course of several years. Kives says it is not feasible to retroactively ask for cognitive data.
Just because we don’t understand everything about the pill, doesn’t make the medication moot. Rather, Kives says prescribing oral contraceptives is a matter of getting to know a patient’s needs. Most patients and medical professionals, she says, are “reticent to the fact that some people are going to be more sensitive to taking hormones than others.”
“What I’ve learned over 20 years of practice is that I can’t tell somebody how they’re going to feel,” she says.
If a patient complains that they don’t feel right on a certain type of medication, it means it’s time to try something new, Kives explains.
“For some women, hormonal medication just doesn’t make sense. They don’t like how they feel taking it,” she says. “What we need to do is listen to our patients.”
With an already existing gap between the level of healthcare offered to men and women, it is vital women feel heard by their doctors.
Unfortunately, many women don’t have physicians who are as willing to listen.
When Girard confided in her doctor, also a woman, that she felt mentally unwell while taking the pill, she was told nothing could be done. She was already on the lowest dose of her birth control, and she did not want to have an intrauterine device (IUD) placed. The only alternative, she was told, was to stop taking the pill and risk pregnancy.
Her doctor encouraged Girard to simply continue with the medication, leaving her increasingly pessimistic.
“I felt really not listened to,” she says. “I thought maybe that’s the truth and there is nothing else that can be done. I felt really left behind and really abandoned.”
Girard turned instead to the internet, where she found an uninspired amount of viable scientific literature, but seemingly endless anecdotal accounts from women just like herself, who claimed to have adverse mental side effects from the pill.
“It’s already so talked about amongst women,” Girard complains. “If the scientific community is not picking up on it now, they’re not going to pick up on it.” With a smile, she adds: “And maybe that’s a very defeatist attitude — and maybe I was still on birth control when I came to this conclusion.”
‘But Mom, everyone is doing it’
For many Millennial and Gen Z women, being prescribed the pill while in school was both contraception and social currency.
When Brooke Allan, a 26-year-old from Vancouver, B.C., started taking birth control as a teen, she remembers the medication coming with a certain level of clout.
“It was seen as a bonus amongst friends. You could say, ‘Yeah, my mom let me go on birth control,’” she recalls. “I do remember the majority of my friends being put on it while they were super young.”
Allan was 15 when her friends and doctor encouraged her to take the pill as treatment for her severe menstrual cramps and minor acne; she revealed she was “hardly sexually active” at the time. She says her doctor did not make her aware of any possible side effects to her mental health.
Allan’s doctor prescribed her Alesse. Shortly after, due to an inauspicious physical reaction to the drug, she was prescribed Ortho Tri-Cyclen Lo, which she continued to take for another seven years.
Then in 2019, Allan switched up her birth control. As a busy film production coordinator, she figured an IUD, with its long-lasting effectiveness and ease-of-use, would be a good alternative to the pill. But her 18 months-long experience with a hormonal IUD – a T-shaped device that is inserted into the uterus and disrupts the body’s ability to get pregnant – resulted in painful, labour-like contractions. She says she was “the most depressed I’d ever felt in my life.”
Allan had her IUD removed and returned to taking the pill. However, in February 2023, Allan decided to stop taking the pill altogether at the encouragement of a naturopath.
She says it felt “like a veil had lifted” over her life.
“For my entire life, I’ve been on hormones that have affected who I am. They affected my personality and how irritable I was,” she says.
While taking hormonal contraceptives, regardless of their variation, Allan says she felt a “low-grade depression.”
“I had like a dark lens over my life where everything that happened to me was perceived as negative,” she describes. “It’s like having road rage 24/7 in everyday life.”
Only two months after stopping the pill, Allan says the change was night and day. She says she is now “overflowing with happiness.”
Allan revealed she has no intention of taking the pill again. In fact, she worries that since prescription birth control is free in British Columbia, where she lives, more people may have the same depressive experience as her.
“It feels like this conversation needs to happen even more so because people need to be informed before they’re accepting handouts,” Allan says. “It’s great that we have birth control, it’s such a privilege, but people need to be informed of what they’re taking.”
Is the pill dangerous?
When it comes to the pill, the science isn’t simple. But for Nicole Pasquino, the clinical practice director at the Options for Sexual Health clinic in Vancouver, B.C., one thing is: compassionate care.
Pasquino is a registered nurse (RN) working at the Options clinic, the largest provider of sexual health services in British Columbia. Similar to Planned Parenthood, Options for Sexual Health offers reproductive care, referral pathways and counselling for people of all ages, genders and orientations.
On April 1, prescription contraceptives became free for all residents of B.C. enrolled in the province’s Medical Services Plan (MSP). Though much of the population now qualifies for free birth control, that doesn’t mean it’s being dished out without care.
“We always operate from a lens of informed consent, especially when it comes to contraception,” Pasquino says.
If anything, Pasquino sees the new program as a positive, mostly because it has eliminated the limitation of cost for many would-be patients interested in contraceptives.
“When people are given the option of birth control without the cost associated with it, their choices are different,” she says.
Nicole Pasquino.
Courtesy of Nicole Pasquino
When cost isn’t a factor, Pasquino and her patients have more room to consider a wider range of contraceptive options and are able to determine what will be best for their unique needs. They can discuss the pros of taking the pill — such as reduced uterine and ovarian cancer risks — and any potential side effects that may be of concern.
Many of Pasquino’s patients who are taking the pill have complained about moodiness and depression. Like Kives, Pasquino said there “isn’t a simple answer” when it comes to birth control and mental health.
Regardless, Pasquino says she listens to her patient’s concerns about how they’re feeling.
“It’s a really important thing for the patient to verbalise and feel they are in a safe space when we have those conversations,” she says. “We’ll explore that with them.”
“If someone comes to me and says, ‘I feel like my birth control is impacting my mental health,’ then I’ll say to them, ‘All right, let’s try something different,’” Pasquino describes.
However, like Kives, Pasquino does not recommend anyone stop taking the pill cold turkey or without a plan.
“I always tell my patients there’s other things in the toolkit,” Pasquino says. “Whatever you’re feeling, we can try and make changes and look at how we can get a better formulation for you.”
A guilty conscience
It’s a privilege to have access to viable contraceptives, including the pill.
But as women’s reproductive rights are increasingly called into question, some feel guilty for turning their backs on the pill, even though they claim to experience adverse side effects.
Josie Morgan, a 26-year-old from Pensacola, Fla., was prescribed the pill as a means of contraception at 19-years-old and took variations of the hormonal medication consistently for seven years.
The entire time she was taking the pill, Morgan says she felt “depressed” and had “severe negative thoughts.”
“I felt like I had gone from being really vibrant, goal-oriented, social and generally very happy, to feeling like someone had pulled the plug on my personality,” she says. “It’s such a hard feeling to describe. I felt like I was not in my own body. I felt like I was not making my own decisions.”
When Morgan told her doctor how she was feeling, she said they were “confused” and “wrote me off.” Morgan came to accept the melancholy she believed to be caused by the pill as her new normal.
But in 2022, Morgan began to question whether she wanted to continue with the medication at all. Looming limitations on women’s healthcare in the U.S. made her decision even more complicated.
In March 2022, Morgan chose to stop taking her birth control pills, cold turkey, and did not initially consult her doctor. One month later, the U.S. Supreme Court overturned Roe v. Wade, which had historically guaranteed the right to an abortion.
The work done by generations of feminists was being slashed, but conversation about women’s rights — particularly to do with healthcare — was taking centre stage. Morgan said she was inspired to ask outspoken questions about her own reproductive rights, including about her mental health while she was taking the pill.
“Within the first month of stopping I noticed such a strong, internal change,” she says. “I felt a cloud lift.”
Morgan says most women understand the physical side effects of the pill, but she is now calling for improved research into possible cognitive side effects, and better doctor-patient communication.
“I’m happy the pill exists because I know it helps so many people, but I think there needs to be more of a discussion and transparency between doctors and patients,” she says.
For Morgan, it’s not about turning one’s back on traditional means, especially when reproductive rights are already in question. Instead, it’s about advocating for better research, support and care for women in the healthcare system.
What now?
As an industry, birth control is changing. In the last decade, numerous medical and technological advancements have pushed the envelope for the kind of contraceptive care possible for women.
One such trend, says Kives, is a switch from the pill to a non-hormonal copper IUD – a choice many of her teenage patients are increasingly considering.
Above all else, Kives says patients in recent years are more informed than before. Kives says many of her patients step into her office with an already developed understanding of the kinds of treatment they do and do not want.
To Kives, the future of the pill is still bright, even if some women are pulling away. She’s particularly intrigued by oral contraceptives like Nextstellis, which uses plant-based estrogen. Some doctors believe this form of the pill may be less likely to cause adverse side effects, as it reportedly has less effect on other hormones already in the human body.
Kives says options like Nextsellis will allow her “more tricks up my sleeve” — tricks that will help her better serve the diverse needs of patients she sees.
The more options she and other health professionals have, the better they can serve those who feel uncomfortable with tried-and-true methods like the pill. Pasquino agrees and maintains that open and honest communication with patients, regardless of their grievance, is vital.
“People are very in-tune with their own bodies,” says Pasquino. She encourages anyone with concerns about their birth control to work with a clinician to develop “strategies on how to manage what they may be feeling and have validation for concerns brought forward.”
“It’s also important that they can work with their health care providers to come up with effective strategies for future family planning if they are stopping their hormonal contraception,” she advises.
Global News does not endorse anyone ceasing their medication without consultation of a medical professional.