Modern contraceptives, defined as methods that are not tubectomies or vasectomies, have increased in popularity over the years, worldwide. According to the World Health Organisation, between 2000 and 2020, the number of women using a modern contraceptive method increased from 663 million to 851 million. An additional 70 million women are estimated to be added by 2030.
These modern methods include hormone-based contraceptives, such as progestogen-only pills (mini-pills), combined oral contraceptives (the pill), and contraceptive patches. Even in India, as per National Family Health Survey (NFHS), use of modern contraceptives has increased in almost all States/UTs. The Overall Contraceptive Prevalence Rate (CPR) has increased substantially from 54% to 67% in the country.
But while hormonal contraceptives, have given women more control over their reproductive choices, their side effects on women’s health are under-researched , complex and vary in different individuals.
Hormones and the mind
Sapna Raina, senior consultant, obstetrics & gynaecology, Narayana Health City, Bengaluru, explains that the mental health effects of contraceptives stem from the hormones they contain, primarily estrogen and progesterone. “When we talk about contraceptives, it’s basically the hormonal contraceptives that affect both the physical and psychological health of women,” she says.
Estrogen has a strong influence on the brain’s neurotransmitters, like serotonin and dopamine chemicals that regulate mood, emotions, and overall mental stability. “Estrogen has a greater impact than progesterone because it may affect neurotransmitters, leading to mood swings, irritability, anxiety, and even depression,” she says.
The combined oral contraceptive pill is often linked to more pronounced psychological effects, followed by progesterone-only pills, also known as mini-pills. While mini-pills tend to have slightly milder side effects, they can still cause fatigue, mood instability, and irritability.
“For some women, particularly those with a history of depression or anxiety, the use of hormonal contraceptives can intensify their mental health struggles,” says Dr. Raina She also points out that contraceptives administered in the form of injections, such as Depo-Provera, can produce similar psychological effects. The intrauterine hormonal device (IUD), like Mirena, however, has a more localised effect and is less likely to cause systemic mental health issues, though mood changes are not entirely ruled out.
Physical risks and recommendations
The effects of hormonal contraceptives are not limited to mental health. Dr. Raina highlights serious physical risks like thromboembolic episodes which are blood clots that can travel to vital organs like the lungs or brain, potentially causing strokes or pulmonary embolisms.
“Prolonged use of combined oral contraceptive pills can make a woman more vulnerable to blood clots, which may dislodge and affect her brain or lungs,” she warns. She also stresses that women on hormonal birth control must stay proactive about their health, maintaining hydration and engaging in regular exercise.
Offering a basket of choices
T.K. Shaanthy Gunasingh, president of Chennai Menopause Society, points out that the onus is on healthcare providers to not prescribe a single method to women, but offering a “basket of choices.” For instance, she says, it is important to ensure that women know about long-acting reversible contraceptives (LARCs), such as intrauterine devices, which can last up to 10 years but can also be removed earlier if desired. Unlike hormonal pills, which require daily compliance, these methods offer flexibility without constant monitoring.
Dr. Gunasingh points out that while healthcare professionals may be familiar with the full range of contraceptive options, not every woman has access to this information. “We must take the time to talk to women about all the available methods, explain how each works, and support their choice. In hospitals, we should discuss contraception options even during pregnancy so that by the time a woman delivers, she has a clear plan. If she changes her mind at the last minute, we respect that, but the key is that she was informed,” she says.
“Flexibility with choices and personalised care that allows women to make informed choices about their reproductive health, knowing they are not locked into one method if it doesn’t agree with their body is vital,” she stresses.
Building awareness
While contraceptives remain a vital tool in family planning, experts advocate for holistic healthcare strategies, ones that not only provide contraception but also educate women about their potential mental and physical side effects. Government initiatives of oral contraceptive pills like Mala D and Mala N, distributed freely at health centers aim to ensure accessibility, and while access is key to ensuring women from all segments of society have a choice with regard to their contraception method, Dr. Raina points to the need for cautious prescription practices and responsible distribution of contraceptives. to prevent misuse.
Experts stress that every individual’s body responds differently, if one method doesn’t suit someone, there is always another option, but there need to be conversations around all of the other options too.
N. Syamala, senior consultant in obstetrics & gynaecology, SP Fort Hospital & Ananthapuri Hospital, Thiruvananthapuram, emphasises that contraceptives are not just for birth control, they are also prescribed for certain medical conditions like heavy menstrual bleeding or hormonal imbalances. However, she says “It is important to understand that emergency contraceptive pills, like the I-pill, are not meant for regular use.”
Dr. Gunasingh further adds, “Contraception should offer women peace of mind, not just in preventing pregnancy but in knowing they have control over their reproductive health. With the right information and medical support, every individual can make choices that best suit their body and lifestyle.”
Published – March 07, 2025 11:00 am IST