Hey guys, it's Tara here. I have a diagnosis of bipolar affective disorder with psychosis, and I want to share my thoughts and personal experience with regard to hormonal contraception (HC) and mental health (MH) relapse.
Now, it is an accepted fact that hormones affect mental health, though I didn't make this connection in my head until my second hormonal contraceptive implant. The mental health community is not talking about it enough, I have never been told by a mental health professional to stay on top of my hormonal health or had any kind of warning with regards to taking a form of hormonal contraceptive.
This is likely due to such little research on the link between hormonal contraception and mental health conditions with psychosis. This is probably why mental health history is not effectively considered when deciding on a birth control method. I would love to contribute to changing this in any way that I can starting with getting you thinking!
Not once but twice, I had a full blown bipolar relapse days after having the implant inserted in my arm. The hospital admissions lasted around 5 and a half months both times. This is a huge revelation for me as I have a history of mental health and with my previous episodes it wasn't so clear cut what the tipping factor to trigger the relapse was! Now I know it is HORMONES! I will share more about my personal journey shortly.
I just want to say I am not here to bash hormonal contraception. And I’m not saying HC is the only factor of my episodes of psychosis, but it is very clear and evident to me that it is a major trigger for relapse. And I can’t be the only one. I know HC can be a lifesaver for many women. But I think it's important to be aware of the potential risks, especially if you have a history of mental health problems.
I should add that it is documented that some forms of hormonal contraception can be used to help with managing mood and depression. There has been quite a bit of research on this and I believe the sexual health professionals do consider depression when selecting contraception but there is still a lot to be done when it comes to linking the effects of HC to mental health, specifically psychosis.
I've used the word psychosis a few times, so just in case you don't know what it is, I’ll briefly summarise it, psychosis is when a person loses contact with reality, the person may experience some or all of the following symptoms:
hallucinations (hearing or seeing things that aren't there),
delusions (believing in things/ideas that are not real) and
disorganised and/or racing speech and thought
Psychosis can cause strange/vulnerable/dangerous behavior's which normally leads to hospital admission, in my case being sectioned EVERY TIME!
FYI psychosis is not limited to people with mental health conditions such as bipolar or schizophrenia - psychosis can also affect people with dementia, brain tumours and substance misusers.
I am pleased to have discovered that there has been some research on the link between psychosis and hormonal contraception. The studies I have come across are pretty recent - one in 2019 and one in 2020. I will link the information below. In a nutshell both studies found that women who used HC were more likely to experience psychosis than women who did not use HC, the risk was even higher for women who used it for longer periods of time. But this was not sufficient to outright prove the connection. However, it is important to be aware of the potential risk, especially for women with a history of mental health problems.
More research is needed to better understand the relationship between psychosis and hormonal contraception. And I think this conversation needs to reach more ears, we need to talk to each other and share our experiences and maybe we can light a fire for change to be made in the system. But at the very least I hope sharing this helps you to make a more informed decision when it comes to deciding on your preference for contraception taking into account the impact it could have on your own mental health.
A little history of my mental health journey
I was first diagnosed with bipolar disorder in 2010. For the first 5 years I spent more time in hospital than out of it! It was a lot! Each admission was long lived, between 4-9 months.
When out of hospital I tried my best to stay well and do what was right for me, which was trial and error and not always recommended by Doctors (for example, not complying with my medication for reasons like such as extreme weight gain or being numb emotionally.
2015 was the turning point for me, I was finally on a medication that agreed with me - I wasn't gaining weight and I could feel my feelings!!! I made some lifestyle changes that reduced my stress levels and addressed my triggers, this all helped keep me out of the hospital! I met my now husband in 2016, our relationship is super stress free which really helps my mental health of course (FYI I was not on any Hormonal contraception and I have been complying with my meds since 2015)
Fast forward to 2018, I gave birth to our daughter, Bella a couple days later the implant was administered and within days of this I was sectioned, hubby took Bella home and I went straight into seclusion on a psychiatric ward. Later I went into a mother and baby unit so I was reunited with my daughter which helped me get better quicker than in the past.
At the time I didn’t make the connection between the hormonal contraception and my mental health as I had just given birth and it was highly likely that I would experience postpartum psychosis due to the statistics on people who have a history of psychosis and childbirth (i was told it is around a 80% chance).
Fast forward to November 2021 - three years after our Bella was born, so three years after my first implant and last episode, it was time to replace my implant - within 4 days of the insertion of the new implant, I was making my way to the mental health ward - I relapsed HARD! Seclusion again for a longer time than usual. It was pretty insane, my husband couldn’t visit me or talk to me for over a month due to me going in and out of seclusion and I didnt see my daughter until I was quite a bit better - about 4 months if memory serves.
It wasn’t until after this second relapse post Bella that I made the connection between my hormones and my mental health - and I decided I would never have a form of HC again nor knowingly do anything that would affect my hormones so significantly.
It is now 2023 and I have only had two episodes/relapses in eight years, which to stress, lined up with the administration of the hormonal contraception.
2 admissions in 8 years is pretty epic for me in comparison to how many admissions I had in the first 5 years and not only because it is way less time in hospitals but also because I now know about the relationship between my hormones and my mental health - so I feel that as long as I keep on top of my hormones and keep a control of anything that can affect them, I should be able to manage my mental health for even longer periods of time. The optimist in me would love to say forever but hubby’s realism is rubbing off, so I’ll keep it as ‘for longer periods of time’
Now - something I want to highlight is this - health care professionals do take your history into account when advising you on the different types of contraception - BUT in my experience the issue of my weight was more important than the issue of my mental health - at the time when choosing the implant I was pretty big - 28 stones which is around 160kg or 350ish-lbs - It is well known that some forms of hormonal contraception can cause weight gain, so the health professional advising you will outright will not give you that type of contraceptive - this left me with fewer options but I chose the implant completely ignorant to the affects it would have on my hormones and thus not knowing the impact it could have on my mental health. The nurse was more concerned about my weight, which is not necessarily bad, the knowledge isn’t really out there for them to warn me of the MH risks from HC.
It would be ideal if there were a solid process in place with regards to contraception and people with a history of mental health.
What would be a great start is if sexual healthcare professionals started giving a disclaimer to people with a history of mental health issues of the potential risks to their mental health condition. At Least then we could make a more informed decision about the type of contraception and risk we are willing to take.
Also to add here, the maternity ward at the hospital I had Bella tried their best, their main concern was making sure I didn't have another high risk pregnancy until I was ready - preferably after reaching a healthier weight. They did what they could to manage my mental health risk which was to plan a c-section for reasons of medication timings, and that is as far as the MH considerations went. If only there was better communication or understanding of MH and HC so we could have planned better.
The missing link in the management of my mental health condition was the knowledge of how hormones affect my brain chemistry and thus my mental health condition. So of course I could not fathom the effect hormonal contraception would cause on my mental health due to the change in my hormone levels.
I am on a mission to learn as much about managing my hormones as possible - such as things like stress management for hormonal health, sleep, what I eat, when I eat, learning about gut health the list goes on…I am thinking I might start sharing this information through some medium or another, we shall see. What do you think ?
I hope this information can serve by encouraging conversation about our experiences of mental health and contraception. Have you connected any dots between them in your own journey? I would love to know. I am hopeful that this can make some sort of change, if one person can benefit from this by making a more informed decision then I have succeeded in my goal. It would be so very much appreciated if you shared your experience if you can relate to this.
If you are concerned about the potential risk of psychosis from hormonal contraception, talk to your doctor. They can help you weigh the risks and benefits of different contraception methods and choose the best option for you.
I just want to add that I am not attacking HC - I know it can and does get used to manage depression and there is evidence that this works for some people but I know for me this is not the way forward. HC does the job of birth control but at what cost? I am no longer willing to pay with my MH - your situation may be totally different - it is up to you to learn and observe your mind/emotions and what affects you.
I’m not a sexual health or mental health expert but here are some things to think about when choosing your contraceptive:
Talk to your sexual health provider and your Dr about your mental health history. This is especially important if you have a diagnosis of psychosis or bipolar disorder.
- Ask about the risks and benefits of different contraception methods. Some methods may be riskier for people with mental health problems than others.
- Consider using a non-hormonal contraception method, such as a copper IUD aka Coil or condoms, diaphragm or other non hormonal methods as they would be less likely to trigger psychosis.
- If you're already using hormonal contraception and you're concerned about the risk of psychosis, please talk to your doctor. They can help you develop a plan to monitor your symptoms and switch to a different method if necessary.
If you found this video useful please share but most importantly if you suffer from any mental health issues and you take hormonal contraception - what is your experience - do you think it is linked ? It would be amazing if you could share in the comments or send me an email if you do not want your business out here for all to see. I would love to collate some evidence if there is enough of you out there and see what if anything can be done. Let's get the conversation going !!!!
Thank you for for being here
Tara
The research I mentioned above:
A 2019 study published in the journal Schizophrenia Bulletin found that women who used hormonal contraception were more likely to experience psychosis than women who did not use hormonal contraception. The study also found that the risk of psychosis was higher for women who used hormonal contraception for longer periods of time.
Another study, published in the journal Psychiatry Research in 2020, found that women who used hormonal contraception were more likely to experience a first episode of psychosis than women who did not use hormonal contraception. The study also found that the risk of psychosis was higher for women who used combined oral contraceptives (COCs) than for women who used other types of hormonal contraception, such as progestin-only pills or the intrauterine device (IUD).
It is important to note that these studies are observational studies, which means that they cannot prove that hormonal contraception causes psychosis. However, the findings suggest that there may be a link between the two.
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