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Mood changes after starting hormonal treatment: what to discuss with your doctor

Alanoud AlturkiMedical review: Tatmeen team9 min read
وجهان لامرأة بين سحب داكنة وضوء دافئ، مع زهور وردية ورسوم جزيئات وخطوط شفافة حول الشعر.
Article contents
  1. Start with the treatment's name and purpose
  2. Put the changes before and after treatment in order
  3. Questions for a clearer treatment plan
  4. Does hormonal contraception cause depression?
  5. What about hormone therapy for menopause?
  6. During fertility treatment, report symptoms and ask for support
  7. Do not postpone physical symptoms by assuming they are anxiety
  8. Frequently Asked Questions
  9. Sources and references
  10. Writer and reviewer

If you notice a mood change after starting contraception or fertility medication, tell the doctor who prescribed it. You do not have to prove that the medicine caused it for your symptoms to be taken seriously. Explain what feels different—for example, your sleep, ability to work or interest in seeing people. Those details, the treatment's name and start date, and how you were beforehand help your doctor consider a possible side effect and other explanations. Symptoms starting after treatment do not settle the cause on their own.

If low mood or anxiety affects your sleep, work or ability to care for yourself, contact your doctor soon. Do not wait for months simply because some side effects may settle with time. If you have suicidal thoughts or fear you might harm yourself, get urgent help now1 from local emergency services or the nearest emergency department, and ask someone you trust to stay with you.

Start with the treatment's name and purpose

“Hormonal treatment” is a broad description. Combined contraceptive pills2 contain an oestrogen and a progestogen, while some other pills and methods contain a progestogen alone. A treatment may be used for contraception or certain period problems; it does not have the same purpose for everyone. Fertility medicines also differ3 according to their purpose and the stage of treatment. Findings about one pill cannot be transferred to every method or medicine.

Start with the product's name and active ingredient as shown on the packaging, and why it was prescribed. A photo of the pack or prescription can help if you cannot remember the name. Your doctor also needs to know whether you had a similar change with a previous treatment, have a diagnosed mental health condition or take other medicines.

Put the changes before and after treatment in order

You can put this information in a private note and bring it to your appointment:

What to record Useful details
Treatment and purpose Product and active ingredient, its form and why it was prescribed. Record the dose as prescribed; do not change it.
Start or change The date you started, switched or made a change prescribed by your doctor.
How you were beforehand Your usual mood and sleep, and any previous symptoms or diagnosis.
New symptoms When did they begin? Are they persistent or changing? How do they affect tasks and relationships?
Other changes at the same time Your period, changes in sleep, another medicine, a procedure or an important source of stress.
What you want from the appointment An explanation of the possibilities and a clear plan for symptoms and follow-up.

This timeline does not calculate a risk or prove a medicine's effect. It can help even when some dates are approximate. Do not restart a medicine your doctor stopped simply to test whether it caused the symptoms.

For example, you might say: “I started this treatment last week. Since then, my sleep has been broken and I have struggled to concentrate at work. I slept better before, but I am also dealing with a new source of stress. I would like us to review what is happening and agree on a next step.” Your experience may be quite different. Describe what you know, even if you cannot pinpoint the day symptoms began.

Questions for a clearer treatment plan

Ask your doctor:

  • Do we need a mental health assessment or to investigate another cause, as well as review the medicine?
  • Is continuing this treatment with follow-up suitable for me, or are there alternatives that address why it was prescribed?
  • If we agree to change contraception, how do I maintain protection from pregnancy during the transition?
  • When should we follow up, and what change should prompt me to contact you sooner?

If the plan is to monitor symptoms for a while, ask for a clear review date and a way to make contact if things get worse. You could ask: “Is monitoring suitable given how much this affects my day now? What should I do if symptoms worsen before our next appointment?” That gives you a plan for your situation, beyond general advice to wait.

Do not change the dose of fertility medication or a psychiatric medicine on your own. If you are considering stopping contraception, ask for a suitable plan rather than leave a gap in protection from a pregnancy you do not want. You do not need to tolerate severe deterioration to “give it a chance”; contact your doctor to decide what is appropriate for you. If you take psychiatric medication and are planning pregnancy or having fertility treatment, tell both teams so they can review the plan together.

Does hormonal contraception cause depression?

Some users report mood changes, but research does not give one answer that applies to every woman and every method. NHS guidance distinguishes reported effects from evidence4 that a contraceptive caused them.

These studies show why the specific method and context matter:

  • A large Danish study published in 20165 observed an association between hormonal contraceptive use and first antidepressant use or a first depression diagnosis. It was observational: the association matters for research and follow-up, but does not establish the cause for each user.
  • A Swedish randomized trial published in 20176 compared one combined pill with placebo in healthy women over three cycles. It found small increases in some mood symptoms during part of the cycle, alongside improvement in depressive symptoms before menstruation. A short trial of one product cannot be generalized to every treatment.
  • A Danish observational study in 20247 compared hormonal intrauterine systems containing different amounts of levonorgestrel and found differences in first antidepressant use. It excluded women with important conditions, including previous depression and heavy bleeding. Its findings therefore do not become a general recommendation to change an intrauterine system used to treat heavy bleeding.

The useful question for you is: “Is this product suitable for me, and could it be contributing to the symptoms I have developed?” You do not need to resolve the research debate before asking for help with your symptoms.

A history of depression does not mean all hormonal contraception is prohibited. CDC guidance from 20242 places no restriction on contraceptive use because of a depressive disorder alone, while highlighting the need to review medicine interactions. That does not replace assessment of your other health conditions or guarantee that every method will suit you.

What about hormone therapy for menopause?

Menopause-related hormone therapy has a different purpose and context too. NICE guidance distinguishes depressive symptoms9 that begin alongside menopause symptoms but do not meet depression criteria from depression that needs assessment and treatment alongside care for menopause symptoms. Contraception findings are not a verdict on this treatment.

During fertility treatment, report symptoms and ask for support

Mood or sleep changes3 may be reported while using fertility medicines, and the treating team should hear about unexpected reactions. Treatment also involves appointments, procedures, waiting and uncertainty about the result. Assessment is needed before attributing every difficult feeling to one medicine.

Psychological support can help you cope with the experience whether or not medication contributes to your symptoms. Ask for practical help that suits you: company at an appointment, help with a daily task or space where you are not repeatedly asked about the outcome. You might tell people: “I will let you know when I have news. What helps me now is being asked what I need today.” If support from people close to you is not enough, ask about professional help.

Do not hold yourself responsible for treatment success because of how stressed you feel. There is no conclusive evidence that stress reduces the chance of having a baby through fertility treatment. Support is for your wellbeing8; it is not a promise of pregnancy.

Do not postpone physical symptoms by assuming they are anxiety

After ovarian stimulation, contact your fertility clinic immediately for noticeable abdominal swelling or pain, vomiting or reduced urination. These may need assessment for ovarian hyperstimulation syndrome10. Breathing difficulty or fainting requires emergency care.

Chest pain, severe or sudden breathing difficulty, or fainting needs emergency care now. So does a headache that starts suddenly14 and is extremely painful, or a severe headache with new blurred or double vision15 or loss of sight. Do not drive yourself; call 997 for an ambulance16 in Saudi Arabia if there is immediate danger or you cannot reach care safely. Do not explain these signs away as anxiety or a psychological effect of hormones.

New pain or swelling in one leg13 needs urgent medical assessment. If accompanied by chest pain or breathlessness, seek emergency care immediately. These signs also matter while using hormonal contraception11 and do not establish the cause on their own.

Frequently Asked Questions

Does hormonal contraception cause depression?

Research does not give one answer that applies to every woman and every method. Some users report mood changes, and a large Danish study observed an association between hormonal contraceptive use and first antidepressant use or a first depression diagnosis. But an association does not establish the cause for each user. The useful question for your doctor is whether this product suits you and could be contributing to your symptoms.

What should I do if my mood changes after starting contraception or fertility medication?

Tell the doctor who prescribed it. You do not have to prove the medicine caused it for your symptoms to be taken seriously. Explain what feels different, such as your sleep or ability to work, and when the treatment started. If low mood or anxiety affects your sleep, work or ability to care for yourself, contact your doctor soon rather than waiting for months.

If you have suicidal thoughts or fear you might harm yourself, get urgent help now from local emergency services or the nearest emergency department, and ask someone you trust to stay with you.

Should I stop my contraception if it affects my mood?

Ask your doctor for a suitable plan rather than leave a gap in protection from a pregnancy you do not want. You do not need to tolerate severe deterioration to “give it a chance”; contact your doctor to decide what is appropriate for you. If you agree to change contraception, ask how to maintain protection from pregnancy during the transition. Do not change the dose of fertility medication or a psychiatric medicine on your own.

Can I use hormonal contraception if I have a history of depression?

A history of depression does not mean all hormonal contraception is prohibited. CDC guidance from 2024 places no restriction on contraceptive use because of a depressive disorder alone, while highlighting the need to review medicine interactions. That does not replace assessment of your other health conditions or guarantee that every method will suit you. Tell your doctor if you had a similar change with a previous treatment or take other medicines.

Which physical symptoms during hormonal treatment need emergency care?

Chest pain, severe or sudden breathing difficulty, or fainting needs emergency care now. So does a headache that starts suddenly and is extremely painful, or a severe headache with new blurred or double vision or loss of sight. Do not drive yourself; call 997 for an ambulance in Saudi Arabia if there is immediate danger or you cannot reach care safely. New pain or swelling in one leg needs urgent assessment, and emergency care immediately if accompanied by chest pain or breathlessness. Do not explain these signs away as anxiety or a psychological effect of hormones.

Writing and article review

Alanoud AlturkiWritten byAlanoud Alturki

Content writer and researcher at Tatmeen, writing in Arabic and English on mental health and everyday life topics, including relationships, stress, work, habits, and family.

Tatmeen teamMedical reviewTatmeen team

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