Kriti*, a resident of Noida, Uttar Pradesh, has been suffering from polycystic ovarian syndrome (PCOS) since the age of 14. Now 28, she recently started taking oral contraceptives after consulting a gynaecologist to regulate her periods. This decision has significantly impacted her mental health. “There was a sudden rush of mood swings, anxiety, and depression. I feel drained all the time. Most days, I find myself crying for no reason at all,” she told me, adding, “One day, I feel on top of the world; the next, it feels like my world is falling apart.” As a result, her self-confidence has also taken a hit.
For many women like Kriti*, choosing contraception is about more than preventing pregnancy. It’s an intricate decision influenced by a host of factors—physical health, personal values, and mental health. Anxiety, depression, and other mental health struggles often play a profound yet under-discussed role in shaping reproductive choices, particularly when selecting contraceptives.
The Hidden Link Between Mental Health and Reproductive Health
Reproductive health and mental well-being are deeply connected, though the conversation around this intersection is still evolving in India. Studies published in journals like Obstetrics & Gynaecology have demonstrated links between mental health disorders and menstrual irregularities, citing hormonal disruptions in the hypothalamic-pituitary-adrenal (HPA) axis as a key factor. Similarly, a 2023 study published in the journal Australas Psychiatry linked declining oestrogen levels during menopause to heightened feelings of anxiety, depression, and mood swings, further complicating the management of reproductive and mental health during this phase of life.
Agreeing, Ruchi Tandon, senior consultant, obstetrician, and gynaecologist at Apollo Cradle & Children’s Hospital, Chirag Enclave, New Delhi, says, “Hormonal changes during menstruation, pregnancy, postpartum, and menopause can influence mental health, often leading to mood swings, anxiety, or depression.”
The Harvard T.H Chan School of Public Health has also reported that women with higher stress levels took longer to become pregnant compared to those with lower stress levels. To this, Tandon adds that conditions like premenstrual dysphoric disorder (PMDD) and postpartum depression (PPD) illustrate how reproductive stages impact mental health. “Additionally, dealing with reproductive health issues such as infertility, miscarriage, or chronic conditions like endometriosis can contribute to stress, depression, and feelings of isolation,” she notes.
The relationship between mental health and contraceptive decisions is equally complex. In fact, a 2016 study published in JAMA Psychiatry explored the association between hormonal contraceptive use and the onset of depression. It found that women using hormonal contraception, particularly adolescents, were more likely to be prescribed antidepressants or diagnosed with depression compared to non-users.
According to Mrunmayee Pathare, a perinatal psychotherapist, some hormonal contraceptives, such as oral contraceptive pills and hormonal intrauterine devices (IUDs), have been shown to influence women’s mood and general emotional well-being. “Changes in hormone levels, primarily oestrogen and progesterone, can affect neurotransmitters like serotonin, which are closely linked to mood regulation. Depending on the hormones influenced by the contraceptive and the individual’s sensitivity to these hormonal changes, women may experience increased irritability, mood fluctuations, bloating, changes in body weight, and more. If used without proper medical consultation, some hormonal contraceptives can also worsen pre-existing mental health concerns,” Pathare says.
This shows that mental health struggles can make it harder for women to feel empowered in their reproductive decisions. They may delay choosing a method or switch frequently, seeking one that causes minimal emotional disruption. “It is crucial to have a thorough discussion with healthcare providers to weigh the benefits and potential risks, considering both physical and emotional health, when choosing the most appropriate contraceptive method,” explains Dr. Nishi Singh, head of fertility at Prime IVF.
Voices of Experience
Take Shanaz, a resident of the Lavkushnagar slum in Uttar Pradesh. Like many women from urban poor backgrounds, she had limited knowledge and access to family planning services. By the age of 28, she had experienced three children, four miscarriages, and two stillborn twins, leading to increasing hospital bills, debts, and declining mental and physical health, as reported by Bayer, a biotechnology company.
Such a scenario can significantly undermine mental health as experiencing miscarriages and stillborns can cause immense emotional trauma with a loss like this leading to grief and depression. Adding to this, rising debt due to hospital bills creates economic stress, which amplifies mental illnesses by heightening hopelessness and anxiety. In totality, Shanaz’s situation embodies the intersection of poverty, gender inequality, and lack of education, all of which contribute to the neglect of mental health needs. This compounded experience makes it difficult for individuals like her to seek help or receive adequate support.
Similarly, in Bihar’s Samastipur district, to address the grievous yet overlooked issue of maternal mental health, the Indian non-profit organization Innovators in Health (IIH), in collaboration with the Schizophrenic Research Foundation (SCARF India), established a free hotline, according to CNN. Anjali Kumari, a local who was four months pregnant, struggled with not eating for days, locking herself in a room, crying, and becoming agitated. Through her sister-in-law Mamta, Kumari found help through the hotline. Unfortunately, not all areas have services like these to address the mental health toll of reproductive stages.
Better knowledge of contraception and family planning can reduce the physical, emotional, and financial burdens faced by women like Kumari– lowering the risk of mental health decline. By preventing unplanned pregnancies, it eases financial stress and empowers women to make informed choices, fostering a sense of control over their lives. In Kumari’s case, her emotional struggles might have been alleviated with better planning, as it would have reduced feelings of powerlessness during her pregnancy.
The Way Forward
Navigating the world of contraception while managing mental health can feel like walking a tightrope. Women are often left to make difficult decisions without comprehensive support. Experts agree on the need for greater awareness, both in healthcare and society, about the profound connection between reproductive and mental health.
“Doctors must conduct holistic evaluations to understand the interplay between reproductive and mental health. They should offer personalized treatment plans that may involve adjusting hormonal therapies, recommending mental health counselling, or integrating both types of care. Regular follow-ups to monitor the impact of treatments and providing resources or referrals to mental health professionals are also essential,” says Dr. Rahul Chandhok, head psychiatrist of mental health and behavioural science at Artemis Hospital. “Encouraging open and honest communication and addressing any concerns promptly helps ensure that both reproductive and mental health needs are managed in the best possible way,” he concludes.
*Names have been changed to protect the privacy of individuals