I’ll admit it. I’ve been a hot mess since I had my first child five years ago. Sure, I struggled with the usual first-time parent emotional ups and downs, but my experience went beyond that. Some days, my body seems like it’s conspiring against me and turning me into a moody monster. I know that sounds dramatic, but I just don’t feel like myself. What surprised me, though, was that the solution to my problem would be taking birth control—especially since I’d had my tubes tied.
My moody journey to Graves’ disease
My first mood issues surfaced about a month after my first daughter was born. I thought I had postpartum depression, but when I started having other symptoms, like hot flashes, hand tremors, and a racing heartbeat, I knew I didn’t just have the “baby blues.” My doctor ordered a variety of tests, including a few to check my thyroid hormone levels. The tests revealed that I have the most common form of hyperthyroidism, known as Graves’ disease. It’s an autoimmune condition that causes my thyroid to produce too much thyroid hormone.
Fast forward two years and my Graves’ disease was declared “in remission” and I stopped taking medication. I have been in remission ever since, but not long after I stopped my Graves’ treatment, I started to struggle with depression and mood swings again. I asked my endocrinologist, Teck Khoo, M.D., F.A.C.E., if Graves’ disease can still affect mood when thyroid levels are normal.
“More likely, it is a separate issue,” he said. “The Graves’ portion of things tends to be more specific to the thyroid gland, and if this is in remission, there is no reason it would be affecting mood.”
So, I tried talk therapy for more than one year, including through my second pregnancy. I noticed my mood issues diminished when I was pregnant, but they came back with a vengeance after I gave birth and had a tubal ligation. My therapist suggested trying SNRI (serotonin–norepinephrine reuptake inhibitor) medication; my doctor agreed and prescribed Wellbutrin. It improved my depression, but I still struggled with severe anger issues.
I hit what I consider my rock bottom moment on Christmas Day, 2016. I was filled with rage and knew something was wrong when I couldn’t even enjoy my favorite day of the year. That night, my husband expressed concern and I promised to visit my doctor.
Weighing my options and the risks of birth control
At my doctor’s appointment, we talked through the last few years, what affected my moods, and what the common denominators were. Since my thyroid levels were normal at my last check-up, my doctor said he weighed whether the mood issues seemed dependent on my menstrual cycle and how birth control pills had affected my mood in the past. Instead of merely increasing my Wellbutrin dosage, he prescribed Estarylla, which is a mix of estrogen and progesterone, because I had tolerated it well before and side effects are generally milder with a combination pill than estrogen or progesterone alone.
Before I agreed to taking birth control again—after all, I had my tubes tied so I wouldn’t have to take it anymore—we talked through the variables and pros and cons. My doctor summed up the cons as an extra pill to remember and an increased blood clot risk, which is a standard risk with any birth control pill, and the overall pros were mood and cycle regulation. But I still had a couple of questions:
- He asked me if I’d like to take the pill consistently to avoid having a period or if I preferred having a placebo week to let my body menstruate. I asked if it would be harmful to not let my body have a cycle to which he responded that there are not any risks specifically from not having a cycle or period if suppressed by birth control.
- I asked whether it would be safe to stay on birth control long term, especially since my family has a history of breast and uterine cancer. He told me it would be safe at my age as there is a very small increase in breast cancer risk for all women who take the pill, which goes away about 10 years after stopping it. If anything, uterine/endometrial cancer risk is reduced.
Listen to your body
Since I was miserable and afraid my mood was negatively affecting my marriage, I decided the pros for taking birth control pills again outweighed the cons. My doctor prescribed me a three-month trial, but I knew just three days in that we had chosen the right treatment. My inner angry monster was soothed, and my personality started to re-emerge.
Although birth control evened out my mood swings, it’s necessary to mention there are mixed reviews on whether birth control helps moods. For every study that shows birth control pills may improve mood swings, there is another that says birth control causes depression and mood swings. So, it’s important to pay attention to changes in your body and speak openly with your doctor. If you genuinely feel like something isn’t right, then it probably isn’t. And sometimes one type of treatment isn’t enough, like in my case, and you have to keep trying until you find the right mix for you. I hope it doesn’t take you five years, but don’t give up. It’s not just in your head.