The rest of my self-care routine was in the midst of an all-natural makeover—organic vegetables, grass-fed beef, skincare ingredients straight from Mother Earth—and the Pill didn’t seem to make sense for me anymore.

I researched some other birth control options, and landed on an IUD; specifically, Mirena: One appointment, three to 10 years of baby-free sex, and a lower dosage of localized hormones.

My OB-GYN was just as enthusiastic about my decision as I was; I had the IUD implanted 20 minutes after my initial consultation. But in the weeks following my birth control switch, I felt decidedly less enthusiastic. Besides the bloating, acne, and slight mustache that had sprouted on my upper lip (true story), I fell into a deep pit of depression. I blamed my constant state of general blah-ness on a recent move, job drama, and the stress of planning my upcoming wedding…but after months of living under this heavy haze with no end in sight, I started to wonder, was my IUD causing my depression?

Can hormonal IUDs actually cause depression?

In short, yes. “A 2016 study of over a million women in the the Journal of the American Medical Association revealed that progestin-only contraceptives, like the IUD, were associated with a higher risk of depression,” reveals Dr. Jolene Brighten, a Functional Medicine Naturopathic Medical Doctor and the author of Beyond the Pill. This isn’t exactly an uncommon side effect, either. “Some studies have stated that progestin intrauterine devices (IUDs) were shown to nearly triple the number of both depression diagnoses and antidepressant use among young women [as compared to those not on birth control],” Dr. Jessica Shepherd, an OB-GYN and women’s health expert, tells Blood and Milk.

Studies show that hormones in IUDs can affect our brain chemistry.

Dr. Brighten concedes that there hasn’t been enough research in the space to fully understand why hormonal IUDs like Mirena can cause mood swings and depression, but there’s evidence to suggest that it comes down to progestin, the synthetic hormone found in many contraceptives. “It appears alterations in brain chemistry that lead to increased production of neurotoxins, elevations in inflammation, alterations in gut health, and nutrient depletions are some of the reasons hormonal birth control may alter mood in some women,” she explains. “We also understand that your [naturally-produced] progesterone stimulates GABA, a calming neurotransmitter in the brain, but progestin, the synthetic hormone in contraceptives, does not.”

Upon hearing all of this, my mind was kind of blown. The reason I opted for an IUD in the first place was because of its localized hormone delivery system, specifically targeted at the uterus—so how, exactly, do these hormones end up messing with our brain chemistry? “Although the intrauterine system primarily works locally, it still delivers [hormones] to the systemic circulation,” Dr. Shepherd explains. Which leads me to another question: Why aren’t people talking about this?

The link between IUDs and depression is real, but often ignored.

If you Google “IUDs and depression,” over 5 million search results prove that people are talking about it. But why aren’t doctors and OB-GYNs talking about it with their patients? Why wasn’t I told that my whole localized-hormones-must-be-better theory didn’t check out? Why wasn’t I asked, “Do you have a history with depression or anxiety?” before being implanted with a one-inch piece of plastic that had the potential to turn my world upside down? Yes, it turns out that women with a history of mood disorders have a higher likelihood of developing IUD-induced depression.

“From what is understood in the research, women with a personal or family history of depression or other mood disorders are more susceptible to experiencing these side effects with hormonal contraceptives, including the progestin-based IUD,” Dr. Brighten shares. Dr. Shepard even goes so far as to say that women with significant depression “are not ideal candidates for the hormonal IUD.”

One reason OB-GYNs may not be addressing this issue? “The package insert on the Mirena states that only around 5 percent of women in clinical trials have depressive mood and nervousness as a side effect,” Dr. Brighten says—in other words, not a significant percentage. “But that doesn’t account for what happens in the general population,” she adds, citing that outside of control groups, the adverse effects of Mirena and other hormonal IUDs may be more widespread than we think.

“Sadly, women are often dismissed in medicine when it comes to mood symptoms,” Dr. Brighten admits; so those who do take these concerns to their OB-GYNs may not be taken seriously. That’s precisely what happened to me when, after doing some independent study and concluding that my IUD was messing with my mood, I confronted my doctor. “It’s in your head,” he said, with a smile and a wave of his hand. “This is just stress from the wedding.” Needless to say, I booked it out of his office (and maybe kind of cursed him out just a little bit) and set up an appointment with a new OB-GYN, who respected my decision to have the IUD removed.

Doctors estimate that it takes about three months for our systems to completely clear IUD-delivered progestin from the body, so my symptoms didn’t immediately go away. But today, six months later, I’m not only happy with my decision—I’m also just plain happy.

What to do if you’re experiencing IUD-induced depression.

Having the hormonal IUD removed isn’t the only solution, though. “There are several progestin-based IUDs that have varying amounts of progestin,” Dr. Brighten says, noting that a lower dose of progestin may be all your body needs to re-stabilize. “There are also non-hormonal contraceptive options, like barrier methods and the fem-tech devices approved by the FDA”—as well as the hormone-free copper IUD. That being said, she doesn’t condone mixing hormonal IUD with psychiatrist-prescribed mood stabilizers or antidepressants. “I don’t recommend women begin medications to manage side effects caused by a medication if it is possible to have an alternative contraceptive that wouldn’t cause side effects,” she says.

With issues as complex and nuanced as reproductive health and mental health, there’s no single approach that will work for everyone. That being said, there is one universal truth: Birth control exists to offer women freedom. It shouldn’t leave you feeling trapped under the weight of depression; and if it does, talk to your doctor—preferably one who will present you with the facts, individualize your care, and listen when you tell them that something’s not right.

FEATURED IMAGE BY JACK ANTAL