Postpartum University® Podcast

The Link Between Hormonal Birth Control and Postpartum Depression EP 218

• Maranda Bower, Postpartum Nutrition Specialist

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Providers, let's challenge the standard 6-week checkup and the conversation around "default birth control". 

What if it's not just "standard care" but a MAJOR factor in the rise of postpartum depression and anxiety we're seeing? Is hormonal birth control a silent driver of postpartum depression and anxiety? It's time to connect the dots. New research links hormonal birth control postpartum to increased maternal mental health risks. Understanding the biological reality of postpartum, including postpartum brain rewiring, shows why synthetic hormones disrupt a healing body. This is a call to action for anyone supporting new mothers. For postpartum providers and perinatal mental health professionals focused on holistic support and evidence-based care, this knowledge is essential for informed consent and optimizing postpartum recovery. 


Check out this episode on the blog: https://postpartumu.com/podcast/the-link-between-hormonal-birth-control-and-postpartum-depression-ep-218/


Key Time Stamps: 

  • 2:37 hormonal birth control postpartum and mental health
  • 3:34 Key finding: 49% increased postpartum depression risk linked to hormonal contraception
  • 5:12 Highlighting birth control as default postpartum care.
  • 6:48 Diving into the biological reasons behind the link.
  • 7:52 The complex postpartum body state: hormones, nutrients, sleep, inflammation.
  • 11:48 Synthetic hormones interfere with delicate postpartum healing.
  • 13:11 Exploring postpartum brain rewiring and changes.
  • 15:26 How hormonal birth control can alter brain structure/function.
  • 17:14 The "neurological collision" of postpartum brain changes and birth control.
  • 20:34 Lack of provider training in postpartum brain science and hormone impacts.
  • 25:07 Systemic issue: medicating women through a sacred transformation.
  • 27:56 What holistic postpartum care and informed consent should look like instead.
  • 31:09 The need for ongoing postpartum support (recovery takes years!).


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Speaker 1:

The postpartum care system is failing, leaving countless mothers struggling with depression, anxiety and autoimmune conditions. I'm Miranda Bauer and I've helped thousands of providers use holistic care practices to heal their clients at the root. Subscribe now and join us in addressing what modern medicine overlooks, so that you can give your clients real, lasting solutions for lifelong well-being. Hey, welcome back to the Postpartum University Podcast, miranda. Here and in today's episode, I'm going to ruffle some feathers, but I do want to start in a way that really grounds us, because I am not here to stir things up. Honestly, the truth is that I have been sitting with this episode for some time.

Speaker 1:

A few weeks ago, I shared the conversation in my newsletter. If you're not in that newsletter, you want to get in ASAP. We've got the link in the show notes. But it was just a short article on a brand new study that came out about postpartum birth control and depression and to this day, weeks later, I am still getting messages about it, messages like wait, this makes so much sense.

Speaker 1:

Why did no one tell me this before? Or this happened to me? I knew something was wrong, but no one believed me. And it really struck a nerve with me, not like in a sensational way it hit, because it's so true and that truth felt both shocking and deeply validating to so many of you. And I'll be honest, I have been struggling with the balance of both of these worlds because, on one hand, I really want to be this calm presence, this peace, this grounded nervous system and this sea of noise. I want to do that for you. And on the other hand, there's also this revolution in postpartum care that I am here to lead, and revolutions are rarely quiet. They're bold, they challenge, they disrupt and they require truth telling. That doesn't always feel comfortable, and so I feel like I'm stuck between both of these worlds. I'm trying to be calm and catalytic, but I've come to believe. Something really, really important here is that we cannot get to the calm unless we first face the truth. So today, that is what we're going to do.

Speaker 1:

We're going to dive into a topic on birth control and postpartum and how it is a leading problem and maternal health that we must talk about. This is not fear mongering, this is not about shame. This is about informed choice. It's about seeing the whole picture, about advocating for women in a system that is all too often forgetting women in the first place. So let's all take a very big, deep breath and let's stay grounded and let's walk into this conversation together, because you deserve to know the truth and this, this is where healing begins. So let's talk about the study that I'm telling you about. It is published in the JAMA Network Open and it's a very respected peer-reviewed journal. I'm going to include the link to that article as well.

Speaker 1:

And the research followed over 610,000 first-time mothers in Sweden. Yes, 610,000. It's a massive sample size which gives the study weight and validity. And here's what they found in this study when hormonal contraceptives were introduced in the postpartum period, especially in the first few weeks after birth, there was a 49% increased risk of developing clinical depression within the first year. Let me say that again, hormonal birth control in the postpartum period was linked to nearly a 50% higher risk of depression. And it wasn't just one type. The study looked at multiple forms of contraception combined oral contraceptives you know, the classic pill with estrogen and progesterone that had the strongest association with negative mental health outcomes Progesterone only pills. Sometimes providers call that the safe pill for breastfeeding had a lower risk early on, but that risk increased later in the postpartum year. So not only do we see a connection. We see a pattern, one that suggests timing matters, type of birth control matters and individual context matters, but you know what the kicker is? Here's the kicker Postpartum and birth control go hand in hand.

Speaker 1:

This is standard care, this is default care. And postpartum, you walk into the six week follow-up appointment. What's the number one thing that you are going to likely leave with? It's not nourishment, it's not emotional support, it's not a recovery plan, it's a prescription, a prescription for birth control. So let's pause here, because we need to name what's happening. We are layering synthetic hormones which dramatically alter brain chemistry and hormone feedback loops, on top of a body that is deeply depleted from pregnancy, actively healing from birth, navigating intense hormonal shifts, experiencing sleep deprivation and often lacking in emotional and physical support. And we are medicating this body, a body that's already under stress, and we are calling it care.

Speaker 1:

And now, finally, science is starting to catch up with what thousands of women have been saying for years. I got on the pill and I spiraled. I was fine until I started birth control. I kept telling my provider I didn't feel right, but they said it wasn't the pill. So the question we have to ask is this what are we actually doing to women in postpartum, because it's not just a prescription, this is a disruption, and now we have data to actually back that up. This is powerful.

Speaker 1:

So I want to dive a little bit deeper, because I had so many people ask me this question why is this happening, right? What's the biology behind this breakdown? So I'm going to break it down just a little bit for you on the physiological level, because this is not just theory. It's rooted in how female body operates, especially in the postpartum window. And first we need to understand that postpartum is one of the most hormonally complex and sensitive time in a woman's life. After the placenta is delivered, hormone levels, particularly estrogen and progesterone, they plummet faster than at any other point in a human lifespan and they don't rebound quickly. In fact, research shows that it takes months, and sometimes longer than a year, for these hormones to return to any kind of homeostasis, especially while breastfeeding, and at the same time, nutrient stores are depleted, sleep is fragmented or non-existent, especially for those who are getting very little support, and the brain is rewiring.

Speaker 1:

We're going to get into this a little bit more. The actual structure changes within the brain and taking place in a lot of different regions of the brain. There's a lot of neuroplasticity happening. It's a fascinating conversation and we have to dive into this deeper. There's also inflammation that is elevated. There is lingering medication residues or side effects from birth interventions. Then we have the nervous system and a survival mode operating from a state of hypervigilance and exhaustion.

Speaker 1:

And now we just like throw in hormonal birth control and so we're adding in the synthetic hormone into the soup of dysregulation. And these aren't even bioidentical Like for those of you who are into the whole hormonal soup of things. We're not even talking about bioidentical hormones. They don't support what's already happening. They're basically trying to override what is happening within the postpartum body. And here's what happens when we do that. We have suppression of natural hormone feedback loops. So birth control shuts down the body's communication with the ovaries. It prevents ovulation, not just pregnancy. And when that comes, suppression of natural progesterone, which is a key mood stabilizing, calming hormone that postpartum women desperately need to rebuild their body right. So it just completely suppresses all of that. Then we have the disruption of serotonin and dopamine pathways.

Speaker 1:

Hormonal contraception is known to alter neurotransmitters. Estrogen, for instance, plays a role in serotonin regulation. Progesterone influences GABA, which is essential for calm and sleep. The synthetic versions do not mimic these effects well. This is scientifically proven over and over and over again. And in postpartum, where neurotransmitters are already really fragile and shifting and changing, this is a recipe for instability.

Speaker 1:

Then we have inflammation Inflammation increases. Several studies link hormonal contraceptive use with increased systemic inflammation, and we already know that inflammation is a key driver in depression, particularly postpartum depression and the fact that a postpartum body is biologically normally inflamed. We want that inflammation in early postpartum because it's helping our body heal. That inflammation is supposed to be acute, it's supposed to be something that is going to go away in time and it's helping us heal. But when that inflammation is not supported, when we're not giving that body what it needs, that inflammation lingers longer and then it causes long-term issues. And then we throw in hormonal contraception on top of it that we already know causes inflammation and we're just entering into this chronic inflammatory state which wreaks disaster on our bodies.

Speaker 1:

Then we have to talk about nutrient depletion, because what would be a conversation of postpartum care without it? We have oral contraceptions that deplete several essential nutrients B6, b12, folate, magnesium, zinc all of which are critical for brain health, immune function and mood regulation. And we again, this is not new. We knew that oral contraceptions and contraceptives can deplete the body of these key nutrients, and postpartum women are already deficient in many of these. And then the pill. What we do is we basically create a deeper hole.

Speaker 1:

So when we ask what is happening, the answer is really, really simple we're interfering with an already delicate and deeply transformative biological process. Instead of supporting the body's return to balance, we're overriding it with medication that's designed to shut down hormonal function. And it's not because providers don't care. It's because the system is set up to prioritize convenience, population control and medical liability over individualized healing. But there's something else that we need to name here, and this one cuts deep. We're also prescribing birth control and postpartum because we don't trust women. We don't trust women to track their cycles. We don't trust women to make their own choices. We don't educate them on fertility, ovulation or their own physiology. We don't give them the full picture. Instead, we hand them a prescription and we call it empowerment. But true empowerment requires informed consent, and if women aren't being told that the pill can increase the risk of depression, along with everything else that I've talked about today, then we're not giving informed consent, and that has to change.

Speaker 1:

Okay, I want to go deeper into the rewiring of the brain that happens in postpartum. Most people don't recognize this, but the postpartum is. It's not just physical recovery. If you're listening to this podcast, you already know this right. It's a complete neurological transformation on top of that, and we have brain imaging studies confirming that after a childbirth, a woman's brain undergoes permanent structural changes right, permanent structural changes. And there was a research actually that was published in Nature Neuroscience that found that pregnancy significantly reduces gray matter volume in regions of the brain associated with social cognition, emotional regulation, empathy. And to restructure the maternal brain for attunement and caregiving is the goal. So this is not a loss. We are not losing gray matter and our brains are not changing in postpartum to become less than it's actually a specialization. This is evolution in a very short window. Okay, so this is such a beautiful thing. It allows us to connect with our babies, it allows us to sense danger faster. It's allowing us to raise our babies in a way that feels really, really good. Again, evolution.

Speaker 1:

And we have a multitude of other studies that show that increased connectivity between the other parts of the brain and amygdala enhance emotional responses and protection. We have heightened sensitivity to threat cues. Right, we have maternal vigilance that goes up significantly. Oftentimes this is what spirals out of control and is perceived as anxiety because, again, we're not taught about how the brain functions or how to support it in those changes. We have enhanced memory and reward system activity and response to the baby's cues. And then we have this brain, this mom's brain, that is adapting in real time to bond and care and protect.

Speaker 1:

And then we enter hormonal contraceptives and multiple studies have shown that hormonal birth control changes the brain. And let's be clear, this is not a conspiracy theory. This is in the literature, okay. A 2015 study out of UCLA used MRI imaging to show that women using oral contraceptives has smaller hypothalamic and amygdala volumes, both of which are essential for regulating mood, emotional stability and stress response. There was a study from Frontiers in Neuroscience in 2020 that found that oral contraceptive users showed significantly altered function and connectivity patterns within the brain's default mode network.

Speaker 1:

So the part of the brain involved in self-reflection and internal narrative and emotional regulation and guess what else we see? Women who use hormonal contraceptives have increased reactivity to negative emotional stimuli, especially during the withdrawal phase of the pill. So when we are getting off that pill, we feel intense negative reactions right, almost as if it is addicting. When hormonals level drop, we face the consequences. These are the same pathways, already heightened and vulnerable in postpartum. Okay. So when we have postpartum plus birth control, we have this neurological collision. And if we were to add it all up, it means that the postpartum brain is already hyperreactive, especially to emotional input and threat cues as a survival adaptation, right. And then we have increased plasticity, meaning the brain is literally more moldable, more sensitive, more vulnerable to environmental and chemical changes. Then we have hormonal birth control that alters neurotransmitter activity, shrinks certain brain regions and changes connectivity between critical emotional regulation regulatory areas right within the brain. And so when we introduce hormonal contraceptives into this already rewiring of the brain, we are manipulating a system that is already stretched to its edge, and we're doing it with zero acknowledgement of the consequences. And so this is why so many report that they feel emotionally flat or disconnected after starting the pill, that they have sudden unexplained anxiety or rage. They have increased intrusive thoughts, brain fog that doesn't lift, mood shifts that they can't trace.

Speaker 1:

I will tell you that there was a brief period of time that after my first I went on hormonal birth control, and it was right. When I started seeing my now husband, I was. I was wanting some level of support and I went on hormonal birth control for just a couple of months and I could not take it. It was just the progesterone pill. It was five milligrams. It was something supposed to be small that my body can handle, because I am very sensitive to everything. You know the other pills that made me extremely, extremely sick, and so this is the one that I ended up settling on and I tell you, it made me feel like a crazy person.

Speaker 1:

I would flip out over the littlest things and I would attack my partner and ask him like what the hell are you doing? Why? Why can't you do this? Why aren't you calling me back? And he's like it's been 15 minutes, what are you okay? Like what is going on?

Speaker 1:

You know, it was like the weirdest, craziest scenarios and I would have to step back from that and be like and I would have to step back from that and be like oh my gosh, who am I? Like this is, this is crazy sauce. I would never behave like this in real life, like this is not me. It made me a different person and I quit it. I was done. I could not be that person. I just flipped out on everybody. I thought that people were always attacking at me and that people were always doing something bad to me and it was weird. It was just insane.

Speaker 1:

And I know that I'm not the only one in feeling that the symptoms mimic postpartum mood disorders. Right, everything that I shared with you here women reporting feeling emotionally flat, unexplained anxiety and rage, increased intrusive thoughts. Women reporting feeling emotionally flat, unexplained anxiety and rage, increased intrusive thoughts, brain fog that doesn't live, mood shifts they can't trace right. That's because these symptoms mimic postpartum mood disorders and we often chalk it up to postpartum depression, when in reality it just may be amplifying pharmacology. It just may be amplifying pharmacology.

Speaker 1:

And here's the worst part Most providers don't know this. They're not taught about the neurological impact of contraceptives in medical school. They do not receive specialized training in postpartum brain science, or hormones for that matter. So again, this is not blame. This is we're not blaming moms, we're not blaming providers. This is not blame. This is we're not blaming moms, we're not blaming providers. This is about education and we must stop treating the postpartum brain like a pregnancy or a pre-pregnancy brain. It's not the same. It has different needs. It requires reverence and patience and, above all, support, not suppression. So the research right.

Speaker 1:

So we have this study by JAMA Network Open that we've been talking about, and it's the first of its kind, this first large scale study to examine the relationship between hormonal birth control, specifically in postpartum, and the risk of developing postpartum depression. And that's a beautiful. But also also, we've had hormonal contraceptives on the market for over 60 years. We've been prescribing them at six week checkups for decades, routinely, casually, often without discussion. Yet not one large scale study or short scale study, whatever you want a small scale study, I don't care what you want to call it. No study until now has looked at how these medications might interact with the brain and body and deep recovery and hormonal chaos and depletion. We have long known that hormonal contraception can impact mood. That data exists.

Speaker 1:

But this the unique, tender and neurologically sensitive postpartum season that has been completely ignored in research. And let's be clear this one study is not the final word, it's a starting point. There is so many questions that study was not able to answer and so we have so much more work that has to be done, a massive, long overdue wake-up call. That demands we look deeper, ask better questions and challenge the assumption that routine care is always safe care. Because, when it comes to the postpartum body, there is no one size fits all there never was and the fact that we're just now beginning to ask these questions tells us so much. Tells us a lot, not just about science, but about who we prioritize in the medical system. We cannot wait another decade for more studies while mothers suffer in silence. It's really time to rethink postpartum care. Okay, maybe we just need to take a breath here, because I really I wanted to zoom out.

Speaker 1:

This conversation isn't about one study. It's about why this study matters in the first place, why it struck a nerve and why my inbox is still full from that newsletter I sent weeks ago. And it's because this birth control at six weeks it's not a personal choice most of the time, it's not a conversation rooted in empowerment, it's a default, it's a box to check and at that six week mark, what is typically the only postpartum follow-up a woman receives? She walks into her provider's office and she's met with a singular focus Are you going back on birth control? Not. How are you sleeping? Not. What's your support system like? How's your bleeding, your digestion, your anxiety? Do you feel like yourself? Just birth control and an all clear.

Speaker 1:

And when you zoom out, you realize this has nothing to do with her readiness physically, sexually, emotionally, hormonally, spiritually and everything to do with system efficiency. And everything to do with system efficiency, liability coverage and a deeply ingrained cultural belief that mothers need to bounce back and get back to being sexually available and productive and manageable. We are medicating women through a sacred transformation. We're interrupting brain rewiring, gut healing, healing, hormonal recalibration, nervous system repair and instead of giving her the nourishment and support her body is demanding, we overwrite it. And we do it with no real understanding of what we're interrupting, because most providers, again, are not trained in postpartum hormone recovery. They don't learn about trauma or neuroplasticity or how depletion affects brain chemistry. They don't study how inflammation changes mood. They just prescribe and again, not their fault. And now that you know this, you know we know better, we do better. That's the way it goes.

Speaker 1:

The system is what we're trained in and that system is what's failing moms. It's the same system that asks a woman are you sad? And if she says yes, she gets a prescription for Zoloft and birth control, often on the same day, without ever testing her iron levels or her B12, or asking if she's eaten anything besides granola bars and cold coffee. In six weeks, no question about what's your birth story. Did you have trauma? It's actually the same system that thinks trauma is only physical, that cleared for sex quote unquote means cleared for intimacy, that you are alive. Hello, I'm here, I'm alive and therefore you must be totally fine.

Speaker 1:

But the hard truth of it all is that if we're asking mothers to protect the system from consequences instead of asking the system to protect mothers from collapse, we're in a big pickle here. We've convinced women that the most important thing they can do at six weeks postpartum is to not get pregnant again, and meanwhile they're still bleeding, their hair is falling out, they haven't slept in a month, they're crying in the pantry and we're handing them synthetic hormones like it's the answer to everything, like they really wanna go have another baby right now. Anyway. And again, not demonizing birth control. Right, there's a place for it. If you want it and you have been informed of all of the things, perfect, okay.

Speaker 1:

But this is really about demanding informed consent. It's about saying not now, not until we've asked better questions, not until we've supported her fully or I'm getting all of the right information, and I feel like this is my best choice, because postpartum recovery is not a race to contraception. It's a return to wholeness and women aren't failingain and simple, the system is Okay. So what do we do instead? Right, what does that new path forward look like?

Speaker 1:

Let's take a talk real quick. Take a talk about what's possible, because I don't just wanna sit here and stir the pot. I wanna show a better way and I wanna be clear. This isn't about want to be clear. This isn't about fear mongering. This isn't about reclaiming, you know, um, the. This is about reclaiming informed decision-making. It's about knowing all the facts, not just, uh, ones that fit into, like this 10 minute checkup at six weeks. So if you're a provider and you're listening into this and you're feeling heavy, maybe even frustrated, because this isn't what you were taught or that you don't know what else to do, I want you to please, please, hear this. You are not to blame, you care, you're here and that means everything. And there is a better way, one that does not rely on defaults or assumptions or prescriptions.

Speaker 1:

First, one that starts with presence and observation, education and nourishment. And here's what that looks like. Begin with listening, not prescribing. Ask about her bleeding, her emotions, her bowel movements, her meals, her relationships. The baby blues are one thing, but so are nutrient deficiencies and unspoken trauma and gut dysbiosis and nervous system dysregulation. What if we just listened first and then we have nourishment over management? Instead of trying to manage hormones with synthetics, what if we focused on rebuilding the systems that regulate them naturally? We're talking about iron and zinc and omega-3s and B12 and magnesium. We're talking about warm meals and cooked vegetables, bone broth, high quality protein the foundational stuff that helps every organ, every hormone, every cell function. And then acknowledge the brain remodeling Postpartum isn't just about the uterus, right, it's about the brain and the body.

Speaker 1:

And, poetic, it's science. And we're putting a woman on a synthetic hormone while her brain is literally rewiring, and that's a really bold move and that should not be taken lightly. So let's educate, provide actual ongoing care, let's normalize multiple check-ins, emotional support, nutritional guidelines and guidance. Ask how she's really doing, not just once, not just at six weeks, but regularly, because postpartum is not six weeks, it's at least six years. Seriously, that's how long in a recent study that it takes to heal in postpartum and feel like ourselves again, feel safe in our bodies again and really a full year of recovery and reintegration would be life-changing. It doesn't necessarily have to be six years, it could be just a full year of support Oof, what a difference.

Speaker 1:

And then educate on a full spectrum of options, from contraception that means everything from fertility awareness methods to barrier methods to exploring what truly is best for that woman in that season of her life, with her unique biochemistry and stress levels and healing timeline and values in mind. And this requires a new kind of care, a new way of thinking, a level of slowness and attentiveness and reverence that we aren't used to in modern medicine, but it's what's required if we want to stop failing mothers. This is the new era of postpartum care and it begins with us. And here we are at the moment. That feels both heavy and hopeful. And we've named the truth the hormonal birth control in postpartum and this season carries risks that deserve to be understood. We've laid out the research, the biological realities, the systemic gaps, and we've envisioned a new way forward, one that's led in informed consent and deep nourishment and radical respect respect for the mother.

Speaker 1:

But here's what I want you to hear most we don't change a broken system by yelling louder. We change it by embodying something different. And you, as a provider, as a mother, as an advocate, you are the shift. You are part of a global community of humans saying this isn't good enough and we can do better. You're the ones brave enough to slow down, to ask questions, to stop assuming and start listening, to start challenging the norm, not with outrage although you can be outraged but with education and compassion and care. And this is exactly why Postpartum University exists to help you rise, to give you the knowledge and tools to support women at the depth. They actually need not surface level fixes, but whole body, soul level healing. Let's be the generation that says we will no longer sacrifice the well-being of mothers for the sake of convenience. We will no longer silence symptoms or shortcut healing. Let's hold a vision of postpartum that is wise and reverent and evidence-informed and radically human, because mothers deserve it, because mothers deserve it, babies deserve it. Providers deserve a part to be a part of this and something meaningful, and every family's future depends on it. Our communities depend on it.

Speaker 1:

If this episode sparked something for you, come be a part of the conversation. Message me on IG. I handle everything on my own Instagram account, so when you connect in, I guarantee you 95% of the time you are connecting in with me personally, I love to have conversations there, so connect in with me there. And, of course, if you are not getting our weekly postpartum provider press newsletter, where we dive deeper into topics like this and give you tools to apply in real practice, you are so missing out. Go to postpartumu the letter u dot com slash press and we will make sure that you get the next newsletter that comes out.

Speaker 1:

Okay, until next time, keep leading with art. Thanks so much for being a part of this crucial conversation. I know you're dedicated to advancing postpartum care and if you're ready to dig deeper, come and join us on our newsletter, where I share exclusive insights, resources and the latest tools to help you make a lasting impact on postpartum health. Sign up at postpartumu the letter ucom, which is in the show notes, and if you found today's episode valuable, please leave a review to help us reach more providers like you. Together, we're building a future where mothers are fully supported and thriving.

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Maranda Bower

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