[Trigger Warning: Depression + Mental Health]
Disclaimer: I'm not a medical professional. I share my personal experiences and cite medical research when applicable. For diagnosis and treatment questions seek the advice of your dedicated medical care provider.
After adding both oral contraceptives and the monthly hormonal ring to my birth control "no fly" list and having that pragmatic conversation with my doctor about the risk of an IUD, I was left with three practical birth control methods at my disposal. I could:
Put a hormonal implant into my arm
Apply a monthly hormonal birth control sticky "patch", or
Take birth control shots every three months
My doctor cautioned against the arm implant pretty dramatically, recalling a few recent anecdotal instances of intense side effects among his patients. He also reminded me that this was a surgery. If I didn't like the implant, I'd have to surgically remove it. Similarly, he dismissed the birth control shot as a non-practical solution that would require frequent and inconvenient scheduled visits to the doctor; due to its high dosage, the shot often came with more intense side effects for its users, too.
He suggested I try the patch as the next best, least invasive, lowest commitment alternative. If I didn't like it, I could simply peel the sticker off of my body, after all. I committed to sticking a tan band-aid like sheet of hormones onto my stomach each month and left the office determined to make this method work.
And for over a year I enjoyed the benefits of the birth control patch with little issue. The only side effect of the patch, it seemed, was an awkward tan line at the beach.
By this point, I was dating my boyfriend (now fiancee) pretty seriously. I was successful at work and had already been promoted twice in my early career. I was living in a group house in the historic DuPont circle neighborhood of D.C. and enjoying the occasional yoga class. I had lots of friends. Ostensibly, the only major challenge in my life was the anemia caused by my NuvaRing bleeding incidents - but I was on top of that. So, why was I feeling so crumby?
Actually, the more I considered it, I was feeling more than just crumby. I was feeling lost and disconnected from my own life. Some days, I felt like I was floating. Others, I felt like I was sat on the passenger side of a moving car with the windows rolled up, and I couldn't get out.
I didn't treat my body well, either. When I wasn't with my boyfriend, I'd abandon all cooking ambition in favor of a bag of microwave popcorn (or two) for dinner. I avoided my roommates when I got home from work and watched Netflix in bed, starting at 6 pm. On weekend nights when I was already drunk, I'd cry and cry to the point where I'd tell my boyfriend I hated myself and I didn't want to be around anymore. How could anyone love me?
At some point, he and I both got concerned about me. I'm grateful beyond measure for realizing that this new state of depression wasn't normal and for seeking help.
Specifically, the birth control patch works in your body by absorbing the synthetic estrogen and progesterone hormones, ethinyl estradiol and norelgestromin, respectively, into your blood stream. As Xulane's website itself explains, this method exposes users to about 60% more estrogen each month than typical birth control pills, which increases the risk of side effects.*
In full honesty, I had never considered that hormonal birth control might impact my brain. Today, I know that mental health issues are some of the most common HBC side effects that women silently suffer through. After reading This is Your Brain on Birth Control, by Sarah Hill PhD, I now know that patients using non-oral contraceptives, like the ring and the patch, are more than 90% more likely to experience depression and anxiety, and these rates are increased among younger patients*. This is not okay. And it's information I sorely wish I had been told before being prescribed these HBC methods. But at the time, I thought, like so many others, that my depression was not only "my fault," but also entirely unrelated to the hormones I ingested (or in this case, absorbed).
Even lacking the scientific knowledge I have now, after several months I began to question my commitment to taking hormones. My body was screaming to tell me I was out of (good) options for hormonal birth control - maybe it was time to "quit" HBC entirely.
**If you or someone you love is experiencing suicidal thoughts, please know you are not alone and reach out to the National Suicide Prevention Lifeline at https://suicidepreventionlifeline.org/
*Resources:
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