Can Birth Control Make You Tired?

Some people who menstruate have noticed they feel tired when taking hormonal contraceptives like the birth control pill. Fatigue and menstruation are in fact linked, but it’s more complicated than simple cause and effect.

Read on to learn more about how hormones, menstruation, and birth control can affect sleep and tiredness.

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What the Research Shows

There is conflicting research on how hormonal contraceptives affect sleep and fatigue.

A 2020 study found that people who used hormonal contraceptives had subjectively worse sleep and more self-reported sleep problems, including insomnia and daytime sleepiness, than those not using it.

Progestogen-only contraceptives appeared to be worse for sleep than combined hormonal birth control.

The authors of this study noted that these results contradict evidence that shows female sex hormones, especially progesteronehave hypnogenic effects (induce sleep). They hypothesized that the timing of taking the pill may play a factor, suggesting that taking it in the morning may lead to daytime sleepiness, while taking it at night could promote sleep. They note that this is highly speculative and would need to be studied to confirm.

In contrast, a 2012 study found that hormonal birth control was associated with improved sleep efficiency and lowered severity of sleep apnea (a sleep disorder that causes breathing problems during sleep).

Many organizations, including Planned Parenthood and the US Food and Drug Administration (FDA), do not include fatigue in their lists of common side effects of hormonal contraceptives. The FDA does mention tiredness as a side effect of emergency contraception (the “morning after pill”).

Progestin vs. Progesterone

Though the terms sound similar, progestin and progesterone are not the same:

  • Progesterone: A hormone that is made in the ovaries
  • Progestin: A synthetic form of progesterone

Hormonal Birth Control May Be the Culprit

How might hormonal birth control induce tiredness?

The two major female sex hormones, estrogen and progesterone, are thought to influence sleep. Progesterone is believed to be particularly sleep-inducing. Estrogen, though less studied in this area, may also have a sleep-inducing effect, as suggested by estrogen replacement therapy, improving the sleep-related complaints of perimenopausal people.

The use of hormonal birth control may indirectly affect sleep and wakefulness. Though more research is needed, the use of hormonal contraceptives has been associated with depression. Fatigue is a known symptom of depression.

While the research is conflicting, some people who menstruate report feeling fatigued while on hormonal birth control, but it improved when they stopped taking that specific method.

Are You Prone to Fatigue With Your Period?

If you are prone to fatigue during your menstrual cycle, discuss this with your healthcare provider before starting hormonal birth control.

Types of Hormonal Birth Control

Types of hormonal contraceptives include:

If you want a non-hormonal birth control option, non-hormonal IUDs are available, as well as barrier methods.

How to Switch Birth Controls

If you want to switch birth control pills, talk to your healthcare provider. There are different strategies to choose from, depending on the type of pills you are using.

Options for switching between combination pills:

  1. Finish the entire pack, including the fourth week placebos, from your old method. Start the pack of the new method on the day you would have started the first day of the old pack. Or,
  2. Start the new combination pill right away, but if it has been more than five days since menstrual bleeding started, use a backup method (such as a condom) or abstain from sex for the next seven days.

Switching from combination pills to mini-pill:

Take your mini-pill immediately, abstain from sex or use a backup method for the next two days if it has been more than five days since you experienced menstrual bleeding.

Switching from mini-pill to combination pill:

Start the combination pill right away, but if it has been more than five days since you have had menstrual bleeding, abstain from sex or use a backup method (such as a condom) for the next seven days.

Premenstrual Syndrome (PMS)

The menstrual cycle can also affect sleep and wakefulness. People who menstruate can experience increased sleepiness and insomnia during the premenstrual period (also called luteal phase).

People with premenstrual syndrome (PMS) can experience symptoms such as:

  • Depression
  • Irritability
  • Difficulty concentrating
  • Anxiety
  • Social withdrawal
  • Insomnia
  • Fatigue
  • Breast tenderness
  • Bloating
  • Headache
  • Hands/feet swelling
  • Aches and pains
  • Changes in thirst and appetite
  • Gastrointestinal symptoms and abdominal pain

Premenstrual dysphoric disorder (PMDD), a more serious and disruptive form of PMS, can come with symptoms in addition to those seen in PMS, including:

  • Nervousness
  • Agitation
  • Anger
  • Severe fatigue
  • poor sleep
  • Confusion
  • memory problems
  • Moodiness
  • Paranoia
  • Emotional sensitivity
  • Crying episodes

Other Reasons for Fatigue

Whether or not you are on hormonal birth control, fatigue that is recurrent, intrusive, or not relieved by rest should be taken seriously and discussed with a healthcare provider.

Fatigue can be a sign of a number of conditions, including:

Summary

Some people who menstruate report feeling tiredness or fatigue while taking hormonal birth control.

Research is conflicting about whether or not hormonal contraceptives can cause fatigue. Potential reasons include sleep disruption, association with depression, and the sleep-inducing effects of sex hormones, such as progesterone.

Fatigue can be a symptom of many other conditions, including PMS, anemia, hypothyroidism, depression, and sleep disorders, such as sleep apnea.

A Word From Verywell

Birth control is not one-size-fits-all. If you feel your birth control is making you feel tired, talk to your healthcare provider about other available options. Regardless of whether or not you are taking hormonal birth control, it’s important to speak with your healthcare provider if you are experiencing fatigue in case it is a symptom of something more serious.

Frequently Asked Questions

  • How does hormonal birth control work?

    The birth control pill prevents pregnancy by:

    • Changing hormone balance to prevent the release of an egg (ovulation)
    • Thickening cervical mucus, making it harder for sperm to enter the uterus
    • Thinning the lining of the uterus, making it less likely a fertilized egg will implant

  • What are the side effects of birth control?

    Some common side effects of hormonal birth control include:

    • Spotting/bleeding between periods
    • Breast tenderness
    • Nausea
    • Headache

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