Does Birth Control Cause Insomnia? (What Does Research Say?)

While it’s not particularly common, there is some research linking birth control pills to depressive symptoms and insomnia.

We’re going to quickly review that research in this short post to understand the likelihood better.

Ultimately, birth control pills have a significant effect on hormone levels, and women’s bodies can have a wide variety of reactions to that sort of effect.

Typical Side Effects of Oral Contraceptives

Insomnia is not one of the primary side effects of birth control pills (oral contraceptives). 

They have been tested for decades and are known to be relatively safe with only mild side effects for most women. The most common side effects are (1):

• Nausea
• Weight gain
• Chloasma
• Spotting and breakthrough bleeding
• Galactorrhea and pituitary tumors
• Choreiform movement disorder
• Depressive symptoms

But nothing directly concerning sleep.

That doesn’t mean that birth control can’t cause insomnia for some women, but it’s more likely an indirect side effect caused by one of those primary side effects.

Can Birth Control Pills Cause Insomnia?

There’s very little research on this specific topic, but let’s go over what’s available.

Some studies have shown that oral contraceptives improve sleep quality when no significant side effects are present (2).

However, one 2016 study from Denmark looked at birth control usage in a population of over 1 million women. They found that usage was significantly linked to antidepressant prescriptions and depression diagnoses (3):

Users of progestin-only pills had a relative risk for first use of an antidepressant of 1.34; users of a patch (norgestrolmin) 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel)

Note that not all birth control pills are progestin-only (they typically contain estrogen as well).

Regardless, those birth control users had a 1.34 times higher risk of using an antidepressant (with a similar rate for depression diagnosis).

Why does this matter?

Depression is one of the biggest risk factors for insomnia.

Another study found that (4):

Oral contraceptive use was consistently associated with more severe concurrent insomnia symptoms

And it appears that the depressive symptom side effects are a possible explanation.

SummaryWhile insomnia is not a common direct side effect of birth control pills, depressive symptoms can be. These depressive symptoms could be putting some women at a higher risk of developing insomnia, although more research is needed to understand this link better.

Why Else Might Birth Control Cause Insomnia Symptoms?

Depressive symptoms may explain insomnia symptoms, but there are other possibilities.

The other obvious possibility is that the hormones in birth control pills may have some effect on sleep. Even if it’s not enough to cause insomnia, these effects could still play some role.

Oral contraceptives typically contain:

• Progestin - Progestin is known to have a hypnotic effect for most people. Studies have shown that it usually leads to an increase in slow-wave sleep and reduced sleep latency (5).
• Estrogen -Note that not all pills estrogen. Estrogen’s effect on sleep isn’t well understood, but it does appear to have some effect. Some research suggests that it has a hypnotic effect up to a certain point (6). However, there’s also evidence that both high estrogen and low estrogen could cause insomnia, the right amount is important.

These hormones are involved in several complex biological processes, and their impact on sleep isn’t one of the better understood parts.

However, they could help explain why birth control improves sleep quality in some, while leading to insomnia in others, as women have varying baseline hormone levels.

Summary: Do Birth Control Pills Cause Insomnia?

There is evidence that birth control pills can cause insomnia for some women.

It may be because they can cause depressive symptoms as a side effect, or because of the effect they have on important hormone levels.

However, it’s not particularly common. So if you suspect birth controls are negatively affecting your sleep quality, you should see a doctor to confirm or rule out this cause.

References

1. Side effects of oral contraceptives
2. A randomized comparative trial of a combined oral contraceptive and azelaic acid to assess their effect on sleep quality in adult female acne patients
3. Association of Hormonal Contraception With Depression
4. Oral contraceptives, depressive and insomnia symptoms in adult women with and without depression
5. Effects of hormonal contraceptives on sleep - A possible treatment for insomnia in premenopausal women
6. Sex differences in sleep: impact of biological sex and sex steroids