Does The Pill Reduce Women's Libido
Author: Michael Castleman, M.A.
Ever since birth control pills were introduced in the mid-1960s, questions have been raised about their effects on women’s sexual desire. Some reports have asserted that the Pill increases desire because it removes risk of pregnancy. Others have said it has no effect on women’s libido. And some have claimed that the Pill is a libido-killer and that loss of sexual desire is a frequent reason women cite for quitting the Pill. Among these conflicting claims, where’s the truth? With the Pill on the market for 40 years now, the answer is still not clear, but here’s what is known.
In both men and women, sexual desire is a result of male sex hormones, androgens, primarily testosterone. It’s a well-established fact that if women’s (or men’s) androgen levels drop below a certain level, they experience a collapse of libido.
The main ingredient of most birth control pills is the female sex hormone, estrogen. Pill use increases blood levels of estrogen -- and decreases androgens. Estrogen-related androgen suppression opens the possibility that this might account for reports of Pill-related libido decline.
Several studies have investigated the Pill, androgen levels and libido in women. In general, they have shown that taking birth control pills lowers blood levels of androgens -- but largely without loss of libido. In fact, a few have shown greater sexual frequency and sexual satisfaction among Pill-using women.
Other studies have given androgen supplements to women on the Pill. Their blood androgen levels increased, but they have experienced no change in libido, sexual frequency or satisfaction.
The other female sex hormone used in the Pill is progestin. It too reduces androgen blood levels. But again, the studies show no significant libido loss in most women using this hormone. In one study, only two percent of women who stopped using progestin birth control pills cited reduced libido as their main reason for switching methods.
Speaking of reasons for quitting the Pill, many studies have investigated this issue. In a New Zealand study of 2,469 women, the most common reasons for quitting the Pill were: desire to get pregnant, no longer needing contraception because the man got a vasectomy, uncomfortably heavy menstrual flow and spotting (bleeding between menstrual periods). Loss of sexual desire did not make the list. A German study of more than 10,000 women produced similar results. The top reasons for quitting the Pill were: desire to get pregnant, headache and bleeding problems (heavy flow or spotting). Libido loss was a very minor factor in quitting.
Spanish researchers compared libido in 1,073 Pill users and women using intrauterine devices (IUDs). They found no differences in sexual desire.
Italian researchers investigated the sexual effects of high-dose and low-dose birth control pills on women’s libido. They found no differences.
But the Italian group also discovered that no matter which dose of Pill their subject took, sexual desire decreased over time. After nine months on the Pill, the women reported significantly less desire than when they started taking the Pill. It’s possible that the Pill was responsible. It’s possible that it has a cumulative depressing effect on sexual desire. But it’s also quite possible that this observation is simply a reflection of the natural course of sexual relationships. New lovers can’t keep their hands off each other. But typically, after six to 12 months, desire and sexual frequency decline.
Meanwhile, various studies have also teased out other reasons for loss of libido in Pill users. Age is a big one. Women taking the Pill in their thirties report less libido than Pill users in their twenties. Marital status is another. Single Pill-users report more sexual desire than married women taking the Pill. A third factor is relationship deterioration. At any age, if a woman taking the Pill feels her relationship is going downhill, her libido suffers.
Where do all these disparate findings leave us? In the words of Jonathan Schaffir, M.D., a professor of gynecology at Ohio State University College of Medicine, who reviewed all the research for a report earlier this year in the Journal of Sex and Marital Therapy, “This review fails to find any reliable predictors of adverse effects on libido in users of birth control pills and other hormonal contraceptives. Although many studies have cited such an effect, the preponderance of the research suggests that only a minority of users are affected.” In other words, most women don’t experience libido loss when taking the Pill, but some do -- only it’s not clear how many.
If you’re taking the Pill or any hormonal contraceptive (Ortho Evra, NuvaRing, Depo-Provera, Minipill), and you believe it’s interfering with your desire for sex, discuss your situation with your contraceptive provider. You might switch to a different type of hormonal contraception. Or you might switch methods altogether and try condoms, a diaphragm or an IUD. Then wait a few months and reassess your situation. If you experience no change in libido, feel free to return to the Pill if you like.
While it appears that the Pill and related methods affect libido in only a minority of women, if you’re one of them, you don’t have to live with libido loss, you have many other birth control options.
Schaffir, J. "Hormonal Contraception and Sexual Desire: A Critical Review," Journal of Sex and Marital Therapy (2006) 32:305.