How does the pill affect your libido?

Taking hormonal contraception such as the oral contraceptive pill may affect sex drive for some women – so why might it have this effect, and what can you do about it? Dr Harriet Connell, a GP with a special interest in hormone health, explains.

The contraceptive pill has rightly been hailed as one of the most significant medical advances of the twentieth century. It can be easy to forget – when it is so easily accessible – that is has revolutionised life for millions by allowing women to enjoy sex without the fear of unwanted pregnancy. This hormone-based contraceptive also helps stabilise hormone levels, which may in turn help alleviate the symptoms of PMS, PMDD, heavy painful periods, endometriosis, acne and reduce mood swings – all of which can affect how likely you are to want sex, become aroused by it and enjoy it. It might seem ironic then that taking a pill in order to enjoy sex without worry can cause some women to lose interest in it. Whilst this is not the case for all women – many don’t notice any changes at all, and others can find theirs actually increases – it is not uncommon for libido to dwindle, and this can be a distressing development for some.

Can the Pill or Other Hormonal Methods Affect Libido?

Female sexual desire and enjoyment can be frustratingly complicated to pin down and explain at the best of times, so can we automatically attribute a loss of interest in it to taking the contraceptive pill? No, but what we do know from decades of research is that the synthetic pregnancy-preventing hormones (oestrogen and progesterone) released into the body when taking the pill can interfere with natural levels of oestrogen, progesterone and testosterone and trigger physical and psychological side effects.¹ These can include, but are not limited to, nausea, bloating, weight gain, headaches, breast tenderness, vaginal dryness and depression. One recent study reveals that women on hormonal contraception had lower sexual responses and satisfaction and experienced increased anxiety and depression, compared to women not using it.²

The link between hormones and your sex drive

To better understand how your sex drive can be altered by the pill it can be helpful to understand how hormones naturally ebb and flow throughout the menstrual cycle and potentially affect the libido.

Hormones, notably oestrogen and progesterone, fluctuate throughout the body during a typical 28 day menstrual cycle which follows four key phases: follicular, ovulation, luteal and menstruation. The follicular phase is the longest one which begins on the first day of your period and lasts around two to three weeks until ovulation occurs. During this time the pituitary gland in the brain releases a follicle-stimulating hormone (FSH) which helps eggs grow in little sacs (known as follicles) on the ovaries. As these eggs mature, levels of oestrogen start to rise and so too does a woman’s sex drive. Ovulation is when the ovary releases one mature egg which can potentially be fertilised by sperm and usually occurs around the middle of the menstrual cycle (between days 14 and 16 in a typical 28 day one) and many women find themselves becoming more aroused and interested in sex around this time. Interestingly too, scientists have shown that straight men find women slightly more sexually attractive around ovulation time – something attributed to a slight change in body odour.³ One study involving lap dancers also found the female dancers received more tips during their ovulation phase, suggesting they may potentially feel more sexually attractive at this point and/or were more attractive to the men.⁴ From an evolutionary stand point this is the time women are at their most fertile.

Following ovulation, the luteal phase begins (at around day 21) and the balance of hormones alters again. Whilst you are still producing some oestrogen it is progesterone that becomes dominant at this point and this hormone can put the dampeners on desire. The uterine lining then thickens to prepare for a potential pregnancy but if this doesn’t happen progesterone and oestrogen levels lower until they become so low that the uterus lining starts to break down eventually resulting in you getting your period. If you experience PMS symptoms (and around 90-97% of women do⁵ ) this is the time in your cycle you are likely to get them and these can lower sex drive in some women (breast tenderness, period cramps and headaches, for example, are not the biggest turn-ons). When levels of progesterone (dubbed the ‘relaxing hormone’ because it has a mild sedative effect) are low you might also feel more irritable, short-tempered, tearful and generally low in mood. Progesterone is also known to promote sleep and relaxation so if levels are depleted this can result in insomnia or disrupted sleep which can affect how much you are in the mood for sex and/or enjoy it. Some women report feeling more interested in sex when they are on their period. Based on the available science, nobody is exactly sure why this should be the case, but it is theorised that the reduced fear of pregnancy might ramp up a woman’s sex drive and/or that menstrual blood may act as a natural lubricant making it feel more pleasurable.

How the hormones in the pill might affect your sex drive

Women who use hormonal contraception are mostly spared this hormonal roller-coaster experience when their natural menstrual cycle is disrupted by synthetic hormones. Basically, the pill works by providing a synthetic hormone at a specific dose which signals to the brain to reduce oestrogen production. When oestrogen levels flatline you are not experiencing those natural hormonally produced oestrogen surges which help to fuel desire.

Testosterone levels have also been shown to be lower in some women taking the pill than those who do not – a result of natural testosterone production being suppressed, along with an increased binding of testosterone to sex hormone-binding globulin (SHBG), a protein produced by the liver, which lowers the available testosterone in the body.⁶ There is some research to suggest that women who take the pill may be exposed to more long term problems caused by this ‘unbound’ or unavailable testosterone resulting in decreased sexual desire, lubrication and arousal and an increase in painful intercourse - effects which may not be entirely reversed when they stop taking it. More research is necessary, however, to establish if this is the case.

The bottom line is this: oestrogen is the primary driver of desire in women, progesterone can inhibit it, and testosterone also plays a significant part in maintaining female sexual desire, arousal and orgasm.

8 ways to support and manage libido changes whilst on the pill

Your chosen method of contraception is, of course, just one thing that may affect your sex drive and other factors to consider include your age, how much stress you are under, how happy you are in your current relationship, whether you are enjoying the sex you are having, experiencing grief and bereavement or physical or mental health problems (and potentially taking medication for them. For example, some antidepressants are known to suppress libido).⁷ But all the things below may help you support and maintain a healthy libido:

Track your cycle. Record any changes to your sex drive on an app such as the free one from Health & Her which can help pinpoint where spikes and slumps in your libido tend to occur and how they might be affected by external factors like stress, exercise and sleep.

Try a different form of pill or contraception. If your sex drive has tailed off on your current contraceptive pill you might find that switching to a different type with a different hormone balance (for example, one that is more oestrogen dominant with less progesterone), a different form of hormonal contraception such as the mini pill or Mirena coil or a non-hormonal type (such as condoms) can reignite it. Be aware that it can take a few months for your body to adapt to a any new type of contraception.

Exercise. Regular exercise not only contributes to overall well-being, but it can also help improve blood flow around the body (including the genitals), help you feel more positive, and raise your energy levels.⁸

Manage stress. Chronic and/or sustained stress can raise levels of the stress hormone cortisol which can dampen desire with research showing that chronic stress can lead to lower levels of sexual arousal.⁹ .

Sleep. Poor sleep can leave you feeling generally tired and moody, and it may also impact hormone regulation and reduce sexual desire. Tiredness caused by lack of sleep is also the most common reason given by women for not wanting sex. Women who sleep longer than average report better genital arousal than those with less than average sleep and those who sleep longer are more likely to have sex the day after a good night’s kip.¹⁰

Eat to support your sex life. A balanced diet plays an important part not just in maintaining good health generally but also your sexual health. To support your overall health and wellbeing, limit processed foods which contain a lot of saturated fat and/or trans fats (found in foods such as cakes, biscuits, pastries; red meat and processed meats like bacon, sausages, ham and salami) which can raise cholesterol levels in the blood. High fat meals can also be hard to digest so you can feel tired and sluggish after eating them. Eating a diet high in ultra-processed foods has also been associated with reduced testosterone. Ideally, try to take inspiration from a Mediterranean-style diet with its emphasis on fish, vegetables, fruit and healthy fats like those in nuts, seeds and olive oil. Include plenty of leafy greens such as kale, cabbage and spinach which are rich in nitrates which your body converts to nitric oxide.

Tuck into foods that help boost testosterone production. Key foods which can increase or balance levels of testosterone in women include zinc-rich oysters, salmon, crab or lobster (zinc contributes to the maintenance of normal testosterone levels in the blood); avocados (these are rich in pregnenolone, which acts as a precursor to testosterone production); mushrooms which have been exposed to sunlight (mushrooms become high in vitamin D and vitamin B5 when left in sunlight for an hour or so. These vitamins contribute to the normal synthesis and metabolism of steroid hormones and can help the production of regular testosterone) and cruciferous vegetables such as broccoli and cauliflower (both rich sources of vitamin B5 is responsible for the production of steroid hormones such as testosterone & oestrogen).