When Taking the Pill Takes Away Libido

For the woman who is done having kids, not interested in having kids, or simply not ready to have kids, fear of pregnancy is a major libido-killer. (Not to mention his bad breath and tighty-whiteys.) And, for the last 50 years, women have enjoyed the almost 100% certainty that birth control pills will prevent pregnancy. But for some women, the very pill that allows their freedom, can impact libido such that they don’t even want to have sex in the first place. How unfair!

Posted on | Lauren Streicher, MD | Comments ()

For the woman who is done having kids, not interested in having kids, or simply not ready to have kids, fear of pregnancy is a major libido-killer. (Not to mention his bad breath and tighty-whiteys.) And, for the last 50 years, women have enjoyed the almost 100% certainty that birth control pills will prevent pregnancy. But for some women, the very pill that allows their freedom, can impact libido such that they don’t even want to have sex in the first place. How unfair!

It may seem odd that while estrogen increases sex drive, the pill, with relatively high levels of estrogen, can have the opposite effect. The explanation lies in the other hormone that’s responsible for that lusty feeling, testosterone. While most women think of testosterone as being the guy’s hormone, it is also part of the hormone cocktail that women need.

Women make testosterone in their ovaries and adrenal glands, which is then released into the blood stream. Some of that testosterone binds to a protein known as serum hormone binding globulin (SHBG) and this is the key: If testosterone is bound to SHBG, it is inactive. It is only free (unbound) testosterone that increases libido. Since birth control pills can increase the amount of SHBG, more testosterone will bind to it, which means less is left in the active form.

This does not occur in every woman, but studies show that those on hormonal contraception with decreased libido have lower free testosterone levels than women who do not take hormonal contraception. If that wasn’t bad enough, in addition to decreasing libido, low testosterone can lead to fatigue, lethargy and moodiness.

So, if you are on the pill and find you would rather play sudoku than play with your guy, what options do you have?

First, you need to figure out if your pill is the problem. Libido is complex, and relationship issues (his bad breath and tighty-whiteys) and other medical conditions often play a role as well. And then there’s stress. Sex is not going to be the first thing on your mind when you think you are about to lose your job, your teenager just came home with a pierced tongue, and the basement just flooded…again. Also, keep in mind that if you are taking an antidepressant, (after all, all this can be really depressing), your medication may be the culprit.

Ultimately, the only way to know if your pill is the problem is to use a back-up contraception and go off for a month to see if it makes a difference. If you determine your libido issues are pill-related, you have 3 choices:

Try a different pill

Some pills may be better than others. Essentially all oral hormonal contraceptives are a combination of estrogen and progestin, but one study showed that pills that contain drospirenone might have less impact on libido than other progestins.

Switch to a different kind of contraception

Birth control pills are not the only way to prevent pregnancy. Many women find that an alternative method of contraception, such as an intrauterine device, is a good solution. (Vasectomy is perfect, but not always practical.)

Stick it out

If another method of contraception is not an option, the lesser of 2 evils is often to take a pill that diminishes sex drive rather than worry about an unplanned pregnancy. Hopefully, one day that female equivalent to Viagra will become a reality. Then, all of our problems would be solved (except for the bad breath, tighty-whiteys, the flooding basement, the job market and that tongue ring...)

Blog written by Lauren Streicher, MD
Dr. Lauren Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical...