I often hear the question of whether the pill can lower your sex drive. The honest answer is that it differs from woman to woman. Some women notice less desire since they started the pill, others notice nothing or actually feel freer.
In this article I explain what can happen hormonally when you use the pill, and why testosterone and SHBG are often mentioned. I keep it deliberately careful, because the research is mixed and there is often more going on than just your pill. See this as background, not a diagnosis.
Can the pill lower your libido?
The pill can go together with less sex drive in some women, but that is far from true for everyone. Research shows a mixed picture: some women notice a lower libido, others notice no difference and sometimes desire actually increases.
So it is not the case that the pill lowers libido in everyone. If you notice a change, it is real and worth discussing. But it cannot be predicted how your body will respond.
According to Thuisarts.nl and the Farmacotherapeutisch Kompas, a changed libido can be a possible side effect of hormonal contraception. At the same time they note that far from everyone experiences this.
How can the pill affect your sex drive?
The combined pill contains oestrogen and a progestogen that suppress your own hormone cycle, so you do not ovulate. This also changes the levels of other hormones that may be linked to sex drive.
One of the mechanisms often mentioned is that the pill can lower the amount of free testosterone. Testosterone plays a role in libido in women, although that link is not as straightforward as sometimes thought.
But sex drive is not only hormonal. Stress, your relationship, tiredness, how you feel in your body and earlier experiences all count. Hormones are one piece of a larger puzzle.
What is the role of testosterone and SHBG?
SHBG stands for sex hormone binding globulin, a protein that binds testosterone in your blood. Only the unbound, free part is biologically active. The pill can raise the production of SHBG, so more testosterone becomes bound and the free part can drop.
That is a plausible mechanism for why some women experience less desire on the pill. Still, the relationship between testosterone and libido in women is not one to one, so a lower free testosterone does not automatically mean less desire.
The table below lists a few hormonal factors that may play a role. It is emphatically an overview of possibilities, not a checklist for diagnosing a cause yourself.
| Possible factor | What it is | What it may mean |
|---|---|---|
| Testosterone | A hormone present in small amounts in women | May play a part in libido, but the link is weak and differs per person |
| SHBG | A protein that binds testosterone in the blood | The pill can raise SHBG, so possibly less free testosterone remains |
| Oestradiol | The main form of oestrogen | Plays a role in the cycle and the lining, but the link with libido is uncertain |
Important: these values do not on their own tell you why you have less desire. A result is a puzzle piece you look at together with a doctor, in the light of your whole situation.
What other causes of low desire are there?
Low sex drive rarely has a single cause. Besides hormones, stress, lack of sleep, medication, your relationship and your mood often play a big role. A busy or sad period can temporarily lower your desire too.
Sometimes low desire points to something else, such as a thyroid that works too slowly, anaemia or low mood. Those are things your GP can weigh up, and they need not have anything to do with the pill.
In our article on low libido and hormonal causes in women we go deeper into the broader background. That gives you a fuller picture than the pill story alone.
What can you do about lowered libido from the pill?
If you notice less desire since the pill and it bothers you, discuss it with your GP. There are different types of pill and other forms of contraception, and together you can see whether a different approach suits you better.
Do not simply stop your contraception yourself without an alternative, because then you risk an unwanted pregnancy. Your GP can guide you through a possible switch and think along about what is wise.
It can also help to look at things beyond your hormones, such as rest, stress and your relationship. The pill is sometimes the culprit, but far from always. Read more about other effects in the pill and side effects and what it does to your hormones.
Testing your own hormones
If you want to map your hormones, you can have a blood test at Lunara without a referral. A hormone test for women looks at values such as testosterone and SHBG.
Such a test gives a snapshot and does not replace a conversation with your doctor. If you use the pill, your hormone values are also affected by the pill, which makes the result harder to interpret. Discuss that in advance with your GP.
If you first want to understand the bigger picture, read our explainer on birth control and your hormones. There we explain what the pill does to your hormones and what you can have tested.
Frequently asked questions
Will my libido return if I stop the pill?
In many women desire recovers after stopping, but that is not guaranteed and it differs per person. How quickly, and whether it happens, depends on more factors than the pill alone. Always discuss a switch with your GP.
Does every pill lower libido?
No. The effect differs per woman and per type of pill, and many women notice no difference. Some women actually experience more desire, for example because the fear of pregnancy disappears.
Can I tell myself whether it is due to my hormones?
A blood test can show values such as testosterone and SHBG, but those do not on their own tell you why you have less desire. Sex drive depends on much more than hormones. You look at a result together with your doctor.
Does the pill affect my hormone results?
Yes, the pill can affect values such as SHBG and testosterone. This makes a result during pill use harder to interpret. Always mention at a test that you use the pill.
References
- Thuisarts.nl. I use the pill and I have little desire for sex. Dutch College of General Practitioners.
- Farmacotherapeutisch Kompas. Hormonal contraceptives. National Health Care Institute (Zorginstituut Nederland).
- NHG. NHG Guideline Contraception. Dutch College of General Practitioners.
Every blood test result through Lunara includes a professional assessment by a BIG-registered doctor. Blood testing through Lunara does not replace the advice of your GP. For treatment decisions, discuss your results with your GP.
الكاتب
