Does Birth Control Lower Your Sex Drive? What the Trials Show
In two placebo-controlled trials the pill did not change overall sexual function, but it slightly lowered desire or interest. Most pill users report no drop, and the shot, ring and implant were linked to more reports of low interest than the copper IUD.
By Kymata Health Editorial Published Last checked
This guide
Women's Libido & Hormones- Question
- Can hormonal birth control lower your libido, and which methods are most linked to it?
- Sources
- 5 cited
- Quick answers
- 3 questions
- Clinician review
- None; sources cited inline
Key takeaways
4 points- In a 340-woman placebo-controlled trial, a common levonorgestrel pill did not change overall sexual function but slightly lowered desire, arousal and pleasure scores1.
- A second trial, of an estradiol-based pill in 202 women, found a small drop in sexual interest; the share with a clinically relevant decline did not differ from placebo (22.2% vs 17.8%)2.
- In a review of 36 studies, 85% of pill users reported an increase or no change in libido and 15% reported a decrease3.
- Compared with the copper IUD, the shot, ring and implant were linked to more reports of lacking interest in sex in a 1,938-woman cohort; the pill, patch and hormonal IUD were not4.
What placebo-controlled trials show
The cleanest test randomly assigned 340 healthy women aged 18 to 35 to a pill containing 150 micrograms of levonorgestrel and 30 micrograms of ethinyl estradiol, or to placebo, for 3 months. Overall sexual function, the main outcome, was similar in both groups1.
Three of seven sub-scores were lower on the pill: desire, arousal and pleasure. Orgasm, sexual concerns, responsiveness and self-image did not differ, and neither did the frequency of satisfying sexual episodes or personal distress1.
A Swedish investigator-initiated trial gave 202 women a pill with 1.5 mg estradiol and 2.5 mg nomegestrol acetate, or placebo, for three cycles. Sexual interest fell slightly more on the pill, but 22.2% of pill users vs 17.8% on placebo had a clinically relevant decline, a difference that was not significant; the authors called the changes minute and probably not clinically relevant2.
Does the method matter?
In the Contraceptive CHOICE Project, 1,938 women were asked 6 months after starting a new method whether they lacked interest in sex. Overall, 23.9% said yes, including 18.3% of copper IUD users. Compared with copper IUD users, the odds were higher with the Depo-Provera shot (adjusted odds ratio 2.61), the vaginal ring (2.53) and the implant (1.60). The pill, the patch and the hormonal IUD showed no association4.
That study was observational, so it shows a link, not cause; women chose their own methods. A 2013 systematic review of 36 studies found no significant difference in desire with pills containing 20 to 35 micrograms of ethinyl estradiol; libido fell only with pills containing 15 micrograms3.
The testosterone question
Combined pills do lower testosterone. A meta-analysis of 42 studies in 1,495 healthy women found total testosterone fell by 0.49 nmol/L and free testosterone by 61% on average, while sex hormone-binding globulin, which binds testosterone, rose sharply. The authors said the clinical effect of those lower levels remains unclear5.
That meta-analysis was funded by Pantarhei Bioscience; its first author was employed by the company and another author was its CEO with an equity interest5. The 2013 review noted that most pill users report no change in libido even though free testosterone falls in most studies3. Our guide to DHEA for women covers the evidence on adding androgens.
If you think your birth control is the problem
Do not stop your method without another one in place, since stopping risks an unplanned pregnancy. We found no trial that has tested whether switching methods restores desire, so a change is a reasonable experiment to plan with your clinician, not a proven fix.
Low desire has many causes, including relationships, stress, mood and other medicines. If low desire is persistent and distressing, see our guide to low libido in women, which covers hypoactive sexual desire disorder and the treatments approved for it.
Quick answers
Questions
3 answersDoes the pill lower testosterone?
Yes. Across 42 studies, combined pills lowered total testosterone and cut free testosterone by 61% on average, mainly because they raise sex hormone-binding globulin5.
Is the copper IUD better for libido?
It was the comparison group in the CHOICE study, and the shot, ring and implant were linked to more reports of low interest than it was4. But 18.3% of copper IUD users also reported lacking interest in sex, and the study could not prove cause4.
Does the estrogen dose in the pill matter?
A review of 36 studies found no significant difference in desire with 20 to 35 micrograms of ethinyl estradiol; a decrease was seen only with 15-microgram pills3.
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References
Every study and document cited in this guide, numbered as in the text.
Sources
5 sources- 1Combined Oral Contraceptives and Sexual Function in Women-a Double-Blind, Randomized, Placebo-Controlled Trial. J Clin Endocrinol Metab, 2016. PMID 27525531
- 2Sexual function and combined oral contraceptives: a randomised, placebo-controlled trial. Endocr Connect, 2018. PMID 30352399
- 3The influence of combined oral contraceptives on female sexual desire: a systematic review. Eur J Contracept Reprod Health Care, 2013. PMID 23320933
- 4Sexual Desire and Hormonal Contraception. Obstet Gynecol, 2016. PMID 26855094
- 5The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis. Hum Reprod Update, 2014. PMID 24082040
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