Hormonal birth control can come with several benefits. As well as preventing pregnancy, it can regulate periods and help combat acne.

But some users report a range of unwanted side effects. And fatigue is one of them.

So can the pill, patch, IUD, implant, or shot cause excessive feelings of tiredness?

Well, the answer isn’t as straightforward as you might think.

“Some hormonal birth control options have stated that fatigue is a possible side effect,” says Dr. Heather Irobunda, an OB-GYN based in New York, New York.

Unfortunately, she adds, it’s unclear how many users face this side effect or the level of fatigue they experience.

Some people can even experience the opposite: better sleep and therefore better energy levels.

Fatigue is listed as a potential side effect of birth control pills, vaginal rings, and the subdermal implant, says Irobunda.

“Side effects, including fatigue, are in part due to the hormones in contraception,” explains Dr. Idries Abdur-Rahman, a board certified OB-GYN in Chicago, Illinois.

So birth control “that is either nonhormonal or low in hormones” can be associated with less fatigue.

That means contraception with higher hormone doses is “more likely to cause side effects,” he says.

“Higher dose birth control pills and Depo-Provera (the 3-month shot) are the most likely culprits (of fatigue) because they are associated with higher blood hormone levels.”

It could be because fatigue isn’t a common side effect.

“I can think of maybe a handful of patients who have reported it to me over my almost 20 years in practice,” states Idries.

Or it could be because hormonal contraceptives and their side effects are still under-researched.

This is especially true when it comes to the effects birth control can have on sleep and tiredness.

Research that does exist has produced conflicting results.

A recent survey of more than 2,000 women found that hormonal contraceptive users had more insomnia symptoms and increased levels of daytime sleepiness.

People using progestogen-only methods reported sleeping less in total compared with those on a combined type.

But a 2010 study found a lower percentage of hormonal contraceptive users woke up during the night.

Similarly, in 2013, researchers noted a link between hormonal birth control and better sleep efficiency.

Sleep efficiency is calculated by measuring the total amount of time spent asleep against the total time spent in bed. The higher the efficiency, the better.

According to Dr. Jamil Abdur-Rahman, chairman of obstetrics and gynecology at Vista Health System in Waukegan, Illinois, “Fatigue resulting from the use of birth control is typically temporary.”

(Fatigue that lasts longer than 3 months is likely caused by something else.)

Birth control-induced fatigue, he says, can also often be more pronounced in the mornings and come hand-in-hand with salt and sugar cravings.

This is sometimes referred to as adrenal fatigue: a form of fatigue some medical doctors don’t recognize.

As Irobunda states, “It is important to make sure that all causes of fatigue are looked into before attributing (yours) to hormonal birth control.”

There are several theories to explain how hormonal birth control causes fatigue.

One says tiredness could be a symptom of another condition caused by birth control: depression.

But the relationship between hormonal contraception and depression isn’t fully understood.

A large-scale 2016 study found that first depression diagnosis and first antidepressant use was associated with hormonal birth control.

Yet a review of studies examining hormonal contraception’s effects on mood, published in the same year, described research on the topic as “limited.”

Another theory, explains Irobunda, is that birth control pills “can decrease the amount of testosterone circulating in the blood” which can then lead to fatigue.

Idries highlights yet another theory: Fatigue could be caused by a person’s individual response to their contraception’s hormones.

“The basal ganglia is the part of the brain that is responsible for fatigue,” he says, and birth control hormones could affect this region in some users.

Then there’s the idea that nutrient deficiencies may be the root cause.

As functional medicine practitioner and registered dietitian Dr. Kelly Bay explains, hormonal birth control can diminish levels of folate, magnesium, and zinc along with vitamins C, B-1, B-2, B-3, B-6, and B-12.

“Many of these nutrients play a significant role in energy production,” says Bay, who practices in New York, New York.

But Irobunda points out, right now, “There is not enough data to reliably know the exact reason some (hormonal birth control users) experience fatigue.”

A number of conditions can cause fatigue.

Nutrient deficiencies that have nothing to do with your birth control can result in excessive tiredness. Iron deficiency anemia is a common example.

An underactive thyroid can also leave you feeling more tired than usual.

Other symptoms to look out for include weight gain, muscle aches and pains, and changes to your menstrual cycle.

Mental health issues are another potential cause of fatigue.

Depression and anxiety can deplete your energy levels and affect your sleeping pattern by making it more difficult to sleep or forcing you to oversleep.

The way you live your life can even have an impact on your tiredness levels.

If you’re excessively consuming alcohol or eating unhealthily, you may feel fatigued.

Too much or too little exercise can also have a damaging effect, along with high levels of stress.

Sometimes, a birth control side effect will go away by itself.

It may take a few weeks or even a few months “and then improve as your body gets used” to your method, Irobunda notes.

“While your body is adjusting, make sure that you are getting enough sleep, eating a balanced diet, and staying hydrated,” she adds.

Jamil advises taking supplements of vitamins B-5, B-6, B-12, and C, as well as magnesium.

Any time you start feeling different, you should track your symptoms and how they affect your day-to-day life.

When it comes to fatigue, book a doctor’s appointment if the tiredness persists.

Show them your symptom diary and be honest about your lifestyle and previous health history.

If you think your fatigue is related to birth control, tell your doctor.

They’ll take this into account and test for any other issues that could be causing you to feel tired.

This may involve discussions about your dietary and exercise habits, as well as blood tests to check for the likes of deficiencies.

Medication may be recommended for thyroid or mental health conditions, and nutritional supplements may be advised if you’re lacking in a particular area.

If you and your doctor are struggling to find the cause of your tiredness, “Consider switching to a different form of birth control to see if your fatigue improves,” Irobunda says.

Changing your contraceptive may help, and it may not.

Jamil recommends changing to a nonhormonal method, such as an IUD, or a form that contains zero or low levels of estrogen — but only if your fatigue has lasted for more than 3 months and no other medical cause has been identified.

Always consult with your doctor before making any birth control-related decision.

Whether you want to swap to a nonhormonal method or come off birth control entirely, you should always speak to your doctor.

The final decision is yours, but they can advise alternative methods that will work for your specific needs.

They will also tell you exactly how to stop your birth control.

You’ll want to be careful about stopping the pill and the like abruptly, as this can cause a disruption in your menstrual cycle and create bleeding issues. If you have an implant or IUD, it will need to removed by a professional.

Go to your doctor’s appointment armed with a list of questions. The following may help:

  • Am I likely to experience any side effects?
  • How quickly can I get pregnant?
  • What other forms of contraception are available to me?

Halting birth control can relieve some side effects, but it can also cause others.

Your mood, libido, and menstrual cycle may be affected.

And if you’d been prescribed contraception for a condition like acne, you may see a resurgence of symptoms once the hormones have left your body.

No two people have the same experience, and you may find positive effects instead of negative ones.

To manage this hormonal comedown, embark on a fulfilling lifestyle.

Ensure you’re eating a regular diet full of nutritious foods like vegetables — and less of the processed variety.

Try to keep your stress levels to a minimum, get enough sleep each night, and don’t forget to exercise.

But if you’re having a hard time coping or finding that side effects are lingering after 3 months, chat with your doctor.

Diagnosing the cause of your fatigue may take a while, says Irobunda.

And your doctor will likely examine all other potential causes before blaming your birth control.

But that doesn’t mean you have to stick to a contraceptive that isn’t working for you.

There are plenty of options to choose from. So if you’re noticing something isn’t quite right, don’t be afraid to ask about the alternatives.

Lauren Sharkey is a journalist and author specializing in women’s issues. When she isn’t trying to discover a way to banish migraines, she can be found uncovering the answers to your lurking health questions. She has also written a book profiling young female activists across the globe and is currently building a community of such resisters. Catch her on Twitter.