Hormonal Effects of Oral Contraceptives on Libido

Mechanisms and Formulations

Synthetic progestins in OCPs may have varying effects on androgen receptors, potentially enhancing the libido-reducing effects of estrogen through off-target effects on both androgen and estrogen receptors, as noted by the American Heart Association 1
Natural estrogens (estradiol valerate and estetrol) in newer OCPs may have fewer side effects overall, but their specific impact on libido is not well established, according to the American Heart Association 1

Progestin-only pills (POPs) are not associated with the same degree of SHBG elevation and may have less impact on libido than combined oral contraceptives, as reported by the American Heart Association 1 and supported by the American Academy of Pediatrics 2
Women experiencing decreased libido on combined OCPs might benefit from switching to progestin-only methods, as suggested by the American Academy of Pediatrics 3

For women experiencing decreased libido on OCPs, consider switching to a different OCP formulation with different estrogen/progestin balance, as recommended by the American Heart Association 1
Trying progestin-only contraceptives may be beneficial for women experiencing decreased libido on OCPs, as noted by the American Academy of Pediatrics 3

First-generation progestins, such as norethindrone, have potent androgenic effects that can impact sexual function, according to the American College of Obstetricians and Gynecologists 4, 5