When I had six years sober, my husband and I decided to get pregnant. I quit the birth control pill and entered the darkest depression of my life.
I wasn’t surprised when the test results came back. After three chemical pregnancies and one miscarriage, it was clear that I was having trouble getting pregnant. But what I didn’t expect was that my fertility troubles might be related to my past struggles with addiction. And what was that common ground? A lack of progesterone.
For years, I had struggled with depression. Though I never charted the highs and lows of my mental health to determine whether it was hormonal, after my OB/GYN explained to me that low progesterone levels could not only cause difficulty in the implantation process, but also depression, I felt like the detective at the end of Usual Suspects, Kaiser Soze. That’s what’s wrong with me.
Progesterone is one of the hormones that stimulates and regulates various functions, playing a key role in preparing the body for conception and pregnancy while regulating the monthly menstrual cycle in order to maintain pregnancy.
But progesterone receptors have also been discovered in the blood vessels, the liver, breast tissue, the bone, and the brain, and have an important influence in the functioning of all those parts of the body. In fact, progesterone plays a key role in regulating dopamine by suppressing prolactin and estrogen, and helps to increase the “dopamine neuron number of embryonic stem cells.” Whatever that means.
When progesterone levels dip, however, this leads to an imbalance between progesterone and estrogen, with estrogen becoming the dominant hormone in a women’s system. Low progesterone can cause weight gain, bloating, changes in appetite, muscle and joint pain, sleeplessness, irritability, anxiety and depression. But researchers have discovered that when people struggling with addiction are given progesterone, they have higher rates of abstinence; the hormone plays a therapeutic role in curtailing smoking and cocaine use in women with drug use disorders.
When I was 12 years old, I had my first cigarette. It would be years before I would have my official first drunk, let alone drug, but I remember that first smoke as though it was yesterday. By 12, I was beginning to feel the first pangs of what I would later understand to be depression, and though it would be two more years before I would get my period, I was beginning to suffer from the mood swings typically associated with menstrual cycles. But that first Camel Light put everything at ease.
According to Drs. Wendy Lynch and Mehmet Sofuoglu in their study, Role of Progesterone in Nicotine Addiction: Evidence From Initiation to Relapse, it is actually estrogen dominance (and progesterone weakness) which trigger these addictive dispositions: “While the mechanism of gender differences in nicotine addiction is not yet clear, evidence suggests that while estrogen may underlie enhanced vulnerability in females, progesterone may protect females.”
By the time I was 20, I was taking birth control pills. No doctor ever tested my estrogen levels. I was prescribed YAZ, a low-estrogen pill that it seemed like all women took in the 2000s, and struggled with a depression so deep, I frequently wound up in bed a few days out of the month, unable to function and plagued by suicide ideation. I was chronically 15 to 20 pounds overweight, and also, by that point, I had become an addict.
Finally, after 15 years on the pill (and over six years sober), my husband and I decided to get pregnant. I quit the pill and entered the darkest depression of my life. I went to doctors but none were able to determine what was wrong with me and offered no solutions other than anti-depressants, which I had never taken and didn’t want to start right before I had a baby. Instead, I waited it out, and started trying to get pregnant. And failing.
By the time I had my miscarriage, a doctor finally was willing to test my hormone levels. As my husband and I sat across the table from her, I prayed that it was as simple as a hormonal imbalance. That at least could be fixed. And I was thrilled when she read that my progesterone was below the average number. As she began to ask about my mental health, I wondered why this was the first time I was having the conversation.
As Lynch and Sofuoglu argue in Role of Progesterone in Nicotine Addiction, “Hormone transition phases, such as those that occur at adolescence, and during pregnancy and following birth, as well as following hormonal manipulation (e.g., using methods of hormonal birth control), may all contribute to changes in vulnerability to nicotine addiction.” But as another group of researchers have discovered, it isn’t only nicotine addiction which is linked to progesterone, but cocaine and opioid as well. As proposed by Kimberly Ann Yonkers, Ariadna Forray, et al. in Progesterone Reduces Cocaine Use in Postpartum Women with a Cocaine Use Disorder: A Randomized,Double-Blind Study, “Progesterone modulates multiple brain functions implicated in the pathogenesis of drug addiction.”
Testing post-partum women who also identified as cocaine addicts, the researchers discovered that when progesterone levels were raised in the group of women, they were better able to abstain from cocaine use. For Yonkers et al. the connection was clear: “There is biological plausibility for the efficacy of progesterone on cocaine use. Progesterone and its active metabolites affect a wide-range of central nervous system functions including modulation of cognitive function, mood, stress response, analgesia, [and] reward processing and response to stimulant drugs.”
If an increase in progesterone could help aid abstinence, didn’t it necessarily follow that a decrease led to an inability to refrain? I’d like to say there is a wealth of literature on this topic, but the only resource I could find was a 2016 article by Dr. Mark Calarco, national medical director of American Addiction Centers. According to Dr. Calarco, “The truth, though, is that addiction and relapse often have underpinnings in physiological hormone responses. When it comes to hormone imbalance, it is important to remember the following: If you do not look for it, you will likely not find it.”
I loved cocaine. If depression felt like a black hole, cocaine was the light that filled it. Much like my depressive episodes, I never charted out the binges of my addictions. Some weeks were just worse than others. Now looking back, though, I see they followed a similar pattern to my depression. Some weeks I would be okay, could get to work, and refrain from a cocaine bender. But other times, I would start and never want to stop.
Of course, after those benders, the depression only got worse. They were the real motivation for my sobriety. Sure, the traffic tickets, broken heart, and weird looks from coworkers at work sucked, but the real impetus was that I wasn’t sure I could survive the depression that ensued after one of my three-day benders. The shame and self-hatred were certainly culprits, but it felt like more than that; it felt like my reserve of dopamine had been depleted far past its reserve. I was simply out of gas.
I struggled as most do to get sober, counting and losing days, weeks, months, even a year at one point. I was on and off birth control pills the whole time, wreaking unintentional havoc on my hormones and sinking into depressions that it seemed like only drugs and alcohol could cure.
As Dr. Calarco writes, for those struggling with hormonal imbalance, “[They may] frequently relapse or have trouble working their recovery. [They] might lack the energy to complete programs or experience depression and have trouble maintaining their motivation. Determining your hormonal balance and taking it into account from the beginning will promote a faster, more successful recovery and improve your chances of remaining clean and sober with a lower chance of relapsing.”
I never went to rehab. I went home and got sober the old-fashioned way, with daily 12-step meetings and a sponsor who kept me on point. But as more and more science begins to back the role between hormones and addiction, there is a powerful argument for not only treating people with drug use disorders with progesterone, but determining their levels to begin with. And perhaps even using such markers as an opportunity for prevention.
After becoming pregnant and having my first child, it feels as though my whole system has been regulated. The depression I suffered my whole life is gone. I have not continued on any birth control, and find that my moods are much more stable without it, and with ten years of sobriety, I feel secure in my recovery in a way that many times over the course of the last decade I have not. However, when I recently asked my doctor for a hormone evaluation, I was denied. Insurance won’t cover it without a miscarriage or other good reason.
As Dr. Wendy Lynch and Dr. Mehmet Sofuoglu explain, “A greater understanding of the role of progesterone in addiction is important not only from a treatment standpoint, but also from a prevention standpoint.” But without further research, discussion, and easier access to hormone testing, how can we have a better understanding?
It’s a question female addicts should begin to ask, and one we should demand be answered.