Active birth control pills may increase emotional eating

By Dr. Liji Thomas, MDReviewed by Lauren HardakerJul 9 2026

Women using active combined oral contraceptive pills reported modest but consistent increases in emotional eating compared with inactive pill days, offering new insight into how synthetic hormones may influence eating behaviors.

Study: Combined Oral Contraceptive Use and Binge Eating. Image credit: Kopytin Georgy/Shutterstock.com

A recent paper published in the journal JAMA Network Open suggests that combined oral contraceptives (COCs) are linked to increased emotional eating, a correlate of binge eating, perhaps because they ensure the presence of synthetic estrogen and progestin at the same time.

Emotional eating during active pill use 

Binge eating is a defining feature of the most common eating disorders, including bulimia nervosa and binge eating disorder. Understanding what drives this behavior is an important step toward prevention, particularly because these disorders disproportionately affect girls and women, frequently occur alongside conditions such as depression and substance use, and are associated with significant health complications.

A growing body of research has pointed to a role for endogenous ovarian hormones in binge eating. Previous studies have shown that food intake, binge eating, and emotional eating tend to increase after ovulation, when estradiol remains moderately elevated alongside high progesterone levels. By contrast, the preovulatory phase, when estradiol is high and progesterone is low, is associated with lower levels of binge and emotional eating.

Importantly, these hormonal associations persisted regardless of body mass index (BMI), negative mood, dietary restraint, or impulsivity. Similar findings were observed across both clinical and population-based samples, and across the full spectrum of binge eating severity, suggesting that the relationship between ovarian hormones and binge eating extends beyond individuals with diagnosed eating disorders.

The findings also align with decades of animal research showing that elevated estradiol and progesterone together are associated with increased food intake. While estrogen generally suppresses appetite, progesterone appears to counteract this effect, promoting food intake.

Despite this growing evidence, researchers had not previously examined whether combined oral contraceptives (COCs), which provide both synthetic estrogen and progestin during active pill use, influence emotional or binge eating. Because active COC pills mimic the hormonal combination previously linked with greater binge eating risk, they provide a unique opportunity to investigate these associations. Most COC regimens consist of 21 days of active hormone pills followed by seven placebo or inactive pills, allowing researchers to compare eating behaviors within the same individual during periods with and without hormone exposure.

To investigate this, the researchers followed 422 women from the Michigan State University Twin Registry who were already using monophasic COCs, the most commonly prescribed formulation, which delivers a constant dose of synthetic estrogen and progestin throughout the 21 active-pill days. Participants completed daily assessments over 49 consecutive days, enabling the researchers to compare self-reported emotional eating, a well-established correlate of binge eating, during active and inactive pill phases while minimizing between-participant differences that could otherwise influence the results.

In addition to emotional eating, the researchers examined changes in weight preoccupation, a measure that previous studies have not found to be associated with ovarian hormone fluctuations, to determine whether any observed effects were specific to emotional eating.

Active pills linked to higher emotional eating

The results showed that women were more likely to show increased emotional eating while taking active pills versus inactive, in two consecutive cycles. The increase in emotional eating was statistically significant but modest, and the size of the association decreased somewhat during the second cycle.

The authors propose that this weakening of association might be due to self-monitoring, where women decreased their emotional eating behavior due to having to record it on a daily basis. They followed up by combining data from both cycles into one mixed-effects model.

The model tested whether emotional eating differed between active and inactive pill days overall, while adjusting for whether the observation came from the first or second cycle. The results confirmed higher emotional eating rates with the use of active versus inactive pills, but at lower levels in the second cycle compared to the first.

The changes in emotional eating behavior were not accounted for by depressive mood, even though low mood was observed in association with active pill use versus inactive. The associations were weaker, however.

In a subgroup with clinically defined binge eating, a similar overall pattern was observed, although the association during the first cycle did not reach statistical significance because of the smaller sample size. Pill type did not alter the occurrence of weight preoccupation, as expected since it does not show strong monitoring effects.

These data suggest a specific effect of COCs on EE that is much more pronounced than that for negative affect and WP.

Hormones may alter brain reward pathways for food

Future studies should explore the mechanisms underlying these associations. The common patterns observed with both endogenous hormones in prior research and exogenous hormones in this study suggest that both may reflect normal rather than abnormal physiology.

Putative mechanisms include the regulation of dopamine and opioid reward pathways by these hormones. As such, COCs may alter the reward systems, thus enhancing the liking for and consumption of rewards, such as highly palatable foods often consumed during binge eating. Notably, previous research suggests that COCs may increase the liking for or desire for such foods, indicating a fertile area for future research.

Given the decrease in emotional eating across cycles, the role of self-monitoring mechanisms (in which women engage in less of this behavior when they have to report their daily consumption patterns) also needs to be validated.

Study focused only on monophasic birth control pills

The researchers did not measure endogenous hormone levels, which might have affected the eating behavior changes. There was no washout period, which could have reduced the differences observed between active and inactive pills. Only monophasic pills were included in this study.

Finally, despite each person serving as her own control, individual genetic and other risk factors could still interact with the ovarian hormones to determine the final risk of binge eating, since not all women on COCs show this behavior.

Findings support more personalized contraceptive care 

This study suggests that active COC pills are associated with increased emotional eating, a correlate of binge eating. Further research is required to identify the high-risk group and adapt the use of COC to each individual.

It is also necessary to identify contraceptives that are less likely to affect emotional eating and binge eating risk. The potential benefit of training COC users to self-monitor needs to be validated, as it could improve patient care and reduce the risk of emotional eating.

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