Birth control pills may lead some women to experience increased emotional eating, according to a longitudinal survey study published in JAMA Network Open.

Researchers followed 422 women taking monophasic combined oral contraceptives (COCs) for 49 consecutive days and compared emotional eating — consuming too much food in the presence of negative emotions — during active hormone pill days with that during inactive placebo pill days. COCs contain both estrogen and progestin, mimicking the postovulatory phase that has been previously associated with this behavior.

Scores were significantly higher during active pill days across two consecutive cycles (β = 0.11 [95% CI, 0.06-0.16] and β = 0.07 [95% CI, 0.04-0.10]). Similar associations were observed in 51 women with clinically defined binge eating episodes.

Emotional eating can escalate into binge eating, binge eating disorder, or bulimia nervosa, said Kelly Klump, PhD, Research Foundation Distinguished Professor of Psychology at Michigan State University in East Lansing, Michigan, who led the study.

Participants were aged 15-30 years (mean age, 22 years; 88% White) and were recruited from the Michigan State University Twin Registry between 2017 and 2024. All had been using monophasic COCs containing 21 active pills and 7 inactive pills. Participants completed daily assessments of emotional eating, negative mood, and weight preoccupation. Researchers analyzed within-person changes, allowing each female to serve as her own control.

Despite the findings, “the key is not to dissuade women from taking them, but to urge practitioners to educate women about potential risks and screen for eating disorders and binge eating,” Klump said.

Future research should focus on identifying which female may be most vulnerable to the effects of COCs on eating behavior, Klump said.

But the findings don’t necessarily translate into clinically meaningful outcomes, said Megan Riddle, MD, MS, PhD, medical director of the Eating Recovery Center in Seattle, who was not associated with the study. Additional research is needed to determine whether the observed effects persist over longer periods of contraceptive use.

“I would not change clinical practices based on this paper,” Riddle said. “I do recommend clinicians have conversations around an individual’s relationship with food, eating, and their body, as part of developing a holistic plan for patient care.”

Riddle said several aspects of the study may limit its generalizability. The sample was relatively homogeneous with respect to age and race, raising questions about whether the findings would apply to more diverse populations.

Researchers did not observe fluctuations in weight preoccupation similar to those seen in emotional eating, suggesting that hormonal influences may be more closely tied to eating behavior than to concerns about body weight, shape, or dieting, Klump said.

Researchers also observed a decline in emotional eating over the course of the study. Klump suggested that the pattern may reflect the effects of self-monitoring, an approach commonly used in cognitive-behavioral therapy for binge eating. Riddle said that other explanations, including the possibility that eating patterns normalized over time, cannot be ruled out. She also expressed concern that recommending patients to closely monitor their food intake could exacerbate disordered eating.

The sources in this article reported no disclosures. 

Brittany Vargas is a journalist covering medicine, mental health, and wellness.