Millions of women worldwide use hormonal contraceptives, and there have long been reports that they can affect mood. A research project was launched in Denmark to look at the scale of the problem, involving the medical records of more than a million women and adolescent girls.
Researchers found that those on the combined pill were 23% more likely to be prescribed an antidepressant by their doctor, most commonly in the first six months after starting on the pill. Women on the progestin-only pills, a synthetic form of the hormone progesterone, were 34% more likely to take antidepressants or get a first diagnosis of depression than those not on hormonal contraception.
The study, published in the Journal of the American Medical Association (JAMA) Psychiatry, found that not only women taking pills but also those with implants, patches and intrauterine devices were affected.
Adolescent girls appeared to be at highest risk. Those taking combined pills were 80% more likely and those on progestin-only pills more than twice as likely to be prescribed an antidepressant than their peers who were not on the pill.
The researchers, Øjvind Lidegaard of the University of Copenhagen and colleagues, point out that women are twice as likely to suffer from depression in their lifetime as men, though rates are equal before puberty. The fluctuating levels of the two female sex hormones, oestrogen and progesterone, have been implicated. Studies have suggested raised progesterone levels in particular may lower mood.
The impact of low-dose hormonal contraception on mood and possibly depression has not been fully studied, the authors say. They used registry data in Denmark on more than a million women and adolescent girls aged between 15 and 34. They were followed up from 2000 until 2013 with an average follow-up of 6.4 years.
The authors call for more studies to investigate this possible side-effect of the pill.
Downplaying The Risks
Other scientists said the research should not put women off using hormonal contraception. Dr Channa Jayasena, a clinical senior lecturer in reproductive endocrinology at Imperial College London, said: “This study raises important questions about the pill. In over a million Danish women, depression was associated with contraceptive pill use. The study does not prove [and does not claim] that the pill plays any role in the development of depression. However, we know hormones play a hugely important role in regulating human behavior.
“Given the enormous size of this study, further work is needed to see if these results can be repeated in other populations, and to determine possible biological mechanisms which might underlie any possible link between the pill and depression. Until then, women should not be deterred from taking the pill.”
Dr Ali Kubba, a fellow of the faculty of sexual and reproductive healthcare of the Royal College of Obstetricians and Gynaecologists, also said further research was needed.
“There is existing clinical evidence that hormonal contraception can impact some women’s moods, however, from this study there is no way of linking causation, therefore further research is needed to examine depression as a potential adverse effect of hormonal contraceptive use,” he said.
“Women should not be alarmed by this study as all women react differently to different methods of contraception. There are a variety of contraception methods on offer including the pill, implants, injections, intrauterine devices, and vaginal rings and we therefore advise women to discuss their options with a doctor, where they will discuss the possible side-effects and decisions around the most suitable method can be made jointly.”
The Reality Of The Dangers
In recent years we’ve seen efforts from the NHS and family planning organisations to encourage teens to use these so-called LARCs (long-acting reversible contraceptives), primarily because they eliminate the need to remember to take a pill every day, but also due to the fact they’re commonly believed to have less severe potential side-effects than the pill. This new research suggests this practice is misguided. We already know that those with pre-existing depression may find the pill worsens their symptoms, and if teens were at greater risk of depression, then continuing this practice would be negligent.
The researchers note that, because GPs are less likely to prescribe the pill to women who already have depression and because women who do experience depression on the pill are more likely to stop taking it, this study probably underestimates the potential negative affect that hormonal contraceptives can have on mental health.
It seems that no study will ever be good enough for the medical community to take women’s experiences seriously. As soon as this research dropped, the experts lined up to deliver their usual mix of gaslighting and paternalistic platitudes. We’re told not to be alarmed, concerned, or deterred from continuing to use our hormonal contraceptives, mostly by men who have never and will never take them themselves. This only highlights the incredible knots the medical establishment will twist itself into in order to deny there’s a problem with the pill.
Dr. Cora Breuner, a Seattle pediatrician and chair of the committee on adolescents for the American Academy of Pediatrics, cautioned against overreacting to the study. She noted that most women use hormonal contraception with no mental health effects and said she sees patients who seek contraceptives to help regulate their moods. Regular access to contraceptives enables women to regulate their menstrual cycles with precision, she said. And although the drugs presents certain risks, the benefits of birth control trump the risks of the alternative.
“An unintended and unwanted pregnancy far outweighs all the other side effects that could occur from a contraceptive,” she said.
If that’s true, why bother researching the side-effects at all?
It is important to remember that women are twice as likely to experience depression as men, reportedly due to “the fluctuation of progesterone and oestrogen levels”, in other words our biological femaleness. It’s apparently acceptable to blame women’s depression on the fact that they’re women, but it’s not OK to claim a powerful medication formulated from synthetic hormones could be at fault.
This “pillsplaining” is specific to discussions of research into the side-effects of hormonal birth control. Usually, when the research is on the pill alone, we’re quickly informed there are many other hormone-based methods to choose from, but unfortunately this new study says those alternatives are even worse. One expert even tried to dismiss the link with depression in pill-taking teens as more likely the result of “teen heartbreak”.
One of the study’s authors, Øjvind Lidegaard, professor of obstetrics and gynaecology, also brought attention in 2011 to the increased risk of blood clots associated with newer, and supposedly “improved”, hormonal contraceptives such as the ring, the patch and drospirenone-containing pills. Lidegaard plans to focus next on researching the possible “association between taking hormonal birth control and attempting or committing suicide”. Researchers originally flagged up this potential link back in 1970 at the Nelson Pill Hearings, but the topic has not been touched since.
Depression and anxiety from hormonal contraceptives may not be the experience of every woman, but that doesn’t mean it’s not the experience of your friend, your daughter or your partner, and of many women out there, who, in learning about these side-effecrs could have their lives changed for the better.