Linking mental health and hormonal contraception: is there a psychological cost?

The launch of hormonal contraceptives in the 1960s transformed the autonomy of people who can conceive… but was it at the cost of mental health?

As evidenced on international platforms such as The Independent and the BBC, a wave of individuals sharing their negative experiences on hormonal contraceptives has emerged. This has highlighted a major gap in research. Even though physical side effects have been well-established, the psychological ramifications of these medications are yet to be fully explored.

The range of hormonal contraception available free on the NHS has drastically expanded since their introduction to society. Options include progesterone injections, intrauterine systems and more, in which each choice includes several brands. There are numerous reasons for taking hormonal contraceptives, such as to alleviate symptoms of menstruation, but the overarching aim is to stop conception.

Hormonal contraceptives rely on pharmacological equivalents to the female sex hormones: oestrogen and progesterone. Each method uses a regime of these hormones to prevent ovulation by convincing your brain it is already pregnant. During the first trimester, the hormonal response is to flood oestrogen and progesterone into the body to facilitate the environment a foetus requires to develop. As a result, ovulation will not occur until after any pregnancy as the body focuses on bringing the foetus to term over producing more fertilisable eggs. Taking these contraceptives will recapitulate this hormonal response so that conceiving whilst correctly using these medications is virtually impossible. Different birth controls may have other effects, such as altering the lining of the uterus, but the common objective is to stop the release of mature eggs.

Looking outside of the contraceptive lens, female sex hormones have been proven to be critical in the regulation of mental health. For instance, elevated levels of oestrogen near ovulation are associated with the highest levels of happiness and energy in comparison to the pre-menstrual phase. However, sex hormones can also have an extreme unpleasant effect. For example, some women experience Premenstrual dysphoric disorder (PMDD), which causes physical and emotional symptoms such as fatigue, anxiousness, and potentially suicidal thoughts. This is thought to be a result of an increased sensitivity to the changes of sex hormones in the menstrual cycle. These opposing experiences imply that there is a spectrum of hormonal effect on mental health. Thus, this exemplifies the importance of understanding how altering natural hormones can impact wellbeing.

A review into research surrounding the negative psychological impact of taking birth control unearthed numerous relevant findings. One study found that side effects such as depressive symptoms were typically reported to be the main reason for discontinuing hormonal contraception. Additionally, another study, which used data from over a million women, observed a link between hormonal contraceptive use and antidepressant prescriptions. Although these studies lack direct methodological design, these results suggest that taking hormonal contraceptives may negatively influence mental health.

More directly, psychologists examined depression symptoms in injectable contraception users to discover an association. Similar discoveries can be seen in pilot studies examining the pill, validating difficult emotional experiences whilst taking hormonal contraceptives. This is not to say that depression or anxiety is inevitable with these drugs. In fact, some women have experienced better mood as a result as seen with PMDD diagnoses.

Current research forwards two conclusions. First, the current state of understanding is only in the preliminary stages; further exploration of existing research is required to establish causality. Second, potential subgroups such as age or ethnicity are yet to be examined. Research must seek to investigate a range of different peoples’ experiences to ensure that any findings are generalisable.

Whilst the present state of research appears daunting, gaps in knowledge between mental health and hormonal contraceptives have been acknowledged. The Faculty of Sexual Health and Reproductive Healthcare recognised ten crucial issues in the study of contraception. Alongside understanding interventions and tests, four of these issues directly relate to side effects of contraceptives. This identification may provide hope that the research community is looking to address the limited insight surrounding these medications.

There are ways that individuals can navigate the confusion surrounding the association between mental health and birth control. Platforms such as The Lowdown offer online opportunities to review contraceptives and provide a source of real-life experiences. Moreover, it is recommended that anyone struggling mentally or physically whilst on hormonal contraceptives contacts their GP to potentially change their prescription. Ultimately, there are ways to naturally boost mood, such as light exercise and better sleep, if being on hormonal contraception is a necessity.

To address the initial question, the cost-benefit analysis of hormonal contraceptives is complex, extensive, and case-dependent. They can improve, hardly affect, or worsen wellbeing. Everyone is genetically different with diverse backgrounds to ensure that no contraceptive method suits all. Consequentially, there will never be a universal answer which reflects the remarkable complexity of the female body. Herein, the importance of generating an improved understanding of how hormonal contraceptives affect our mental health is signified.


Image: Reproductive Health Supplies Coalition on Unsplash  

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