Before I dig in, I want to say this first. I am not advocating for women not taking the pill. This couldn’t be farther from the truth. Your body is YOURS and you get to decide how you want to feel and live your life. It can be well worth the trouble for a woman to choose a pill that works for her because not worrying about getting pregnant in a prime time of her life and her career is a huge deal. It frees a lot of women from the reproductive consequences of having sex. I am a huge advocate for this as I was on the pill myself and I can appreciate the benefits. However, there is a cost that we pay in order to avoid these reproductive consequences. A cost that many of us may have not even had second thoughts about. Instead of thinking critically about how the pill is changing and influencing women’s sex hormones, we feel as though WE are the problem when we face any pain, discomfort on mood changes when on the pill.
So let's dig into some of the research when it comes to the pill and mood changes.
Side note: When I am talking about the birth control pill, I'm talking about any of the various forms of the pill that enter the bloodstream and change our sex hormones. This includes the oral pill, IUD, ring, patch, etc.
More than half of women who discontinue the pill because of side-effects do so due to changes in mood. Even worse, many women will continue to stay on the pill despite these mood-related side effects because they feel they don't have any other good options.
And I'm not talking about mood changes where you may have one or two crappy days. I'm talking about being diagnosed with depression, going on antidepressants, and having a higher risk of suicide.
One of the most important studies in this area comes from researchers in Denmark. The Dannish Registry has health records of the entire population, and therefore we have learned some valuable lessons from their research. The Danish Sex Hormone Register Study is an ongoing nationwide cohort study that includes all women living in Denmark.
There were a few different studies that came from this data. They tracked changes in the risk of being diagnosed with depression, as well as the risk of being put on an antidepressant, whether the women where on the pill or not. They also assessed suicide risk in this population of women. Over a million women between the ages of 15-34 were tracked over the span of 14 years.
Here is what they found:
After 6 months, women who were on hormonal contraceptives were 50% more likely to be diagnosed with depression compared to women who were not prescribed contraceptives. These women were also 40% more likely to be prescribed an antidepressant during this time.
Adolescents aged 15 to 19 years were the hardest hit group. Those who started on hormonal contraceptives had an 80% increased risk of starting on an antidepressant, and those using progestin-only pills had the greatest risk.
Adolescents aged 15 to 19 years were at 2x risk of suicide attempts and at 3x the risk of experiencing suicide than adolescents not on the pill.
Why are adolescents 15-19 years of age so at risk? This is a time of post-pubertal transition. Women's brains are not fully developed during this time and they are more prone to being influenced by hormonal signaling. There is not an area of the brain that isn't going to be influenced by the birth control pill.
While these results highlight correlation and not causation, I think these results should still be taken seriously. Dr. Sarah Hill, PhD (author of This Is Your Brain on Birth Control) raises a really important question: Does taking the birth control pill while the brain is still developing lead to long-term changes?
We don't currently have an answer for this, and we definitely need more research.
Often women are put on the birth control pill at such a young age due to reasons other than contraception. It might be because your skin is breaking out, or you have an irregular cycle, or your period cramps are really painful. There is so much we can do for these symptoms as Naturopathic Doctors and we have other ways of treating these symptoms versus just going on the pill. These other treatments do not have long-term effects on our brains.
The pill changes women's sex hormones systemically, not just locally at the level of our ovaries. Our experience of the world on the pill changes, period. Keeping a journal of your physical, as well as psychological symptoms, before and after starting hormonal contraception, can be a useful tool to help determine whether birth control pill use is right for you.
I want you to be informed and advocate for your health. Not being informed about this information means we are at the mercy of our doctor's discretion. He or she would be making decisions for you that affects your entire body, and who you are as a human being. Let's have informed conversations with our doctors before starting on something like the birth control pill.
Reach out and connect with me if you would like to discuss your birth control options further.