Students call for more research on impacts of hormonal contraceptives
During your time as a student, you might find yourself experimenting with different kinds of birth control, and figuring out which one works best for your body. You might also experience forms of mental illness—but for some people, these events seem to be connected.
Research into this relationship has gone back and forth over the years, and the ethical issues with prescribing a placebo for contraception in control groups have complicated the process of establishing cause and effect even further.
Hormonal birth control’s impacts on mental health were first studied in the 1960s and 1970s, with researchers drawing a potential link between depression and synthetic estrogens and progestins in a 1981 paper. However, in 2004 a new study proposed that these mental health symptoms were derived from psychological reactions to the practice of contraception, rather than any pharmacological effects. The authors concluded that more study is needed, but “it is reasonable to hypothesize, given the present data, that contraceptive activity itself is inherently damaging to women.”
But in November 2016, research emerged from Denmark that found an increased risk for the first use of an antidepressant and the first diagnosis of depression among users of hormonal contraception, with the highest rates among adolescents. The authors cautioned that based on these findings, “health care professionals should be aware of this relatively hitherto unnoticed adverse effect of hormonal contraception.” However, in February 2018, another study concluded that “there is insufficient evidence to prove a link between birth control and depression.”
With a roller coaster of findings comes uncertainty among people looking to protect themselves against pregnancy, amid a lot of unknowns on mental health effects.
“I felt like requesting a female doctor”
Although the research is mixed, Robin’s University of Ottawa doctor was certain that, despite her mental health side effects, she had to be on the pill — and it wasn’t a one-time conversation.
She told me that although it made sense when he first suggested it, she soon found her symptoms troubling. Robin noted that she had been going through other life challenges with roommates and her physical health, but this was different. Suddenly, she felt like her life was “surreal.”
“I would walk by the river, and I would think about jumping in the river all the time and swimming away, and I remember having that be my thought over and over again,” she said.
“I wasn’t self-harming, that wasn’t my intention, but I remember thinking over and over again, if I could just get in the river … and those thoughts went away very quickly after stopping birth control,” she explained. “It was very surreal, it was like a disassociation between what I did and what would actually happen.”
Although she started feeling calmer after quitting the pill, she was met with concern at her next doctor’s appointment.
“He was like ‘you’re too young, it’s not worth it,’ and tried to talk me back into it,” she recalled.
Robin told her doctor she was interested in an IUD, but he said she would have the same problem. “He seemed very concerned about me in a very personal and uncomfortable way, and I just kept saying I would love to try an IUD, and it was very frustrating and awful.”
She kept seeing the doctor for three years, and every time she went he prescribed birth control pills to her. She told him she wasn’t interested, and never filled the prescriptions, but he kept prescribing it anyway.
“He didn’t deny me an IUD, but he really scared me away from it. I don’t have one now, I just have nothing but a deep-seated fear of pregnancy and birth control.”
“I’ve never been fully the same after I was on birth control”
Kait Bennett had never experienced anxiety before, but after starting birth control in her first year at Carleton University she began to feel like everything in her life was a huge deal.
“Having to confront my work about needing a day off, I’d be calling my parents like ‘I don’t know how to do this, what happens if they say this, and what happens if this or that happens,’” she recalled. “Everything was a big deal, and I didn’t really recognize that maybe it was birth control, I just thought that I was going through a bit of a difficult time.”
It wasn’t until her mom suggested it that Bennett considered her birth control could be the culprit.
“When I stopped it, all of that went away,” she said. “I wasn’t worried about all of these little things, I felt clearer.”
“I would say birth control was the biggest factor (in my anxiety), because when I stopped it I didn’t feel that same sense of urgency … it really made me very anxious, and I’ve never had anxiety in my life.”
A year later, Bennett decided to give birth control another shot, but found herself in “rages,” and feeling very “mad at everything (and) frustrated.”
She told me that even though she’s off birth control now, she’s “never been fully the same.”
“I still have some anxiety that’s entered in my brain and hasn’t gone away, and I was never like that before it.”
“You feel like a completely different person when you’re on it”
Katherine MacNeil is no stranger to birth control side effects—she tried six or seven different types because of her adverse physical reactions to the pill. When she finally found one she thought would be manageable, she soon noticed the “physical effects were lower but the mental effects were extremely high.”
“At the time I was on it, I was diagnosed with panic disorder and generalized anxiety disorder and it definitely impacted those immensely,” MacNeil said.
In addition, she remembers the physical symptoms adding a lot of anxiety to her life.
“I was bloated all the time and that too caused anxiety because I was feeling so self-conscious that I was gaining weight,” she said. “I was working out all the time and stressing out over the way I looked because I could feel it causing impacts on my physical image.”
For MacNeil, doctors never identified a possible link between her mental illness and her contraceptive until she came to Carleton. She says that because every other pill had caused adverse physical effects, previous doctors had said she would “just have to take it and live with it.”
She said it was frustrating that her mental health effects often weren’t acknowledged when she sought help.
“I went to a walk-in clinic and said I’m on this birth control, are there any other options, and (the doctor) was like, there’s no proof that it makes you gain weight or distort images of yourself, there’s no proof of that … she was like, don’t use birth control then.”
Although MacNeil had other challenges in her life at the time, she believes birth control was still the main factor in her mental struggles.
“As soon as I went off it a weight lifted off my chest,” she recalled. “I had a different image of myself … this is the best I’ve been mentally in a while, one year off of it, I actually feel back to 100 per cent myself.”
Help wanted: Birth control research
Although the women I spoke with had different experiences, they were unanimous on the need for more research.
“It’s a huge issue because so many of my friends are not even taking any form of contraceptives because of these effects of birth control,” Bennett said. “We can’t even protect ourselves, because of what a pill is doing to us.”
Robin agreed that more answers are needed, “with as much passion as (she) can put into the word, yes.”
Until there’s more research on the connection between birth control and mental health, MacNeil suggests doing a little research on your own if you’re planning to try birth control.
“It’s really important if your doctor is not informing you of everything that could potentially happen to do your research yourself, and be aware that there are side effects that maybe they don’t disclose with you,” she said. “Especially if you already have existing mental health issues going into it.”
Bennett sees no reason why researchers can’t answer the questions that these experiences bring to the table.
“Why is it that they can’t come up with something that doesn’t make you crazy, and make you feel like life is over, you know? I definitely think with how many different birth controls there are out there, they need to do more research in finding something that doesn’t do this.”
Editor’s note: Robin’s last name has been removed for privacy reasons.