Birth control offers a woman autonomy and freedom over her life and body. And according to the Centers for Disease Control (CDC), as many as 62 percent of women of child-bearing age currently use some form of contraception.
Of all the different forms available, oral contraceptives (birth control pills) are among the most popular. Birth control pills are used by nearly 30 percent of women who use contraception. The CDC estimates that nearly 13 percent of females between the ages of 14 and 49 are on it at any given time.
Unfortunately, despite all its benefits, "the pill" has also been scientifically linked to a variety of health problems, including one that may surprise a lot of women: depression.
Are women, as well as the parents of female minors, being made adequately aware of the potential health risks of oral contraception—something that many women rely on for decades? Let's take a look at what the evidence says about the overlooked link between women's mental health and "the pill."
The Link Between Depression and Contraceptives: A Look at the Evidence
Change in mood and loss of libido are some well-known side effects of taking the pill, or any type of hormonal birth control for that matter, including the patch, ring, implant, injection, or hormonal intrauterine device (IUD). But some research indicates that for certain women, changes in mood may be much more intense than simply feeling down or irritable:
- An old systematic review from 1981 involving 12 clinical studies found that the majority of the studies (9) showed a depression rate ranging from 16 percent to 56 percent among women who used oral contraceptives; the other three studies found no association.
- A 2003 study from International Review of Psychiatry offers evidence suggesting that changes in estrogen levels—which hormonal contraceptives inherently impose—may trigger depressive episodes in females who are already at risk for depression.
- More recently, a 2016 study published in JAMA Psychiatry analyzed the health data of over 1 million 15- to 34-year-old Danish women between the years 2000 and 2013. The researchers found that women who used hormonal contraception had an increased risk of being diagnosed with depression and being prescribed an antidepressant. The rates appeared to be highest among adolescent girls.
Why the link? Some research suggests that oral contraceptives increase the level of an enzyme in the body called tryptophan oxygenase, which may lead to Vitamin B6 deficiency (altered mood is a key sign of this nutrient deficiency). More recent research, presented at the 2019 annual meeting of the Radiological Society of North America and reported by Medical News Today, found that women taking oral contraceptives had significantly smaller hypothalamuses than women who didn't.
The hypothalamus is an area in the brain that is involved in multiple processes of the body including regulation of mood and sex drive. While the research wasn't conclusive on how this may impact a woman's mood (the authors suggest there could be a mitigating effect on anger), it does open up future areas of research.
Overall, the general theory is that hormonal changes induced by oral contraceptives may contribute to the increased depression risk, at least in some women, even if the exact mechanisms aren't fully understood. As it stands, we do know that women are already more at risk for depression compared to men, which certainly suggests a hormonal link.
Other Health Risks Associated with Birth Control Pills
Right now, the evidence connecting oral contraceptives and other types of hormonal birth control isn't conclusive. But there are other known risks and side effects of taking birth control pills that women should be aware of, including an increased risk of certain types of cancer, including breast cancer and cervical cancer.
For example, a 2003 systematic review published in Lancet found that taking oral contraceptives for fewer than 5 years, 5 to 9 years, or 10 years or more was associated with a 10 percent, 60 percent, and doubled increased risk of cervical cancer (respectively) compared to women who didn't take oral contraceptives. It's been proposed that birth control pills—which contain synthetic varieties of naturally occurring hormones like estrogen and progesterone—may stimulate cervical and breast cancer growth because these cancers have receptors for these hormones.
On the other hand, other research suggests that taking birth control pills may reduce the risk of other types of cancer, including endometrial cancer, colorectal cancer, and ovarian cancer, such as by reducing the number of ovulations a woman has (and thereby reducing her exposure to certain hormones), decreasing the level of bile acids in the blood, and suppressing endometrial cell cancer directly.
In other words: "the pill" isn't all bad, and it does offer benefits beyond preventing unwanted pregnancies in certain women (such as managing endometriosis). But it's still an important medical decision women need to make, especially if they have individual or family risk factors for depression and other types of mood disorders.
Taking control of your reproductive health is important, no matter what your age or gender. If you're currently taking birth control pills and are curious about their impact on your health, it's important to talk to your doctor before making any changes—it's never a good idea to start or stop taking a prescription medication without chatting with your doctor first.
Just be aware that like any medication, oral contraceptives do come with certain risks, and these are continually being explored in the scientific community. By taking steps to become a more informed consumer, you'll be able to exert better control over your health and your future.
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