The Atlanta Journal-Constitution
Use of pill declines as side effects questioned
Sterilization, use of IUDs on rise among women ages 15-44.
When Sophia DuRose was 19, her primary physician prescribed her a birth control pill to help regulate her periods. But soon after DuRose, now a junior at the University of Pennsylvania, began taking the pill, she noticed her mood changed drastically.
“I just felt this crushing apathy,” she said. “I felt like I wasn’t enjoying the things I normally enjoy as much as I used to. And I felt like the things that should’ve made me sad, I was just too drained to care about.”
Like many other women who experience side effects from oral contraceptives — which may include decreased libido, nausea, migraines, weight gain and mood changes — DuRose began wondering whether there was a better option for her.
According to the U.S. Centers for Disease Control and Prevention, nearly 6 million women in the U.S. use oral contraceptives, making it one of the most popular birth control methods. But oral contraceptive use among women ages 15-44 dropped from 15.9% between 2011 and 2015 to 13.9% between 2015 and 2017, while other methods of birth control, such as female sterilization, intrauterine devices (IUDs) and contraceptive implants became more widespread. Male sterilization, equally effective and less invasive, is used as a contraceptive by about a third of married or in-union women ages 15-45, according to the United Nations.
In a 2013 National Health Statistics Report published by the CDC, 62.9% of women who stopped using oral contraceptives did so because of side effects.
It is common to hear about the pill’s negative mood effects on social media such as Reddit and Facebook groups. But studies actually point to the opposite: Most women on hormonal birth control experience no effect, or a beneficial effect on mood.
However, a 2016 review of existing scientific literature on hormonal birth control and mood pointed out there is a lack of research in this area, and that negative mood effects are measured differently in every study. Often, researchers lump different types of contraceptives together in studies, when each contains different levels of hormones.
What’s perhaps more concerning is that this lack of knowledge extends to how birth control affects developing adolescent brains. One of the largest studies to date on birth control’s effects on mental health was conducted by researchers at the University of Copenhagen in 2016. Scientists found that among more than 1 million Danish women, those using hormonal contraception were more likely to be prescribed antidepressants for the first time in subsequent months and years. But experts have pointed out that the study does not account for life changes, making it impossible to know whether it’s hormonal contraception driving that risk.
“It’s somewhat remarkable that the pill has been on the market for half a century, but its effects on the brain are poorly studied and not understood,” said Michael Lipton, a neuroradiologist at Albert Einstein College of Medicine in New York. Lipton studies how oral contraceptives affect the hypothalamus, a region of the brain that is key to controlling body temperature, emotions, sex drive, sleep cycles and appetite.
In a study presented at the 2019 annual meeting of the Radiological Society of North America, Lipton found that women who take a combination pill containing both progestin and estrogen have a smaller hypothalamus volume.
“We haven’t shown or proven that the pill causes this,” Lipton said. “But the finding is significant. However, it’s not necessarily harmful or surprising.”
Rachael Polis, a pediatric and adolescent gynecologist for Crozer-Keystone Health System, said that she screens all her patients for depression before prescribing birth control. It’s part of “sorting out what is safe for a patient to take,” she said. When a patient has preexisting mental health issues, Polis often works with their psychiatrist to pick a contraceptive method that works best for them. For example, a patient looking for a hormone-free option can get the Paragard, a copper IUD that lasts for as long as 12 years.
“I always tell patients that birth control is not one size fits all,” she said. “But we will find something that works for her. Sometimes it’s a little bit of trial and error.”