Hormonal contraception and women’s mental health

A massive Danish study has sounded alarm bells about the effect of hormonal contraceptives (including oral contraceptive pills, patches, vaginal rings and hormone-releasing IUDs) on women’s risk of developing depression… but who is listening?

Researchers from the University of Copenhagen utilised Denmark’s excellent centralised medical record-keeping system to track over 1 million women aged between 15 and 34, over a 14 year period (from 2000 to 2013), comparing their use of hormonal contraceptives to their risk of subsequently being prescribed antidepressants or being diagnosed with depression at a psychiatric hospital.

Their findings were concerning, to say the least. Compared with women who used no form of hormonal contraception, the risk of being prescribed antidepressants for the first time was:

  • 23% higher for women taking the combined oral contraceptive pill (e.g. Microgynon, Levlen, Norimin, Brevinor, Yasmin, Diane,Triphasil);
  • 34% higher for women taking the progestogen-only pill (e.g. Microval, Microlut, Micronor);
  • 100% higher (i.e. double the risk) for women using a contraceptive patch (e.g. Ortho Evra);
  • 60% higher in women using a vaginal ring (e.g. NuvaRing);
  • 40% higher in women using a levonorgestrol intrauterine system (e.g. Mirena); and
  • 90% higher in women using a medroxyprogesterone acetate depot (e.g. Depo-Provera, Depo-Ralovera).

Even more concerning, adolescents (aged 15-19) who were prescribed hormonal contraceptives were even more susceptible than older women; the risk of being prescribed antidepressants for the first time was:

  • 1.8-fold higher in teens taking combined oral contraceptive pills;
  • 2.2-fold higher in teens taking the progestin-only ‘mini-pill’; and
  • 3-fold higher in teens using non-oral hormonal contraceptives.

The risk of being diagnosed with depression at a psychiatric hospital followed a similar pattern in both adult women and adolescents.

As if these numbers weren’t bad enough, the researchers pointed out that they are most likely underestimates of the true risk of developing depression as a consequence of using hormonal contraception, because of the ‘healthy user bias’.

Women who notice a deterioration in their mood, and who consequently stop taking their pills or using their devices, don’t end up in the doctor’s office complaining of depression and hence aren’t prescribed antidepressants. In fact, when the researchers compared depression risk in women currently using hormonal contraception to those who had never used it, they found that the risk was 38% higher than when they compared current users to women who weren’t using it currently but may have in the past.

As the authors point out, previous research has shown that women are about twice as likely to be diagnosed with depression at some point in their lives than men… but only after puberty. In fact, some studies have found that pre-pubertal girls are less likely to be depressed than boys.

Women’s greater proneness to depression has been attributed by some researchers to the effects of women’s fluctuating sex hormone levels on various regions of the brain involved in emotional and cognitive processing. However, the synthetic progestins found in all hormonal contraceptives have a more pronounced effect on neurotransmitters involved in mood than the body’s own progesterone.

In my practice, I’ve seen several women who had become suicidally depressed while using hormonal contraception, particularly implants which release these progestins into the bloodstream over several months. And many of my clients have shared heart-rending stories of the impact of their black moods on their relationships with partners and children, and even on their careers.

A cynic might argue that putting a teenage girl on hormonal contraceptives is the perfect way to generate a lifelong-customer. According to the Danish study, within 6 months she is likely to be back in the doctor’s office complaining of depression. A prescription for antidepressants (most commonly an SSRI such as Cipramil, Lexapro or Zoloft) is almost guaranteed; these drugs have been found to worsen the course of depression, causing it to become chronic and increasing the risk of relapse if she stops taking it. Rather than recognising the relapse as drug-induced, her doctor will mostly likely conclude that she ‘needs’ to stay on the antidepressant indefinitely.

In addition, taking an SSRI antidepressant may increase her risk of developing a new set of symptoms that will earn her a bipolar diagnosis, and a prescription for yet more drugs.

If she stays on the SSRI, she’ll end up with a 70% higher risk of suffering an osteoporotic bone fracture, which will result in a prescription for bisphosphonate drugs or infusions such as Fosamax, Actonel and Aclasta.

Furthermore, if she continues taking her SSRI during pregnancy, her baby has almost double the risk of developmental delay and autistic spectrum disorders in infancy leading to cognitive difficulties in childhood, and an almost 40% higher risk of speech and language disorders which raises the risk of the child earning his or her own crop of diagnoses which result in becoming a lifelong customer of the medical-industrial complex.

There has been very little media coverage of this important Danish study since it was published late last year, and I am yet to encounter a client whose GP or gynaecologist has discussed the study with them, despite over half of my female clients being on antidepressants when they first see me and the majority using some form of hormonal contraception.

GPs seem shockingly willing to prescribe hormonal contraceptives to both adult women and teenage girls, without any informed consent process whatsoever. The risks and benefits are never discussed in a balanced way; instead, doctors will patronisingly tell any patient who is impertinent enough to ask if hormonal contraceptives carry risk, that pregnancy is far riskier.

That’s not the point. The fact is that women are only capable of becoming pregnant for less than a week out of every month, whereas men are constantly fertile; yet in most relationships, women bear the sole burden of responsibility for contraception – sometimes at great cost to their physical and mental health.

In his excoriating book Male Practice: How doctors manipulate women, the late, great Dr Robert Mendelsohn argued that institutionalised sexism in modern medicine resulted in far more unnecessary, degrading, and dangerous practices being inflicted on women than on men. Unfortunately, even most female doctors are socialised by their medical education into exposing girls and women to the considerable risks of hormonal contraception without a second thought, let alone a proper informed consent process.

The only defence against this institutionalised sexism is for women to start thinking and talking contraception as a feminist issue, demand that their partners take equal responsibility for the prevention of unwanted pregnancy, and get themselves informed about the risks of hormonal contraception, and the alternatives to it.

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