The European Medicines Agency demands that a warning about a heightened suicide risk be included in the medication package insert for contraceptive pills. What is the connection between hormones and mental health?
I've only taken the contraceptive pill once in my life. It was in my early 20s, for about three months. During this time I burst into tears at the most inane issues. Missing my bus was the end of the world. But personal anecdotes, that should be emphasized, are not science and maybe as a young student I was just stressed and therefore easily upset.
But there are scientific studies that do draw a connection between depression and hormonal contraception. One Danish study in particular has received a lot of attention. It was published in 2016 and looked into the relationship between hormonal contraception and depression.
The health data of more than one million Danish women between the ages of 15 and 34 were monitored over a total period of 13 years. The evaluation of the data showed that women who take a combined pill (estrogen and progesterone) are 23 percent more likely to also take antidepressants than women who do not use hormonal contraception. With the minipill (progesterone only) the probability was even 34 percent higher. Teenagers were even more susceptible to being negatively influenced in their mood by the pill.
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The study everyone has been waiting for
I remember reading the study and thinking: Finally! Finally, there is a representative large-scale study that shows we are not just crazy crybabies. The pill really can have a negative influence on our feelings!
The fact that it was possible to do such a large-scale study is because everyone in Denmark has an electronic patient file. The scientists were able to access the health data of all Danish women. The patients remained anonymous, of course.
Nevertheless, one has to keep in mind that the data does not show that the pill is responsible for depression or other psychological problems. It only shows that hormonal contraception and antidepressants are often taken together.
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Women who take the pill have a higher risk of suffering from depression than women who do not use hormonal contraception
In autumn 2018, the same working group submitted another study. This time it was about the relationship between hormonal contraception and suicide. Almost half a million Danes were included in this study. Their health data was tracked for an average period of 8.5 years. The group included all women who turned fifteen between 1996 and 2013 and had not used hormonal contraception before their 15th birthday.
The result: the probability of suicide is about three times higher for women taking the pill than for women who did not use hormonal contraception. And the probability of a (first) suicide attempt is twice as high with the pill as it is without it. Similar to the study on depression and the pill, teenagers were particularly at risk.
Another concordance between the studies is that the alternatives often proposed to women who have problems with the pill have even greater effects on mental health. These alternatives include hormone spirals, the vaginal ring or hormone patches.
There is no local effect
When I was in my early 20s looking for alternatives to the pill, my gynaecologist suggested a spiral, because it would only "work locally."
But if you think about it, that can't be true, because the processes of the menstruation cycle and the entire hormone regulation are controlled by the brain. In addition, hormones are transported via the bloodstream. Moreover, if there's one organ that has a high blood supply, it's the uterus. So the hormones are transported from there into the whole body, albeit in smaller doses.
The problem with the pill and mental health is that every woman reacts differently. This is due to genetics. While some women react extremely sensitively to hormones, the majority may never have a problem with the pill. According to a study from 2002, for example, 94 percent of more than 3,500 participants stated that they were satisfied or very satisfied with the pill.
This is also supported by the Danish studies. Yes, it is true that the risk of depression and suicide is higher if you use hormonal contraception. Overall, however, the risk is still very low. For example, the data from the 2016 study shows that out of 10,000 women who do not take the pill, an average of 30 are diagnosed with depression. For women who take the pill, the average is 45.
Every woman reacts differently
After my experience in my early twenties, I decided against hormonal and in favor of natural contraception. That also has its risks, especially in terms of safety. But at least I don't cry at bus stops anymore. Ultimately, every woman has to know what is right for herself. Those who do not feel comfortable with the pill or other hormonal contraceptives should not take it lightly and talk to their gynaecologist.
In addition to depression and suicide attempts, the pill is also associated with other risks. These include an increased likelihood of thrombosis, an increased risk for certain types of cancer and reduced libido.