I couldn’t take it anymore. I felt like I had lost my mind. My skeleton was clawing out of its muscle casing. My skin had become too thin to protect me from the outside world, everything affected me. I loathed myself, I thought I was completely useless and I couldn’t stop having terrifying, debilitating, all-consuming panic attacks. At one point, I even found suicidal thoughts creeping into my mind.
One day, after being sent home from work in a taxi because I felt I couldn’t breathe (even though I could), I went to the doctor. I was having a panic attack. The doctor prescribed what I now know to have been a very high dosage of beta blockers and put on a waiting list for therapy (CBT).
This was out of character then, and remains so now. My friends didn’t know what to do with me. My boyfriend didn’t know how to respond to me. I couldn’t get better and I didn’t understand what was happening to me. I’d been low before, I’d felt ‘a bit depressed’ but I’d never been consumed like this.
I felt so desperate and couldn’t wait, so I found a therapist privately and took the hit financially (I was fortunate that I could do this). Dutifully, I took the beta blockers twice a day. The panic lessened, but didn’t stop. I became exhausted.
Months later and still not myself, I began to wonder whether my contraceptive pill could have anything to do with it. That year I’d started on a new one: Cerazette. It dawned on me that the last two times I’d felt seriously depressed were when I had started new hormonal contraceptives: Microgynon aged 14 to regulate seriously irregular periods and Marvelon aged 19 when I was in my first year of university. I had felt amazing on the pill only once, whilst taking Dianette. But I had been advised not to take that anymore because of the increased of thrombosis with continued use and the onset of migraines with aura.
On Microgynon I had experienced dark moods and impulsive, uncontrollable rages. In my teens I’d put that down to being a ‘moody teenager’. On Marvellon I became depressed, anxious and had no libido. I dropped out of university and dreaded having sex with my boyfriend at the time. At no point did I consider a connection between any of these experiences and my contraceptive pill. On Dianette though, which I took after Marvellon, I felt like a Super Woman.
At the age of 24, newly single I decided to go back on the pill. That’s when I was prescribed Cerazette, a progestrogen only pill.
Looking back, I think I lost myself about 3 weeks into taking it. In the fog of panic attacks, beta blockers and therapy it still didn’t occur to me that Cerazette could be the, or at least part of the, reason. As soon as it dawned on me I typed ‘Cerazette and pa…’ into Google. The internet auto-completed my question for me: ‘Cerazette and panic attacks’, ‘Cerazette and anxiety’, ‘Cerazette and depression’ flashed in the drop down search bar, one after another. They lit up, flashing; a real life light bulb moment. Maybe this wasn’t all me?
I feel into a click hole – there were reddit threads, community posts on forums and blog posts written by women who thought their pill was affecting their mental health. But, I soon found, there was very little medical evidence. I booked an appointment with my GP and proceeded to grill her about it. She said it was very unlikely to be my pill, suggested I should continue taking the beta blockers and conceded only that I could ‘come off the pill and see what happened’ if ‘I really wanted to’.
I left my GPs surgery feeling dismissed and embarrassed. However, I did stop taking Cerazette and haven’t touched hormonal contraception since. My panic attacks and depression didn’t disappear over night but, gradually, the clouds completely rolled away. I do still feel depressed and anxious occasionally but it’s on what I would consider to be very normal and manageable scale. I experience the highs and lows of human existence but I don’t have debilitating anxiety attacks in the middle of the day for, seemingly, no reason.
Many millions of women take the pill and experience no significant side effects. Some even experience the positive benefits, as I did with Dianette. However, many more also report serious mental health side effects.
Depression is listed as a potential side effect of the contraceptive pill in the tiny but thick leaflet that comes in the cardboard box containing your pill. Indeed, it has known to be a downside of the synthetic hormones in contraception for a long time.
A long history of discontent
The history of anecdotal evidence of women feeling that hormonal contraception’s mental health side effects are being ignored is long. In the 1970s the Nelson Pill Hearings took place at the US Senate. They took place because Barbara Seaman, a journalist, had brought the issue to the attention of Gaylord Nelson, a Wisconsin Senator. She had written a book, The Doctor’s Case Against The Pill, which contained anecdotal side effects and data that patients were not aware of.
A documentary made later revealed that no women were asked to speak at the Nelson Hearings. However, it’s because of them that the side-effect leaflet now comes in every packet. Alice Wolfson, journalist, activist and founder of America’s National Woman’s Health Network, protested at the hearings. ‘Women make superb guinea pigs’,she said at the time.
Today the hormones levels, specifically of oestrogen, in contraceptive pills are much lower than when it first came onto the marketmaking them safer overall in terms of physical side effects (such as blood clots).
However, the conversation about negative mental health side effects is, gradually, getting louder. In the five years since I sat on the sofa in my rented flat, mid panic attack in the early hours of the morning and googling the links between hormonal contraception and mental health problems this issue has remained on the agenda and made headlines.
Holly Grigg Spall published her book Sweetening The Pill in 2013, a study found that hormonal contraception can alter who women are attracted to in 2014 and earlier this year a study conducted by researchers at the University of Copenhagen came closer than any other to demonstrating a correlation between hormonal contraception and depression.
According a Debrief survey of over 1,000 women the majority of users who have reported adverse mental health side effects to their doctor don’t feel that they were taken seriously. Indeed, many of the women we’ve spoken to didn’t make the connection between their declining mental health and their pill until years after they experienced the side effects. Some of them, like me, were also prescribed medication for mental health problems which, like mine, went away when they stopped taking hormonal contraception.
University of Copenhagen contraception research
Correlation doesn’t necessarily imply causation, but despite the wealth of anecdotal evidence, increasing research on this subject and fact that depression is a known potential side effect of hormonal contraception the NHS website doesn’t explicitly list depression, anxiety or panic attacks as side effects. Instead, ‘mood swings’ and ‘changes’ are listed alongside ‘breast tenderness’ among the pill’s ‘disadvantages’.
Professor Øjvind Lidegaard is a gynecology expert at the University of Copenhagen, he was the lead author of the recent study, which looked at the medical records of more than one million Danish women and national registers of prescriptions over sixteen years. The study found that women taking the hormonal contraception were more likely to be prescribed an antidepressant than those not on hormonal contraception. The difference was more noticeable for women on the progestrogen-only pill, and even more noticeable still for young women, aged between 15 and 19 on the combined pill.
Speaking to The Debrief, Professor Lidegaard explained that this sort of long-term study has not been conducted before because, in reality, it is difficult to do. ‘I think that the main explanation is that it is not easy to make this kind of connection’ he says, ‘we followed more than one million women – for more than 16 years – where else can you make such a close follow up of so many women over such a long period?’ As The Debrief have discovered as a result of this investigation, the NHS in England doesn’t currently have a way of collecting such data (more on that in a moment).
Professor Øjvind Lidegaard also attributes the present lack of research to the fact that ‘both oral contraception use and mood changes, including depression, are very frequent events’, meaning they aren’t always traced. He also thinks that doctors may not be ‘very observant that some women get depression when taking hormonal contraceptives because non-users experience it too.’
Citing vested interest as another factor, he says ‘I think it’s also true that the companies who produce these pills are very willing to support proving that there are benefits to taking hormonal contraception. It is much more difficult to get support to study the negative reactions and demonstrate the adverse effects’ he says. His view is that, for this reason, ‘many more studies have been conducted to prove that they protect against, for example, ovarian cancer than they increase the risk of depression.’
‘Some people are very reluctant to accept the risks of these products’ Lidegaard says, ‘and in the US it’s much worse than in Europe’. Is it a case of women needing to know more? A case of more research being done? A case of more clarity, I ask. ‘Just as the US have elected a President who is questioning of experts’ he says, ‘I would say that the medical world is also affected by what I would call ‘contrafact’ messages, which, of course, make many doctors in doubt about what is true and what is not true.’
Lidegaard’s research has received a mixed reception. What does he make of those who say it is not conclusive? ‘I do not agree with people who say that this is not indicating a link’ he says emphatically, ‘I think our study is strongly indicating a causal relationship.’
Following our conversation with Professor Lidegaard, The Debrief sent Freedom of Information (FOI) requests to the NHS, asking whether similar records were available in England. Sounds easy enough, right? Wrong. The NHS’s Business Services Authority (NHSBSA) told us that it isn’t currently possible to pull the records of women who are simultaneously being prescribed the contraceptive pill and medication for depression or anxiety from their data collection systems.
In a statement they said:
‘Further to discussions with a colleague, they have confirmed that data will be available dating back to April 2015, as this was when we started to capture NHS Numbers, giving us the opportunity to count the number of unique patients. This will not be possible until our data warehouse is introduced. This is still some way off, however. It is hoped that it will be ready next year, however I am at pains to make promises of when exactly this will be.’
Taking into account the wealth of anecdotal evidence out there and my own experiences, it was clear that more research and information was needed when it comes to how hormonal contraception can interact with a woman’s mental health but the data wasn’t available. If it’s not possible to gather data about the drugs that women are being prescribed nationally is it any wonder that this issue is so often given short shrift by GPs or that conflicting messages come from the medical community?
The Debrief then submitted an FOI to the Medicines and Healthcare products Regulatory Agency (MHRA). The MHRA has a system by which they monitor all healthcare products in the UK to ensure that they are safe for patients called the Yellow Card Scheme. A medical paper explains the benefits of this scheme:
‘One of the main reasons given for advocating direct patient reporting was that suspected ADRs (Adverse Drug Reactions) reported to GPs were not then passed on to the regulatory authority, or even recorded in medical records…Evidence from the Netherlands patient reporting scheme also showed that patients report a suspected ADR when they consider that a health professional has not paid attention to their concerns.’
The Debrief asked the MHRA how many times a Yellow Card had been submitted for all of the synthetic hormones used in contraception. The results were that thousands of yellow cards had been raised about hormonal contraceptives; the majority of them were pertaining to mental health problems ranging from, but not limited to, anxiety, depression, mood swings and suicidal thoughts.
THE MHRA provided The Debrief with data collected between 1999 to 2016 in the form of Drug Analysis Prints (DAPS) which list all the ‘spontaneously reported Adverse Drug Reactions (ADRs)’ that they have received about hormonal contraceptives in that time.
The MHRA stresses that ‘it is important to understand that the inclusion of a particular reported reaction in the DAPs does not necessarily mean it has been caused by the drug, only that the reporter had a suspicion that it may have been.’ And, indeed, this data is by no means perfect because not every woman who experiences negative mental health side effects which she thought might have been caused by her contraception would have reported it, or even known that the Yellow Card Scheme existed. I certainly didn’t.
However, when it comes to the psychiatric side effects of the pill the number of reports was, nonetheless, revealing.
There were 839 reports of psychiatric reactions to Desogestrel between 2002 and 2016. Desogestrel is found in 6 types of contraception, including Cerazette. That means, on average, 60 people a year have written in to submit concerns about contraception containing this hormone, or 5 people per month. Levonorgestrel, which is found in 8 types of hormonal contraception including Microval, the Mirena coil, Norgeston and Norplant, has been reported 1,377 times for psychiatric side effects since 1999.
To put this in context, a newer hormone combination -Ethinylestradiol and Drospirenone - which is found in Yasmin and Daylette among others, has so far been flagged up 189 times since 2002. That’s the equivalent of 13.5 people per year writing to voice their concerns about its effects on their mental health.
Of course, this data is neither perfect nor conclusive. Firstly, it only dates back to 1999 and many of these hormones have been available since the 1960s. Secondly, not everyone who experienced a mental health problem whilst taking a hormonal contraceptive would connect the two and go out of their way to report it. However, what this data does show is that people are going out of their way to flag up their concerns about the psychiatric side effects of hormonal contraception.
Depression, decreased libido and the contraceptive pill
In their response the MHRA also stated that ‘psychiatric side effects such as depressed mood, depression and decreased libido are recognised adverse reactions for most hormonal contraceptives and are in general listed in the Patient Information Leaflet that accompanies every medicine.’ With the fact that the NHS refer to them as ‘mood changes’ and call them ‘disadvantages’ in mind, The Debrief decided to ask The National Institute for Health and Care Excellence (NICE), who publish guidelines for healthcare professionals in England, whether they had ever developed any specific guidance on how hormonal contraception and mental health issues intersect in female patients?
Their answer was no. In a statement they said:
‘NICE produces a range of guidance and information products, including clinical guidelines, which are recommendations on how healthcare and other professionals should care for people with specific conditions. The majority of topics for our work programmes are referred to us by the Department of Health and NHS England but occasionally other government departments such as Public Health England ask us to develop guidance on specific topics. I can confirm that we have not been asked to develop a guideline on treating patients who feel that they are experiencing mental health problems which may be caused by their hormonal contraceptive, including contraceptive pill or hormonal coil.’
Are we any closer to finding an answer?
The NHS cannot yet provide data on how many women are or have previously concurrently taken hormonal contraception and medication for mental health problems. And so, we are left with limited data to look at. What we do know is that nobody in England has ever bothered to try and collect that data, to see whether there is a correlation which would provide the grounds to try and establish a casual link in the way that Professor Lidegaard has in Denmark. Thanks to the MHRA, we now also know that patients are flagging their concerns about adverse psychiatric reactions to hormonal contraception via the yellow card scheme.
In order to try and fill in the data gaps The Debrief conducted a survey of 1,022 women. 46% of them are currently taking the pill and 47% have taken the pill in the past. Of those women 46% told us that taking the pill had decreased their sex drive.
When asked about how the pill impacted on their mental health, 45% said that they believed they had experienced anxiety, 45% said they had experienced depression and 20% reported experiencing panic attacks which they attributed to their hormonal contraception.
Of the women who felt the pill had impacted negatively on their mental health, 43% said they had sought medical advice. 26% of these women were prescribed medication (anti depressants or beta blockers) as a result, while 55% said that they felt their concerns about how the pill was interacting with their mental health were not taken seriously.
Annabel* is 22, she took the pill between the ages of 14 and 18. ‘I’m sure it sounds like a cliché but I’m not the sort of person who’s prone to depression’ she tells me, ‘it was totally uncharacteristic and such a dramatic change’. She explains that she was taken off the combined pill and put on the progestrogen only pill when her mother was diagnosed with breast cancer, that’s when the problems began, ‘I had a total drop. It’s only with hindsight that I’ve been able to link it to the pill. I was really anxious, really depressed.’
It was 9 or 10 months before Annabel sought help for the problems she was experiencing. I ask her why she waited so long? ‘Before it happened I was really confident’ she explains, ‘and then, all of a sudden, I didn’t want to leave my house. I was embarrassed. I didn’t want to go out. I was really hard on myself and sad all the time, I would have really bad episodes where I’d think “I hate myself I hate myself”.’ How exactly did she feel? ‘it was a sense of self loathing, loss of libido and mood swings’ she elaborates, ‘totally unprovoked. I would just randomly snap and be so angry and upset, then I was fine again.’
At her lowest point Annabel says she experienced suicidal thoughts. ‘It is so not like me’ she says emphatically, ‘I can’t stress that enough. I would panic and think I just want to die. I had never, ever in my life felt like.’ What made her seek help? ‘I told my best friend’ she says ‘she was like… “OK, let’s get it sorted”. That’s when I spoke to a GP and they told me to come off the pill’. Annabel says that her doctor took what she was experiencing very seriously, ‘because it had been such an obvious change – I was completely fine and then so unhappy 3 months later they took it quite seriously.’
If she had known that her pill could possibly have made her feel like this, would she still have taken it? ‘The main thought that I felt when I was suicidal’ she says, ‘was that in a week’s time if I still feel like this I will wish I had done it today. That’s why I want to speak about this because it doesn’t get spoken about enough. I feel really strongly about this.’ Ultimately, she says, ‘I think if someone had said that mental health problems would be a side effect then I wouldn’t have taken it at all, but its easy to say that with hindsight.’ And what does she do for contraception now? ‘I’ve got the copper coil and I have no problems with mental health at all.’
Gemma, now 30, also thinks that the pill affected her sense of self. She began taking it at the age of 15 and stopped in her late twenties. ‘I began, mainly for my skin and continued to use it as contraception until a couple of years ago’, she tells me. For a long time, she explains, ‘I just thought I was really sensitive. I cried all the time – arguments, adverts, anything. I would cry at the drop of a hat.’
What made her want to speak about this experience? ‘I suffered from UTI infections so I came off the pill and started using condoms. It was only then I realised how much it had affected my mood. I would never, ever go on hormonal contraception again’ she says.
For Gemma the adverse effect that the pill had on her mood defined her sense of self and shaped her identity for over a decade. ‘When I was younger I just assumed that was how I was’ she says, ‘I got down about thinks, quite stressed and it would result in tears and breakdowns.’ She explains that it got particularly bad when she was at university, ‘I got myself so worked up about things, when I look back now I’m like that wasn’t me, I’m actually quite laid back. It was for such a huge chunk of my life, that’s why I would never go back on it’.
Gemma touches on something that Professor Lidegaard points out, because many women start taking the pill at a young age it can be difficult for them, let alone doctors, to identify whether their pill is having an adverse effect on their wellbeing. As a teenager you don’t have a frame of reference for your own emotional repertoire, and therefore having the confidence to say ‘this isn’t me’ isn’t necessarily in your arsenal.
Did Gemma ever raise her concerns with a doctor? ‘I never talked to my GP’ she says, ‘I thought I was just quite sensitive.’ Although she would never take it again she doesn’t feel wholly negative about the contraceptive pill, ‘in a way, it was a good way for me to have contraception but I think the effects should be more talked about’ she says, ‘I’m not sure I’d ever recommend it to anyone, but, equally, I wouldn’t want someone younger than me to not use contraception.’ What does she think about the way the problems with the pill and women’s contraceptive choices are spoken about in general? ‘I think it’s disappointing’ she says.
Natasha is now 22. She started taking Microgynon in the summer between her first and second years at university. She recalls ‘feeling more and more tired and anxious’ and explains that she ‘suffered from panic attacks’ which at their worst would cause her ‘to space out completely and scratch [her] arms and legs…to feel something real’.
How did this impact her life? ‘I lost all my friends at uni and my boyfriend’ she says, ‘I wasn't easy to be around’. She explains that all of this lead to her ‘having suicidal thoughts’; ‘I couldn't face living like that for the rest of my life’ she says. Natasha began counselling and was prescribed an antidepressant, Sertraline which, she says, ‘levelled out [her] mood swings’. However, she says, they ‘didn't make me feel like normal me, I still felt like I was living in a haze.’
It was a change in the health of a family member that prompted Natasha to come off the pill. ‘I stopped taking the pill in the next year because it turned out my mother had suffered from blood clots which meant I was also at risk’ she explains. She is now taking the DEP injection. How does she feel now? ‘I haven't had a single panic attack and my occasional low moods are nowhere near as severe as they were before’ she tells me.
Did she ever make the connection between her mental health and her contraception? ‘My mum had mentioned that maybe the pill was the trigger for my illness and, although I dismissed it at the time (one nurse said that actually the pill should help and it would level out my moods) the timeline from when I started taking the pill and when I ended fits with when I felt ill’ she says, ‘I had never suffered from depression or anxiety before but during the time I was ill, it was diagnosed as severe. Now I am off the antidepressants, don't receive counselling and am back to the old me and feeling better than ever.’
Similarly, countless other women who took The Debrief’s survey reported similar experiences. Sophie, now 25, says ‘as I got older and got more emotionally intelligent about myself I realised. I now look back and I had long term depression and anxiety for about a year, which I do think was because of the pill. My turning point was coming off the pill when I broke up up with my long term boyfriend and It was like a cloud had lifted. I don’t think I’d realised how my sense of self and mental health had nosedived over 2 or 3 years, it was like somebody had turned the lights on.’
She says that for a long time she didn’t twig that it could possibly be her pill that was causing issues. ‘I remember when I decided to come off it, I felt so awful and googled my pill and mental health. I just thought “maybe it isn’t me…maybe there isn’t something wrong with me…”. I felt like my GP’s solution was just “here’s another pill, nobody sat me down and said “well, if you’re having mental health issues here’s what you can do…here are your options…”.’
What does Sophie think about the way GPs deal with this issue? ‘I think it needs to be more seriously considered’, she says, ‘in my experience it wasn’t something that put me in any danger but it made me very unhappy for a long time and I felt totally lost as to why I was so unhappy.’
Teenage angst or serious side effects?
With suicidal feelings at the extreme end of the spectrum and anxiety, depression, panic attacks, loss of libido, a warped sense of self and mood changes across the board, the sliding scale on which hormonal contraception can impact women’s mental health and day to day wellbeing is clearly vast, wide ranging and, sometimes, very serious.
Professor Anne MacGregor is a specialist in Sexual and Reproductive Healthcare at Barts Sexual Health Centre in London. She co-authored _The Pill _ which is a definitive work on reproductive health. She also refined what’s known as ‘the pill ladder’. You might have seen it, it’s a handbook which lists every pill and its contents, some GPs will consult in when trying to decide which pill will work best for you.
‘I think its important to open any discussion on the pill in the context that the pill is only one of a number of different methods of contraception’ Professor MacGregor says. She explains that in her work, ‘much of what we do is trying to taylor the method of contraception to the individual rather than the other way round’.
So, why does she think the pill is, so often, the go to method of contraception for young women? ‘I think the pill became the default because it was the first’ she says. ‘It was designed in the 1960s, it freed women up – it was an amazing revolution – I don’t think the younger generation are aware of the freedom that it suddenly gave women –they suddenly – for the first time – had a method of controlling their own fertility.’
There’s no doubt that the pill was not just innovative, it was revolutionary. However, that doesn’t make it a sacred cow beyond reproach or further research. Professor MacGregor agrees that there is still substantial work to be done. ‘If you came to some of the contraception conferences’ she says, ‘you would see how much research is going into not just refining our knowledge of how the pill works, but how the different progestrogens work. Each of the synthetic pills that we have available will contain the same synthetic oestrogen, but there are a number of different types of progestrogens that are used together with the oestrogen. Each of those will affect the way that it works and how the woman feels in herself.’
How many are we talking? ‘There are, I think, about 40 different varieties by the time you juggle different types of progestrogen and different types of doses’ she says, ’and a woman will respond to each of those different pills in a slightly different way.’
Only the begining of the contraception conversation
Professor MacGregor is clear that this is, in reality, only the beginning of the conversation we need to be having about the pill. ‘There is a very clear need to try and make pills as safe as we possibly can’ she says, ‘to consider whether actually having them in a pill form is the most appropriate route’. So what would potential alternatives be? ‘For example, there is a patch that we’re trying to look at – gels, vaginal rings – so that women have a lot more contraceptive choice depending on their lifestyle and where they live in the world.’
Does she think that the mental health side effects of the pill could have been overlooked at best or, at worst, handled badly? ‘Our understanding of anxiety and depression still needs work’ Professor MacGregor says, ‘the difficulty is trying to recreate or mimic “naturalness” as much as possible. Clearly synthetic hormones are going to affect different people in different ways. The problem is that we can only look at what side effects people report, and then look at them as a statistical group. But, within that group you may have individuals who respond very well or very badly to synthetic hormones.’ What does she mean by this? ‘There are women who will say after going on the pill “it’s changed my life and it’s fantastic”.’
And what does she think about the way the pill is prescribed in England? Could the care women receive be better? ‘I’m not sure how many prescribers will necessarily be aware that there is this ladder of differences in how pills affect women’ she says, ‘but it is something that we do try and put out to the wider audience…but not everybody picks up on it.’
When it comes to GPs training in women’s health, specifically, does she think there is an issue here? ‘Not all GPs are trained in sexual and reproductive health care. They have to do an extra qualification to gain very specific experience. For example, most weeks at Barts we are training GPs in this additional training for contraceptive prescribing – so not every GP will know this or even be interested in it, which can make it more difficult for young women – particularly as they don’t feel confident in saying to their doctor “look this pill just isn’t suiting me”.’ This is something that many of the young women who responded to The Debrief’s survey voiced. What does Professor MacGregor think about how their needs are being addressed? ‘Unless the prescriber knows that there are pills that will function in a person in a different way, then the young woman can be in quite a difficult position, and, sometimes be made to feel quite stupid for the way that they feel.’
'It shouldn't be difficult to identify... timing is everything'
However, she says, it really shouldn’t be that difficult for doctors to identify when there are issues. ‘There is quite a simple way of identifying whether it’s the pill or whether it’s life – and that is the time relationship of when a person starts taking something new and their mood. If somebody starts taking a pill and immediately their mood goes downhill, then it would be very difficult for it to be anything other than the pill. Timing is everything. It’s very important that people look at the context of what women are experiencing. For GPs its making sure that you ask the right questions and that you listen to what the answers are.’
At present, the sort of data harnessed by Professor Lidegaard is not available within the NHS. Until it is, it won’t be possible to conduct a study of just how big the scale of this problem is. However, what’s clear is that women are going out of their way to report psychiatric side effects of synthetic hormones.
As far as Professor Lidegaard is concerned, his study is just the beginning. For him, three things need to happen: ‘the first step is that the scientific community should accept and recognise that there is a causal relationship between depression and hormonal contraception. When the scientific community has accepted this correlation then the next step is to inform doctors that there is this link so that they can inform the women who get these products that one of the possible adverse effects of these products is that they could get depression. And then women should, thirdly, with this information reconsider whether the best contraception method for them is hormonal contraception or whether they should find others which influence their mood and mental health less. This is relevant, especially, for women with a previous history of depression.’
‘We have for a long time known that oestrogen generally improves women’s moods while, on the other hand, progesterone depresses women’s moods’ he says. ‘And that is why some women (even if they aren’t taking hormonal contraception) experience mood changes in their mood during the menstrual cycle when their progesterone is highest. All types of hormonal contraception are progesterone dominated – so they include much more hormones which have the same effects as progesterone and oestrogen – therefore its not surprising at all that these hormonal contraceptives can cause depression. It’s completely in keeping with our basic understanding of how sex hormones influence the mood.’
Does Professor Lidegaard have any more research on the way? ‘We are publishing a study very soon about suicides in women who are taking hormonal contraception’, he says.
If mental health problems are a known side effect of the pill, then GPs should discuss this seriously with female patients. Would it be so much to ask for women to be advised to monitor their mental health when switching or starting the pill?
It makes sense, medically and biologically, that hormonal contraception could adversely affect women’s mental health. What we need now is the data and research to back that up, followed by support for those experiencing problems. Expecting women to play pill roulette – trying them all until you find one that doesn’t make you feel sad, bad or mad – isn’t good enough.
In the last six decades since man (!) came up with the pill we’ve invented mobile phones, the Internet and microwaves. And yet, the default for sexually active women is still an imperfect pill which is known to have adverse mental health implications. We need more studies, better research and real talk about what the pill can do to women who don’t get on with it - and we need it now. How we can we make informed decisions about what we put in our bodies if we don’t have any ‘proper’ information or evidence?
More than this, it’s time to demand better research and innovation in contraception. You wouldn’t use a microwave manufactured in the 1970s (hopefully), and as one of the women we spoke to, Bridget, 25, said if we can fly robots to Mars surely we can come to understand women’s health and serve women better than we do now? This cannot be as good as it gets.
Will I ever be depressed again? Will I ever have a panic attack again? Will anxiety ever crash over me like a tsunami again? I hope not. But, if it does, at least, I would like to know those feelings are my own and not being caused by my contraception.
*If you are concerned about your pill, or hormonal contraception, please contact your GP immediately *
Share your pill stories with us @thedebrief #madaboutthepill
*names have been changed
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This article originally appeared on The Debrief.