Content warning: mental illness, suicide mention.
Use of hormonal contraception is a celebrated part of 21st century healthcare. Since the contraceptive pill was introduced in 1961, hormonal contraception in the UK has evolved from being accessible only to married women, to being widely available to people of all ages and relationship statuses. Choices have since expanded beyond the pill, with the implant, coil, and many more options now easily available on the NHS.
This is, of course, how it should be. Everyone has a right to contraception as they have a right to all other healthcare; free at the point of use, and free of judgment or shame. Similarly, we have a right to be fully informed about the contraception we are taking, about the risks or potential side effects of what we put in our bodies. This area is, unfortunately, one in which we are significantly lacking.
Most of us are aware of the multitude of possible side effects of hormonal contraception. Stories emerge of changes to skin, weight, and most notably, mental health. Problematically though, these remain just stories. A lack of meaningful research in this area means that we have little more to go on than tales of personal experience which, when passed on, can morph into mistruths and urban myth.
Although a vast number of those taking hormonal contraception do have a positive relationship with it, this blind spot is undeniably dangerous. How can we be expected to make informed decisions about our sexual health without reliable information? This lack of conclusive evidence also makes any problems encountered easy to dismiss. The groups who rely on hormonal contraception are, broadly, cis women, trans men and non-binary people. These are groups whose wellbeing has been historically sidelined, with conclusive evidence that women in pain are taken less seriously than men. In one American study it was found that women are more likely to be prescribed sedatives when they express pain, whilst men are usually given narcotics; women’s pain is regularly disbelieved and questioned, read instead as unjustified anxiety. The lack of research into hormonal contraception’s effects on mental health are an extension of this lack of regard for the health of bodies that are not male, cis, and white. Willful ignorance is a powerful tool, making it acceptable to invalidate experiences of individual struggle as unfounded scaremongering.
There is only one recent, frequently cited study into the link between the pill and mental illness, carried out in 2016 in Denmark. This study found that women taking the combined pill were 23 per cent more likely to develop depression, and those taking the mini-pill were 34 per cent more likely. However, the results of this survey seem to have faded into obscurity, with the pill still being prescribed liberally to young people, and gaping holes in our knowledge of the link between hormonal contraception and mental illness remaining.
This absence of research left us curious. Keen to hear about a wider range of experiences, we created a survey into the effects of hormonal contraception on mental health. The survey was shared on Facebook and Twitter, and gathered almost 400 responses in just three days. The popularity of the survey was striking in itself; such an instantaneous and collective response showed the questions we posed were ones people are eager to be asked, whilst the detail and emotion present in the answers suggested a resounding will to share stories which are often dismissed. The results of the survey were even more telling.
In response to whether they felt a change in their general mood whilst taking hormonal contraception, 67.8 per cent of respondents said that they had. In response to whether they felt hormonal contraception had impacted their mental health, 56.9 per cent said that they did. Of the 220 respondents who elaborated on this change, four respondents indicated that it had been positive. These respondents cited changes such as ‘not stressed about having shitty random periods’, and ‘made me less temperamental’. Negative responses frequently referred to anxiety, depression and mood swings, with two respondents specifically identifying suicidal thoughts.
Individual experiences were long and often distressing, as the extremity of the potential impact of hormonal contraception was communicated. One respondent told us: ‘I felt unable to cope with anything, spending at least half an hour nearly every day just crying in my bed’, while another said ‘I felt I wanted to shout or cry 80 per cent of the time which is quite a marked charge from my typical behaviour’.
The most commonly used form of contraception for those answering the survey was the combined pill, with 196 out of 396 respondents having only experienced this form of contraception. Of this group, 65 per cent said that they felt the pill had affected their general mood, and 51 per cent felt it had affected their mental health. These statistics are alarming when compared to those currently available to people taking the pill. In the list of potential side effects that come with Rigevidon, a commonly used brand of the combined pill, ‘mood swings including depression’ is listed as a ‘common side effect’ that ‘may affect up to 1 in 10 people’. This listed statistic is a far cry from the responses our survey garnered.
It goes without saying that our survey’s reliability may be undermined for several reasons. Firstly, it was open to everyone, and there is always the potential for the same person to answer multiple times. Furthermore, those with negative experiences are more likely to respond than those with positive experiences. Having said this, even if we halve the percentage of people who said their mental health and been affected, we are still left with 28.5 per cent. This is almost triple the advertised statistic, indicating a worrying disparity between current accepted research and the lived experiences of those taking hormonal contraception.
It has to be asked whether the age at which someone starts to use the pill might be responsible for this discrepancy. The average age of a clinical trial is likely to be significantly higher than the average age of a first-time user of hormonal contraception (which, in the case of our survey, was 17). Young people can take until the end of their teenage years, if not longer, to fully stabilise following puberty, and so it would not be surprising if hormonal contraception had a greater impact on their bodies.
Additionally, it is not uncommon for starting university to mark a student’s first foray into long-term contraception. It is to be expected that a large number of our survey’s respondents were around university age, given our own statuses as students, editing a student newspaper. It’s been well documented that the first year of a degree is a difficult time for many, with many mental health problems first presenting themselves in this period. Even for the mentally well, it’s possible that an alteration in hormonal balance could turn a commonly unsettled period into something harder to cope with.
Interestingly, 56.5 per cent of people who said they felt their hormonal contraception affected their mental health said that they had continued to take it despite these concerns. When asked why, common responses highlighted the undeniable convenience and benefits such as regular periods, the ease of staying protected from pregnancy, alleviation of period cramps, and the positive effects for sufferers of Endometriosis and Polycystic Ovary Syndrome. There was a collective feeling that the benefits ultimately outweighed the risks.
Every individual choice made about what contraception to use or not use is a personal, valid decision belonging solely to the person taking the contraceptive. Some of our respondents raised this point in the survey, expressing the opinion that, whilst there are certainly problems that need addressing, we should acknowledge the empowerment that hormonal contraception has meant for many people. One respondent emphasised that ‘we must not forget that hormonal contraceptives were one of the biggest steps towards female sexual freedom’ and that we should ‘responsibly acknowledge their value and importance, both culturally and medically (6-20 per cent of women are affected, as I am, by Polycystic Ovary Syndrome, where the pill can be an effective medication to preserve fertility and stabilise hormonal levels), while taking into account their side effects’. Another, Sophie, identified that ‘the pill is also a tool for me for general welfare, and I’m tired of it being made into this enemy that we should all fight against’.
Given the personal nature of such a decision, and the apparent weight of its potential implications, our survey fed back a worrying pattern in the influence of sexual partners on an individual’s contraceptive decisions. One respondent described how ‘my boyfriend and I stopped having sex as condoms “didn’t work for him”. Although I felt the pill was ruining my relationship emotionally with my partner, not being on it turned my partner away from me’, while another explained: ‘my partner doesn’t enjoy having sex with a condom – me neither but to be honest I would have chosen the condom over the pill, if it were just me’.
In another question, we asked ‘have you ever felt pressured by a sexual partner to take hormonal contraception?’, to which 24 per cent responded ‘Yes’. Though not the majority, this statistic is high enough to be worrying, suggesting almost one in four people who have taken or are taking contraception have felt external pressure to do so.
We also asked about experiences with GPs. Of the respondents who went to the GP about concerns regarding their contraception’s effects on their mental health, 55.6 per cent said they felt their concerns had not been taken seriously. This, combined with the pressure felt from sexual partners, reveals an expectation, often placed on women, to bear the brunt of avoiding pregnancy, regardless of personal cost. This expectation is steeped in a history of assuming and accepting that women and mental health problems go hand in hand, and that women are prone to exaggeration and ‘Hysteria’. Hysteria was a diagnosable condition almost exclusively associated with women and recognised by the American Pscyhiatric Association up until 1952, but the reverberations of it still echo in today’s healthcare systems.
A common theme in responses was that of doctors’ dismissals, which some felt were based on their racial or gender identity. As one respondent told us, ‘I don’t entirely know what it looks like to have a doctor listen to you and take your concerns seriously in the sense that, they hear you’re in pain and struggling and actually have a conversation with you towards figuring out what you need to do and are comfortable doing. I do think it’s implicitly at least in part because I’m a Black woman.’
Doctors’ reluctance to recognise these issues can also be seen in their willingness to prescribe hormonal contraception as a solution to other problems such as acne or severe period pains, even where the patient has a history of mental health problems. Conversely, we asked survey respondents if they had ever been prescribed anti-depressants at the same time as taking hormonal contraception, and a staggering 26.1 per cent said that they had.
With all of this in mind, the cancellation of a 2016 trial for a male contraceptive injection due to concerns over the side effects was a shock to some. Surely this is yet another glaring example of gender inequality in the eyes of the pharmaceutical and medical professions?
In truth, the issue was slightly misreported by many news outlets, with headlines such as ‘Male birth control study nixed after men can’t handle side effects women face daily’ proving to be misleading. The study was called off by an independent safety-review board, who intervened following the suicide of one participant, as well as another being unable to regain sperm function. Tough as hormonal contraception might be on those who currently have access to it, there is no place for something quite so harmful behind our pharmacy counters.
Hope is not dead for champions of male hormonal contraception though. On Sunday 18 March it was announced that researchers at the University of Washington had developed a new contraceptive pill which is effective, safe, and doesn’t impact on sex drive. There is little mention in the articles accompanying its release of any potential effects on mental health, but it seems that this might be at least a step in a new and exciting direction.
Taking into account the multiplicity of responses to our survey, it seems that while hormonal contraception is, like any other medication, a complex choice to make involving weighing up significant benefits and risks, this choice is clouded by a severe lack of information. While it is clear that many doctors aren’t fully aware of the wide-ranging implications hormonal contraception can have, it would be naive to pin all the blame on them.
They are working with woefully insufficient research which is ultimately undermining their work. What our survey proves is that we desperately need more professional, considered research conducted into hormonal contraception, carried out in the interests of those taking the contraception, rather than pharmaceutical companies. As one respondent identified, ‘differentiation is key’. Any research must listen to the varied experiences of those affected as they listened to the cis men who reported side effects of male contraception during trials. As control over your reproductive system is a right, so too should nuanced information about it be.
You can find a full list of the results of our survey through the link below:
Special thanks to Katharine Cook for her analysis of our survey’s data.
Illustration by Josh Green