Contraception: Once Again Under Fire

8. November 2016

The "pill" is as popular as ever among women of childbearing age. It is considered a relatively safe option as a contraception. Now researchers are demonstrating that these medications lead to mental function disorders. However some questions arise with regard to the study.

According to representative surveys about six to seven million women nationwide take oral contraceptives. Among those from 18 to 20 years of age, 80 percent resort to this method. With few exceptions the preparations are oestrogen-progestogen combinations. However “the pill” doesn’t only lead to desired effects, as Holly Brockwell UK reports. The 26 year old journalist called on fellow women, via Twitter (#MyPillStory), to convey their experiences.

The women in part complained of depressive symptoms that they associated with the “pill”. Charlotte Wessel Skovlund and Øjvind Lidegaard from the University of Copenhagen have now investigated the observation in scientific terms.

Science meets truth

Together with colleagues they evaluated data from the National Prescription Register and the Psychiatric Central Research Register. All 1.1 million participants were at the time of the survey 15-34 years old and lived in Denmark. Medication data was collected from January 1995 to December 2013. This also included prescriptions of antidepressants.

Paint by numbers

Wessel Skovlund and Lidegaard did indeed find statistically significant connections to all types of contraception. Compared to women not using contraceptives, the relative risk (RR) of receiving a prescription for antidepressants came in at 1.23. There were significant differences depending on the drug and pharmaceutical preparation. The spectrum ranged from 1.34 (progestins), 1.4 (intrauterine pessaries containing levonorgestrel) and 1.6 (vaginal rings with etonogestrel) to 2.0 (norelgestromin patch). Similar statistical correlations were determined in relation to diagnosis of depression.

Particularly at risk were young women between 15 and 19 years who received combination products (RR 1.8) or contraceptives with progestins (RR 2.2). The maximal risk of developing depression occurred six months after starting to taking them.

The publication raises several questions. Skovlund and Lidegaard suspect a causal relationship between depression and hormones, but do not provide proof for this. Cohort studies have significant potential to end up taking in confounding factors. The focal point is the question as to why women take contraceptives involving hormonal actions and which decide, for example, against using the pill in favour of non-hormonal methods of birth control. An open question remains as to whether factors such as strong relationships play a role. These factors may also have links to depression. Last but not least, doctors criticise that the relative risks are impractical for medicine to deal with. This is because, when considered in absolute terms, the risk remains relatively limited. In Denmark 1.7 percent of all women, regardless of the specific aspects relating to their pregnancy prevention, receive antidepressants. With hormonal contraceptives the rate is 2.2 percent.

Lust killer straight from the pharmacy

Yet depression is just one aspect of a wide range of mental disorders associated with hormonal therapies. Christian W. Wallwiener from Tübingen has for years been investigating whether the “pill” triggers sexual dysfunction. As early as 2010 he published results of a study involving approximately 1,000 medical students from Germany. Wallwiener collected personal details as needed for the Female Sexual Function Index (FSFI). At the same time he recorded what form of contraception had been used. In the case of hormonal contraception the researchers found significantly higher risk associated with sexual dysfunction.

Recently published data confirms Wallwiener’s findings. His new cohort took in 2,612 medical students up to the age of 30. Simultaneously, the researchers recorded other factors. His conclusion: around 40 percent of all female medical students are at risk of developing a sexual dysfunction. Risk factors primarily include hormonal contraceptives. (Other risk factors include nicotine consumption, obesity, fitness level and relationship status.)

“Pill against the pill” – a big failure

161108_Kontrazeption_Report Card

Bad marks for Addyi in all areas: The National Women’s Health Network spares no criticism. © NWHW / Screenshot: DocCheck

It’s quite clear that women – and their partners as well – want another kind of pill, so as to not kill lust. For pharmaceutical manufacturers, the topic presents a fine opportunity. Last year the US Food and Drug Administration (FDA) after several revisions gave the green light to flibanserin. The serotonin modulator is to be used on patients with hypoactive sexual desire disorder (HSDD). Valeant at the same time invested in massive public campaigns and sold the euphoria far and wide.

When looked at scientifically the matter appears significantly less rosy. Loes Jaspers from Rotterdam examined what sort of effects really come from using Addyi®. Base data came from 5,914 women. The so-called lust pill only led to renewed sexual satisfaction for a period of less than two months, writes Jaspers. He speaks of “minimal change”. At the same time, many patients suffer from dizziness, nausea, fatigue and drowsiness.

Still clearer words were expressed by the National Women’s Health Network. “Clinical studies now show that nine out of ten women do not experience improvement in their sexual desire”, it says in a report. Missing studies were criticised, as was also lack of information about interactions. The “pill against the pill” has led to hardly any improvement in practice.

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Gynaecology, Medicine

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