The Pill:
Everything You Didn’t Know

We all know the drill by now.  You hear or see an advertisement for a prescription drug accompanied by a laundry list of side effects.  Perhaps we’ve been conditioned to tune out the risks as a cue from the monotone drone and teeny tiny script.  Besides, who wants to think about the gory details? However, for the 11 million women in America taking oral contraceptives, maybe it’s time to become better aware of the potential side effects of the pill in the context of overall health as well as mental health.

There is no denying the power of the pill and it’s benefits.  After all, oral contraceptives profoundly changed history by providing women more flexibility and freedom for reproductive choice.  Because of its efficacy and safety, it is still the most common reversible contraceptive among all women aged 15-49 nationwide. Also, there is an association with a reduced risk of ovarian cancer, endometrial cancer, rheumatoid arthritis, and pelvic inflammatory disease.  On the other hand, unbeneficial and potentially dangerous side effects are well documented which include spotting, weight gain, migraines, mood swings, risk of blood clot and stroke, increased blood pressure, and sleep disturbances.  

Originally, the pill was intended as a means for married women to hit pause in between pregnancies.  We’ve come a long way since 1960 and as time has evolved, it is not uncommon for a woman to start taking the pill in her teens and continue use well into her thirties.  A study published in the Journal of the American Medical Association Psychiatry found that overall, women who use hormonal contraceptives were more likely to have mood disturbances including depression. The study found that young women on hormonal birth control in their late teens and early twenties were especially more likely to be treated with antidepressants than their peers who were not taking the pill.  

A randomized placebo controlled study found that women who take hormonal birth control have increased levels of cortisol which peaked when the women were exposed to psychological stress.  In other words, women on the pill experienced more stress during stressful situations. This has other clinical implications because increased cortisol is also associated with autoimmune and inflammatory disease.  

Considering that the pill has been part of daily life for so many women over the span of nearly six decades, it is a bit puzzling that only recently has there been investigations into the results of long term use.  Therefore some side effects that may seem minor when applied to short term exposure can have a compounded effect over longer durations. For example, there is a relationship between reduced nutrient absorption and the pill.  Specifically, key nutrients that are depleted are vitamins C, E, B6, B12, folic acid, and riboflavin and minerals such as zinc, selenium, and magnesium. Complicating the matter, many of these nutrients are essential for the creation, activation, and maintenance of hormones which can potentially manifest in more severe side effects of the pill or problems related to other areas of hormone health.  The World Health Association recognizes the potential risks associated with micronutrient malabsorption and recommends that clinicians guide women on the pill to take nutrition supplements as healthy best practices. 

Sometimes when trying to look at the big picture we miss the small, but important details.  While it is uncomfortable to embrace the negative effects of the pill, it may be the best way to evaluate the pros and cons and how they measure up with your total health and quality of life.  Having this information can empower you to have more meaningful conversations with your care team and deepen the mind-body connection.  

 

 

Sources:

Current Contraceptive Status Among Women Aged 15–49: United States, 2015–2017

NCHS Data Brief No. 327, December 2018. https://www.cdc.gov/nchs/products/databriefs/db327.htm

Welling, L. L. M. (2013). Psychobehavioral Effects of Hormonal Contraceptive Use. Evolutionary Psychology.

Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. 2013 Jul;17(13):1804-13.

Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154–1162.