More proof that the oral contraceptive pill causes depression
... and researchers provide a helpful definition of 'women'
A study drawing on data from nearly 265, 000 UK women has found that taking the oral contraceptive pill doubles the risk of experiencing symptoms of depression, during the first two years of use. And women who took the Pill in their teens but subsequently stopped, have an 18 per cent higher lifetime risk of depression than women who never used it. But you shouldn't worry about that, because according to the authors of another recent study which helpfully defined women as "individuals assigned female sex at birth who identified as women", oral contraceptive pill-takers whose mood crashes when they take the inactive pills in the pack, can solve this problem by just taking the hormonally active pills end-to-end, with no 'pill pause' to allow a withdrawal bleed. Genius!
If you read my article New study finds all forms of hormonal contraception raise breast cancer risk, you'll be aware that I've written quite extensively about the effects of hormonal contraceptives on women's risk of anxiety and depression, and even their brain structure and function:
In Hormonal contraception and women’s mental health, I shared the results of a massive Danish study which found that women using any form of hormonal contraception (including oral contraceptive pills, patches, vaginal rings and hormone-releasing IUDs like Merina) were more likely to be diagnosed with depression. Compared with women who used no form of hormonal contraception, the risk of being prescribed antidepressants for the first time ranged between 23 per cent higher for women taking the combined oral contraceptive pill, to 100 per cent higher (i.e. a doubling of risk) in women using a contraceptive patch. Girls aged 15-19 were 80 per cent more likely to be diagnosed with depression if they were taking the combined oral contraceptive pill, all the way up to three times more likely if they used non-oral hormonal contraceptives (again, including the ever-more-widely prescribed Mirena).
In More evidence that taking the Pill in your teens is linked to depression, I reported US data that confirmed the Danish study, finding that women who had never used oral contraceptives had less than one third the odds of suffering major depression as women who had started taking the Pill during adolescence.
And in This is your brain on the Pill, I delved into two studies which identified distinct changes in the structure and function of the brains of women taking oral contraceptives. Namely, Pill-taking women had significantly smaller volume of the hypothalamus, a region of the brain that produces many hormones and helps regulate essential bodily functions including body temperature, mood, appetite, sex drive, sleep cycles and heart rate. They were more reactive to emotionally negative images, and those who had begun taking oral contraceptives in adolescence also showed a blunted response to a social stressor, which has previously been found to be a risk factor for depression. (You know what else decreases hypothalamic volume? Puberty blockers and cross-sex hormones used in the 'treatment' of individuals who don't identify as members of their sex. Interesting, right?)
However, other studies have reported opposite findings, such as this one and this one which reported lower prevalence of depression and suicidality in current users of hormonal contraceptives. What could account for this discrepancy between study outcomes?
The healthy user bias is a prime candidate. To put it simply, women who experience adverse mood effects from hormonal contraceptives are - very sensibly - more likely to stop taking them. Studies which fail to take healthy user bias into account may inappropriately conclude that "hormonal contraception may reduce levels of depressive symptoms among young women" because they lump together two categories of non users: the never users and the ex-users. Ex-users of hormonal contraceptives include many women who quit taking them because their mental health took a turn for the worse, and these women may suffer lasting effects even after discontinuing use. Never users are likely to have a whole slew of different characteristics than ex-users (including, for example, higher prevalence of religious faith) that impact their risk of depression, quite aside from the fact that their brains have never been exposed to exogenous forms of reproductive hormones at pharmaceutical doses.
A team of researchers from Sweden, Denmark and Australia set out to design a study on the mental health impact of hormonal contraceptive use, that countered this healthy user bias. They combed through data from UK Biobank, a population-based cohort that recruited 500,000 participants who were aged between 37 and 71 years between 2006 and 2010, from across the United Kingdom, and has since collected reams of information from them using questionnaires, interviews, physical health measures, biological samples, and imaging.
Their study, titled 'Population-based cohort study of oral contraceptive use and risk of depression', examined the incidence of depression (identified via interviews, inpatient hospital or primary care data) in 264,557 female participants. To help differentiate the effect of oral contraceptive use from genetic and familial influences on mental health, the authors also looked at Pill use and depression in pairs of sisters enrolled in UK Biobank.
Just over 80 per cent of participants had taken the oral contraceptive pill at some point in their lives. On average, women who had ever used the Pill had higher socioeconomic status and were less likely to have a family history of depression than never users.
But despite having these two characteristics that are relatively protective against depression, women who had started taking the Pill during adolescence nearly doubled their risk of being diagnosed with depression during their first two years of use, compared to women who had never taken it. Those who first took the Pill during adulthood had a 74 per cent higher rate of a depression diagnosis two years after commencement. Self-reported symptoms of depression (without a formal diagnosis) were twice as common in the first two years of Pill use as in never users, with women who reported first use in adolescence once again having a higher rate of such symptoms. While the lifetime risk of a diagnosis of depression was only 5 per cent higher among ever users than never users, self-reported symptoms of depression were 27 per cent more common in ever users than never users.
Women who had commenced taking oral contraceptives during adolescence, but had subsequently discontinued use, had an 18 per cent higher risk of being diagnosed with depression even two years after they had taken their last pill. And self-reported symptoms of depression were 40 per cent more common among women who had recently discontinued the Pill, and 13 per cent more common in women who reported previous but not current use.
Analysis of oral contraceptive pill use and depression risk in pairs of sisters provided support for the hypothesis of a causal relationship between the two, "such that OC use increases the risk of depression."
Discussing their findings, the study's authors commented that
"It has been hypothesized that the increased risk later in life among those who used OCs [oral contraceptives] during adolescence may be attributed to a greater susceptibility to gonadal hormones, including hormonal contraception, during crucial developmental periods that affect the organization of brain structures and may lead to long-lasting changes."
Population-based cohort study of oral contraceptive use and risk of depression
Remember the smaller hypothalamic volumes found in women taking oral contraceptives, that I reported on in This is your brain on the Pill?
Here’s what a doctor who spoke out about the damage being wrought on children attending a ‘transgender clinic’ in a major children’s hospital had to say about the hypothalamus, and treatments which interfere with its function:
“The hypothalamus is this almond-sized structure in your brain, it’s one of the most primal structures we have, and it controls all the other hormonal structures in your body—your sexual development, your emotions, your fight-or-flight response, everything. But it shouldn’t be described in such cold physiological terms because your hypothalamus is not just a hormone factory. It’s this system that allows you to stand in awe of the beauty of a sunset, or to hear the sounds of orchestral music and to stop whatever you’re doing and want to listen. And I always think that if someone were to ask me, Where is it that you would look for the divine spark in each individual? I would say that it would be somewhere ‘beneath the inner chamber,’ which is the Greek derivation of the term hypothalamus. To shut down that system is to shut down what makes us human.”
Yet after acknowledging the very disturbing possibility that commencing the oral contraceptive pill in adolescence may lead to permanent changes in women’s brains, the authors then go on to reassure their readers that
"It is important to emphasize that most women tolerate OCs well without experiencing adverse mood effects, making them a great option for many."
Population-based cohort study of oral contraceptive use and risk of depression
Right, so let me get this straight: if you start taking the Pill during your teens, it may permanently affect your brain in ways that are very poorly understood (because hardly anyone is studying them), but don't worry about that, as long as you don't seem to have any obvious negative impact! After all, the authors point out, "many women benefit in terms of avoiding abortions and unwanted pregnancies, as well as menstrual bleeding and pain disturbance".
Keen-eyed logical fallacy-spotters will identify this as an example of the false dilemma fallacy - the argument is that if we don't allow teenage girls to take a hormonal drug that might have permanent effects on the structure and function of their brains, many will be doomed to have nasty periods and to repeatedly get up the duff, which will either screw up their lives or force them into having abortions. But these are not the only available options; there are diet and lifestyle interventions which address the underlying causes of menstrual dysfunction rather than just disabling the metaphorical oil warning light, and there are other forms of contraception that don't mess with one's hormones or one's brain, and that share the responsibility for avoiding unwanted pregnancies more equitably between partners.
And then there's the important conversation that needs to be had about the sexual revolution that was brought about by oral contraceptives, and whether it has had a net positive or negative effect on both women and men (a subject I touched upon in New study finds all forms of hormonal contraception raise breast cancer risk).
In any case, it's disturbing to see researchers first identifying a dramatic increase in the risk of depression in oral contraceptive users, especially teenage girls, and then hand-waving that risk away because only a minority are obviously affected. At this point in time, there is no way to predict which girls and women will become depressed after commencing oral contraceptives. And once that depression has set in, it may persist long after the afflicted woman stops taking the Pill, affecting not just her but her partner, children and other loved ones. That's a high price to pay for the 'convenience' of having sex completely decoupled from reproduction.
Speaking of paying high prices, is the near-ubiquitous use of oral contraceptives a contributing factor to women's declining levels of happiness and poorer mental health, in comparison to men? And how will we find out, if researchers tip-toe around the issue because they're too afraid to contradict the dogma that hormonal contraception has been the best thing to happen to women since the end of corsetry?
Well, who cares anyway! A crack team of researchers concluded, after studying 180 women from Salzburg, Austria, for a single cycle, that since women on the combined oral contraceptive pill experience more negative feelings, anxiety and "mental health symptoms" when they're taking the inactive 'dummy' pills in their pack, they should skip the dummy pills and take the hormonally active pills end-to-end. Voila, problem solved!
You can glean some sense of the researchers' bona fides by reading their description of the participants. The 'cases' were "individuals assigned female sex at birth who identified as women and used COC [combined oral contraceptives] for 6 months or longer."
Newsflash: sex is determined at the moment of conception, and is observed at birth. And as far as I'm aware, the key prescribing indication for combined oral contraceptives is that you're a f@*#ing woman. An actual woman, who has ovaries that produce eggs, and who can therefore become pregnant, not a confused or disturbed male who "identifies" as one because he likes dressing up in frocks. How did this biologically incoherent nonsense manage to get published in a peer-reviewed medical journal, you ask? Easy: it was published in a JAMA journal, the ultimate academic wokehole.
The control group was simply described as "women with natural menstrual cycles"; perhaps the researchers had enough healthy shame to not describe them as "women with natural menstrual cycles who identified as women". At least they didn't call them 'uterus-havers'.
Anyway, the all-female research team concluded that since naturally-cycling women's premenstrual mood changes and anxiety flare-ups were comparable to those reported by oral contraceptive users when they switched from active to dummy pills, "it should be explored whether long-term COC [combined oral contraceptive] users benefit more from the mood-stabilizing effects of COCs in cases of continuous intake."
In other words, don't worry your pretty little head about whether those synthetic hormones are causing permanent alterations to your brain or screwing up your gut microbiome and increasing your risk of autoimmune and inflammatory diseases; just keep taking them end-to-end until you go through menopause... and then you can switch to hormone replacement therapy which also increases the risk of depression.
A cynic might begin to suspect that pharmaceutical profits and ideological conformity to feminist dogma trump researchers' concern for women's health. But that couldn't possibly be the case, could it?
