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3 October 2016

A new study shows that the pill is linked to depression – so what should women do?

Strong links between the pill and depression have confirmed what many women have long suspected. So why are female contraceptives still so rubbish – and when will they finally get on with male ones?

By Stephanie Boland

Another day, another piece of scientific news that has women everywhere going “duh” as a new study reveals a link between the female contraceptive pill and depression.

While it may seem obvious that a medicine which impacts on hormone levels can have an effect on mood, the research, undertaken in Denmark, shows stronger links than some may have expected. Its study of over a million women aged 15-34 found that those taking a combined contraceptive pill are 23% more likely to use antidepressents than those that do not. That statistic was even higher for the progesterone-only pill (34%), the patch (100%), and the vaginal ring (60%).

The link was strongest in adolescents: those using combined oral contraceptives are 80% more likely to take antidepressents. Put alongside another recent study, showing the percentage of teenage girls who have experienced mental health problems has increased dramatically in under a decade, this is a potentially troubling statistic.

Of course, women have mentioned these problems for a long time – but does it actually put them off using the pill? To find out more about women’s experiences, I created a survey asking them to share their thoughts.

What women said

The immediate response seemed to confirm the study’s findings.

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The majority of the 257 women who answered were still taking the pill: 54.9% of them. Many of them had positive feedback, too: 32.6% said they liked that the pill helped with cramps, and plenty of women said they didn’t notice any impact on their mood. Some even said the pill had a positive influence, such as one respondent who said it made her “calmer”.

Nowadays it seems as though everyone is talking about the negative consequences of the pill. I would like to report an entirely different experience. I have never had any side effects, whether physical or mental. The pill has set me free.

My experience has been wholly positive — it’s given me so much control (so I don’t have to be on my period when camping, on holiday, etc.) and I’m really grateful for that.

Others, though, said the pill caused them anxiety, depression, or mood swings – although in some cases they “balanced out” after a while, or got better on a different type of pill.

On microgynon I had ten minute crazy angry-sad mood swings. Extreme mood swings for a short duration. I started taking when I was ~16 so assumed I was just unstable. Got off Microgynon and those swings stopped. Went onto Yasmin and it fed into my depression and made me want to self harm which I hadnt had the urge to do for 4+ years. Got off Yasmin onto loestrin 20 and have had zero emotional problems on this pill.

On the pill, ironically, I had no libido. However, the mini pill has no such side effects!

For some women, the change felt severe. “Hellish mood swings which sunk into depression”, one reported, while others mentioned anger, irrational upset, or being generally more emotional or “weepy”. One respondent said that she felt “felt like my emotions were much more concentrated: like someone had turned the volume up on all of them: so the same emotions, just more intense”. For others, the opposite was true: “I felt slightly depressed, like all my emotions had been slightly blunted”.

It seems blindingly obvious to me and my data pool of twentyish girlfriends with whom I share contraceptive detail that progesterone a) makes you eat more b) makes you gain weight more easily by adjusting blood sugar and fat storage mechanisms and c) makes a minority but a sizeable minority – about a quarter of us – feel low, sluggish and mildly depressed.

Sometimes, women attributed changes to the pill only after they stopped taking it:

It’s more I noticed the changes when I came off – so realised the pill repressed my sex drive, made me more woolly-headed. Since coming off I have felt that change.

Others were told by doctors that their symptoms weren’t related to the pill, only to find they stopped when they stopped taking it:

I tried various different ones over the years and they all gave me chronic migraines. After I stopped taking it, they went away! Various doctors over 5+ years told me the two were unrelated

The best option

So why might women stick with the pill, even if it makes them miserable?

Some of it may be down to the fact that women are more likely to think they’re making a fuss if something has adverse effects. But in many cases, it just suits them better than any alternative.

After all, the injection and implant can have their own side effects, condoms are fiddly and expensive — unless you can be bothered to trot to your local sexual health clinic for some free ones each month – which few of us do, given you can just add them to your basket in Sainsbury’s. And the copper IUD, one of the few long-term non-hormonal options, gives some of us periods reminiscent of the lifts in The Shining.

That leaves withdrawal and the rhythm method, which – even if their perfect use success rates aren’t as bad as you’d think – are beyond the willpower and diligence of many of us.

In fact, you could do a Dorothy Parker’s “Resume”-style poem about all the ways female contraceptives are bothersome: coils pain you, spermicides are damp…

More information

It’s not surprising, then, that many women said the pill was their best option. Asked to select which things they liked about it, 60% of respondents liked that the pill gave them control, while 55% said they liked the pill because they didn’t have to deal with condoms.

Several women specifically said the pill was the best method for them, while criticising aspects of it.

I dislike the fact that it’s near impossible to get the Pill for free anymore. My local sexual health clinic closed down due to budget cuts, so now I end up paying every three months because there’s nowhere close by to access the Pill for free. Another annoying side effect of the Pill besides my bank balance? It’s made my already sizeable breasts even larger. Overall though, it’s the easiest contraception for me.

I don’t like any of the pills I’ve tried — they have all affected my mood to a varying degree but I take it to control irregular periods so it’s my best option.

Others want more or better insight and advice, ideally from specialists, as well as the space to be honest about their sexual health:

I would have liked to have had a specialist doctor or nurse to talk to about my options, but I really didn’t believe the NHS would provide that. I wasn’t prepared to try out another pill on a whim, and there seems to be a lot of pressure to stick to one unless you are really f-ing miserable. I also didn’t feel like I could be honest about the fact that we were realistically not going to be using condoms.

I only went on it because I went to my GP about my migraines — I wasn’t sexually active at the time and it was pretty much forced on it to ‘cure my horrible acne’, not my migraines. I’m still angry 6 years later.

I wish anyone (doctor, nurse etc) had asked me about my family history of depression or even taken my side effects more seriously. I thought I was losing my mind!

There isn’t enough information for young women when they make this decision to take oral contraception. Doctors don’t push the available alternatives enough

A male pill?

For some women, it’d be a relief to be shot of the burden of arranging contraception altogether. The good news is that the so-called “clean sheets” pill, which allows male orgasm while preventing ejaculation, is in the pipeline — as it were. Researchers at King’s College London and UCL have banded together to begin trials. (Previous versions caused side effects including dizziness, tiredness and stomach upset, which of course women have been dealing with for years while taking the pill, but are apparently beyond the coping capacity of men.)

Another option in development is Vasalgel. This polymer contraceptive, intended to be reversible, is currently being tested through not-for-profit social initiative. But even that may not be enough — 42.7% percent of the women who responded to my survey said they wouldn’t trust a male partner, even one with who they were in a committed, monogamous relationship, to handle contraception for them both – which is fair enough, given the bare facts of who can walk away from an unwanted pregnancy.

I’m forced, therefore, to end this article on a giant shrug. Much as I may dream of a contraceptive that doesn’t hurt, is 100% reliable, and doesn’t mess with your hormones (and, well, isn’t abstinence), it’s not clear when that might happen, or what it may be. One thing I’m sure of, though: next time women start saying a medication is making them miserable, we should get the studies rolling ASAP.

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