Anyone who follows scientific research or health-related news will probably have noticed the recent media frenzy about a study, published in JAMA Psychiatry, that has demonstrated a link between hormonal contraception and depression. You can read the paper here.
The study was the largest of its kind, following over 1 million Danish women aged 15-34 over a period of 13 years, and investigating contraceptive use, diagnoses of depression, and prescription of antidepressant medications. They demonstrated that all hormonal methods of contraception studied, including the combined contraceptive pill, progestin-only pill, contraceptive patch, vaginal ring, and intrauterine system, were associated with an increased likelihood of a subsequent diagnosis of depression, and use of antidepressants. The risk was even greater in adolescents.
Although I take an interest in most health-related research, my eyes are always drawn to anything related to a) hormones and b) mental health, due to my own personal experiences. I was first prescribed the contraceptive pill when I was around 13 years old, due to acne, and my miriad of health problems began not long after. I was severely depressed for most of my adolescence and early adulthood, and I always wondered if my contraceptive pill usage was a factor. I first became depressed around the time that I started taking the contraceptive pill, and this recent research suggests that could have been one of the factors that led to my mental health problems.
I’ve also always been convinced that the contraceptive pill was a huge contributory factor to my physical health problems. My recurring viral symptoms first started when my GP switched my contraceptive pill when I was around 15 years old, and they used to happen every single month when I had the pill-free week. The symptoms then completely went away for a couple of years when the pill was changed again, and throughout my life the severity of illness has been very clearly linked to hormonal changes.
I don’t think it’s sensible to blame anyone or anything for a health condition. It would be easy to slate the GP who prescribed a strong oral contraceptive to a 13 year old. It would be easy to see the pill as the devil, the good-for-nothing evil tablet that may have led me to a lifetime of ill health. Maybe, while we’re at it, I should blame myself for taking them? But ultimately, everyone on this planet is just doing the best they can, and both me and my GP obviously thought, rightly or wrongly, that it was the best option at the time.
Nonetheless, I do have concerns about attitudes towards the contraceptive pill, certainly in the UK. GPs seem to be quite keen to prescribe it to anyone who has a vagina. I don’t remember having to beg for the pill at that tender age of 13. In fact, I’m certain it wasn’t even my suggestion – I wouldn’t have known to ask for such a thing, and certainly not for acne. I subsequently spent the next 12 years or so of my life on the contraceptive pill, absolutely no questions asked, despite the fact that I was very sick for much of that time, with a clear link to my menstrual cycle. These days, I’m much more conscious of what I put into my body, and I honestly wouldn’t dream of touching a contraceptive pill anymore.
But yet, when it comes to contraception, it still feels like there is an underlying assumption that it is the woman’s problem. If a couple want to have sex but don’t want a baby, then surely it is a shared responsibility to achieve that? From my own experiences in my early 20s, I remember thinking that the pill was really the only choice. If I wanted a sexual relationship then I basically had to be on the pill. No-one seems to much like using condoms, and no way in hell was I getting a metal device shuffed up my hoo-ha. So the pill it was, and to be honest, I was quite happy with that. I don’t recall anyone ever explaining to me exactly how the pill works, or the potential risks associated with taking it (including as the research now suggests, an increased risk of depression).
In fact, I remember only a couple of years ago, realising via a book I was reading, that the pill completely suppresses your own hormonal cycle. One of its mechanisms of action is to suppress ovulation. No ovulation, no baby. But ovulation is the primary mechanism by which women make sex hormones (oestrogen & progesterone). So no ovulation also means no hormones (or at least, very low levels of hormones). I couldn’t believe it. For all those years, I had effectively been producing next to no hormones of my own, and was taking synthetic ones instead. How is that ok? How is it acceptable that I was doing that for my entire adolescence, without even knowing it? Perhaps I was just naive and stupid for not doing more research, for not knowing that that was what the pill was doing to me. But I sure as hell don’t think I am the only one to have taken those pills without fully understanding its effects.
I really think this reflects a broader issue in healthcare: patient choice. In research we have informed consent. That is to say, anyone taking part in research must provide their consent to take part, after having been provided with all the information they need to make an informed decision. A patient would not be expected to take part in research without knowing exactly what is expected of them, and potential benefits and risks. Why on earth, then, is this principle not applied to everyday healthcare? Surely a patient, as the end-user of the service, has a right to make a choice about whether or not to take a medication? And surely, that decision, should be informed? I don’t expect that my GP, all those years ago, had any inkling whatsoever that the contraceptive pill could have the potential to affect my health so badly, in the way that I believe it has. But there are clear risks associated with the pill, and I should have been provided with all the information necessary to make an informed decision. That is not to say that I would have made a different decision. I had acne, and that made me miserable, and there’s a chance I would still have taken those pills if I had known the potential risks of doing so. But at least I would have been making my own decision based on all the information available. Maybe, then, I would be able to look back on that decision without the pang of regret that I feel now. It is about time that patient-doctor relationships are seen as a two-way process of communication. Not an expert dominating their authority over a naive layman. After all, the patient is the expert of their own body, and surely that is important too?