Is there a disregard for the effects of contraception on women's mental health?

[PinkFluffyJumper]

I've just been wondering about this recently as I'm planning on giving up on hormonal contraception following some awful, awful mood swings and depression.

I've read about women whose experiences of this (as a result of hormonal contraceptives) have been disregarded by some HCP.

Given that this seems to be quite common/widespread, why aren't the effects of these drugs on mental health more widely spoken about?

[CajaDeLaMemoria]

They are. I think.

Certainly in the two big areas of the UK I've lived in, the effects are discussed and monitored.

To a certain extent, though, the side effects have to be disregarded. I would hate for my GP to decide I have to change contraception, rather than have that choice myself. If I suffered from any of the side effects, I'd seek help for them separately if I wanted too.

I don't want someone else to make, or attempt to influence, my decision on contraceptives. Unless of course there are serious risks such as DVT.

[PinkFluffyJumper]

That's a good point, Caja, I'd never want a decision like that to be forced upon me.

I'm thinking more about the women who complain of mental health-related side effects to their GP/FPC and are, to some extent, ignored and told to persevere as emotional issues and mood swings are seen as secondary to any physical problems. (This has happened to at least two friends of mine - one was on the mini-pill and the other on Mirena).

[Salbertina]

Interesting.. And v valid.

[hatgirl]

I was taking microgynon for several years no problems, then started experiencing bleeding before the end of the packs and worried that it wasn't working for me any more. GP prescribed loestrin instead... after probably six months of taking it I had a complete and utter mental breakdown after months of very low mood for no apparent reason. It affected friendships (some of which didn't survive - I became very paranoid and withdrew from friendships) and my relationship (which fortunately did survive!).

Went back to the GP about all of this ( me and DP had already self diagnosed it was because of the pill) who offered me Yasmin instead. I said I would think about it and would have a break from taking anything for a month or so... that was 3.5 years ago and I've never been back! No further problems with my mental health whatsoever.

I just don't want to take that risk again plus the years of taking microgynon caused cervical erosion (the cause of the bleeding that led to the change in the first place!) I feel quite strongly that contraception is something women/ media and HCP need to talk more about in terms of both physical and mental side affects

[grimbletart]

My daughter suffered from bad depression in her second year at university. It came out of the blue after a brilliant first year. Being a typical mum I wondered if she had got into drugs, bad trip..whatever. She subsequently revealed that she had started taking the contraceptive pill and it had plunged her into really black despair. Once she made the link and stopped her mood lifted within a week or two.

In later years she tried it again (different brand), same thing happened. She stopped, mood lifted within a week or two again.

I think it could be more common than any think.

[grimbletart]

any = many. Doh.

[FeckOffCup]

I'm thinking of asking to get sterilised because the pill affects my mental health badly, bad anxiety and on and off depression, occasional suicidal thoughts. I don't want the coil for personal morality reasons (I don't agree with the fact that you can still conceive but it stops implantation, I believe that a life is created at conception. I don't want abortion outlawed before I am flamed but for me personally it is not an option, I couldn't live with the guilt). I'm pretty sure they will say no to sterilisation, I'm 31 with one child (don't want more) but I wonder if saying it's for mental health reasons would help my argument.

[YoniMatopoeia]

If you look at the number of people who report problems with the merina coil (mood swings, depression as well as physical symptoms), and say that the gp replies that it can't be their coil,, then I would say that it is either ignored or minimised a lot.

[FloraFox]

I agree entirely Pink. I have never had a doctor raise this with me as a possible consequence of hormonal contraception and I definitely think it is a significant issue. It's not even mentioned as an issue on the Wikipedia page, for example. It's a very good question why this is not being looked at more seriously. Scientists still know relatively little about hormones which makes it quite alarming that so many women are taking hormones for long, long periods.

It's certainly something I will be discussing with my DD when the time comes.

[NiceTabard]

This is a very interesting topic and I agree with the OPs thoughts.

I think it may be linked in with the general approach that seems to happen a lot with women to do with reproductive type issues. A general minimisation of side effects, lack of warning of what might happen, dismissal of symptoms etc.

I had a mirena for a while and I had a host of stuff happen - of course much of it is subtle and you don't know for 100% that it's the mirena rather than a coincidence. But they stopped when I had it taken out.

Incidentally I had to have it out under a GA as the strings had vanished. That was a possibility that was definitely not mentioned to me at any point and yet the woman who first realised when doing a smear said "Oh you're the third this morning where the strings were awol". You'd think the possibility of having to have a GA to remove the thing would be raised - it doesn't sound like a rare occurrence.

Other side effects were permanent low level thrush and of course the ubiquitous low mood.

[NiceTabard]

Also what bothers me is that with the fact they don't really know what tampering with hormones does beyond the immediate effect eg no periods. And yet it is deemed acceptable for females to be on hormones basically from the day they become fertile to the day they die. So never functioning in the way that "nature" intended IYSWIM.

While I think there are huge great things that hormone related drugs and treatments can do, I think there should be much more research into other ways of doing things.

[thecapitalsunited]

I felt like no one would listen to me when I had issues with hormonal contraception. When I came off the pill after realising that my depression had got significantly worse since taking it, I wanted a copper coil and the GP kept insisting that I consider a Mirena right up until I had it fitted. This is despite the fact that I had broken down crying in the GP's office and have a history of depression.

I tried to commit suicide in my teens and I think that the first GP to prescribe the contraceptive pill should have told me that it could affect my mental health rather than try and sell it to me as practically side effect free.

[LurcioLovesFrankie]

Grimbletart - your daughter's experience soubds like it was exactly like mine. Black depression, inability to work (I think in addition to emotional effects, it has cognitive effects - I could not think properly), and complete loss of libido (I found a certain black humour in this - the pill's very high effectiveness compared to other methods is probably because you don't bloody want to have sex any more once you're on it). And I definitely found that my concerns were poo-pooed by health care professionals. I've since found out that something like 1 in 3 women are affected by depression while on the pill. But I think it's seen as acceptable collateral damage for making PIV sex easy. (Don't get me wrong, I'm a big fan of PIV, but I think there is a default societal assumption that any price is worth paying by women for a sex life that allows men to have PIV). The only other time I've found this level of disregard by HCP for my ability to form rational judgements about my own experience was as a new mother - if you tried to form an argument rationally, you were ignored, only losing the plot emotionally was recognised as an acceptable sign that something might be amiss over either your own or your child's health. It does feel like there's a common thread of dismissing women's health experiences as trivial or unimportant.

[Madamecastafiore]

I am about a million times less stressed since having Mirena removed. It's like I have lost the pissed off gene. Have also rediscovered sex, well until getting pregnant again!

I most certainly think mental health is not considered as much as it should be when fecking about with our hormones.

Can you imagine if men were getting the same symptoms we get with hormonal contraception? Actually moody arses would probably be no different other than the sex thing!

[NiceTabard]

It is a good point that if a treatment for men affected their sex drive / performance then it would be a side effect raised carefully with patients and I suspect not considered acceptable in something that was not for quite serious conditions.

The same most definitely does not apply to women. Loss of female sex drive / performance does not seem to be flagged up in the same way or treated as serious.

I think that has many reasons. One is that (I think) drugs used to be tested on men - and it was assumed that the results would apply to everyone - and of course they didn't. I think they found this out first when they tested some pain killers on women.

The second thing I wonder is if it ties in to the idea that sex for women is not that important to them and so it doesn't really matter, and that if their performance is affected (ability to become aroused / orgasm) then that doesn't actually mean sex can't take place. Whereas if a man can't get an erection / come then that is a pretty huge deal, seemingly.

I was on a drug recently which had a side effect of loss of interest / loss of ability to get aroused / near impossible to orgasm and it said in the bit of paper in the packet that might happen. BUT when researching on the net to find out more, many sites only said that men may experience loss of desire / inability to become aroused / inability to orgasm, and said nothing about that exact same side effect applying to women as well.

[AutumnMadness]

Thanks for this topic, OP. While I am sure some GPs are attentive to this issues, it is also my experience that the side-effects of hormonal contraception are largely ignored. My problem, however, was not mental health, but disappearing libido and weight gain. Every time I raised these matters with the family planning clinic, they just offered a different brand of pill, without any consideration for the hormone doses or reputation of the drug. At the end, I gave up the pill entirely and never looked back. I do believe that there is a lack of will in the medical community to discuss the effect hormonal contraception has on women. It would be interesting to see what happens when similar drugs become widespread among men (if ever).

[TolliverGroat]

Anecdotally it's interesting how many women on MN report telling their GP/HCP that they are having depression/mood swings/other mental health issues that have started since they started using [X] method of contraception who are told that there's no possible link even though the manufacturer's monograph clearly lists mental health issues among the known possible side-effects.

In turn that suggests that mental health side-effects are probably being under-reported under the Yellow Card scheme (IIRC you can self-report without going through a GP, but how many people actually do that?).

[Scruffey]

I don't think there is much regard for the mental or physical health of the woman where hormonal contraception is concerned. It's a disgrace.

[Viviennemary]

I've always a feeling that the side effects and long term effects of hormonal contraception is swept under the carpet to an extent.

[FloraFox]

I can't imagine that any hormonal pill for men will be approved or if it was that many men would take it. My Mum used to say that the Pill was approved with very little testing, particularly of the effects of long term use. I found this paper which looks fascinating and I'll read it properly later:

jhmas.oxfordjournals.org/content/57/2/117.full.pdf

And look at this:

en.wikipedia.org/wiki/Barbara_Seaman

I've never heard of her but this is fascinating!

[tribpot]

The public can indeed report an adverse drug reaction via Yellow Card (although for some options like a coil it may need to be reported as a device rather than a medicine).

[TheCrackFox]

Very interesting topic.

From my own experience hormonal contraceptives seriously effect my mental health but doctors don't care/believe me.

[Cluffyflump]

I've often pondered wether gps get some kind of commission for fitting the mirena coil.
I've had many (gps) try to really 'push' it to me, despite my history of pnd.

I have tried just about every form of hormonal contraception and all have had a detrimental effect on my mh.

I am now using the copper coil and although my periods are hell on earth, at least I'm not an emotional wreck, with no sex drive.

I feel strongly that woman's reproductive health (especially pain management) are defiantly feminist issues.

I shudder every time I speak to a friend who has had a cs/ecs and hear that they have been left in agony, trying to pick up their newborns with no help from nursing staff!

It seems to me that a woman's pain, be it physical or emotional is nowhere near as important as a mans in society.

[CognitiveOverload]

I think gps assume the benefits outweigh the unwanted side effects unless a patient says otherwise. I use condoms for this reason.

[FloraFox]

Barbara Seaman was talking about the pill's effect on mental health in 1969 according to this obituary:

www.nytimes.com/2008/03/01/nyregion/01seaman.html

She raised suicidal depression as a side-effect as well as the other, more familiar ones such as heart attack and thrombosis.

She was apparently blacklisted as a writer and pharma companies would pull their advertising from publications which printed her articles (according to wiki).