How Oral Contraceptive Prescription Oversimplifies Mental Health
“Model of Contraceptive Pill” credited to Wellcome Images licensed under CC BY 4.0, edited through cropping
On October 10th, the government of Canada’s new pharmacare plan became law, now covering a total of 52 kinds of oral contraception (OC) and 78 kinds of contraceptives. If accepted by each individual province, it would no longer require the user to pay out of pocket or through insurance for birth control. However, with this potential increase in the availability of birth control, there simultaneously needs to be increased awareness around hormone considerations when prescribing birth control to women. The over prescription of oral contraception as a blanket solution for other medical problems is harmful due to the complexity and lack of clear understanding of women’s hormone cycles and mental health, which has occurred due to generational stigma around mental and reproductive health.
The complexity of the female hormone structure comes mainly from the menstrual cycle. It has been modernly categorized into three stages, all marked by different levels of hormone fluctuation and different kinds of hormones entering the body. Around day 11, marked by the start of menstruation, there is a rapid spike in estrogen levels, followed two days later by a rapid spike in luteinizing hormone and the steady increase of progesterone. By day 15, the estrogen has rapidly dropped again, along with the luteinizing hormone, yet the progesterone will continue to rise. There is a correlation between mental health and hormones: as outlined above, the rapidly changing proportions of hormones in the female cycle mean that any form of manipulation can have complex effects which should be better understood.
Regardless of any previous mental health diagnoses, most women will experience a significant increase in neuroticism or negative emotions, including but not limited to anxious and depressive episodes due to their changing hormone levels during their menstrual cycles. Most notably, the depression rate between men and women only begins to diverge when women are of reproductive age, and due to different neurological reactions to the hormones involved in the menstrual cycle, some women will experience a larger exacerbation of mood changes during their periods compared to others. Overall, women are affected by hormonal changes, both on as a gender and individually due to individual medical history. This is why it is paramount that when prescribing OCs for non-contraceptive related matters, there must be caution through research and a comprehensive understanding taken.
Over 100 million women across the globe rely on either the estrogen or estrogen and progesterone combination pill for oral contraception. In addition to use for contraception, OCs are prescribed to treat acne and severe cramps. As of 2023, the FDA had approved one over-the-counter non-prescription birth control pill for women, Opill;, however, this OC is a progesterone-only pill, and progesterone-only oral contraceptives have been shown to trigger depressive symptoms in women. There are currently three kinds of OCs that have been approved to treat acne in women by the FDA but carry known risks of depression and mood changes. There are two kinds of OCs that have not been approved by the FDA for acne treatment that are still prescribed for acne control. Additionally, OCs can be used for relieving cramps, but only come with a warning of mood swings or irritability.
The mental health risks that come with the use of birth control are further exacerbated due to mental health stigma still present today. In Canada, 40 per cent of parents would not report to their pediatrician if their child was experiencing mental health concerns. Furthermore, society has a deeply rooted stigma around sexual health that, despite slowly improving within the past generation, is still experienced by both patients and healthcare providers. The stigma surrounding reproductive health prevents patients from seeking proper care and medical professionals from providing it. Having two different stigmas come together surrounding women’s reproductive and mental health demands that women deal with amplified challenges when they are trying to take care of their health.
The overall argument is twofold: with new legislation in North America decreasing the costs of OC, there is a risk of overprescription for women that are not using OCs for contraceptive purposes. There needs to be a push to use other methods of control for acne and period cramps. Moreover, there is a lack of education surrounding the extent that OCs can affect mental health. Each patient has a highly personalized medical history, different family history of mental health disorders, and could subsequently be more affected by OCs than others. The lack of clear communication about the psychological side effects of birth control can cause undue harm to the user and create more apprehension about proper use for reproductive safety due to unnecessary problems caused in the past. Overall, there is a clear need for greater education from doctors and medical professionals regarding the mental health effects of oral contraceptives. Women’s hormonal systems are complex and require appropriate attention to ensure the safe use of these medications and to prevent their overprescription for non-contraceptive purposes.
Edited by Nina Shariff.
Featured Image: “Model of Contraceptive Pill” credited to Wellcome Images licensed under CC BY 4.0, edited through cropping.
