Psychological side effects of hormonal contraception: a disconnect between patients and providers

Insights on the Side Effects of Female Contraceptive Products From Online Drug Reviews: Natural Language Processing-Based Content Analysis

BACKGROUND

Most online and social media discussions about birth control methods for women center on side effects, highlighting a demand for shared experiences with these products. Online user reviews and ratings of birth control products offer a largely untapped supplementary resource that could assist women and their partners in making informed contraception choices.

OBJECTIVE

This study sought to analyze women's online ratings and reviews of various birth control methods, focusing on side effects linked to low product ratings.

METHODS

Using natural language processing (NLP) for topic modeling and descriptive statistics, this study analyzes 19,506 unique reviews of female contraceptive products posted on the website Drugs.com.

RESULTS

Ratings vary widely across contraception types. Hormonal contraceptives with high systemic absorption, such as progestin-only pills and extended-cycle pills, received more unfavorable reviews than other methods and women frequently described menstrual irregularities, continuous bleeding, and weight gain associated with their administration. Intrauterine devices were generally rated more positively, although about 1 in 10 users reported severe cramps and pain, which were linked to very poor ratings.

CONCLUSIONS

While exploratory, this study highlights the potential of NLP in analyzing extensive online reviews to reveal insights into women's experiences with contraceptives and the impact of side effects on their overall well-being. In addition to results from clinical studies, NLP-derived insights from online reviews can provide complementary information for women and health care providers, despite possible biases in online reviews. The findings suggest a need for further research to validate links between specific side effects, contraceptive methods, and women's overall well-being.

Genetic Confounding of the Association Between Age at First Hormonal Contraception and Depression

BACKGROUND

Previous research has shown that females who use hormonal contraception are at increased risk of developing depression, and that the risk is highest among adolescents. While this finding could reflect age-specific effects of exogenous hormones on mental health, genetic liability for mental disorders could be confounding the association. Our goal was to test the plausibility of this hypothesis by determining whether polygenic liabilities for major depressive disorder (MDD), bipolar disorder (BD), schizophrenia (SCZ), and attention deficit hyperactivity disorder (ADHD) are associated with younger age at hormonal contraception initiation.

METHODS

We conducted a cohort study using data from the Danish iPSYCH2015 sub-cohort, a representative sample of people born in Denmark between May 1981 and December 2008. Polygenic scores (PGSs) for MDD, BD, SCZ, and ADHD were created using the most recent genome-wide association study meta-analyses from the Psychiatric Genomics Consortium. Associations between PGSs and hormonal contraception initiation in the following age categories: 10-14, 15-19, 20-24, and 25+ were examined via Cox regression. We examined any hormonal contraception, oral contraception, and non-oral contraception.

RESULTS

PGS-MDD and PGS-ADHD showed the strongest associations with hormonal contraception initiation at age 10-14 (PGS-ADHD: HR = 1.21 [95% CI = 1.16-1.27], p = 6.16 x 10-18; PGS-MDD: 1.21 [1.16-1.27], p = 1.22 x 10-17). The associations then steadily decreased as age at hormonal contraception initiation increased. Both PGS-MDD and PGS-ADHD were also associated with initiation at ages 15-19, but not at 20-24 or 25+. PGS-BD and PGS-SCZ were also associated, albeit not as strongly, with initiation at age 10-14 only (PGS-BD: 1.07 [1.02-1.13], p = 6.87 × 10-3; PGS-SCZ: 1.09 [1.04-1.14], p = 8.61 × 10-4).

CONCLUSIONS AND RELEVANCE

These results suggest that genetic confounding could explain some of the association between early hormonal contraception use and depression. Where possible, researchers studying this important topic should account for possible confounding by genetic liability for mental disorders.

A comparison of the knowledge of hormonal contraception between women living in urban and rural areas of Poland

The Contraception Policy Atlas and its latest 2024 study shows that the availability of contraception in Poland is a meagre 33.5%, the lowest of all European countries. The aim of the research, therefore, was to assess and compare the knowledge of women, living in rural and urban areas of Poland, about the modern methods of the hormonal contraception (HC) they use, includes all hormonal methods (pill, implant, patch, etc.). The study involved 239 women. The research was conducted using an online survey distributed to the public via community forums. The most commonly used method of HC was the combined pill, with 62.27% of the women surveyed using this type of contraception. None of the women surveyed used the emergency contraceptive pill. This finding is concerning given the broader context of contraceptive use in Poland. There were differences in the reasons for contraceptive use according to the place of residence. Women living in rural areas were less likely to use HC to relieve menstrual pain (28.81%) than those living in small and medium-sized towns (47.87%), and also less likely to use HC to regulate their menstrual cycle (27.12%) than those living in small and medium-sized towns (42.55%). Despite the fact that all the women who participated in this study were using HC, 13.39% stated that they did not know how this type of medication affects the female body. There was a tendency for women living in rural areas (20.34%) to be more likely to say 'don't know' than the women from large towns (9.20%). The most commonly indicated side effect of contraceptives on the female body was an increased risk of thromboembolic events (70.71%).

Associations between oral hormonal contraceptives and internalising problems in adolescent girls

BACKGROUND

Oral contraceptive pills (OCP) have received increased critical attention recently owing to their perceived link with mental health, especially among adolescent girls. The empirical literature, however, includes mixed findings on whether OCP use is associated with poorer mental health.

AIMS

To examine the association between the use of OCP and internalising problems in adolescent girls.

METHODS

This study was embedded in the iBerry study, a population-based cohort of adolescents oversampled for behavioural and emotional problems from the greater Rotterdam area, The Netherlands. In 372 girls, internalising problems were measured using the Youth Self Report, and use of OCP was determined by parental interview and self-report questionnaire across two subsequent waves (mean ages 14.9 and 17.9 years, respectively). Multiple regression analyses were performed to determine the association. Analyses were adjusted for various sociodemographic factors and adjusted for previous internalising problems assessed at a mean age of 14.9 years.

RESULTS

In total, 204 girls (54.8%) used OCP. OCP use was associated with fewer internalising problems in adolescent girls compared with non-use (adjusted β = -2.22, 95% CI [-4.24, -0.20]; P = 0.031).

CONCLUSIONS

In this research, we found that adolescent girls using OCP reported fewer internalising problems compared with non-users. This association was most prominent for girls with pre-existing internalising problems. Although healthy user bias may have a role, our observations suggest a potential therapeutic benefit for those with greater baseline challenges.

The relationship between hormonal contraceptives, level of anxiety and emotional awareness: pilot project

An important part of the side effects of combined oral contraceptives (COC) usage is its psychological impact, which includes mood changes, anxiousness and depression. The psychological impacts are expected to be caused by physiological fluctuations of sex hormone levels during the menstrual cycle; this cycling is, however, suppressed in COC users. In our study, we assessed the differences in emotional awareness and anxiousness between women long term users of anti-androgenic COC (AA) and women with no COC use in their medical history (C). We also searched for intraindividual differences by comparing the results of both groups for the follicular and luteal phase of their cycle. A total of 45 women aged 18 to 22 participated in this study. The respondents were given our battery of questionnaires at the beginning of their follicular phase - this battery included two State-Trait Anxiety Inventory questionnaires (STAI-I, STAI-II), as well as a Levels of Emotional Awareness Scale (LEAS) test. The respondents were given only STAI-I in their luteal phase. We also analyzed the hormonal profile of our respondents. Our results show a significant difference in the LEAS analysis, implying the possibility of altered emotional awareness in AA group. STAI-I and STAI-II analysis did not yield any significant results, showing that anxiety levels of COC users probably do not differ from the general female population. We therefore discovered lower emotional awareness in COC using women (AA). Key words LEAS, STAI, Combined oral contraceptives, Anxiety, Hormonal profile.

Feasibility of a contraceptive-specific electronic health record system to promote the adoption of pharmacist-prescribed contraceptive services in community pharmacies in the United States

Objectives

Pharmacists in over half of the United States can prescribe contraceptives; however, low pharmacist adoption has impeded the full realization of potential public health benefits. Many barriers to adoption may be addressed by leveraging an electronic health records (EHR) system with clinical decision support tools and workflow automation. We conducted a feasibility study to determine if utilizing a contraceptive-specific EHR could improve potential barriers to the implementation of pharmacist-prescribed contraceptive services.

Materials and Methods

20 pharmacists each performed two standardized patient encounter simulations: one on the EHR and one on the current standard of care paper-based workflow. A crossover study design was utilized, with each pharmacist performing encounters on both standardized patients with the modality order randomized. Encounters were timed, contraceptive outputs were recorded, and the pharmacists completed externally validated workload and usability surveys after each encounter, and a Perception, Attitude, and Satisfaction survey created by the research team after the final encounter.

Results

Pharmacists were more likely to identify contraceptive ineligibility using the EHR-based workflow compared to the paper workflow (P = .003). Contraceptive encounter time was not significantly different between the 2 modalities (P = .280). Pharmacists reported lower mental demand (P = .003) and greater perceived usefulness (P = .029) with the EHR-based workflow compared to the paper modality.

Discussion and Conclusion

Pharmacist performance and acceptance of contraceptive services delivery were improved with the EHR workflow. Pharmacist-specific contraceptive EHR workflows show potential to improve pharmacist adoption and provision of appropriate contraceptive care.

Family Planning for Patients With Inflammatory Bowel Disease in the Post-Dobbs Era

Federal protections for abortion care in the United States ended in June 2022. For people with inflammatory bowel disease (IBD) who are capable of pregnancy, the implications of an unwanted or mistimed conception, particularly in the setting of active disease flares or teratogenic treatment, are precarious and geographically variable. Prioritizing evidence-based and person-centered counseling for preconception health and contraceptive care needs is important during health care visits and not limited to reproductive health providers. Development of multidisciplinary clinics or complex contraception clinics in high-volume IBD centers can support time-sensitive counseling and services for patients. This article reviews reproductive considerations for people with IBD, particularly in the setting of legislative restrictions in the post-Dobbs landscape.

Common Mental Disorders and Associated Factors During Pregnancy and the Postpartum Period in Indonesia: An Analysis of Data From the 2018 Basic Health Research

OBJECTIVES

A substantial proportion of women experience mental health challenges during pregnancy or the postpartum period. Common mental disorders (CMDs), including depression, anxiety, and obsessive-compulsive disorder, are prevalent. Identifying causes and associated risk factors is imperative for early intervention and the prevention of mental health issues.

METHODS

This study utilized data from the 2018 Basic Health Research, which was conducted nationwide in Indonesia, using a crosssectional approach. We focused on women aged 13-49 years who were currently or previously married, and had experienced pregnancy, including 8889 pregnant women and 77 012 women who had delivered between January 1, 2013 and August 31, 2018. The Self-Reporting Questionnaire-20 was employed to assess CMDs. Multivariate logistic regression was performed.

RESULTS

The prevalence of CMDs in pregnant women was 12.6%, while postpartum mothers exhibited a prevalence of 10.1%. Poor health status displayed the strongest impact on CMDs during both pregnancy (adjusted odds ratio [aOR], 12.23; 95% confidence interval [CI], 9.01 to 16.60) and the postpartum period (aOR, 16.72; 95% CI, 14.85 to 18.82). Additional significant factors for both group include young maternal age, lack of education, unemployment, history of hypertension, and smoking status. Among pregnant women, CMDs was also associated with first-trimester pregnancy, previous pregnancy complications, and small upper arm circumference. For postpartum mothers, significant factors include living in rural areas, history of abortion, unwanted pregnancy, pregnancy complications, lack of antenatal care, spontaneous delivery, postpartum complications and contraceptive use.

CONCLUSIONS

CMDs can impact in pregnant and postpartum women. Early diagnosis and management must be seamlessly integrated into primary healthcare practices.

Understanding the Interplay Between Premenstrual Dysphoric Disorder (PMDD) and Female Sexual Dysfunction (FSD)

Premenstrual dysphoric disorder (PMDD) is a severe variant of premenstrual syndrome (PMS), categorized as a mood disorder due to marked symptoms of depression and anxiety, compounded with severe physical symptoms. Female sexual dysfunction (FSD) can manifest as low libido, difficulty achieving sexual pleasure, and dyspareunia, causing functional and psychological distress. PMDD and FSD are globally prevalent conditions with postulated biological, psychological, and social associations between them. Nevertheless, sexual dysfunction in PMDD is an important aspect of women's health that has been understudied and has notable methodological limitations. In this narrative review, we summarize the existing literature on sexual function in women with PMDD and PMS, specify the distinctions between PMDD and other general symptoms of PMS, highlight the significance of understanding sexual dysfunction in the female population, and outline some available therapeutic options. Studies show that women frequently experience debilitating sexual distress during the premenstrual phase; however, there is an essential need to formulate standardized tools for definite diagnosis. Selective serotonin re-uptake inhibitors (SSRIs) and combined oral contraceptive pills (COCPs) are approved medications for PMDD, while flibanserin and bremelanotide are effective in treating FSD. However, the potential effects of these treatment modalities on the two comorbid conditions render them inconclusive. Awareness of PMDD and FSD among clinicians and society can allow the implementation of targeted interventions to alleviate the suffering of women and enhance their quality of life.

The effect of lavender on mood disorders associated with the use of combined oral contraceptives (COCs): a triple-blinded randomized controlled trial

BACKGROUND

The use of contraceptive methods is influenced by their effectiveness, availability, and minimal side effects. OCPs are one of the most effective and widely used methods of pregnancy prevention worldwide. This method not only prevents pregnancy but also helps prevent and treat other diseases. One of the main reasons for discontinuing this method is the emotional disturbances associated with its use. Lavender is an evergreen, fragrant plant that has gained significant attention for its anti-anxiety effects. This study was conducted to investigate the effect of lavender essential oil capsules on mood disorders during the use of COCs.

METHODS

This triple-blinded clinical trial was conducted on 60 married women (aged 15-49 years old) who were consumers of COCs, referring to 26 health centers in Tabriz, Iran. The participants were randomly assigned to either the intervention (consuming one gelatin capsule containing 80 mg LEO daily) or control (consuming one placebo capsule daily) group. The intervention continued for 56 days. Scores for positive and negative were determined using the Positive and Negative Affect Schedule (PANAS) questionnaire; and for stress, depression, and anxiety were measured using the DASS-21 questionnaire on day's 28th and 56th post-intervention. Data analysis was conducted using the t-test and ANOVA with repeated measures, and a p-value of < 0.05 was considered significant for all analyses.

RESULTS

A statistically significant difference was observed in mood disorders, stress, and depression between women receiving LEO or placebo. The consumption of LEO increased the positive mood on day 28 [MD (95% CI): 4.5 (2.1 to 7.0), p = 0.001] and day 56 [5.9 (3.4 to 8.3), p < 0.001] while decreased the negative mood on day 28 [MD (95% CI): -3.5 (-5.3 to -1.3), p < 0.001] and day 56 [-4.3 (-6.3 to -2.2), p < 0.001], stress on day 28 [MD (95% CI): -4.9 (-7.1 to -2.8), p = 0.001] and day 56 [-5.3 (-7.6 to -3.1), p < 0. 001], and depression on day 28 [MD (95% CI): -3.0 (-4.9 to 1.1), p = 0.003] and day 56 [-3.1 (-5.0 to 1.2), p = 0.002]. There was no statistically significant difference between the two groups in terms of anxiety.

CONCLUSIONS

The consumption of LEO with COCs improved mood disorders and reduced stress and depression. The use of hormonal contraceptives and mood changes should be considered by providers. Therefore, regarding the possibility of mood changes, it is expected that appropriate counseling and education will be provided to women who consume COC., providing appropriate solutions, including the simultaneous use of LEO.