Contraception Feminism Health

Psychobehavioral Effects of Hormonal Contraceptive Use

Written by Andy

Here is an extract from a research paper titled: “Psychobehavioral Effects of Hormonal Contraceptive Use” by Lisa L. M. Welling, Psychology Department, Oakland University, Rochester, Michigan, USA. There are some worrying statements:

Abstract: Although female use of hormonal contraceptives (HCs) has been associated with a variety of physical side effects, the psychological and behavioral side effects have received comparatively little attention until recently. Indeed, the long-term impact of HC use on human psychology has been vastly under-researched and has only recently become a focus for mainstream scholars. Women who use HCs report higher rates of depression, reduced sexual functioning, and higher interest in short-term sexual relationships compared to their naturally-cycling counterparts. Also, HC use may alter women’s ability to attract a mate, as well as the mate retention behaviors in both users and their romantic partners. Some evidence even suggests that HC use alters mate choice and may negatively affect sexual satisfaction in parous women, with potential effects on future offspring. Interestingly, HCs have become a standard method of population control for captive nonhuman primates, opening up exciting avenues for potential comparative research. Here, the existing literature on the psychobehavioral effects of HCs in humans and nonhuman primates is reviewed and discussed. The potential resulting downstream consequences for the path of human evolution and recommendations for how future research could tease apart the underlying causes of these psychobehavioral effects of HC use are discussed, including suggestions for research involving nonhuman primates.

Further into the paper you can find:

  • In 2007 in the United Kingdom, 40-54% of women aged 16-34 and 27% of women under the age of 50 reported currently using the most popular form of HC, the oral contraceptive pill (Lader, 2007). From 2006-2008, the number of US women who had ever used the oral contraceptive pill stood at 82%, with 22% of women having used an injectable or shot (Mosher and Jones, 2010).
  • High proportions of HC users can be found in developed nations as well as in emerging and developing economies (United Nations, 2009).
  • However, this popular method for avoiding unintended pregnancy is not without physical, mental, and behavioral side effects, including possible effects on mate choice and offspring health. Given the worldwide popularity of hormonal contraception, any potentially disruptive effects of HC use, such as effects on affect, mate choice, and/or influences on offspring health (discussed below), need to be considered, as the widespread use of HCs over several generations may then prove to be an important issue.
  • In normally-cycling women, follicle-stimulating hormone (FSH) promotes the growth of immature egg follicles in the ovary during the first phase of the cycle, termed the follicular phase. Luteinizing hormone (LH) surges instigate the release of a mature ovarian follicle at ovulation, causing progesterone levels to increase steeply in the luteal (second) phase of the menstrual cycle. If implantation of a fertilized egg does not occur, then progesterone and estrogen levels decrease and menstruation occurs. HCs work by preventing the release of gonadotropin-releasing hormone (GnRH) from the hypothalamus, thereby blocking a signal to the pituitary gland to produce FSH and LH. This inhibits follicles from maturing/releasing and causes the ovaries to be relatively dormant. Therefore, daily use of HCs mimics the hormonal state of pregnancy by increasing and flattening a woman’s levels of both progesterone and estrogen, resulting in the prevention of ovulation and a loss of normal fertility (reviewed in Alvergne and Lummaa, 2009).
  • High-dose HCs are associated with uterine tumors, mammary gland tumors, and mammary gland intraductal hyperplasia, although use of high-dose HCs is no longer standard (Valerio, 1989).
  • However, HC use is also associated with a variety of negative physical side-effects, such as an increased risk of venous thromboembolism (Bloemenkamp et al., 1999; Farmer, Lawrenson, Thompson, Kennedy, and Hambleton, 1997; Farmer and Preston, 1995; Lidegaard, Edström, and Kreiner, 2002; Parkin, Skegg, Wilson, Herbison, and Paul, 2000; Spitzer, Lewis, Heinemann, Thorogood, and MacRae, 1996), myocardial infarction (Lewis, Heinemann, Spitzer, MacRae, and Bruppacher, 1997; Lewis, Spitzer, Heinemann, MacRae, and Bruppacher, 1996), ischemic stroke (Heinemann et al., 1998; Kemmeren et al., 2002) (see also Cole, Norman, Doherty, and Walker, 2007), and weight gain (e.g., Molland et al., 1996). HC users also experience more sleep disruption than non-users (Shine Burdick, Hoffmann, and Armitage, 2002) and are at a higher risk of acquiring gallstones (Etminan, Delaney, Bressler, and Brophy, 2011). Additionally, there is some, albeit limited, evidence that HC use may be associated with an increased risk of migraines (Allais, Gabellari, De Lorenzo, Mana, and Benedetto, 2009), high blood pressure (Fisch and Frank, 1977; Weir et al., 1974), cervical cancer (Delgado-Rodriguez, Sillero-Arenas, Martin-Moreno, and Galvez-Vargas, 1992; Moreno et al., 2002), breast cancer (reviewed in Marchbanks et al., 2002), and fetal abnormalities (reviewed in Waller et al., 2010). Despite these slightly elevated health risks, it is generally agreed that HCs are a safe means of effectively preventing pregnancy.
  • Recently, researchers have documented negative effects on mood and psychological well-being as a consequence of HC use in women (Bancroft, Sanders, Warner, and Loudon, 1987; Herzberg and Coppen, 1970; Kahn and Halbreich, 2001; Kurshan and Epperson, 2006; Oinonen and Mazmanian, 2002). DeSoto, Geary, Hoard, Sheldon, and Cooper (2003) found that women using HCs exhibited more symptoms of borderline personality disorder (BPD), a disorder characterized by a pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image (Lieb, Zanarini, Schmahl, Linehan, and Bohus, 2004), and that women with high pre-existing levels of BPD symptoms became significantly worse after starting HC use (DeSoto et al., 2003). Sanders, Graham, Bass, and Bancroft (2001) found that negative changes in emotional and sexual well-being were important predictors of discontinuation of oral contraceptives (see also Graham, Ramos, Bancroft, Maglaya, and Farley, 1995; Rosenberg and Waugh, 1998; Rosenberg, Waugh, and Meehan, 1995)
  • HC users describe higher rates of depression (e.g., Kulkarni, 2007) than normally cycling women.
  • HCs appear to influence sexual behavior, with reported or apparent reduced sexual functioning and interest in humans (Bancroft et al., 1987; Caruso et al., 2004; Graham et al., 1995; Sanders et al., 2001; Wallwiener et al., 2010; but see Caruso et al., 2005)
  • However, human female HC use is also associated with a greater number of reported sexual partners (Little, Jones, Penton-Voak, Burt, and Perrett, 2002) and significantly greater interest in engaging in short-term sexual relationships across all phases of the menstrual cycle (Guillermo, Manlove, Gray, Zava, and Marrs, 2010), indicating that women who choose to use HCs may differ from others in their degree of sociosexuality. Still, whether a higher number of sexual partners is the cause or the consequence of the use of contraception is unknown.
  • HCs seem to, in some ways, limit women’s ability to attract mates.
  • Additionally, although the voices of normally cycling women become more attractive near ovulation, potentially allowing women to be better able to attract high quality mates when fertility is high, this effect of changing vocal attractiveness is not observed in those using contraceptive pills (Pipitone and Gallup, 2008).


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