Tag Archive for: birth control

Oral Contraceptives & the Autonomic Nervous System: the Effects of the Pill on Your Body’s Autopilot System


Authors: Tania J. Pereira, PhD candidate, Women’s Cardiovascular Health lab at York University| Editors: Romina Garcia de leon, Shayda Swann  (Blog Coordinators).

Published: November 4th, 2022 

It has almost been 100 years since it was discovered that you could make an animal infertile by implanting an ovary from a pregnant animal. This discovery would be the basis for the birth control pill, although it wouldn’t be commercially available until the 1960’s. Since then, multiple variations (known as generations) have been created to reduce the side effects of birth control use – ranging from blood clotting to unwanted weight gain or acne and changes in mood. Thankfully, newer generations of birth control have been made with lower hormone levels – although some of the more minor health-related side effects persist. 

While most side effects are physically visible, what about the unseen consequences? 

Research suggests that within three months of use, birth control changes certain tissue volumes in specific regions of the brain. These regions control our emotions and how we manage emotional information. This means that birth control users could experience more negative and intense emotions. Birth control also changes the connections between different regions associated with higher cognitive function and emotional processing, meaning that birth control may alter mood by affecting how an individual regulates their emotions. 

From these changes, it is understandable how birth control might affect a user’s mood – but could other functions also be altered?

My research focuses on how birth control alters the function of your autonomic nervous system, which controls all unconscious processes, such as heart rate, blood pressure or breathing. The autonomic nervous system is a network of the brain, neurons and the body’s organs. This system is also responsible for your “fight or flight” response. 

More specifically, I am interested in how the body controls these processes in response to exercise. During exercise, key feedback about the physical movement and the metabolic environment of the exercising muscle are sent to the brain. This feedback is used to adjust your heart rate, blood pressure or breathing to support the exercise intensity.

Interestingly, birth control users have lower blood pressure responses to passive movement and handgrip exercise than non-users. Additionally, birth control users breathe more rapidly during handgrip exercise than non-users. Women generally do not increase their blood pressure during handgrip and other studies have observed that birth control rescues the blood pressure response. Both studies used similar exercises and performed the trials at similar times of their pill cycles (i.e., the birth control pill has an active dose phase ~21 days and a sugar pill or no-hormone phase ~7 days). Although, the types of birth controls used in each study were different; the first had increasing hormonal doses over the pill cycle, while the second had the same hormone dose with every pill.

While it is not clear what the effects of birth control are, both studies confirm that birth control use is altering the control of the body’s exercise response. 

There is not a lot of research on birth control, and it is made more complicated by the fact that different types of oral contraceptives can have different effects. Additionally, birth control is not the only form of hormonal contraceptive. There are implants, injections, intrauterine devices, vaginal rings, and patches. Each unique method of administration could present unique altered effects. 

My future research will aim to clarify some of these inconsistencies by more strictly controlling for phases, formulations and generations, as well as expanding the current body of knowledge on alternative hormonal contraceptives. 

Hormones are a complex and fascinating aspect of women’s health that I hope to further explore. 

Oral Contraceptives and Emotions: How Progestin can Influence Mood and Socio-Emotional Cognition

Author: Minhal Mussawar, University of Saskatchewan | Editors: Romina Garcia de leon, Shayda Swann  (Blog Coordinators) 

Published: September 23rd, 2022

Oral contraceptives are one of the most commonly chosen forms of contraception in Canada. Reasons for this include high therapeutic value and status as a cheap and accessible form of contraceptive, but also for their health benefits, such as managing dysmenorrhea, premenstrual syndrome and reducing the risk of ovarian cancer. Hence, they represent a cost-effective way of mitigating and treating many health conditions. Unfortunately, they also come with a number of negative side effects, including nausea, headaches and cramping, and can increase the risk of cardiovascular conditions in some users. Moreover, the likelihood of developing serious complications, such as venous thromboembolisms, can vary depending on whether an individual is taking a combined or progestin-only pill, meaning that certain patient populations may fare better on one type of pill than another. Another health condition that may be influenced by oral contraceptive type is breast cancer, where women who use high-dose estrogen pills are at a higher risk of developing breast cancer than those who use lower doses.

Evidently, there is plenty of research regarding the physiological effects of oral contraceptives on its users. In an age where female participants are being studied more and the scientific community has acknowledged its history of favouring male participants in the past, this type of research has become paramount as it represents a push towards sex inclusivity in literature that was previously non-existent.

Yet, while progress has been made with respect to studying the physical effects of oral contraceptives, less can be said about their cognitive and psychological effects. One study reported mood differences associated with the use of combined oral contraceptives, and another noted differential effects on verbal memory based on whether participants were in the active pill phase (pills that contained the active ingredients of estradiol and progestin) of their birth control or the inactive phase (“placebo” pills). However, aside from generalised research on the effects of combined pills, few studies have assessed the extent birth control can impact a person’s cognitive functioning. Even fewer have separated the effects of ethinyl estradiol and progestin (the two active ingredients in all combined oral contraceptives) and independently studied their effects. Our study aimed to address this issue; we wanted to see how one component of the combined oral contraceptive pill – progestin androgenicity – can affect various cognitive and emotional parameters.

Progestin androgenicity refers to the extent to which a progestin is structurally related to the androgenic hormone testosterone; progestins with high levels of androgenicity tend to bind to testosterone receptors in the body with a higher affinity than their anti-androgenic counterparts. This, unsurprisingly, leads to more androgenic side effects when taking the pill. For our study, we first looked at the existing literature on progestin type and cognitive differences. We found a few papers that suggested users who took oral contraceptives with androgenic progestins performed worse on verbal memory tasks than those who took anti-androgenic contraceptives. Other research suggested that individuals who took oral contraceptives with androgenic progestins performed better on visuospatial and socio-emotional tasks.

Based on this research, we anticipated that individuals taking highly androgenic progestins would yield higher and more accurate scores on social-emotional cognition (emotion recognition and rejection sensitivity) relative to non-androgenic progestin users. Our findings aligned with this hypothesis, as we found that androgenic progestin users were better at recognising negative emotions such as facial expressions of sadness, fear and disgust. Interestingly enough, androgenic users also reported feeling significantly more stressed when measuring their mood on a visual analogue scale compared to anti-androgenic users. Overall, these results indicate that highly androgenic progestins may have a negative psychological effect on users versus anti-androgenic users.

 

 

                                                                

Figure 1. Progestin androgenicity effects on mean stress scores on the Visual Analogue Scale (standard error bars shown). Androgenic users reported feeling significantly more stressed throughout the lab session.

 

Figure 2. Average rate of correct identification (%) for sadness on the Emotion Recognition Task (standard error bars shown). Androgenic users were significantly more accurate at identifying sadness compared to anti-androgenic users.

These findings are consistent with previous research on androgenic hormones and socio-emotional cognition; studies have found correlations between social threat identification and testosterone. Additionally, anti-androgenic progestins have historically been used to treat negative mood in premenstrual syndrome; this makes the association between negative mood and androgenic progestins expected.

So how do we interpret these findings on a larger scale? Well, there are two key implications that arise from this study, the first of which comes from the association between negative mood and androgenic progestin use. As noted earlier, oral contraceptives with anti-androgenic progestins can be used to treat negative mood symptoms in premenstrual syndrome. With this in mind, it may be worth considering progestin androgenicity when prescribing oral contraceptives to this patient population, as well to patients who may be at risk or have a history of depression and anxiety as androgenic progestins could potentially exacerbate any negative thoughts they may have. The second implication comes from how oral contraceptives are viewed in general. Since they are  very common drugs, it can be easy to underestimate their effects, as a result, people who may consider using them may not appreciate how much of an impact they may have on their socio-emotional functioning. In fact, it is not uncommon to hear about people “just going on birth control” once they become sexually active, and while implementing contraceptive measures ought to be encouraged, those who are considering using them should still be informed about their potential side effects. The same goes for people who expect their partners to start oral contraceptives.

This research represents the tip of the iceberg when it comes to studying the psychological effects of oral contraceptives. There are a multitude of other factors at play that should also be considered in light of this study; for example, ethinyl estradiol dose can induce its own effects on users, independent of progestin type. This is also something that we hope to look into further with our research, where our next steps involve assessing the role estrogen plays on the same parameters. We look forward to seeing the results and hope it can help elucidate the role each hormone can play.  

 

Are All Women in Canada Really Free to Choose?


Author: Kennadie Chaudhary, AccessBC Campaign Coordinator | Editors: Alex Lukey and Arrthy Thayaparan (Blog Coordinators) 

Published: February 26th, 2021

Access to contraception, as a reproductive right, is a basic human right. However, many Canadians are unable to exercise this right for a variety of reasons. One of these reasons is the significant barrier of cost. People who can get pregnant are disproportionately affected by the often high costs of contraception. These costs can include between $75 and $380 for an intrauterine device (IUD), $20 per month for oral contraceptives, and up to $180 per year for a hormone injection. Lack of coverage for contraception means youth, people with low-income, and those from marginalized communities face a severe disadvantage when making choices about their bodies. Thus, acknowledging the factor of cost is essential to making universal access to contraception a reality. 

There are numerous benefits to accessible contraception, which are evident in studies in North America and around the world. In Canada, the cost of contraception is almost entirely the responsibility of the user, with few exceptions. This is in contrast to several countries which similarly have universal health care, but have chosen to subsidize prescription contraception, either in full or in part. Countries with universal healthcare that subsidize contraception include over 11 members of the European Union, the UK, Australia, and New Zealand. Countries with universal access to prescription contraception have recognized the social and public health benefits of doing so, and their programs are often revenue positive. A 2015 study in the Canadian Association Medical Journal​ estimated that the cost of delivering universal contraception across Canada would be $157 million. Yet, the savings for direct medical costs of unintended pregnancies alone would be approximately $320 million. 

A Colorado program offering free IUDs to young people saw a 54% reduction in teen pregnancies and a 64% decline in teen abortion rates over eight years. The program came to a cost of $28 million, saving the US government an estimated $70 million. In Canada, about 59,000 adolescent pregnancies per year are unintended. Studies such as the Colorado program show the immense impact that access to contraception can have. Unintended pregnancies are expensive and can significantly alter an individual’s life plans. Further, reducing unintended pregnancies and allowing women to properly space births by providing them with access to contraception prevents over 200,000 maternal deaths worldwide each year.

Access to contraception is not only an issue of health. Contraception is also an issue of gender equality. While condoms are often easily accessible at little or no cost and vasectomies are covered under provincial health insurance plans, people with uteruses face significant barriers to autonomous contraception due to cost and requiring a prescription. Advancing gender equality requires recognizing that the costs of prescription contraception should not disproportionately fall on women alone. Women’s right to decide if and when they want to get pregnant should not be based on what they can afford. The ability to make that decision freely will contribute to the status of women, their right to health, and their empowerment as decision-makers.

AccessBC is a province-wide campaign that advocates for universal no-cost prescription contraception in British Columbia. AccessBC is currently running a letter writing campaign to urge the BC Government to include this policy in the upcoming 2021 budget. You can learn more about AccessBC, the need for, and benefits of, making all prescription contraception universally available at no cost, at www.accessbc.org.

Photo by Reproductive Health Supplies Coalition on Unsplash