Time to take another look at the Pill

Michael Cook
Mar 19, 2015
Reproduced with Permission

If there is one request by patients which is spurned by all doctors, without any fear of being labelled paternalistic, it is muscle-bound young men asking for performance-enhancing steroids. Extensive research confirms that anabolic steroids damage the liver and the heart, among other problems.

So, if widespread steroid use is discouraged for men, why haven't the neurological effects on women of the steroid-based contraceptive pill been studied just as thoroughly? After all, the pill is the principal artificial means for controlling population and is currently being used by 100 million women each year. This includes many girls who have just entered puberty. Its cumulative effect could have a significant impact upon society.

Yet up to now only the impact of steroids on men has been the focus of research because hormonal fluctuations during menstruation affected results when women were included in trials. There is less data, therefore, about the effect of steroids on women.

In a challenging article in the open source journal Frontiers in Neuroscience , three Austrian researchers argue that 50 years after its introduction, it is time to assess what the chemistry of the pill does to the female brain.

Their survey of the literature suggests that the effects of the pill vary considerably with age and individual physiology. Finer-grained studies are needed to assess the precise effects of steroids on cognition and emotions and whether their effect is "feminizing" or "masculinizing".

For instance, it is widely accepted that the pill affects women's moods. In most women its use seems beneficial, but sometimes it is associated with increased rates of depression, anxiety, fatigue, neurotic symptoms, compulsion and anger. And these studies may be too positive because depressed women may have dropped out of trials. Most studies have focused only on depression, while other dimensions, like anger or empathy, have hardly been studied. So research into the effects of the pill upon emotions is far from adequate.

One particular area of concern is the pill's effects upon teenagers. The prefrontal cortex of the brain appears to be one target of structural changes in women who use the pill. But this is an area of the brain which is not fully developed until a woman's early 20s. What impact will early contraceptive use have upon teenagers? There is no clear answer.

The authors are not scaremongering. They don't even seem to have any ethical objections to using the pill. They simply set out the state of current research and point out that there are significant gaps in our knowledge.

They write: "As the number of women using oral contraceptives constantly increases, while the age of first contraceptive use constantly decreases down to sensitive neuroplastic periods during puberty, the associated changes in personality and social behavior imply significant consequences for society."

And they are not the first to voice concerns like this.

A well-known article published in 2010 in Trends in Ecology & Evolution found that women who are using the pill are attracted to different types of men and that their own attractiveness to potential mates is disrupted. Evolutionary theory provides a thoroughly unromantic perspective on courtship and marriage, but it makes some sense . If their physiology is working normally, women are primed for compatible partners with whom they will have children. But, says the article, "any drug specifically designed to eliminate ovulation and the associated oestrus psychological and physical changes will have maladaptive side-effects." This could have long-term consequences on the ability of couples to reproduce and the reproductive success of offspring.

However, the authors of this paper noted that "the potential side-effects on a range of women's psychological attributes and behaviour have never been investigated by FDA or drug companies". If drug companies and regulators really had the well-being of women and mothers at heart, the authors contended, they would have done clinical trials to investigate the effects of the pill on mate choice, attractiveness, relationship satisfaction, the probability of divorce and the health of children.

In addition to other suspicions that use of the pill is linked to various cancers and cardiovascular disease, these suggestions ought to be unsettling. They imply that the pill - which is freely prescribed for younger and younger women, married or unmarried -- has never been thoroughly tested by pharmaceutical companies and has been poorly regulated by government authorities. Yet women have been left in the dark. No one discusses these issues.

Why not?

Isn't the answer obvious? The pill has allowed women to be sexually active without fear falling pregnant. They can choose when to bear children and how many they will have. This has opened up new career possibilities and new lifestyles for them.

So there has effectively been a silent trade-off between reproductive freedom and informed consent. Had more questions been asked, had the psychological and social effects of the pill been thoroughly investigated, it might never have been so widely available, especially for teenagers and single women. The regulators would have imposed more conditions and women would have been much more wary of possible side-effects.

Sex in the City comes with a hefty price tag.