Personalizing contraception – a population health issue

Following Prof. Jenny Higgins’ research on the “pleasure deficit” and birth control use, A PHS 795 student points us to a CNN report on a JAMA Psychiatry study linking hormonal birth control to an increased risk in depression. They write:

The recent release of a research article linking depression to various forms of birth control for females ironically comes just as we finished discussing the pleasure deficit with Dr. Jenny Higgins.  Thankfully this particular CNN article recognizes that correlation is not causation, however, there still seems to be some confusion among the lay public about the relationship between the two.  Correlation versus causation aside, this shows yet again how contraceptive companies ignore the effects contraceptives can have on females, other than their effectiveness of preventing pregnancy.  Women are more likely to stay on their birth control method if the side effects are acceptable to them, and according to this article and others I have read, many women tell anecdotal stories of going off the pill due to the emotional response.  Women want more from their lives, their relationships, and their contraceptives than just preventing pregnancy.  Moving forward, we need to find a more individualized approach to birth control prescriptions in order to determine which will have the most positive impact on the woman’s life.  Women need to be more aware of their options for preventing pregnancy, and the public and physicians need to open up that conversation.  There’s so much silence around this topic that so many women don’t know that if they aren’t happy with their current method, they can and should change it.

This was an observational study with limited ability to control for factors that affect both birth control use and depression, but the results should lead to further investigation.


3 thoughts on “Personalizing contraception – a population health issue

  1. This article on the observational study directly states that it shows a correlation, and not a causation, which I think is a really important fact to make clear in the article. Some people though may read the title, and incorrectly think that birth control causes depression. Maybe this is a miscommunication issue that physicians should be aware of and address when discussing contraceptive options. However, this study could lead to future studies on discovering different confounding factors or perhaps discovering a causation. Either way, I agree that it is important for physicians to talk to their patients about their options, and really understand what they are looking for in contraceptive. The very last sentence of this article is a quote saying how physicians and patients ultimately need “to decide which method of birth control is right for their lifestyle and well-being,” and this is where I see Prof. Jenny Higgins’ research on the pleasure deficit really come into play. Are physicians really taking the time to find the right birth control to fit their patient’s lifestyle and well-being? This individualized approach needs to be addressed more when discussing contraceptives.


  2. I found this article a little frustrating in how it discussed the study. As Erin mentioned above, this is a correlation that was found and the article fails to a street that until almost three quarters of the way through. However, I think this article poses a really important topic – how carefully we test women’s contraception and how important we feel women’s experience of their contraception really is. The pill or oral contraceptives have a history that is fraught with racism and sexism. This article does a great job of laying out this complex history, even if they at times overstate the implications of a correlation, if anyone is curious – From the onset, the pill was going to be given to men and was developed as such. However, men claimed to be too impacted by the side effects and therefore, it was given to women. While I don’t doubt there are many explanations that can and have been made for this, it speaks to a lack of interest in maintaining women’s health outside of her ability to conceive a child, as well as a lack of belief that her sexual pleasure and sexual enjoyment are important as she selects birth control. Professor Higgins work on sexual acceptability really gets at this idea of whether or not a device really works for women both within clinical symptoms, side effects, and their sexual function and enjoyment. I loved reading her inventory for questions clinicians may ask women to help inform their choices of contraception, but I don’t think that matters as long as the medical field doesn’t take the side effects of contraceptives on women seriously. This correlation is important in as much as it should spur rigorous study as to how the pill impacts women over the life course. Many women take the pill for 3-5 years or more. The residual impacts of that and the individual effects it can have on women’s sexual functioning, sexuality, and overall health are largely unexamined. We should work at both expanding counseling for contraceptives around the theme of pleasure, but we should also pressure researchers to study women’s contraceptives and side effects more carefully and have clinicians lay those out for women. Many teenage women are placed on the pill to reduce acne – I am curious if the physicians take the time to explain that the pill may drastically reduce their libido given that teens may continue this prescription for the years that they experience their first sexual relationships.


  3. I agree with Erin’s comment that the article may mislead people about the causation of depression. It is true that correlation can be found in the study of the Denmark professor. However, it is just like Dr. Kathryn Holloway said in the article, depression is a complicate issue which has many related cause factor aside from hormone level. Thus it should not “be taken lightly and a misdiagnosed”. As a result, to quickly jump to conclusion, which the first part of the the article is most likely doing, is a dangerous act that may cause long lasting harm like the measles vaccine incident. I would think that the writer should be more careful about how to present the information about this matter.
    On the other hand, I agree with Erin that this article can serve as a suggestion for further study in contraception, hormonal and non-hormonal. It is also an alarm bell to call out attention, as health care practitioner, in the future that, having an effective contraceptive measure is not enough but how it can fit into a patient’s life is the most important part.


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