Independent Study
Birth control is usually not the first thing that comes to mind as the cause of mood swings or weight gain. Anxiety, mood swings, and depression are common side effects, but Kinjal Sagar, now 26, didn’t connect them when she got her first birth control prescription at 22.
She remembers travelling nearly two hours from home to evade the judgment of her family doctor and seeking advice from a more empathetic physician.
“The risks of causing hypertension or cancer were nowhere near,” Sagar said. Initially, when she experienced mood swings, she thought it might be due to her ongoing battle with depression, taking a new form.”
It was through conversations with friends that she began to suspect birth control might be the cause. Realizing her intake of hormonal contraceptives might be the issue, Sagar decided to stop taking them.
Eventually, her partner pointed out her changing behaviour, snapping at small things and suddenly bursting into tears without an apparent reason. He asked if it could be related to her birth control, recalling his sister’s similar experience.
Getting the courage to visit an ob-gyn was a challenge due to the fear of judgment deeply rooted in her.
“It took me months just to get the courage to book an appointment,” Sagar confessed.
“I wanted someone to confirm that my mental health wasn’t entirely to blame, but that side effects were influencing my behaviour and feelings. I didn’t want to keep blaming myself for everything,” Sagar said.
A recent study conducted by researchers at the University of Oxford examined the possible correlation between different types of hormonal contraceptives and breast cancer risk.
In the study, 9,498 women aged 20 to 49 with invasive breast cancer were compared to 18,171 non-affected women.
Breast cancer risk may be increased by hormonal contraceptives of any type, regardless of their specific type.
It challenges the notion that only some hormonal contraceptives might pose a risk. Combining estrogen and progestogens in an oral preparation increased the risk of breast cancer by 23 per cent.
Dr. Jerilynn Prior, an endocrinology professor at the University of British Columbia and an authority in women’s health research, is known for her significant strides in comprehending menstrual cycles, hormonal shifts, and women’s reproductive well-being.
“If you’re harbouring suspicions that your contraception might be triggering feelings of depression or vulnerability, these concerns are not without merit,” Prior said. “This apprehension reaches beyond emotional well-being, encompassing various facets of womanhood within the context of our society.
“This holds true even when considering certain health factors, such as hypertension and other related issues,” she said.
Concerns over mental health and physical appearance have a detrimental effect on women’s quality of life. As a result, Prior said some women may hesitate to start hormonal methods, delay or discontinue them prematurely due to emotional distress, further complicating contraception decisions.
Baneet Kaur, 27, was in her early teens when she was introduced to hormonal contraceptives due to her irregular menstrual cycles.
She said she is unsure about using hormonal contraceptives again after previously suffering from anxiety and despair.
“Knowing how delicately balanced my body is, I don’t want to upset that balance once more,” Kaur said.
“I recall my ob-gyn prescribing birth control pills when I was just 15,” she said. “I experienced intense mood swings, weight gain, frequent headaches, and nausea. I even developed fibroids, which may have been linked to the pills. Who’s to say?”
The thought of risking her mental health, knowing how it can spiral into days where she couldn’t get out of bed, was terrifying.
“Plus, the last time I was on them, I gained weight massively, which further affected my self-esteem and overall well-being,” Kaur said.
She remembers how her ob-gyn provided information about possible side effects, yet one possible side effect, cancer, remained unspoken.
“I was too young to even think about asking,” Kaur said.
After over a decade of prescription renewals, Kaur accumulated more than 100 pills without much consideration, with minimal knowledge of what they were doing to her.
As she delved deeper into online information, Kaur’s perspective began to change. The previously unquestioned faith she had in her pills started to waver and doubts arose regarding their effectiveness and how much they truly benefited her.
Kaur finds herself thinking about the possibility of developing cancer given the latest studies shedding light on the link between hormonal contraceptives and breast cancer.
Claire Knight, the senior health information manager at Cancer Research UK, said hormonal contraceptives such as combined and progestogen-only options can only slightly increase the risk of breast cancer, especially given that their primary users are typically younger than 50, an age group with an already low risk of developing the disease.
Knight suggested that to dramatically lower the risk of developing cancer, women should concentrate on lifestyle choices including quitting smoking, eating a healthy diet, drinking less alcohol, and controlling their weight.
The decision to use contraception should be chosen on a personal level following consultation with a doctor, said Knight, notwithstanding the possibility of advantages and other non-cancer hazards.
The study identified a limitation in its results, indicating that while they had proven short-term connections between hormonal contraceptives and breast cancer risk, they lacked knowledge of potential long-term associations or the impact of the entire length of contraceptive use on breast cancer risk.
Shivangi Gupta, 27, said medical practitioners play a critical role in identifying and evaluating the emotional effects of hormonal contraceptives.
She said in her experience they frequently fell short in failing to recognize the physical effects that these contraceptives may have on health.
“The complexity of women’s mental and physical reactions when using hormonal contraceptives can make it difficult for them to receive support and advice,” Gupta said.
Gupta is aware of the benefits that hormonal contraceptives, but she has also read countless accounts that outline possible drawbacks. She was influenced by her friend’s experience with serious health issues and discovered that she was dealing with similar issues.
She faced a troubling situation when her monthly cycle persisted for three months without stopping, causing her to lose a significant amount of blood.
“The recurring theme during my doctor’s visits was the consistent recommendation to consider different hormonal contraceptives and assure everything would resolve itself. Across four visits to different doctors, the advice remained unchanged,” Gupta said.
“Initially, I was prescribed a seven-day treatment that provided temporary relief, but the issue persisted. My periods would return, and the cycle of symptoms would repeat all over again,” she said.
Gupta’s internal struggle between the desire for effective contraception and the fear of emotional turbulence prevented her from making a decision.
“We still have a lot to learn about the potential effects of taking these drugs, despite all the scientific studies. Since quitting the doses can have a disastrous effect on your emotional and physical health,” she said. “It’s like guiding your body into self-inflicted agony. Once you start, it’s like walking onto a path you’re committed to. It’s daunting that there is also the potential cancer risk uncertainty.
“I’m not willing to roll the dice when it comes to my health,” Gupta said.
Dr. Sarah E. Hill, a psychologist and author of “How the Pill Changes Everything: Your Brain on Birth Control,” explains in her book, “The hormonal contraceptives can modify women’s brain activity and behaviour through the modulation of hormone levels, primarily progesterone and estrogen. These shifts can have repercussions on mood, emotions, and cognitive capacities, influencing choices of partners, social dynamics, and even a woman’s self-conception.”
In the book “How the Pill Changes Everything: Your Brain on Birth Control,” psychologist and author Dr. Sarah E. Hill wrote hormonal contraceptives possess the capability to alter women’s brain patterns and behaviour by affecting hormone levels, particularly progesterone and estrogen.
“Certain adjustments because of contraceptives can impact emotional states, cognitive functions, and even shape preferences in relationships and social interactions, as well as contribute to a woman’s sense of self,” she wrote.
Hill explained hormonal contraceptives can alter or change women’s brain patterns and behaviour by affecting hormone levels, particularly progesterone and estrogen.
Certain changes brought on by contraceptives may affect a woman’s sense of self and her emotional and cognitive states as well as her preferences for relationships and social interactions, Hill wrote.
Shreya Sikka, 28, explored the palpable anxiety surrounding the use of these contraceptives, which is fueled by potential negative effects. She recalled the significant changes in her body because of using hormonal birth control.
“While it might be considered trendy to casually mention being on birth control, the reality is that it doesn’t provide foolproof protection, a truth that some members of Gen Z may either overlook or choose to ignore,” Sikka said.
“It may be fashionable to mention birth control in passing, but the truth is that it doesn’t offer failsafe protection, a fact that some members of Gen Z may either overlook or choose to ignore,” she said.
She speculates many young girls might not be completely informed of the possible side effects, leaving them unprepared for any future alterations.
Furthermore, Sikka draws attention to the widespread belief among her generation that using birth control is cool, frequently just to flaunt the fact that one is “on a pill.”
World Cancer Research Fund (WCRF) data indicates breast cancer accounts for roughly 24 per cent of all cancer cases and is the most often diagnosed cancer in women worldwide.
Breast cancer rates have been increasing over the years, with around 2.3 million new cases reported in 2020.
These numbers underscore the urgency of understanding potential risk factors according to data from WCRF, including hormonal contraceptive use, that could contribute to the development of breast cancer.
Other elements such as hormone replacement treatment (HRT), environmental exposures, genetics, age, and individual medical histories are important. While age and genetics cannot be changed, people can choose to live a healthy lifestyle and keep aware of potential risk factors to lower risk.
Prior said women’s decision-making is significantly impacted by the worry of potential emotional and physical harm.
The general societal stigma surrounding mental health and body image is intertwined with worries about mood swings, weight gain, decreased libido, and other adverse effects.
“I saw there were various levels of understanding of particular negative effects during the study on how women first used birth control. The majority of women were particularly concerned about the possibility of gaining weight,” Prior said.
She said it’s important to note even the lowest dose pills contain estrogen levels about four times higher than those present in a natural menstrual cycle. This heightened hormonal influence can potentially play a role in affecting mood and emotional balance. Furthermore, this factor could potentially contribute to the risk of experiencing depression as well.
Krupa Druv, 26, has been relying on hormonal contraceptives to manage multiple issues.
“The pills regulated my period irregularities and averted unintended pregnancy,” she said. “But as time went on, I began to experience adverse effects that were difficult to ignore.
“I still held to the notion that these medications couldn’t possibly cause such a serious condition as breast cancer,” Druv said.
Her trust in the effectiveness of hormonal contraceptives was reinforced by her ob-gyn’s assurance.
“My ob-gyn thoroughly described all the possible adverse effects and emphasized that there was no chance of malignancy,” Druv said. “I was able to make a decision for my health that was safe because of that certainty.”
Dr. Imran Shahzad, an Etobicoke-based physician, said medical experts are aware hormonal contraceptives containing only progesterone can more significantly affect mood compared to those with an estrogen component.”
But he said using birth control to control periods or other issues is often not a danger.
“I’ve given prescriptions to many of my patients who have taken medications for a long time without experiencing serious health issues or negative side effects,” Shahzad said.
JAMA Network, a medical journal published by the American Medical Association, reports that since 2019, about 1.1 billion women have used family planning services with around half of them choosing hormonal treatments like progesterone-only or estrogen and progesterone combinations.
When used properly, these options, which include pills, implants, and patches, provide effective and reversible contraception. The relationship between hormonal contraceptives and numerous negative outcomes, including cancer, cardiovascular issues, fractures, and metabolic impacts has given rise to inconsistent conclusions.
“It’s critical to understand that depending on an individual’s body type and lifestyle, hormonal contraceptives can have a variety of impacts,” Prior said. “While some women may feel significant alterations, others may not at all notice any changes.,” Dr. Prior said.
Heta Khakhar 