{"id":18847,"date":"2023-12-13T12:11:39","date_gmt":"2023-12-13T18:11:39","guid":{"rendered":"https:\/\/naturalwomanhood.org\/?p=18847"},"modified":"2024-04-09T10:59:54","modified_gmt":"2024-04-09T15:59:54","slug":"pilule-contraceptive-pause","status":"publish","type":"post","link":"https:\/\/naturalwomanhood.org\/fr\/birth-control-pill-pause\/","title":{"rendered":"La \"pause pilule\" mensuelle est-elle pr\u00e9judiciable \u00e0 la sant\u00e9 mentale des femmes ?\u00a0"},"content":{"rendered":"\n

A recent study in JAMA Network Open<\/em><\/a> <\/em>found that long-term birth control pill users experienced noticeably worse mental health during the four to seven day phase of placebo pills, also known as a \u2018pill pause,\u2019 each month [1]. (This \u2018pause\u2019 causes a woman on birth control to bleed each month, and is often mistakenly called a \u2018period.\u2019). Researchers speculated that, from a mental health perspective, perhaps the pill pause should be eliminated altogether<\/a> (i.e., that the placebo pills should be eliminated from monthly pill packs). <\/p>\n\n\n\n

But that\u2019s not the only possible takeaway from the data, which we\u2019ll delve into in this article. What\u2019s more, the idea of taking continuous hormonal contraception doesn\u2019t take into account the potential total impact of other birth control side effects or<\/em> the known health benefits of ovulation, the latter of which are inaccessible to women on the Pill, which primarily prevents pregnancy by preventing ovulation. <\/p>\n\n\n\n

Oral contraceptive users who took a pill pause had similar dips in mental health as naturally cycling women<\/span><\/h2>\n\n\n\n

In the study, conducted in Salzburg, Austria, between April 2021 and June 2022, Danish and Austrian researchers tracked mental health data from 180 women. The women were split into three even groups. Two different oral contraceptive (OC) groups were studied to see if the type of birth control mattered for mental health symptoms. All users had been on their birth control pill for 6 months or more. The third group, the control group, was made up of naturally cycling women (i.e., women not on any form of contraception). <\/p>\n\n\n\n

Negative affect (a sense of seeing the world negatively), positive affect (a sense of seeing the world positively), anxiety symptoms, and other mental health symptoms were measured twice in each participant, once during the active pill phase of OC users and once during the pill pause week of placebo pills. Naturally cycling women were measured midway through the luteal phase (the second half of the cycle, following ovulation, when progesterone is highest) and then again during menstruation. <\/p>\n\n\n\n

During the hormonal withdrawal phase, when OC users took the placebo pills, users in both the birth control groups reported increases in mental health symptoms and anxiety. Interestingly, they experienced about the same amount of symptoms as naturally cycling women experienced around the time of menstruation. The researchers observed that withdrawal from synthetic hormones in the Pill appeared to mimic the natural withdrawal from endogenous hormones experienced by naturally cycling women during their periods. Additionally, OC users with mental health symptoms unrelated to their periods reported worse symptoms during the pill pause than OC users who didn\u2019t have mental health issues at baseline. <\/p>\n\n\n\n

Does this mean that a birth control \u2018pill pause\u2019 should be eliminated?<\/span><\/h2>\n\n\n\n

The researchers reported: <\/p>\n\n\n\n

\u201cOur data suggest a significant increase in negative affect, anxiety, and mental health symptoms during the pill pause in long-term COC users, which was (1) irrespective of COC type, (2) moderated by baseline depression scores, and (3) comparable with mood changes observed along the [natural cycle].\u201d <\/p>\n\n\n\n

\u201cOur data suggest a significant increase in negative affect, anxiety, and mental health symptoms during the pill pause in long-term COC users, which was (1) irrespective of COC type, (2) moderated by baseline depression scores, and (3) comparable with mood changes observed along the [natural cycle].\u201d <\/p><\/blockquote><\/figure>\n\n\n\n

The researchers commented, \u201cThese results question the use of the pill pause from a mental health perspective.\u201d They then speculated that \u201cLong-term COC users may benefit more from the mood-stabilizing effects of COCs in cases of continuous intake.\u201d But this isn\u2019t the only possible way to read the data! <\/p>\n\n\n\n

It\u2019s true, as we\u2019ve covered previously<\/a>, that the withdrawal bleed women experience during the pill pause serves no physiological purpose. That\u2019s because a withdrawal bleed isn\u2019t a true period since it doesn\u2019t follow ovulation. Ovulation has real benefits for brain<\/a>, breast<\/a>, bone<\/a>, heart<\/a>, and immune<\/a> health, and<\/em> preps the woman\u2019s body<\/a> for healthy future pregnancies. Women who are on oral contraceptives, i.e. not cycling naturally, miss out on the benefits of ovulation. <\/p>\n\n\n\n

Potential benefits of the birth control pill pause<\/span><\/h3>\n\n\n\n

Keep in mind, too, that some of the many side effects of hormonal birth control use, including increased risk of certain cancers, are likely dose-dependent. The more synthetic hormones you consume and the longer you consume them, the higher your risk. The monthly pill pause may mitigate some of this risk. Research is needed to confirm or disprove this theory. <\/p>\n\n\n\n

Should women take oral contraceptives continuously for mood stabilization?<\/span><\/h2>\n\n\n\n

The researchers referenced the presumed \u2018mood-stabilizing\u2019 effects of specifically long-term (longer than 6 months) OC use. At the same time, they simultaneously acknowledged the significant negative mental health effects associated with oral contraceptive use in many other studies, especially for teen users. How can both these things be true? Does birth control stabilize mood if you take it for long enough? <\/p>\n\n\n\n

Some women undoubtedly suffer mental health problems from OCs<\/span><\/h3>\n\n\n\n

As summarized in a Contemporary OBGYN<\/em> commentary<\/a> on the study: <\/p>\n\n\n\n

\u201cApproximately 407 million women worldwide use hormonal contraceptives, and data has indicated a 1.8-fold increased risk of a first depression diagnosis or antidepressant use in the first few months of [combined oral contraceptive] use, as well as a 2-fold increased risk of a suicide attempt.\u201d <\/p>\n\n\n\n

\u201cApproximately 407 million women worldwide use hormonal contraceptives, and data has indicated a 1.8-fold increased risk of a first depression diagnosis or antidepressant use in the first few months of [combined oral contraceptive] use, as well as a 2-fold increased risk of a suicide attempt.\u201d <\/p><\/blockquote><\/figure>\n\n\n\n

The researchers believed that some women are more hormonally sensitive than others (this has similarly been speculated in research into the connection between hormonal birth control use and postpartum depression<\/a>), and these women are more prone to worsening mental health on OCs. As a result, they\u2019re likely to stop using OCs in the first few months of use. It\u2019s also possible that prolonged OC use gradually makes women more sensitive to hormone withdrawal periods, such as during the postpartum period. <\/p>\n\n\n\n

Some women don\u2019t seem to suffer mental health problems from OCs<\/span><\/h3>\n\n\n\n

The researchers argued that women who aren\u2019t<\/em> hormonally sensitive are more likely to continue taking their OCs long-term, and these are the women who could end up in a study of long-term OC users. This phenomenon is called the survivor effect. It may be, then, that OCs don\u2019t so much stabilize mood if you take them for long enough. What may actually be happening is that women who weren\u2019t as hormonally sensitive in the first place don\u2019t experience worsening mood from their OCs. <\/p>\n\n\n\n

What we don\u2019t yet know<\/span><\/h2>\n\n\n\n

Is the withdrawal phase or the active phase of birth control to blame for its negative mental health effects?<\/span><\/h3>\n\n\n\n

The researchers observed: <\/p>\n\n\n\n

\u201cAlthough it has been reported that women with a history of depression are more susceptible to negative mood symptoms during short-term COC use, 13<\/sup><\/a>,14<\/a>,\u00a052<\/a><\/sup> to the best of our knowledge, this was the first study demonstrating a similar effect in long-term COC users.\u201d\u00a0<\/p>\n\n\n\n

Because the researchers found that the women reported mental health symptoms during<\/em> their pill pause, this might mean that the hormone withdrawal<\/em> (rather than the active ingredients in OCs) is at least part of the problem. For this reason, long-term OC use might stabilize mood to some degree, particularly if there is no pill pause and therefore no hormone withdrawal. <\/p>\n\n\n\n

What are the health effects of steady reproductive hormone levels on the female body?<\/span><\/h3>\n\n\n\n

But more research on the long-term mental health effects of OCs is needed because steady-state reproductive hormone levels in the body (as maintained by OC use if there is no pill pause) don\u2019t naturally occur in the body. Qualitative evidence, such as the research evolutionary psychologist Sarah E. Hill<\/a> shared in her book This is your brain on birth control<\/em>, suggests that after years of OC use, many women reported feeling as though they were \u201cseeing the world in color again\u201d or as if they were emerging from a fog when they stopped taking their pills. Further high-quality studies are needed to assess what years of OC use, especially continuous use, do to mental health in the long run. <\/p>\n\n\n\n