We answer commonly asked questions about the Pill
THE PILL AND BONE DENSITYA 2010 study published in the Journal of Clinical Endocrinology and Metabolism found young women on low-dose oestrogen pills had a six per cent lower spinal bone density than non-users.
What’s happening? Natural oestrogen peaks can stimulate bone growth, but the pill keeps oestrogen levels steady, says study author Dr Delia Scholes.
“What we don’t know,” says Scholes, “is what happens to your bones when you quit the pill.”
In other words, though it might negatively affect bones, there’s no proof that taking the pill leads to osteoporosis or bone fractures.
THE PILL AND BLOOD CLOTSPill users are at a slightly higher risk of venous thromboembolism (VTE), blood clots that form in the legs. But risk depends on the type of pill.
A study in the BMJ found women on pills with drospirenone – a new synthetic progestogen – were about three times more likely to develop VTE than those on pills with an older progestogen, levonorgestrel. Even with drospirenone, the rate is only three in 10,000.
That slim possibility “shouldn’t be a deal breaker,” says gynaecologist Dr Ashlesha Patel. If you have a family history of blood clots, ask your GP about the ingredients in your pill.
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THE PILL AND CANCER RISKWhether or not the pill’s artificial oestrogen increases a woman’s breast cancer risk is still up for debate. A recent Boston University, US, study found that some pill takers had a 65 per cent higher risk of developing breast cancer than non-pill-takers.
However, a study published in the New England Journal of Medicine found the opposite – that past or current pill use did not affect breast cancer risk. The current bottom line is that if you’re already at high risk (if you have a family history) you should always get a second opinion before taking the pill.
THE PILL AND YOUR EMOTIONSEver heard a woman say the pill makes her a crazy, moody she-devil? So far there are very few published clinical studies linking depression or anxiety directly to pill use.
Professor Jayashri Kulkarni, the director of Monash Alfred Psychiatry Research Centre in Melbourne and an expert in women’s mental health, is conducting an observational study due to be finished next year on the pill’s mental health side effects – something she believes affects millions of women.
“I’m not just talking about clinical depression or women who have a family history. We have many case studies of women who say that the pill makes them feel flat, or grey, or not quite themselves, or that they feel vague, or irritable or hostile. Then they come off the pill and suddenly things improve.”
In her research so far Professor Kulkarni has found women taking the pill were almost twice as likely to be depressed compared with those not on the pill.
It’s complex figuring out whether tampering with your natural hormone levels is what’s making you crabby. “Natural hormonal changes that occur in a menstrual cycle will affect our mood anyway. The majority of women get at least one premenstrual symptom, and sometimes going on a contraceptive pill can actually level out the ups and downs,” says sexual health physician Dr Terri Foran.
It’s established that oestrogen and progestogen alter the brain’s nerve circuits and affect your brain, and hormones have been linked to our moods since at least, ooh, the first time Eve cracked the shits at Adam in the garden of Eden. But science doesn’t know exactly how this works.Whether taking the pill levels out your moodiness or makes you feel like jabbing a pen in your colleague’s eye could be to do with the type of pill you’re taking. Most contraceptive pills today contain both progestogen and types of oestrogen, but at varying doses.
But other types contain only one or the other hormone. Professor Kulkarni’s study results so far indicate it’s the progestogen that could be associated with lower mood.“Progestogen-only contraception – the mini pill, Depo-Provera [the hormonal contraceptive injection] and Implanon [a hormonal contraceptive subdermal implant] – seem to create a worse depressive profile for those
women who are vulnerable.”
The hormone oestradiol (a type of oestrogen) on the other hand has been found to help women level out mood swings, which is why doctors often prescribe the pill to help treat PMS. A study from the University of Albany, US, found oestradiol decreased anxiety and depression in mice.
“It is a neuroprotective agent, so it’s actually quite good for mental state because it has that capacity to be like an antidepressant in the brain,” says Dr Kulkarni.