Recently, in a piece for the Ms. Magazine blog, re:Cycling’s Elizabeth Kissling remarked on the lack of media coverage of serious safety issues with the popular birth control pill brands Yaz and Yasmin. Of the coverage there has been, little has looked beyond the significant number of injuries and deaths caused by blood clots to the potential dangers held in the negative psychological impact of these drugs, an impact that it appears a large number of women may have experienced.
As I read the stories of women who had suffered strokes or gone blind, I wondered how many women using Yaz or Yasmin had also been driven close to death, or perhaps even died, due to the depression the pills can provoke.
I decided to interview Dr Jayashri Kulkarni at Australia’s Monash University, one of the few people researching into this area, to find out more. As a practicing psychiatrist Dr Kulkarni treats women with mental health issues as well as leading research studies into this possible root cause of psychological problems.
Of the potential for these pills to create suicidal tendencies in users Dr Kulkarni says, “We have seen amongst women using these oral contraceptives a profound lowered self-esteem which causes them to lose perspective, misinterpret comments, and feel like no one would notice, or the world would be better off, if they weren’t around anymore. We’ve seen suicide attempts.
Dr Kulkarni is undertaking both a large-scale national and international survey of women’s subjective experiences with Yaz, Yasmin, as well as the Mirena IUD, Depo Provera shot, and Implanon implant and a smaller scale in-clinic study of the impact of oral contraceptives like Yaz and Yasmin on women over a three month period. The psychological impact is not what she calls “major depression” but instead a “sub-clinical depression” wherein women experience a mood change that impacts their relationships, work, and overall happiness.
“This depressive syndrome has a spectrum of symptoms. We tend to think depression just means sadness, but it can present as fuzzy headedness, inability to multitask, guilt, irritability, anxiety, and in behavioral changes like the development of obsessive compulsive disorders. Women experience a change in perspective that makes them magnify issues that occur in their lives, be that a slight weight gain or an argument with a partner, into feelings of worthlessness. It can also cause impulsivity, making the woman suicidal.”
At her clinic Dr Kulkarni describes treating a mother who found it difficult to let her children go to school for fear something would happen to them and another who became transfixed with the idea that her partner was cheating, and so called his phone repetitively to check on him. She believes that the provoked anxiety can display itself clearly as panic attacks, but it can also appear as paranoia and agoraphobia. When taken off Yasmin and Yaz these women returned to their previous state with a healthy perspective.
The Depo Provera shot and Implanon implant have shown in the research to also cause particularly profound depression. For women who have a history of mental health issues or have environmental factors that make them more vulnerable to mental health issues, these methods have been seen to provoke serious negative changes in mood.
Dr Kulkarni’s hypothesis is this: “Low estrogen pills and progesterone-only methods seem to cause depression at the highest rate. In our research we’ve seen women respond better to higher dose estrogen and natural progesterones. Clinical studies on animals have shown progesterone in a low dose causes increased anxiety, but conversely in a high dose it alleviates anxiety.” Her findings will be published later this year in full.
At present Dr Kulkarni treats her patients by changing their hormonal birth control method with her research in mind, a practice she believes to be generally successful. She prescribes new pill Zoely to patients who have responded badly to other brands. Zoely (which contains 2.5 mg of nomegestrol acetate and 1.5 mg of 17-beta-estradiol) was refused approval by the FDA for the US in 2011.
There are only a handful of studies available on the impact of hormonal birth control on mood. Dr Kulkarni admits that it is difficult to find funding and support for such research. Ideally she would want to have a study of 60,000 women on different brands of pill across two or three countries who would be followed over a period of two years. However she feels compelled to continue with this line of investigation to “validate” the experiences of the women she sees every day who have developed symptoms of depressive syndrome when on hormonal birth control.
“Working as a psychiatrist it was very obvious to me that women were presenting with depressive symptoms and that this was connected to their choice of birth control. I built what I was hearing from women into a research project because I have a passionate belief that women have the answers. Yet they tell their doctors what they know is going on and they don’t feel heard. I want their experiences to be validated by providing evidence that this is indeed happening.”
Considering millions of women worldwide take hormonal birth control and many may be experiencing these serious mental health side effects – not to mention that some of the worst methods are currently the most popularly prescribed – why does this potentially huge problem get so little attention?
“I have a horrible, uncomfortable feeling that it is because women’s issues are just not seen as important or given priority,” Dr Kulkarni admits, “I think underpinning the disinterest is the idea that this is a woman’s choice. Women don’t have to use these drugs, so we don’t have to research side effects. We have conservative groups who are anti-contraception and they don’t think women should be using these drugs anyway. Then we have the feminists who feel the pill was the best thing to ever happen to women and that it freed them to achieve all of their goals. They think by doing this research we’re attacking the pill. In between these two forces the area of safety and side effects does not receive the attention it should. We need to educate women that these side effects are possible, and we need to education their medical practitioners so that they listen to women when they say the problem is the pill.”
This is an important issue. However, I wonder if Dr. Kulkarni is seeing a representative sample of women who take oral contraceptives. After all, they’re seeing her for depression, not gynecological care. Perhaps there are other factors at work besides and/or in addition to the Pill?
There are good reasons why the FDA refused to approve Zoely (aka NOMAC/E2) — although touted as a “natural” estrogen, the relatively high dose of estrogen increases the risk of blood clots and other complications. So, it appears no safer than Yaz or Yasmin and may even be more dangerous.
Thank you Holly for keeping us in touch with the research and the growing concern and dialog about the problems with contraceptive endocrine disruptors.
Clio – you’re right. Dr Kulkarni suggests pills with higher estrogen cause less emotional side effects. I would say the trade-off is clearly higher risk of serious physical side effects.
In regards to Zoely – I did respond to Dr Kulkarni during our interview that it sounded like Zoely was just another touted miracle pill like Yaz and Yasmin and that it could possibly lead us down a similar road of problems, with a large number of women going on it and a large number experience problems.
The studies she is conducting – the larger one is using questionnaires sent into the clinic from all over Australia, so it does sample a lot of different women. The other smaller studies in-clinic, she’s not using her own patients and she’s actually putting the women on pills and following them over three months. My criticism, which I put to her, is that many women won’t feel they experience noticeable issues until after some time, maybe even years. But, obviously, as I point out here, funding is the reason for the restrictions.
I disagree with Dr. Kulkarni that lack of research into these issues related to the pill is because women’s issues or not given priority. The truth is much closer to what she says farther on: that feminist groups, and I’ll add mainstream pro-choice sexual and reproductive health-care providers and educators, are terrified of any research that may suggest the negative effects of hormonal methods of birth control may outweigh the benefits for many women.
They have to get their act together to start serving women who have already ditched these methods by a) acknowledging the validity of their concerns, and b) developing programs that help women use barrier and fertility awareness methods effectively and confidently. Until they do both of these things, the urgent need for which is readily apparent, they will not be open to supporting the kind of research Kulkarni is doing, nor can they be considered to be meeting their mandate for self-determined decision-making and choice around contraceptive issues.
Laura this is a good point – part of the problem is the pressure to present a united front against anti-choice, anti-birth control, anti-sex education opponents. How can we have a nuanced discussion about safety without giving ammunition to the enemy?
I find that unfortunately “the enemy” has an awful lot of good, important stuff to say on this issue – so much so that I’m not always sure who “the enemy” really is as far as I’m concerned – the feminist media pundit who ignores this issue entirely or the religious-minded Catholic who’s anti-abortion, sure, but mostly keeps that to herself, and talks openly and honestly about hormonal birth control’s pitfalls. In the end, of course, the enemy isn’t one person or another, or even one group or another, because surely there’s misogyny in fundamentalist religion and misogyny in the acceptance that healthy women need to be medicated, but in the ideology that drove us all to think that way in the first place.
I think this group-dividing thinking – of they’re all-wrong and we’re all-right is what prevents this conversation from happening publicly.
If she was using the Mirena, hormonal, IUD she may have a time when she doesn’t have periods. Best to request a full exam by her doctor, but it could be that she will need time to adjust and for her cycle to return.
Thanks for your reply. By “enemy” I mean folks like Rick Santorum who want to get rid of birth control as well as abortion.
I address this in my forthcoming book ‘Sweetening the Pill or How We Got Hooked on Hormonal Birth Control’ at length.
Note: I thought I posted this on July 4th but it didn’t show up here. So I’ll try again:
Clio, I’ve been working at unlocking the door to these kinds of conversations for over 20 years in my work as part of the mainstream SRH community. They pay lip-service to contraceptive choice, but don’t come through with programs or acknowledgement of the growing issue of resistance to HBC.
The way I keep my pro-choice cred is by writing about (championing) abortion rights, diversity and sexual health education. The way as a community we present a united front against the antis is to publicly acknowledge that the full range of contraceptive choices must include non-hormonal methods and that we are as committed to providing services to use these methods as we are to providing HBC to women who want it and experience no issues with it.
What the SRH community has got to stop doing is insisting that drugs and devises are the most effective therefore women are being irresponsible or stupid to reject them. These methods are not the most effective if women stop using them because of problems without support from health-care providers and experience unintended pregnancy as a result, which is, to my mind, not their fault but the fault of providers who offered no support to use alternatives.
This recent post at Feministing: https://feministing.com/2013/07/03/guest-post-the-freedom-not-to-choose-birth-control/ is just one example of how this is happening. But if I wrote something for Feministing about how my colleagues in SRH orgs and clinics are shirking their duty, failing to support reproductive justice, by not providing better support and services to women who want to use barriers and FAM, I wonder if they would reject or publish it.
So, yes, this needs to be a nuanced conversation, but first the SRH community has to be willing to start talking about it. True reproductive justice will not be achieved until this happens. I’m optimistic that day is coming.
Let’s just be clear – NOT talking about the issues women have with hormonal birth control isn’t helping either. In fact, it provides fodder for articles such as this one:
https://www.legatusmagazine.org/oral-deception/
A large number of my Twitter followers are anti-abortion and Catholic, even though I frequently tweet pro-choice articles. They listen and respond to what I say because we have a common ground. A much better situation than dismissing them as “the enemy” and thus proving them right.
HI, I’ve recently published an article on my website written by one of my clients who came to me for Acupuncture to get help with detoxing from Yasmin. Feel free to have a read and comment. All the best, Karla
https://natureheals.co.uk/acupuncture-and-detoxing-from-yasmin/