Prioritise Female Health: The Gap in Hormonal Contraception Research

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The healthcare sector’s overwhelming complacency with current female hormonal contraceptives has resulted in a lack of innovation for new methods. Between 2017 and 2020, pharmaceutical companies funded no more than 25 clinical trials worldwide for contraception options, with most studies focusing on incremental changes to existing hormonal contraception options. This is staggering in comparison to 2019 alone, when industry funding supported around 3,100 cancer drug trials and 600 cardiovascular drug trials. For some women who use hormonal contraception, serious side effects can emerge, and alternative options are often limited or unsuitable, restricting full agency over their bodies. Many medical professionals’ perceptions of these side effects can push aside women’s experiences and perpetuate institutionalised misogyny and medical bias. This gap in research is failing women; impactful changes are needed for female reproductive health to become a priority in medicine.

Stories Told by Female Friends

I spent the entirety of my education at an all-girls school, where frequent open discussions among my peers about the obstacles we faced as females took place: from one friend throwing up during her Intrauterine Device (IUD) insertion, to stories of catcalling and stalkers.

A recent example was my female friend’s visit to a General Practitioner (GP) to start a conversation about changing her contraceptive pill; a story which she is happy for me to share with you. Over the last several months, she had noticed a change in her mood and an increase in her tendency to suffer from anxious and depressed mental states. Within a couple of minutes, sat opposite a male GP, she’d been prescribed antidepressants, along with the dismissal that her contraception wouldn’t be to blame. She left the doctor’s office feeling deflated by her experience of being undermined so swiftly. Dissatisfied with her unwanted new prescription, later that day she phoned to make another appointment to see a female GP.

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Since recently finishing my Master’s in Psychiatric Research, in my own time, I have been investigating pitfalls in our scientific knowledge, corroborated by stories told to me by the women in my life. In particular, the inadequacy of female contraceptives has been at the forefront of these conversations, understandably so since my friends and I are in our mid-20s. My friend’s account of being patronised in a medical environment is one of many that I have read in books or online, which have infuriated me enough to motivate the writing of this article, in the hope of bringing more awareness to this issue.

Although my friend has faced negative side effects, the freedom that hormonal contraception provides for women to have control over their fertility is irrefutable; many women have positive experiences. However, while ‘mood swings’ are known to be a commonly reported side effect of hormonal contraception, information provided on the NHS website is vague; simply stating that if side effects become a problem, a different contraception may be better suited.

In guidelines from the National Institute for Health and Care Excellence, which advises healthcare providers on the topic of hormonal contraception, there is only a very brief mention of the mental health implications, stating that the manufacturers of hormonal contraceptives are aware of the possible risk for suicide and suicidal behaviour. Across 13 years, a large prospective study of over 1 million women living in Denmark tracked the association between their hormonal contraception use and risk of depression. The study found that women using hormonal contraception had a slightly higher risk of depression and were more likely to be prescribed antidepressants compared to non-users. But this is one of the very few studies that examines the mental health implications of hormonal contraception.

Fury in Forums and Coercive Consults

A quick Google search of depression and hormonal contraception reveals floods of forum posts recounting women’s experiences of side effects, with many describing feeling like an entirely different person. Despite these serious concerns from users over their wellbeing, research into how these side effects can be managed and the development of alternative contraceptive solutions is limited. The lack of research has left a gap in the knowledge of medical professionals, evidenced by my friend’s experience of a GP not taking the time to listen to her concerns about side effects.

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Feeling dismissed in healthcare settings is frequently reported by women. Concerns regarding the side effects of contraceptives are no exception. A recent survey of 188 women found that 43.6% had experienced mood changes as a side effect of their hormonal contraception. The survey also found that side effects were the most common reason that women switched or discontinued their hormonal contraception, with the majority reporting that their healthcare provider had not adequately discussed the possibility of psychological side effects.

Furthermore, it was revealed from a study examining women’s lived experiences during consults with medical professionals that many felt a patient-professional power imbalance existed, the relationship even being described by some as coercive when discussing contraception options. Continuing with this kind of research is crucial to identifying the shortcomings and spreading awareness in the medical field in order to bring about change.

A Call for Better Care

I expect you’ll be pleased to hear that my friend’s second appointment was much more positive. The female GP showed compassion and empathy for her experience, even to go as far as to apologise upon the retelling of her appointment with the other GP. Taking the time to listen to my friend’s concerns and give her the attention she deserves, the GP thoroughly went through the options available and signposted her to information that would be helpful. The conclusion was to change the contraceptive pill she was taking, and to follow up in a few months to see how her mood was progressing. The GP’s awareness and education of the topic led my friend down a completely different route in comparison to the outcome of the previous appointment.

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While my friend had the resilience to advocate for herself, this is not something that should be required of women in order to have their reproductive health concerns addressed sufficiently. The healthcare system’s lack of meaningful advances to improve female contraceptive options is baffling. Urgent funding, research and education are needed in order to expand the medicine available for women to ensure they have autonomy over their reproduction. Until then, women are left with no other choice than to use trial and error with the hope of finding a compatible option, far less than they deserve.