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Image Source: Owl Illustration Agency on Unsplash 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. Image Source: Owl Illustration Agency on Unsplash 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 g uidelines 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.   Image Source: Owl Illustration Agency on Unsplash 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.   Image Source: Owl Illustration Agency on Unsplash 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.

Pregnancy and Postnatal Outcomes of Women with Intellectual Disability. This article is co-written by Ayeshah Mateen Allahwala and Vaheshta Sethna. Ayeshah Mateen Allahwala is a final year psychology student at the University of Karachi, passionate about mental health, human rights, and education. Beyond her studies, she volunteers with NGOs working with children from underserved communities and writes to make mental health knowledge accessible for all. In this blog, she draws on recent research to explore what pregnancy and life after birth are like for women with intellectual disabilities, and how care during and after pregnancy can be better tailored to support them.   Vaheshta Sethna is a Senior Lecturer in Family Perinatal Mental Health (Education) at the Social Genetic Developmental Psychiatry Centre, King’s College London. Her research focuses on the health and needs of families during pregnancy and the postnatal period. She is especially interested in how psychological and social risks, as well as sources of strength, shape a child’s development. Through her work she aims to guide more compassionate and effective support for vulnerable families and foster hope in their care journey. In this piece, she shares insights from her recent work into pregnancy and postnatal outcomes for women with intellectual disabilities and their babies. Photo by Aditya Romansa on Unsplash The moment they meet the world, but it meets them differently   Surrounded by echoes of doctors, nurses, fluorescent lights beaming above, the clatter of medical equipment, a flurry of instructions, sensations, reassurance, overflowing emotions, she lays there as her body and mind are going through unimaginable things, an embodiment of strength, ready to give birth. She feels confused, senses judgement and thinks: “ How will I be able to do this ?”   Motherhood is often seen as a time of significant personal change, filled with both joy and challenges. These challenges can be even more pronounced for mothers with an intellectual disability . What is intellectual disability? Intellectual disability is a neurodevelopmental condition that affects brain development and functioning. It is a lifelong condition that begins before adulthood. Globally, the prevalence of intellectual disability is estimated at 1–3%, with higher rates seen in low- and middle-income countries where access to early intervention and healthcare is limited. According to an internationally recognised framework for diagnosis (i.e. the International Classification of Diseases, 11th Revision ( ICD-11 )), intellectual disability is referred to as a disorder of intellectual development . It is characterised by significantly reduced intellectual functioning and limitations in adaptive behaviours, such as communication, social participation, and independent living. Individuals with an intellectual disability learn and understand things more slowly , and need extra help with daily activities throughout life. When preparing for motherhood, these challenges can turn a healthcare setting into a confusing maze of unfamiliar terms and decisions. For women with an intellectual disability who become mothers, the experience of pregnancy and birth is profoundly shaped not just by their condition, but by how society and the healthcare system respond. And yet, these women carry the same hopes, the same love. Pregnancy & intellectual disability When a woman with an intellectual disability becomes pregnant, she may encounter a distinct set of challenges that impact her physical health, emotional wellbeing, and ability to navigate the healthcare system. Having an intellectual disability often involves difficulties with comprehension, memory, communication, and decision-making; skills that are essential for engaging effectively with healthcare services. Photo by Hans for Unsplash+ The Many Facets of Challenges   Women with an intellectual disability may face multiple barriers in accessing antenatal care (also called prenatal care), the medical support a woman receives during pregnancy to keep both her and her baby healthy. It includes regular check-ups, blood tests, ultrasound scans, advice on nutrition, and guidance on what to expect as the pregnancy progresses. These challenges include communication difficulties, fear of judgment or stigma, and a lack of tailored support. For example, medical advice may be delivered too quickly, in technical language, or without checking for understanding. This can leave women feeling vulnerable, not only medically but emotionally as well. Some women with an intellectual disability have reported inadequate treatment by healthcare staff, including limited understanding of their needs, and insufficient support during pregnancy and childbirth. However, this is not universally observed, suggesting that while negative experiences are reported, they are shaped by differences in staff awareness, training, and healthcare system practices. Therefore, inclusive perinatal care , i.e. care during pregnancy and after giving birth that is flexible, patient-centered, and communication-sensitive, is essential for supporting pregnant women with intellectual disability .   Research Evidence   A recent research study examined pregnancy and postnatal outcomes for women with an intellectual disability to shed light on maternal and infant health outcomes.   The authors used a systematic review study design - a type of scientific study that doesn’t collect new data, instead it is a careful and thorough way of looking at existing published evidence on a specific question to understand what the overall evidence shows.   In this case, the researchers identified previously published global studies, with the aim of finding out:   ● The health risks women with an intellectual disability face during pregnancy ● Potential complications their babies experience.   Through this information, the study aims to provide a clearer, more reliable picture of the challenges- which will help point the way forward for better care.   The researchers screened 103 full-text articles and ultimately included 9 articles (encompassing data from 8 distinct cohorts) that fulfilled the study eligibility criteria (i.e. studies were only eligible if they focused on women with an intellectual disability, defined according to internationally recognised manuals used to identify and describe mental health conditions).   What did the authors report? Women with an intellectual disability are more likely to experience health issues such as urinary tract infections in mid to late pregnancy, gestational hypertension (a condition characterised by high blood pressure that develops after the 20th week of pregnancy in a woman who did not previously have hypertension), and postpartum haemorrhage (heavy bleeding after birth). They are also more likely to experience postpartum haematoma, which is a collection of blood or internal bleeding that happens after childbirth. Women with intellectual disabilities tend to stay longer in hospital after giving birth and are more likely to be discharged to somewhere other than home. Additionally, their babies are more likely to be born premature, at less than 37 weeks gestational age, as opposed to full-term delivery at approximately 40 weeks.  Some babies may require extended neonatal care . Notably, the limited number of studies reviewed showed mixed results regarding the association between intellectual disability and outcomes such as birthweight, congenital conditions (health problems present from birth), Apgar scores (which assess a baby’s health right after birth), stillbirth, and neonatal death. Importantly, the systematic review highlights significant gaps in robust, up-to-date data on this topic. The included studies were limited to high-income countries and the groups of women with intellectual disabilities were much smaller than the comparison groups without disabilities. This smaller sample size may have made it harder to detect rare outcomes, like stillbirth, and as a result, the patterns seen in the data weren’t strong enough to confidently say they weren’t due to chance. Finally, the study only looked at how children developed during their first year of life, indicating that any results related to later development or long-term outcomes weren’t included in the study. Photo by Getty Images for Unsplash+   Why this Review is Significant   This study confirms the urgent need for larger more inclusive studies so we can better support women with intellectual disabilities who often face health inequalities and rely more on services. It provides empirical evidence advocating for change, urging policymakers and pushing for inclusive health strategies such as using simple, easy-to-understand information, providing extra time and support during appointments, and ensuring accessible and patient-centred maternity care – thus, empowering women to make informed decisions throughout pregnancy and childbirth.   Time to Change the Narrative   Ultimately, every mother hopes for a safe birth and a healthy baby. Women with intellectual disability share the same dreams, but the system often meets them differently. By listening more closely, adapting care and treating them with better understanding, healthcare providers can help rewrite this story - one where strength, love, and equity guide every birth.

Photo by Alex Green on Pexels A diagnosis can feel like a key — unlocking understanding and access to help — or like a label that locks you into something you can’t escape. I was 35 when a psychiatrist gave me a diagnosis of borderline personality disorder (BPD)/ Emotionally Unstable Personality Disorder (EUPD). I am now 43, and I still have an ambivalent relationship with the diagnosis. I was diagnosed with depression and anxiety aged 18 and have had various forms of treatments. I have taken several different antidepressants. In terms of therapy, there has been intermittent support when it has got to crisis level, like CBT and counselling around self-esteem and anxiety. I am now in a position where I can afford private therapy, which has allowed me to identify that childhood trauma is the reason for my behaviours, thoughts and unhelpful coping mechanisms, the most significant event being the suicide of a parent. I am open about my diagnosis of depression and anxiety in my personal and professional life but not about my diagnosis of BPD/ EUPD. The only people who are aware are my wife, mother and sister. This is, I think, due to internalised stigma and a fear of reaction. It has made me a guarded person who finds it difficult to make and keep friendships.   My past experiences inspired my undertaking of a Social Sciences degree, as I wanted to understand the reasons for social inequality and discrimination, and my successive jobs as a Support Worker, Work Coach and Benefits Caseworker. I like to write; in a perfect world, I would make a living from writing full-time. EUPD is perhaps the most stigmatised mental health diagnosis. Conversations around mental health are becoming more common and there is a wider understanding of the long-term impact of trauma and adverse childhood experiences. As my therapy makes me realise how much stigma I feel, it is the right time to discuss how we talk about diagnosis and add my voice to the conversation. Debate about diagnosis sits at the heart of mental health discourse, between the need for validation and the risk of stigma. Below, I discuss the pros and cons of diagnosis, which drift towards focusing on the cons due to my own experience, not to say it will be the same for everyone. The Case for Diagnosis Within the clinical community, it is partly accepted that the diagnosis of BPD has limitations , particularly due to the high overlap of symptoms with other mental health conditions, such as bipolar disorder. However, it is still felt that diagnosis is overall beneficial. A benefit of diagnosis can be validation. I felt like an outcast for so long that having a diagnosis gave a satisfying sense of relief. Dialectical Behavioural Therapy is often the most effective treatment for EUPD. However, to access DBT through the NHS, a majority of hospital trusts require a diagnosis, or at least “strong traits” of EUPD. In these cases, having a diagnosis is essential. For some, including myself, even passing the barrier of having a diagnosis did not lead to support.            Research has also shown that, for some, diagnosis “facilitates self-understanding, self-legitimation and self-enhancement.” The Case Against Diagnosis Attitudes in society to people with a diagnosis of EUPD remain predominantly negative; those with EUPD are seen as dramatic, or worse, dangerous.   Society tends to focus on the observable behaviours (self-harm, impulsivity) rather than on the underlying trauma and emotional pain .       An argument against diagnosis is labelling.     Labelling can lead to a situation where the “problem” is seen as being with the person, rather than society's failure to recognise behaviour as a coping mechanism. Research has shown that negative psychosocial impacts of diagnostic labelling (stigma, changes to self-identity, relationship strain, social or professional discrimination) are common. Photo by Yankrukau on Pexels The key argument against diagnosis has to be stigma , which is both disempowering and frightening. This can be internalised, which can significantly impact an individual’s sense of self. I felt ashamed and blamed myself; I very much felt like there was something wrong with me, and it was too late to return to the manufacturer. This can be self-perpetuating and make recovery difficult.   That is not to say that diagnosis cannot be helpful: into the early 20 th century, Schizophrenia was generally seen as madness and sometimes as possession by the devil or evil spirits, and still is in some cultural settings. Medicalising the condition went some way to reducing stigma by seeing it as a treatable medical condition.          Stigma is often formed by representations in the media. There has never been a character with a diagnosis of EUPD in a British soap opera, despite it being diagnosed more often than schizophrenia, which has been portrayed often on tv. The soap opera Hollyoaks has perhaps had the character who has demonstrated the most significant traits of EUPD, Cleo McQueen, who has shown emotional dysregulation, impulsivity, identity disturbance, interpersonal difficulties and self-harm in the form of an eating disorder. EUPD was not explicitly mentioned.        This lack of representation is likely to lead to false beliefs and a lack of understanding. Mentions of EUPD in the media are predominantly negative and reinforce harmful stereotypes, as it is constantly portrayed as a character flaw or moral failing.              Given this, it is high time that representations in the media of those with EUPD change, and negative portrayals are challenged, particularly given the fact that research has shown that 54% of people say that seeing a well-known character on screen with a mental health condition has improved their understanding. Perhaps the reason for this lack of representation is a misunderstanding of the condition, or a fear of showing an emotionally complex person. I urge those in the media to challenge this. Accurate and compassionate portrayals could shift public understanding, as they once did for schizophrenia. What's in a name Borderline Personality Disorder has origins in the 1930s.  Borderline was used because people with this condition were thought to be on the border between neuroses and psychosis. As the term “borderline” was seen as archaic, and with the intention of reducing stigma, the term EUPD was introduced and is now widely used in the UK and Europe. There is a suggestion that this term is less stigmatising ; and a more accurate reflection of the condition. Personally, I still feel it has an overwhelming negative connotation, as it gives no nuance and suggests the person is permanently unstable.   I would explain EUPD as a response to events during childhood. We learn coping strategies that continue through to adulthood, these can be unhealthy and damaging to those around us, but should not be seen as bad behaviour or attention-seeking. They should be seen as maladaptive, but protective. For example, alcohol can, in the short term, calm a chaotic mind and avoidant behaviour can avoid facing challenging emotions.  If we understand EUPD as a response to trauma rather than a fixed disorder, diagnosis could become less about labelling and more about understanding.   Photo by Vie Studios on Pexels

Behind-the-scenes insights into mental health research, written by scientists and academics on the studies that are making the headlines and shaping the field of psychiatry and psychology. Our Articles on: Read Now Shifting Skills, Not Reality: Teens and AI Chatbots I will shift. Two teenagers scribbled this same line repeatedly in their journals. Both later died by suicide after extensive interactions with Character.AI chatbots Rona Hiley-Mann 6 days ago 5 min read The Rhythm Within: How Circadian Timing Matters for Health and Mood The first time I heard about circadian rhythms was in my high school biology class. I remember breezing past the term, memorising that “circadian rhythms = sleep-wake cycles,” and not thinking much more about it. That is, until I started to study them in graduate school. 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