Question 1

Given your knowledge on this topic, what things would you advise adolescents to consider before taking a hormonal contraception? Especially given that their brain is still in development!

Sarah Hill · Accepted Answer

I would advise adolescents to be wary of taking the pill for reasons other than pregnancy prevention. There isn't very much research on the effect of taking hormonal contraceptives on brain development. The research that has been done on adolescent birth control pill use suggests that adolescent women are particularly vulnerable to experiencing negative mental health side effects, including depression and increased suicide risk. Others find that going on the pill in adolescence can increase a woman's lifetime risk of developing major depressive disorder, even after women go off it.

For young women considering using the pill for pregnancy prevention,  the benefits of pregnancy prevention may outweigh these risk. For these women, I would advise them to tell a friend or loved one to keep an eye on them to make sure that they aren't slipping into a depression. I would also recommend that they keep a journal to make sure that they are able to catch themselves if they start developing changes in their personality or outlook on life.

Question 2

My mental health has improved dramatically since going off the pill. Why wasn't I warned about these side effects?

Sarah Hill · Accepted Answer

I think that most doctors haven't been educated about the mental health side effects that the birth control pill can have on women. This is because doctors generally aren't in touch with research in neuroscience and psychology. Their research literature focuses more on body parts (heart valves, arteries, and the like) while the psychology / neuroscience literature focuses more on the experiential effects of things going on in the body (body / brain connection stuff). Until medicine begins to integrate research on the experiential effects of bodily states, many doctors won't be reading the research about how drugs make people feel, psychologically.

Question 3

How does your research fit with the fact that some women successfully use the pill to avoid the hormone shifts and detrimental symptoms involved in PMS and PMDD?

Sarah Hill · Accepted Answer

This is not at all at odds with the message in my book. No two women will respond  to hormonal contraceptives the same way. For some women, the pill makes them feel better (for example, some women with PMS and PMDD). For other women, it makes them feel worse. The big take-away from the book is that each woman should learn to listen to her own body and choose whatever option feels best for her : )

Question 4

Does the progesterone only mini pill avoid any of the partner preferences and libido effects that you have identified?

Sarah Hill · Accepted Answer

I wish that were the case, but it is doubtful. Most of the effects that the pill has on things like partner preferences and libido result from the ovulation-suppressing effects of the progestins in the pill. The progestins - in addition to preventing ovulation and its corresponding estrogen surge - increase sex hormone binding globulins, which cause testosterone levels to tank.  : ( I wish I had better news for you!

Question 5

Is this research being used to come up with new pill formulas and methods that mitigate these side effects?

Sarah Hill · Accepted Answer

I sure hope so!! We are currently in the process of trying to get funding to learn more about the brain pathways that are targeted by different forms of hormonal contraception. We are hopeful that this research will be used to inform research and development efforts aimed at giving women some new hormonal contraceptive options.

Question 6

How can this knowledge help women who have to take a hormonal contraception for medical reasons such as PCOS, endometriosis, PMDD etc?

Sarah Hill · Accepted Answer

This is a great question. I always advise women to become experts in what feels right for their own bodies. If a woman feels better off the pill than she does when she's on it, that's important for her to know so that she can make a mindful choice about her birth control options. If a woman feels better when she is on the pill than when she is off of it (which is often the case with women who have e.g., PMDD), that's also important for her to know. The idea is that each of us should become as educated as possible about the tradeoffs that are being made when we are on the pill so that we can make informed choices about what is best for us. For some of us, this means being off the pill. For others of us, it can mean being on it.

Question 7

I'm curious about how antidepressants might interact with birth control pills?

Sarah Hill · Accepted Answer

Many women are prescribed antidepressants while on the birth control pill, so you can rest assured that this is a pharmacologically safe combination. You will need to talk to you doctor about the specifics of the pills that you are on, though, as the drug interactions will differ depending on what you're using.

Question 8

Has this area of research moved beyond correlation to establish causation?

Sarah Hill · Accepted Answer

There are some studies on the effects of the pill on various facets of psychological functioning that have been experimental, which is the type of study design that is required to make claims about causation. However, the majority of research on the impact of the pill on women (and not female animals) has been correlational. The reason for this is that randomly assigned people to take the pill or a placebo is... a little problematic. To start with, it's a pretty basic human rights violation to prevent pregnancy without consent. It's also a huge breach of ethics to give someone a placebo pill that they think is preventing pregnancy (can you imagine the lawsuits?).

Although many of the studies that are out there are correlational (making it necessary to be cautious in their interpretation), many are thoughtfully designed. They control for many third variables to help rule out alternative explanations and are able to account for the directionality problem by virtue of the study design. I encourage readers to look at the preponderance of the evidence to draw their conclusions about what is meaningful and what is not since it will be hard to deliver a smoking gun with this type of research.

Question 9

Could taking the pill effect my level of attractiveness to men?

Sarah Hill · Accepted Answer

Yes! Research shows that women experience an increase in sexiness near ovulation in response to surging estrogen levels. In particular, this research finds that women feel, look, smell, and sound maximally attractive to men during this time.  Because the pill suppresses ovulation (and its corresponding estrogen surge), pill-taking women miss this monthly sexiness boost.

Question 10

What psychological and behavioral changes will taking birth control actually have on men?

Sarah Hill · Accepted Answer

When women are on the pill, this can affect men in two ways. First, because the pill suppresses ovulation, it also suppresses many of the fertility-related cues that men find desirable in women. For example, research indicates that men find women sexier and more desirable near ovulation compared to other points in the cycle. Research also finds that being around ovulating women increases men's levels of testosterone. Accordingly, the pill may decrease men's attraction to their partners by suppressing women's mid-cycle spike in sexiness and preventing cycle-based testosterone boosts. This could change men's behavior in lots of different ways, ranging from how they treat their partners to how they respond to competitive challenges (testosterone increases competitiveness).

A second way that it can impact men is through the changes it has on women's sexual decision making. The pill - because it prevents pregnancy almost without fail - is linked with greater sexual unrestrictedness in women. This means women are more willing to have casual sex with men than they used to be, and that their standards for what an acceptable sex partner has to have achieved, have declined. This has been great for women and women's liberation, in general, but it may have the unintended effect of robbing men of the single biggest motivator of male achievement known to man: the fear of involuntary celibacy. Motivating men to achieve obviously isn't women's JOB (and it's the fault of men, not women, if men aren't able to achieve the way that they once were). However, the pill may have played one small role in the growing achievement gap between men and women.

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