Pill use in New Zealand is trending downwards alongside growing concerns being voiced online by wellness influencers. Photo \/ Dean Purcell<\/p>\n
The Herald on Sunday spoke to three Kiwi sexual health experts about four issues women have experienced, or have questions surrounding, when it comes to the impact of the contraceptive pill.<\/p>\n
Can the pill cause you to \u201close your personality\u201d or experience major mood changes or depression?<\/p>\n
At the Auckland Gynaecology Group in Newmarket, gynaecologist Dr Praveen De Silva helps women with a variety of problems, ranging from difficulties with contraception to severe pelvic pain, endometriosis and heavy bleeding.<\/p>\n
He says he always acknowledges that low mood can be a very rare side effect of the pill, but the results aren\u2019t consistent across an extensive number of studies.<\/p>\n
\u201cI think my opinion is that overall, I haven\u2019t seen a clear trend that the pill causes depression, but I am a lot more careful about women who already have a history of depression or are prone to depression. I do counsel them that there can be side effects,\u201d De Silva says.<\/p>\n
The pill has become one of the most widely studied medications since its introduction in the 1960s, he says, and across these studies incidents of women getting a dulled or flattened mental state from taking the pill are not common.<\/p>\n
Dr Beth Messenger in consultation with a patient at a Sexual Wellbeing Aotearoa clinic.<\/p>\n
Sexual Wellbeing Aotearoa \u2013 formerly Family Planning \u2013 medical director Dr Beth Messenger says the pill does not cause depression but there still are some people who experience significant low mood using hormonal contraception.<\/p>\n
\u201cMy big thing is that an individual can have a really negative experience with any medication or procedure, even if the research doesn\u2019t tell us that that\u2019s likely or to be expected,\u201d she says.<\/p>\n
\u201cBut we have to allow that to not affect our clinical judgment for other people \u2013 it doesn\u2019t mean it isn\u2019t a valid treatment.\u201d<\/p>\n
Hobsonville Family Doctors GP Kate Richardson, who has been a GP for over 10 years and has a special interest in women\u2019s health, says most people tolerate the contraceptive pill well but there is a small subset of women who experience low-mood symptoms or anxiety, and it is difficult to predict who will be affected.<\/p>\n
\u201cI just tend to say that there is a small risk if someone is feeling different on the pill, whether that\u2019s feeling flatter, more anxious or not like themselves. That\u2019s valid and we need to take that seriously.\u201d<\/p>\n
\u201cWomen want to feel heard, respected and understood\u201d: Dr Kate Richardson inside her clinic at Hobsonville Family Doctors, Auckland. Photo \/ Dean Purcell<\/p>\n
De Silva says a change in mood can typically improve as a person continues taking the contraceptive pill. However, if someone is experiencing a severe mood disruption, the effects are essentially reversible because the pill will wash out of their system quickly once they stop taking it.<\/p>\n
\u201cI think that social media in particular over-calls the chance of mood being affected on the pill, and I personally feel that most women and most people are not affected,\u201d he says.<\/p>\n
Messenger says at the other end of the spectrum, there are also people with Premenstrual Dysphoric Disorder (PMDD), a mood disorder associated with severe distress, for whom the pill can act as an effective treatment in some cases.<\/p>\n
Does the pill cause women to lose their sex drive?<\/p>\n
De Silva has noticed concerns about a lowered sex drive from the pill being raised by people on social media, but says there is no clear evidence this is the case.<\/p>\n
In some studies, a slight decrease in sex drive has been recorded in a small number of people but there are just as many studies showing an increased sex drive in women taking the pill, he says.<\/p>\n
\u201cEven though we haven\u2019t been able to prove a link with the pill reducing your sex drive, I think for those who do find their sex drive is affected, in theory it could make some sense,\u201d he says.<\/p>\n
Dr Praveen De Silva at the Auckland Gynaecology Group in Newmarket. Photo \/ Michael Craig<\/p>\n
\u201cWomen have a bit of testosterone that is produced by their ovaries and that is probably the hormone that is responsible for libido and sex drive. Some scientific studies show a reduction in testosterone levels for women who take the pill.\u201d<\/p>\n
However, he says at a population level, the data isn\u2019t strong enough for doctors to confidently say the pill will reduce sex drive.<\/p>\n
Richardson says some women have told her they have experienced a noticeable change in libido after starting to take the pill, but it\u2019s not a common experience.<\/p>\n
\u201cI do also remind women that obviously libido is influenced by many things. Relationship factors, stress, sleep, mental health, so not just hormones. So I think it\u2019s really important that we look at their whole context,\u201d she says.<\/p>\n
De Silva says for women who are experiencing other gynaecological symptoms like pelvic pain or irregular vaginal bleeding, the pill can help to fix those things and can give them a more positive view of sex.<\/p>\n
Can the pill change who you are attracted to?<\/p>\n
Messenger says she is aware attraction can change during the menstrual cycle and it\u2019s possible that when some women are on the pill, it could cause variation in sexual attraction; however, it is very difficult to identify whether the pill is the reason behind any changes.<\/p>\n
\u201cApparently around the time of ovulation, women are typically more attracted to slightly rougher, tougher-looking male types. And towards just before their period they\u2019re more attracted to slightly softer, more gentle-looking male types,\u201d Messenger says.<\/p>\n
A study from Newcastle University in 2013 that is often referenced in online debate involved one group of women who were non pill-users being tested against a group of women on the pill about how they perceived the attractiveness of different male faces.<\/p>\n
It found a significant decrease in women on the pill selecting faces with strongly masculine traits.<\/p>\n
De Silva says there is no strong evidence the pill changes who you\u2019re attracted to and this falls more into the realm of online clickbait.<\/p>\n
Richardson agrees that evidence around the pill altering personal attraction is weak and inconsistent, and says the few studies that do show changes in attraction to certain face shapes or pheromones\u2019 are mostly conducted in a lab setting and lack the complex factors that shape real-world relationships.<\/p>\n
Is staying on the pill for a long time safe?<\/p>\n
De Silva says the pill is extremely safe to take for long periods of time.<\/p>\n
\u201cI would be comfortable with most people being on the pill for over a decade with no adverse effects,\u201d he says.<\/p>\n
In fact, a reduction in ovarian cancer and uterine cancer has been recorded for people who are on the pill.<\/p>\n
\u201cWe are slowly learning that the true magnitude could be as much as 50% reduction in ovarian cancer for people who are long term on the pill. So there is a massive advantage,\u201d he says.<\/p>\n
Dr Beth Messenger says if women feel dismissed or unheard about their contraceptive issues they should seek advice from other health practicioners.<\/p>\n
Messenger says the pill reduces the risk of ovarian cancer because it stops a woman from ovulating, which decreases the likelihood of ovarian cysts and cancer developing.<\/p>\n
\u201cAnd this is the bit that often goes missing, is that actually there are health benefits to going on the pill,\u201d she says.<\/p>\n
The pill can be used as a treatment for heavy and painful periods, acne and premenstrual syndrome (PMS), she says.<\/p>\n
De Silva says there is a slight increase in the risk of breast cancer with long-term use of the pill, but the outright chance of getting breast cancer from the pill is so low that there is little for women to fear.<\/p>\n
There are also very rare cases of younger women having a stroke or blood clot from the pill, and women over 40 can be at risk of stroke if taking the combined pill, but doctors ask patients about their family history out of caution around these risks, he says.<\/p>\n
Across Sexual Wellbeing Aotearoa\u2019s 29 clinics in New Zealand, Messenger says it is witnessing a move away from oral contraceptives and towards long-acting, reversible contraceptives such as an IUD. However, she is uncertain whether this trend is happening across the whole population because oral contraceptives are easier to access in the community.<\/p>\n
\u201cI think one of the key messages for people is if you think something bad is happening to you because of your contraception, whether it\u2019s the pill or not, you need to go and talk to somebody about it,\u201d she says.<\/p>\n
\u201cIf you feel dismissed and unheard, try to find someone else to talk to.\u201d<\/p>\n
Richardson suspects a high level of interest in wellness and holistic health could be driving some of the fears around the use of the contraceptive pill, and she has seen discussions framing the pill as pumping artificial hormones into the body.<\/p>\n
\u201cThe wellness sphere is really great because it\u2019s getting people to look at their lifestyle holistically, but I do think it\u2019s creating a feeling of people needing to be worried,\u201c she says.<\/p>\n
\u201cI think social media and the internet is great because there is a lot of good information out there, but it can be a bit of a minefield for women figuring out what\u2019s credible and reliable.\u201d<\/p>\n
Ultimately, it\u2019s absolutely vital that there is an open line of communication between a GP and a patient, she says. If a contraceptive option is not working for a patient, changes should be made and alternative options explored.<\/p>\n
De Silva says he doesn\u2019t believe enough attention is paid to women in their late 20s or early 30s who have stopped taking the pill because they want to become pregnant but are dealing with symptoms such as pelvic pain, irregular bleeding or a lack of enjoyment of sex.<\/p>\n
\u201cPeople become very used to the pill that they\u2019re on and so either changing pills or coming off a pill is a nightmare,\u201d he says.<\/p>\n
The pill is not only used for contraception and can be prescribed to women to help with debilitating pelvic pain or heavy irregular bleeding, and De Silva says for these women, the results can be life-changing.<\/p>\n
\u201cI feel there\u2019s a real stigma, that a lot of families don\u2019t talk about these things … and it\u2019s quite an isolating feeling when you get these problems.\u201c<\/p>\n
Richardson says she doesn\u2019t see her job as being to tell someone to come off the pill or stay on it, but rather to support patients in choosing the contraceptive medication they feel comfortable using that also supports their needs.<\/p>\n
\u201cWomen want to feel heard, respected and understood,\u201d she says.<\/p>\n
De Silva urges people to request to see a GP who has a special interest in women\u2019s health \u2013 or to ask to be referred to a specialist \u2013 if they are struggling with side effects from contraception or dealing with pelvic pain, heavy bleeding or a lack of enjoyment of sex and feel they haven\u2019t been listened to by their doctor.<\/p>\n