Australasian Science: Australia's authority on science since 1938

A Fresh Look at the Pill

By Michael Cook

If anabolic steroids are considered dangerous, why has so little research been done on the long-term safety of another steroid – the contraceptive pill?

If there is one request by patients that is universally spurned by doctors, without any fear of being labelled paternalistic, it is for performance-enhancing steroids. Extensive research confirms that anabolic steroids damage the liver and the heart, among other problems.

If widespread steroid use is discouraged for men, why haven’t the neurological effects of the steroid-based contraceptive pill on women been studied just as thoroughly? After all, the pill is the principal artificial means for controlling population and is currently being used by 100 million women each year. This includes many girls who have just entered puberty. Its cumulative effect could have a significant impact upon society.

Until now, only the impact of steroids on men has been the focus of research because hormonal fluctuations during menstruation affected results when women were included in trials. There is less data, therefore, about the effect of steroids on women.

In a challenging article in the open source journal Frontiers in Neuroscience, three Austrian researchers argue – that 50 years after its introduction – it is time to assess what the chemistry of the pill does to the female brain.

Their survey of the literature suggests that the effects of the pill vary considerably with age and individual physiology. Finer-grained studies are needed to assess the precise effects of steroids on cognition and emotions, and whether their effect is “feminizing” or “masculinizing”.

For instance, it is widely accepted that the pill affects women’s moods. In most women its use is beneficial, but sometimes it is associated with increased rates of depression, anxiety, fatigue, neurotic symptoms, compulsion and anger. And these studies may be too positive because depressed women may have dropped out of trials. Most studies have focused only on depression, while other dimensions, like anger or empathy, have hardly been studied. So the mood research is far from adequate.

One particular area of concern is the pill’s effects upon teenagers. The prefrontal cortex of the brain appears to be one target of structural changes in women who use the pill. But this is an area of the brain that is not fully developed until a woman’s early 20s. What impact will early contraceptive use have upon teenagers? There is no clear answer.

The authors are not scaremongering. They simply set out the state of current research and point out that there are significant gaps in our knowledge. They write:

As the number of women using oral contraceptives constantly increases, while the age of first contraceptive use constantly decreases down to sensitive neuroplastic periods during puberty, the associated changes in personality and social behavior imply significant consequences for society.

Other researchers have voiced similar concerns.

A well-known article published in 2010 in Trends in Ecology & Evolution found that women who use the pill are attracted to different types of men and that their own attractiveness to potential mates is disrupted. This could have long-term consequences for the ability of couples to reproduce and the reproductive success of offspring. However, the authors of this paper noted that “the potential side-effects on a range of women’s psychological attributes and behaviour have never been investigated by FDA or drug companies”.

The authors contended that if drug companies and regulators really had the well-being of women and mothers at heart, they should have initiated clinical trials to investigate the effects of the pill on mate choice, attractiveness, relationship satisfaction, the probability of divorce and the health of children.

For many people, these results could be unsettling. They suggest that the pill has not been thoroughly tested by pharmaceutical companies and has been poorly regulated by government authorities.

Why not?

The answer is obvious. The pill has allowed women to be sexually active without fear of pregnancy. They can choose when to bear children and how many they will have. This has opened up new career possibilities and new lifestyles for them.

So there has effectively been a silent trade-off between reproductive freedom and informed consent. Had more questions been asked, and the psychological and social effects of the pill been thoroughly investigated, it might never have been so widely available, especially for teenagers and single women. The regulators would have imposed more conditions and women would have been much more wary of possible side-effects.

Sex in the City comes with a hefty price tag.

Michael Cook is editor of the online bioethics newsletter BioEdge.