What does the pill’s effect on the human stress response mean?

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The birth control pill has been life-changing for generations of women. It has allowed us to dream bigger and achieve more than even the most optimistic feminist would have ever dared imagine possible 60 years ago. Freeing women from the possibility of an unintended pregnancy has removed a powerful storm cloud that was perpetually present for our college-bound grandmothers and great-grandmothers. It allowed women – for the very first time in history – to plan. As a result of this freedom, there are now some 2.2 million more women enrolled in collegethan men, with women 30 and younger also being more likely than men to have earned a college degree

There is little doubt that, for many women (myself included), the pill is the most pivotal prescription they’ll ever fill. 

But just as we honor the spirit of democracy through the act of self-reflection and critical discussion, we need to continually push to get access to as much information as possible about this great emancipator of women. Women and women’s issues have almost completely been ignored for decades by medical research, which means that we know embarrassingly little research on the range of effects that the birth control pill can have on women’s bodies. And this particularly true when it comes to the impact of the pill on the brain and the stress response. 

Although many of us think of our stress response as being something to be avoided, it’s actually one of the unsung heroes of emotional and physical well-being. This is because it’s not our stress response that causes stress. Life causes stress. Our stress response is the way that our body copes with and manages the stress created by our crazy, overscheduled lives. The specifics of the stress response differ a little bit depending on what’s stressing us out (e.g., pressing deadline versus wildebeest stampede), but there are a few common ingredients that operate across pretty much all of them. One these ingredients is release of the stress hormone cortisol. Cortisol’s job is to dump fat and sugar into the bloodstream to allow for quick escape from dangerregulate inflammatory activity in preparation for injury, and potentiate brain cell activity to allow us to learnfrom our stressful experiences. Each of these activities is integral to our ability to adaptively respond to stress, so much so that we see it in virtually all healthy, functioning living organisms.  

Except for women on the birth control pill.

For almost three decades now, researchers have been documenting thatwomen on the birth control lack the cortisol response to stress.Pill-taking women exhibit higher than average levels of total cortisol, high levels of corticosteroid binding globulins (CBGs), and dysregulated responses to exogenously administered cortisol. And this is significant because these patterns are typically only observedwhen the body becomes so overwhelmed with cortisol signaling that it has no choice but to shut the signal downaltogether. For example, this type of pattern is often observed in children who have been abused or abandonedand those with a joint diagnosis of PTSD and major depressive disorder.We should all be alarmed by the fact that the stress hormone profiles of women who are on the birth control pill look more like those belonging to trauma victimsthan they do like those belonging to otherwise healthy young women. 

So, why haven’t you heard about this before and what does it mean?

Although researchers have been documenting this effectsince the mid-1990s, the information isn’t widely known.  The problem goes back to the lack of research on women and the pill: rather than being the focus of inquiry into the psychological and neurobiological effects of the birth control pill, these patterns are often reported as footnotes in the margins of research about other things. So, these effects aren’t well-known among researchers, let alone the millions of women who are the birth control pill or even the doctors who prescribe it. This information is critical, though, to women’s health and well-being and may help solve some of the most vexing problems in women’s health. For example, disruptions in cortisol signaling are believed to underlie many neuropsychiatric disorders, including depression and anxiety, as well as metabolic disorders such as obesityand insulin resistance.

Although the precise impact of the birth control pill on each of these outcomes is currently not well-understood, its impact is likely to be significant. Already, stress dysregulation in the context of the pill has been linked to problems with learning,the ability to process negative emotions, and memory for emotionally-laden events. Others find that pill-taking women’s brainsand lipid profilesshow evidence of hippocampal shrinkage and elevated triglycerides, both of which are also linked to chronic stress. 

Your doctor isn’t going to tell you about this research. In fact, it’s unlikely that your doctor has heard about it before. In addition to being woefully understudied, the neurobiological and psychological effects of the birth control pill aren’t topics that most medical doctors consider to fall under the purview of medical practice. Most neuroscientists don’t read the results of medical research and most physicians don’t read research in neuroscience.

The pill will likely continue to be the best option for many women. However, we deserve to have access to the information that science gives us so that women can better monitor their health to make sure that their birth control pills are working for, and not against, their long-term health and well-being. 

It is estimated that only 2% of annual sales revenue from contraceptives gets funneled back into research and developmentof new and better ways to prevent pregnancy. That number is unacceptable and suggests that we have gotten far too complacent with the options that we currently have available. Doing better will require a significant investment in research on issues that are important to women, including the ways that the pill modifies women’s stress response. It will also require that we change the way that medicine is practiced, with doctors being more aware of the psychological effects of the drugs they prescribe. There may well be better versions of the pill to be created, but we aren’t currently innovating to find them.

There has been a 9% decline in pill usage in the US in the last fifteen years, reflecting women’s growing distrust of medical professionals who have minimized the extent of the pill’s side-effects. Understanding what the full range of these side-effects are – and being able to recognize and treat them – is a critical next step in regaining women’s trust in medicine and their birth control pills

This is re-posting of an article I published first on Medium.

Published by Sarah E. Hill, PhD

I am a research psychologist, author, and director of the women in research initiative.

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