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Abstract
Governments and society have accepted and enthusiastically promoted contraception, especially contraceptive steroid hormones, as the means of assuring optimal timing and number of births, an undoubted health benefit, but they seldom advert to their limitations and side effects. This article reviews the literature on the psychological, social, and spiritual impact of contraceptive steroid use. While the widespread use of contraceptive steroid hormones has expanded life style and career choices for many women, their impact on the women's well-being, emotions, social relationships, and spirituality is seldom mentioned by advocates, and negative effects are often downplayed. When mentioned at all, depression and hypoactive sexual desire are usually treated symptomatically rather than discontinuing their most frequent pharmacological cause, the contraceptive. The rising incidence of premarital sex and cohabitation and decreased marriage rates parallel the use of contraceptive steroids as does decreased church attendance and/or reduced acceptance of Church teaching among Catholics.
Lay summary: While there is wide, societal acceptance of hormonal contraceptives to space births, their physical side effects are often downplayed and their impact on emotions and life styles are largely unexamined. Coincidental to the use of “the pill” there has been an increase in depression, low sexual desire, “hook-ups,” cohabitation, delay of marriage and childbearing, and among Catholics, decreased church attendance and reduced religious practice. Fertility is not a disease. Birth spacing can be achieved by natural means, and the many undesirable effects of contraception avoided.
Notes
1 Food and Drug Administration product warnings and information (RX List 2015): Side effects: inflammation at the insertion site, symptoms of cerebral, pulmonary, cardiac or peripheral thrombotic or embolic episodes or hypertension, breast mass, icterus, or depression.
Clinical trials with 942 women from several countries preceded approval of Implanon. Adverse reactions leading to discontinuation of treatment reported by more than 1% of subjects included irregularities of menstrual bleeding 11.1 percent, emotional lability 2.3 percent, weight increase 2.3 percent, headache 1.6 percent, acne 1.3 percent, depression 1 percent. In the subset of 330 U.S. subjects, 6.1 percent experienced emotional lability, and 2.4 percent reported depression. Adverse reactions which did not result in discontinuations reported by more than 5 percent of subjects included headaches 24.9 percent, vaginitis 14.55, weight increase 13.7 percent, acne 13.5 percent, mastodynia 12.8 percent, abdominal pain 10.9 percent, pharyngitis 10.55 percent, leukorrhea 9.6 percent, influenza-like symptoms 7.6 percent, dizziness 7.2 percent, dysmenorrhea 7.2 percent, back pain 6.8 percent, emotional lability 6.5 percent, nausea 6.4 percent, pain 5.6 percent, nervousness 5.6 percent, depression 5.5 percent, hypersensitivity 5.4 percent, and insertion site pain 5.2 percent.
As post-marketing experience is based on voluntary reporting, the FDA cannot estimate their frequency or establish a causal relationship, but the list encompasses every organ system. Warnings and precautions in U.K. literature not mentioned in U.S. sources for etonogestrel include ectopic pregnancy in the event of contraceptive failure, which is considered to be more likely than intrauterine gestation, as progestins slow transport of the embryo in the fallopian tube. Implantation normally begins when the embryo is 5.5 days old; if the movement of the embryo is slowed, it will begin to implant in the tube.
2 Some years ago a psychologist from the NIH who had no religious affiliation came to me for instruction in the Billings Ovulation Method of NFP. She had already used mechanical and hormonal contraceptives, but responding to a comment I had made at an NIH meeting, decided to seek a natural method. After using the method for three months she told me ‘this method is so different – now I can be all there, now I am not holding anything back.’ The contrast between contraception and fertility-acceptance methods has never been explained more simply.
3 The far greater incidence of thrombo-embolic episodes discovered subsequently and multiple lawsuits for over $1.9 billion have dampened enthusiasm for this drug, which was heavily marketed as lacking the negative effects of the androgen-derived levonorgestrel contraceptives (Drugwatch Citation2014). Despite the numbers of women who have suffered or died from pulmonary emboli, myocardial infarction, or strokes, Yaz, Yasmin, and Ocella are still on the market.
Additional information
Notes on contributors
Hanna Klaus
Dr. Hanna Klaus is director of the Natural Family Planning Center of Washington, D.C.; co-founder and director of the Teen STAR Program, USA; and a Medical Mission Sister. Dr. Manuel E. Cortés is professor of physiology, researcher, and director of Departamento de Ciencias Químicas y Biológicas, Universidad Bernardo O'Higgins, Santiago, Chile; and associate researcher of Teen STAR Chile.