> Methods: We recruited healthy adults aged 23-35 who identified as women currently using (n = 62) or having used (n = 37) solely combined OCs, women who never used any hormonal contraceptives (n = 40), or men (n = 41).
> Results: Compared to men, all three groups of women exhibited a larger GMV of the dorsal anterior cingulate cortex, while only current users showed a thinner ventromedial prefrontal cortex. Irrespective of the menstrual cycle phase, never users exhibited a thicker right anterior insular cortex than past users.
They really run a number on your emotions. Not surprised to see this but fairly surprised to see it coming out this long after they've been on the market.
Anecdotally, I’ve heard from women friends about pills having effect on depression, libido and anxiety. Not super surprising given how much it messes up with hormones
I appreciate that people are looking into this, and I think more research of this kind should be funded.
However, one needs to be cautious when claiming an "impairment" in fear regulating regions from a measure of cortical thickness with MRI. For once, there is no evidence that a slightly thinner or larger cortical thickness means better or worse regulation of any kind.
Second, morphology studies are susceptible to many sources of biases which are not really addressed in this study. For example, anything that affects hydration levels or causes a redistribution of blood and cerebral spinal fluid volume can lead to significant changes in measures of cortical thickness, since they will change the contrast between gray and white matter that drive cortical thickness measurements.
Changes in thickness have been found even when comparing people scanned in the morning and in the evening [1]. Any drug intervention could be expected to cause physiological changes that could act as confounds.
Also, in the discussion one reads: "Interestingly, no lasting effects of combined oral contraceptives (COCs) use were detected when comparing the four groups."
This suggests that the changes could be driven by physiological changes instead of permanent changes in brain circuitry.
It would be great to see a follow up study controlling for potential confounding effects (for example, measuring baseline perfusion, blood pressure and controlling for time of day effects and usage of other drugs), and expanding the study with functional tests that involve fear regulation.
What are the socio-political effects of mass psychological changes brought about by putting a large chunk of the population on medications without full knowledge of the side effects?
Imagine putting an equally large percentage of the population on androgenic medications.
Because there's no reason to assume that the "default" state of nature is some ideal or good for anything. It could be but what are the odds? We're still apes in a world that changed wildly out of pace with the speed of natural evolution.
> equally large percentage of the population on androgenic medications
Its funny you say this because doing this would actually put humanity back to the testosterone levels men had for most of human history.
Probably people would become more risk-averse, on average. Interest rates would tend to go lower, as money in the future would gain relative value compared to present money.
> What are the socio-political effects of mass psychological changes brought about by putting a large chunk of the population on medications without full knowledge of the side effects?
Not really a question big pharma is interested in discussing ...
If you’re a man who doesn’t want children or has finished having children: get a vasectomy. They’re easy, low risk and help reduce the (significant) contraceptive burden on partners.
(Although technically a vasectomy is reversible, it isn’t guaranteed and so a vasectomy is not a good option if you intend to have children someday)
Not as easy as the current trend of "just get a vasectomy, it's easy and reversible" suggests. The problem with a vasectomy is that there is a low, but non-zero chance that you get long-lasting pain from it. After all, they cut through a bunch of nerves and muscles. These aren't just some dumb useless tubes.
So, given you're in a stable relationship, you essential trade X years of care-free sex (until menopause) for a slight risk that it fucks you up pretty badly. In other words: the potential upside is limited, the potential downside is quite severe.
Regarding reversibility: Not as easy. It's a sophisticated operation which requires a specialist and takes 2-3 hours. If your body produces more sperm than it can absorb, they might rupture tiny tubes in your epididymis, which makes it almost impossible to reverse. The risk is higher the longer ago the vasectomy was.
Why do people use pills rather than copper IUDs? At least based on information on the web, it seems copper IUDs are strictly better: cheap, easy to insert and remove, nothing to do after initial insertion, no side effects other than "increased menstrual flow".
Potential complications from use. Have heard some horror stories with regards to IUD failure (and resulting pregnancy) and uterus perforation, so it is not such a small risk as to by hypothetical.
> no side effects other than "increased menstrual flow".
It's my understanding that with birth control pills, a woman can indefinitely delay her menstrual cycle. I can absolutely see some making a choice to not have periods at all, if the other side effects for them are negligible. An option that not only brings periods back but makes them messier would not look very attractive in comparison.
As with most things health and lifestyle, everything involves tradeoffs, and choices are dependent on individual valuation of those tradeoffs.
If you have a toddler, they like to jump on your body and belly at random times, leading to increased risk of perforation. Same likely applies if you have a more active lifestyle.
Birth control pills can help with other conditions in addition to / aside from contraception. My understanding is that they are used, for example, to try to treat symptoms of endometriosis and have been used to control acne. Dr. Google claims they can even help lower the risks of some cancers.
IUDs can cause side-effects especially the first few cycles after insertion.
Not true, I have had exes with IUIs and they all had crippling pain and much worse cramping with them. In every case I talked them into get rid of the IUI, and the pain went away.
The best birth control method (as defined by least side effects and max efficacy) I’ve come across is cycle tracking / family planning (called that because you can use it to get pregnant as well as prevent pregnancy). It’s simple (you can only get pregnant at certain times in your cycle), but there’s nothing for pharma to sell (it’s free!). Weirdly, doctors never seem to trust women to go through with it (and always try to push medicated birth control), but it’s easy, even before Apple added it to their products.
You may want to rethink "max efficacy" there for the natural family planning approach.
There are multiple methods (temp tracking, calendar tracking, vaginal mucus tracking, etc) that fall under the general header of natural family planning. High efficacy numbers only come with extremely consistent use of multiple methods. With all that work, it ties with the effectiveness of birth control pills. With only a portion of that work, it's not very effective at all in comparison.
> FAMs are about 77%–98% effective. That means 2–23 out of 100 couples who use FAMs will get pregnant each year, depending on which method(s) are used. If you use multiple FAMs together, they work even better.
> The better you are about using FAMs the right way — tracking your fertility signs daily and avoiding sex or using birth control on “unsafe” days — the more effective they’ll be. But there’s a chance that you’ll still get pregnant, even if you always use them perfectly.
Cycle tracking is pretty unreliable. It's also dangerous to record that information when it may be used against you if you do get pregnant and have an abortion.
A good friend of mine developed a serious case of pcos from birth control medication which started in her teen years. It's impacting her fertility, growing facial hair, pre-diabetes symptoms, and impacting weight gain/loss. Her doctors just "shrug" and suggest to get back on birth control as a solution. Imagine allowing your teenage daughter to be on a semi-permeant dosage of hormone altering poison.
I didn’t think PCOS could be triggered by birth control - doesn’t seem to be a lot of evidence to support this either. Looking at the mechanism of action of COCs, I can’t think of a mechanism of why COCs would cause PCOS. Oral contraceptives are usually first line in treating PCOS which makes this anecdote even more weird. Can you provide any more information?
Its not an officially supported theory, but there's alot of anecdotal evidence out there that going off of BC after many years can cause these symptoms with some women.
tl;dr article describing a study [0] by Peyrot,C, Brouillard,A, et al comparing the ventromedial prefrontal cortex volume between the brains of { women using, women abstaining from, women who never used, men } oral contraceptives. They found reduced volume in the brains of women using contraceptives and some amount of recovery in women abstaining. The linked article is ambiguous about whether the effect dampens or increases fear, but the study indicates a correlation between hormonal contraceptives and higher stress.
Readit News
I would expect the study to compare it to other women not using OCs. Does this methodology make some sense that I'm missing?
> Methods: We recruited healthy adults aged 23-35 who identified as women currently using (n = 62) or having used (n = 37) solely combined OCs, women who never used any hormonal contraceptives (n = 40), or men (n = 41).
> Results: Compared to men, all three groups of women exhibited a larger GMV of the dorsal anterior cingulate cortex, while only current users showed a thinner ventromedial prefrontal cortex. Irrespective of the menstrual cycle phase, never users exhibited a thicker right anterior insular cortex than past users.
(Source: https://www.frontiersin.org/articles/10.3389/fendo.2023.1228...)
I agree with you it’s somewhat confusing why they use men as their benchmark. But really this isn’t my field of expertise.
What a weird thing to say if you study the effect of the pill on women.
Changes in thickness have been found even when comparing people scanned in the morning and in the evening [1]. Any drug intervention could be expected to cause physiological changes that could act as confounds. Also, in the discussion one reads: "Interestingly, no lasting effects of combined oral contraceptives (COCs) use were detected when comparing the four groups." This suggests that the changes could be driven by physiological changes instead of permanent changes in brain circuitry.
It would be great to see a follow up study controlling for potential confounding effects (for example, measuring baseline perfusion, blood pressure and controlling for time of day effects and usage of other drugs), and expanding the study with functional tests that involve fear regulation.
[1] https://www.sciencedirect.com/science/article/pii/S105381191...
What are the socio-political effects of mass psychological changes brought about by putting a large chunk of the population on medications without full knowledge of the side effects?
Imagine putting an equally large percentage of the population on androgenic medications.
> equally large percentage of the population on androgenic medications
Its funny you say this because doing this would actually put humanity back to the testosterone levels men had for most of human history.
Women and men respond differently to testosterone, so this argument does not hold.
But there is? Thousands of years of evolution is actually a pretty high bar to pass.
Imagine what would happen if people start routinely living to 150.
Dead Comment
Not really a question big pharma is interested in discussing ...
(Although technically a vasectomy is reversible, it isn’t guaranteed and so a vasectomy is not a good option if you intend to have children someday)
So, given you're in a stable relationship, you essential trade X years of care-free sex (until menopause) for a slight risk that it fucks you up pretty badly. In other words: the potential upside is limited, the potential downside is quite severe.
Regarding reversibility: Not as easy. It's a sophisticated operation which requires a specialist and takes 2-3 hours. If your body produces more sperm than it can absorb, they might rupture tiny tubes in your epididymis, which makes it almost impossible to reverse. The risk is higher the longer ago the vasectomy was.
Potential complications from use. Have heard some horror stories with regards to IUD failure (and resulting pregnancy) and uterus perforation, so it is not such a small risk as to by hypothetical.
It's my understanding that with birth control pills, a woman can indefinitely delay her menstrual cycle. I can absolutely see some making a choice to not have periods at all, if the other side effects for them are negligible. An option that not only brings periods back but makes them messier would not look very attractive in comparison.
As with most things health and lifestyle, everything involves tradeoffs, and choices are dependent on individual valuation of those tradeoffs.
Have you ever experienced recurring or ongoing debilitating pain? Going from 1-2 days of pain per month to more doesn't sound like "no side effects".
Aren't they meant to be extremely painful to insert/remove?
IUDs can cause side-effects especially the first few cycles after insertion.
Deleted Comment
The best birth control method (as defined by least side effects and max efficacy) I’ve come across is cycle tracking / family planning (called that because you can use it to get pregnant as well as prevent pregnancy). It’s simple (you can only get pregnant at certain times in your cycle), but there’s nothing for pharma to sell (it’s free!). Weirdly, doctors never seem to trust women to go through with it (and always try to push medicated birth control), but it’s easy, even before Apple added it to their products.
There are multiple methods (temp tracking, calendar tracking, vaginal mucus tracking, etc) that fall under the general header of natural family planning. High efficacy numbers only come with extremely consistent use of multiple methods. With all that work, it ties with the effectiveness of birth control pills. With only a portion of that work, it's not very effective at all in comparison.
From https://www.plannedparenthood.org/learn/birth-control/fertil... -
> FAMs are about 77%–98% effective. That means 2–23 out of 100 couples who use FAMs will get pregnant each year, depending on which method(s) are used. If you use multiple FAMs together, they work even better.
> The better you are about using FAMs the right way — tracking your fertility signs daily and avoiding sex or using birth control on “unsafe” days — the more effective they’ll be. But there’s a chance that you’ll still get pregnant, even if you always use them perfectly.
[0] https://www.scopus.com/record/display.uri?eid=2-s2.0-8512774...
[1] https://www.sciencedirect.com/science/article/abs/pii/S00057...