Web Roundup: Grand Not-So-Unified Theory of Birth Control Side-Effects

Recently, a number of news outlets reported the results of a new research study on the correlation between hormonal contraceptives and breast cancer. The study analyzed data from several Danish national health registers, following 1.8 million women between 15 and 49 years of age. Previous studies of breast-cancer risk among women who use hormonal contraceptives reported inconsistent findings – from no elevation in risk to a 20-30% increase. Furthermore, most of the studies focused on combined oral contraceptives with a high-estrogen dose, while contemporary contraceptives consist of lower doses of estrogen and include additional forms of hormonal birth control: levonorgestrel-releasing intrauterine devices (IUDs), contraceptive patches, and progestin injections. The study found few differences in breast-cancer risk between the formulations, including IUDs – which was a particular focus of many news articles since IUDs are believed to have less severe side-effects than oral contraceptives because of the low levels of hormones they release. The study concluded that absolute increases in risk were small, and that risk was 20% higher among women who currently or recently used hormonal birth control. Media reports on the study differ in tone, some being more alarming, saying that the risk “might be small but shouldn’t be dismissed”, while some attempted to parse out the difference between the study’s implications for personal health and implications it has for public health.

Other research on the relationship between hormonal contraceptives and cancer showed that hormonal contraceptives potentially reduce the risk of endometrial and ovarian cancer, and possibly colorectal cancer. Long-term use of oral contraceptives is associated with an increased risk of cervical cancer, but a study published in December last year implied that IUDs might lower the risk of cervical cancer. Hormonal contraceptives have been linked to an increased risk of blood clots and stroke. The question of how a person negotiates all these findings is a complex one, especially considering the fact that scientific findings often don’t translate well through media. A number of researchers highlighted that the risks that hormonal contraceptives carry should be weighed against the benefits they have, and some even expressed  concern that reports on the relationship between contraceptives and cancer might “scare women away from effective contraception”.

Seeing how women are largely responsible to assure birth control and use hormonal contraception, let’s look at the gender dimension of clinical trials on contraception. The fact that the burden of use of hormonal contraception falls on women opens up questions about gender bias in medicine and clinical trial design. Research on non-hormonal injectable male contraceptive is underway in the form of Vasalgel – which should avoid the adverse effects that hormonal contraceptives have – but researchers have been struggling with assuring funding to complete their studies. In October 2016, it was reported that a promising clinical study on injectable hormonal contraceptive for men was halted due to side-effects the treatment had, including mood disorders, acne, and increased libido. The trial ended after twenty men dropped out because of the side-effects. Before its conclusion, the trial reported that the injectable male contraceptive had similar level of efficacy as the female combined pill, and significantly better efficacy than real-life use of condoms. In comparison, female hormonal contraceptives report side effects spanning from the aforementioned increased risk of certain cancers, blood clots, stroke, and in case of IUDs pelvic inflammatory disease, to common side-effects such as breakthrough bleeding, nausea, headaches, weight gain, depression, changes in libido, and so on. A recent study found a link between hormonal contraception and depression, including suicide attempts, especially among adolescents. Authors of the studies stated that healthcare professionals should be more cognizant of “relatively hitherto unnoticed adverse effect of hormonal contraception”. Some previous studies did not find a correlation between hormonal contraception and depression, and it should be noted that depression is a multicausal illness that is more prevalent in women, which may skew the data investigating the correlation. Multiple editorials critique the design of studies that use large – but incomplete – databases, such as the one used in the study linking depression and contraception. Inconclusive findings aside, the use hormonal birth control carries obvious risks and is accompanied by unpleasant – and potentially serious – side-effects.

What are the implications of the fact that the study on male hormonal contraceptives was halted after (male) participants in the study dropped out because of side-effects that are commonly experienced by women using hormonal birth control? How does this intersect with race and class, especially when we take into account the dark history of birth control trials? Gendered medical gaze and bias against women in medicine is widely recorded, through informal narratives as well as scientific research – particularly in cases of “invisible” symptoms and illnesses, such as pain, but also in the process of diagnosing a condition. Having in mind recent scares on the future of birth control availability and the impact the media interpretation of medical studies has, further anthropological unpacking of the politics of birth control trials and distribution seems particularly important.

Title inspired by: Leslie Jamison. 2014. Grand Unified Theory of Female Pain. VQR.