The pill, mental health and evidence base versus lived experience. Yes it’s a feminist issue.


So @DrAliceRoberts wrote this article about her experiences of the Pill and mental health in the Guardian, and @cbpolis  did a response on her blog and twitter exploded into a giant debate about evidence based medicine and rather unfairly people told Dr Alice off for writing the article due to her position as a public engagement officer for science. Erm – well given the fantastic discussion she has stimulated I think she is doing a wonderful job!!!

I got very cross about these discussions so here is my contribution based on my experiences as a scientist turned social scientist with a passionate interest in sexual health education and supporting young people and adults to make the best contraceptive choices available to them and that those decisions are informed by facts not opinion.  For information my masters degree was in Evidence based practice (in education) and challenging homophobia (and I looked at gender for a lot of it as well). So I like to think I have a reasonable understanding of evidence based practice and sexual and mental health.

So the following is based on me pretending I know what I am talking about, but before I also get yelled at on twitter by the EBM evangelicals- or picked apart for selective evidence, this is a blog post and not an RCT (randomised control trial for those not in the know) so pretty much these need to be taken as musings and not evidence of anything other than THIS STUFF IS VERY IMPORTANT TO THINK AND TALK ABOUT. 

So here are my points:

1) All science occurs under patriachal capitalist conditions. We like to think science is objective but it simply can never be due to these forces. We can try, but the fact of the matter is pharmaceutical companies have vested interests in favourable research, female research and researchers are much more likely to be marginalised (and no I don’t think “double blind peer review” is enough to ensure female led research has an equal footing to male led research).  Female voices and experiences are continually erased throughout history and in life and this is also true in science.

2) The evidence for and against the pill possibly causing mental health issues is still very mixed, however much people are firing evidence one way or the other to “prove their point”. The only conclusion I think that can be made is “we don’t know enough yet but it’s worth investigating further.” 

The very clever @Unity_MoT (luff him) has been pointing out the following.

 

 

3) So erm How dare people erase the lived experience of women like this!? The sheer volume of women on twitter talking about their mental health experiences as a result of hormonal contraception should be raising red flags somewhere. How can this be dismissed because the “evidence” (such as it is) says there is no effect!? How about listening to women? That especially goes to clinicians. In my job I have worked with clinicians who are far to willing to prescribe LARC’s (long acting reversible contraceptives) without bothering to take the time to ensure this is an informed choice by the young person. To the extent I know of a young lesbian woman with an implant in (despite not having sex with men) because the Dr wasn’t listening too her and she was too embarrased to come out to them, and inexperienced to know that the implant might not be the best choice for her to sort her painful periods given she DOESN’T HAVE SEX WITH MEN AND IS NOT AT RISK OF TEENAGE PREGNANCY. I’ve seen clinicians first hand dismissing women who are drawing a link between their mental health and the pill as “its not due to that” and deciding there must be something else going on, so prescribing anti-depressants. Big Pharma must be rubbing their hands with glee. 

 

4) I’m sharing my lived experience here in solidarity with Dr Alice Roberts but at same time it is probably bit TMI for my work blog post (sorry!) Certain pills made me feel mental and as soon as I came off them I felt so much better. However I have had times in my life where I was fine on a particular pill and then when I went back to it years later I didn’t react well to it.  So based on my sample size of 1 I think the pill may effect mood but it doesn’t always and there may well be other factors at play, but for me the mood lift in the days after coming off the pill is too much to be a coincidence. Interestingly my husband considers my mood on hormonal contraception to be much more regular, than off the pill where it is admittedly at times variable 😀 but a regular low mood is not as much fun as a rollercoaster ending in a dip of weepy cathartic PMT. 😀 

5) So in conclusion where does this furore leave those of us who talk about contraception for a living? I don’t see there is any problem in talking about one of the possible side effects of the pill may be low mood and explaining that the evidence for this effects is mixed, lots of women will be fine, other women may not feel great on it,  so it is down to the individual to try out the contraception that works best for them and their life and with the side effects they feel they can live with. 

As an aside a sexual health colleague of mine is trying to get clinicians to explain the side effects of the implant, such as erratic bleeding for a few months after insertion to women. This is because studies have shown that women who have the implant for more than 8 weeks are more likely to keep it once the bleeding has settled down, but those who weren’t expecting these side effeects can’t cope and want to get it taken out early but then face battles with health professionals reluctant to remove it. He thinks some work done around explaining the side effects and supporting women to get through the early days whilst their body settles into the new method would mean less women taking it out, and less costs to the NHS.   Reasonable I think.

What I’m trying to say is some expectation management about side effects in the early days can help women find a method to best suit them but the key is give women the facts and support them to make their own choices. Don’t disregard our voices because our experience doesn’t fit with the evidence narrative.

Informed choice innit. 

Rant over. 

 

 

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