Hormonal Contraception Affects People with Adverse Childhood Experiences
Symptoms from hormonal contraceptives are common, but researchers found that people with adverse childhood experiences (ACE) are more likely to report decreased sexual desire because of using contraception.1
“We need to figure out who are these women at greatest risk for these side effects so we can educate them beforehand that they might be at greater risk, or we can offer them alternatives,” says Andrew M. Novick, MD, PhD, an assistant professor at the Center for Women’s Behavioral Health and Wellness at the University of Colorado Anschutz. “When it comes to hormonal contraception, there is this problematic situation in which the vast majority of women seem to tolerate them well, and there are no issues at all. But then you have this population that has a lot of difficulty tolerating them.”
Novick and colleagues studied brain-based side effects, including mood and sexual drive, to determine which group may be at most risk. They found differences between women who had experienced ACE and those who had not.
Hormonal Contraception the Culprit?
Participants completed an online survey that showed them erotic; pleasant and non-erotic; and neutral images. They completed a reward task rating of what they saw.
“We had them do a behavioral task to see if they were able to get excited about certain types of stimuli, including sexual stimuli, as well as pictures of puppies and happy people together, and things that would normally evoke a positive response in most people,” Novick says. “What we found was you actually didn’t see too much when just comparing the women with adverse childhood experiences to those without adverse childhood experiences.”
But when investigators confined their sample to women on hormonal contraception who were experiencing decreased sexual desire, they found that women tended to have a much lower expectation of pleasure with the external stimuli.
“Those who had high levels of adverse childhood experiences also reported they were experiencing decreased sexual desire,” Novick explains. “They had lower expectation of pleasure from positive sexual stimuli compared to women who did not have a history of adverse childhood experience.”
There are many possibilities for the results, but Novick and colleagues found hints that hormonal contraception was the culprit.
“When we analyzed the data from women no longer on hormonal contraception but who said they discontinued it due to decreased sexual interest, they reported no difference and were no longer showing these behavioral deficits on our rewards path,” he says.
Novick continues to study this phenomenon to determine whether the reported decreased sexual interest is due to something beyond pure biological effects. For instance, a person who experienced ACE may feel guilty about nonprocreative sex.
“The study I’m doing now is where we’re taking women from the beginning who are not on any medications or hormonal contraception and giving them either oral contraception or placebo, and we’re studying their brain,” he says. “We use a functional MRI scanner to see their brain. We do this before they start on the pill or placebo, and we do it 21 days after.”
Even without a definitive answer to why women with ACE report decreased interest in sex while using hormonal contraception, providers should screen for ACE among their patients, Novick suggests.
“As a psychiatrist who believes strongly in the influence of someone’s childhood experiences and trauma, I think it’s important for every doctor to know whether someone has a history of ACE,” he says. “It affects so many things in terms of their risk and health — beyond psychiatric illnesses.”
The results of this study suggest ACE is a factor in how a woman feels while taking hormonal contraception. “Our research should hint it might be useful, and that according to preliminary research, a person with an adverse childhood experience might be at higher risk of side effects on oral contraceptives,” Novick explains. “If you screen your patient, and they have a high level of ACE, it would be premature to say you shouldn’t prescribe hormonal contraception. But if you find evidence of this, the message should be to screen people at risk for side effects and to offer some nonhormonal options like the copper IUD, condoms, diaphragms, and gels that alter vaginal PH.”
If patients have experienced bad side effects with hormonal contraceptives, providers should discuss options like vasectomy if patients do not plan to have children in the future, Novick says. If nothing else, the study shows how women experience side effects to hormonal contraception, and their feelings are real, valid, and should not be written off, he adds.
REFERENCE
- Novick AM, Stoddard J, Johnson RL, et al. Adverse childhood experiences and hormonal contraception: Interactive impact on sexual reward function. PLoS One 2023;18:e0279764.
Symptoms from hormonal contraceptives are common, but researchers found that people with adverse childhood experiences (ACE) are more likely to report decreased sexual desire because of using contraception.
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