← The Clay Travis and Buck Sexton Show
The Clay Travis and Buck Sexton Show
Wellness Unmasked: The Mental Health Risks of Hormonal Birth Control in Teens
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- [00:01]
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- [03:12]
Dr. Nicole Safire
Welcome to Wellness Unmass. I'm Dr. Nicole Safire and we are going to do something a little different this week. I had something planned for the podcast episode to be released this week. However, yesterday I found myself going down this never ending rabbit hole. Have you ever done that where you start searching one thing and then you're like, oh, well, that's interesting. I'm going to click on this link and then this link and then several hours later I have to change our entire week's topic because I'm still down the rabbit hole and I'm just going to bring you guys down with me. So yesterday, if you saw I do a weekly segment on Fox and Friends Weekend called Weekend Wellness and we always talk about some sort of news of the week or some wellness topic, usually some social media trend that I think is totally bogus. This week though, I was asked to kind of dive into some of the less common or less known side effects of contraception use. All right, it seems pretty straightforward. I've been studying contraceptives, contraceptives for, I don't know, aids. And just as a woman, I knew about them, obviously. But as I was looking for the more, or I should say less commonly known ones, that's when I found myself kind of going down this rabbit hole as a woman. Anywhere from 60 to 75% of women of childbearing age are all on contraceptives here in the United States, whether it's oral contraceptives, implantable devices like rings, IUDs, surgical contraception, where you have your tubes tied during some sort of surgery. There are a lot of different contraceptives these days, but but the most common, the overwhelmingly most common, are the hormonal Oral contraceptives or, you know, the pill as most people know it as. So I kind of focused there a bit and one of the things that really stood out to me, Listen, I, I deal in breast cancer every single day. So I. People ask me all the time, is there a rise of cancer risk when it comes to oral contraceptives? That's not what we're focusing on today. That's an entirely different conversation. But I can tell you that there can be a slight increased risk of breast cancer when it comes to some of these contraceptive methods. When you stop taking the hormonal contraceptives, your risk does tend to go back to normal with some time. So, you know, I wouldn't say cancer risk if you don't already have a known family history of cancer is necessarily a reason not to try them. But again, that's not what we're going to talk about because while that is interested in, for my daily job that the rabbit hole that I started going down yesterday, which I found extremely alarming and I can't believe that I'm not hearing I haven't heard about this more. I guess it's just not what mainstream media wants to talk about is its effect on mental health. And not just mental health of all women, but mental health specifically in adolescents and young adults who take hormonal contraceptives. So let's talk about this. First of all, we know when it comes to contraceptives, it is wildly advertised. You can see it. Pharmaceutical companies are now able to do radio and podcasts and ads and TVs and social media and all these other things. And usually when you see the ads, it's female empowerment, doing what's right for you. Kind of all these strong, buzzy, feel good terms. I guess they don't really want to focus on the negative side of that. You know, as a teenager myself, when I was having really difficult menses or menstrual cycles, you know, heavy bleeding, lots of pain, I think a lot of women deal with it, you know, headaches, you know, some acne. Some of all the stuff that comes with being a teenager, a knee jerk reflex these days are putting these kids on contraceptives. I was one of them. I don't even remember having that conversation. I just, you know, my mom and I told the doctor, well, these are the symptoms. And the doctor's like, all right, well birth control, it's a very common thing, especially in teen girls. It's not just for, you know, contraceptive. You know, that's like the nice little thing they Say they're like, it really can help with the moods and the acne and all these other things, which by the way, it can, you know, contraceptives does decrease sebum, which can help with acne. I'm not saying it doesn't have benefits whatsoever. I'm not. But I don't remember having the conversation about what we're about to talk about. So one of the, what I was discovering yesterday in my downward spiral is the fact that there are. I'm going to be scrolling because I want to reference things because as you know, I like to be very fact based. I love data, I love objective medicine, meaning I like to take the opinion out of it and I just like to report on the facts. So since I've really only been studying this for a solid 24 to 48 hours, I'm going to reference some things because I wouldn't call myself an expert, but at this point I am incredibly more knowledgeable about this topic than I was a week ago, a year ago, 10 years ago, or I guess it was 30 years ago and not quite 30 years ago when I was prescribed these myself as a teen. But the fact that there is a relationship between hormonal contraceptive use and depression and not just suicide attempt, but suicide completion in teenagers. And I was thinking, all right, well maybe there's a few case reports, some anecdotal evidence, you know, did you know, causation, correlation. Is there really evidence to suggest that oral contraceptives or these hormonal contraceptives could be doing this? Well, let me tell you, there was not just a couple of case reports. We had these really big observational meta analysis studies looking at this like, this is not new. This isn't something that's just popping up. This is something that's known about. It just really isn't talked about. I'm going to just throw out some stats from some of these studies. We're not going to go into all of these studies. I'm going to spare you that because I read them. One out of UPPSALA University showed 130% higher risk of depressive symptoms in teens who took oral contraceptives. The Danish registry data, this was the biggest one. It looked at over a million women over about eight years. And essentially he said of the young girls, teens, young adults who were taking hormonal contraceptives, they had a 70% higher chance of also being prescribed antidepressants at the same time. So it was like, it's like this endless cycle. All right, we're going to prescribe contraceptive hormones. And now we're going to prescribe antidepressants. And the antidepressants are probably going, going to, you know, are trying to help the effects of the hormones, but we're going to keep giving the hormones and we're going to keep needing the antidepressants. And by the way, when you start antidepressants as a teen, your likelihood of staying on them through adulthood is through the roof. So it's not like it's a short lived thing. Oh, we'll just do it for a little bit. Absolutely not. And there is a clear difference between teens and adult users. When a teen started oral contraceptives, the risk of depression and these suicidal thoughts was significantly more than that in adult users. And it also varied a little bit by the type of contraceptives. Interestingly, most common associated were the hormonal IUDs as well as the oral contraceptives. So I kind of took a pause at this point. I'm like, wow, I'm seeing a lot of evidence. They're certainly talking about it. But I really want to know, is it true? Were there really, really documented data on suicide and all of that? And the answer was yes. It's not just, oh well, there was a risk of depression. Oh, it was more than that. So there's this study out of Denmark, looked at nearly half a million women age over 15. Again, the follow up was about 8 years. This was part of that Danish registry that I was already talking about. They found hormonal contraceptive use doubled the risk of suicide attempts. Doubled the risk, by the way, if that's not bad, it tripled the risk of completed suicide. Meaning they didn't just attempt suicide, they killed themselves. They tripled the risk. Those who were on the contraceptives had a threefold risk of completing suicide, of killing themselves than those who never were on the oral contraceptives. Now you can say, well, how do we know that they didn't have mental illness? How did they, we know that they weren't predisposed to it. All good questions, all good questions. Okay. We always have to look deeper at the data, but they did account for this. If those, if anyone had a known history of mental illness, known history of depression, they were already removed from this study. Now again, science is imperfect, but I'm telling you that these numbers are not equivocal. We're talking major increased risk of depression, suicide attempt suicide completion, being prescribed antidepressants, all when kid, I call them kids. I mean I have a 25 year old? Yes, a 16 year old girl. A 15 year old girl is a kid to me. When we are prescribing kids these medications, there are heavy consequences. With this, another study came out of Sweden. This was a big Swedish registry. It looked, I mean it was less populated. About 216,000 women looked at 15 to 22 year olds. The combined oral contraceptive users had almost a two times suicidal behavior in the first month compared to those without the oral contraceptives. And they actually said that, they said the suicidal ideations and attempts were more likely within the first two months, but it didn't actually go back down to normal with time. And if it was a progesterone only pill, like the mini pillow, I think it's referred to in the cool world, it was even higher. Another one Finland analysis of almost 600,000 women ages 15 to 49 over a couple year period, they said that they found no increase of attempted suicide. However, it certainly did increase depression. I mean, so take it what you will. Depression can lead to suicide if you have an increased risk of depression. I'm going to say at some point people with depression contemplate, if not complete suicide. So nine studies total looked at some of this stuff. Three on suicide attempts, five on completed suicides. And the majority of these showed an increased risk. Some of them were equivocal, some just said, well, we can't really say for sure that there's an increased risk of suicide attempt or completion. But they certainly there was not a question that it could increase the risk of depression in people who do not have a history of depression. You're listening to Wellness en Masse. We'll be right back with more.
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- [18:29]
Dr. Nicole Safire
Hula.
- [18:30]
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- [18:59]
Dr. Nicole Safire
Why would teenagers be more vulnerable to these? You know, why isn't it the same for teens versus adult women? Well, I mean common sense kind of comes in right here. The reality is the teenagers brain, their body, it's still forming. I know 15, 16 year olds think they know it all and that they're already adults, but the reality is they're not. In fact, adolescence is a critical period for brain development and hormonal regulation that is puberty. It doesn't just happen overnight, it takes time. And there's something called the HPA axis. And without getting into the granular detail, there's a little gland in your brain called the hypothalamus. Then you have the pituitary, another one, and then you go down to your adrenal glands, which are two glands that it's hard for me to do with my shoulder pointing to my back. Your two little adrenal glands sit on top of your kidneys. Now this is your HPA Access. And this is important for your stress response. So your fight or flight, it's part of that, your cortisol levels. And so there have been many studies showing how synthetic hormones like oral contraceptives may dysregulate this cycle and dysregulate your mood resilience, you know, your ability to deal with stress. And particularly oral contraceptives, based on this science, not just because it's my opinion, have shown that it can significantly affect this HPA axis, again, which regulates the body's stress response. So this impact can lead to altered cortisol dynamics, including blunted cortisol response to stress. So if you're stressed out, your body's like, well, I just don't know how to deal with it. And that internalizes and that can lead to depression and just mood and emotional reactivities that are abnormal for you, not the way that they're meant to be. So there have been several studies that have looked at that cortisol levels, women on and off oral contraceptives and the other hormonal contraceptives. And it does show there's variations in the cortisol and their response to certain stimuli. They've actually done imaging studies. I mean, as a radiologist, of course, I love the imaging studies. They looked at functional mri and they looked at MRI and they showed on women who have been on hormonal contraceptives compared to those who are not on hormonal contraceptives, their brains look different. There are certain areas in their brain where their cortices are. Are thinner. Are they react differently to traumatic stimuli. Like if they were to be seen a picture that should invoke some sort of reaction. It's your visual pathway. So you see it. It registers in your brain. And then your brain said, all right, let's send out these hormones. We gotta deal with this stress that actually happens in your brain. Well, oral contraceptive users, sometimes it's a blunted response. They don't respond the same way to stimuli that they should. It's all very interesting. Again, this was part of that deep dive I was kind of going into. And I think I could continue to go, but we had to record because I have to get this out for you guys. But, you know, I just got really concerned about this because, listen, there are so many stories about teens who have acne who are being bullied, and so they go on prescription hormonal contraceptives, and it's the only thing that works for them. I don't think anyone here is saying no one should be on medications, especially if it's helping them. Because I can tell you, if a teenage is not feeling good about their physical appearance and they're being bullied or they're just. That can also lead to depression. That can also lead to suicidal ideations and suicide completion. I just am saying that I think that the risk of these contraceptives in younger girls is not talked about enough. And in fact, we have black box warnings on SSRIs, which is a very common antidepressant, which ironically is like what some of these girls are being put on because their contraceptives are giving them depression. There are black box warnings on SSRIs, warning that there's increased risk of suicidal thoughts and completion with the use of these medications. And. Okay, so then the question is. All right, well, if there's already a black box warning on SSRIs, obviously the data on that showing a direct, not just correlation, but causation exists. I mean, you'd think so, right? I thought so too. Again, that was another level of that rabbit hole that I went down. Let's talk about. Why did the SSRIs get their black box warning? Well, in 2004, when they were being prescribed like candy, there started to be all of these case reports, and parents were saying, hey, specifically in kids under 25, they're not doing well. They're talking of being institutionalized. Suicide really just all started with some of these anecdotal reports, which, you know, it often does. So in 2004, when SSRIs were starting to be prescribed like they were candy, especially in young adults and teens less than 25, there were a lot of reports. I wouldn't say a lot of reports considering how many was being prescribed, but there were reports of increased suicidal attempts and completion of people who had just been put on these medications. Well, aren't these medications supposed to help the depression, not escalate it? Well, so the FDA said, all right, let's, we're going to take a break because again, FDA not always the first. In fact, Europe said, we need to take a look at these a little bit closer. Europe started doing a little deeper dive. They started putting warnings out. So the FDA is like, well, I guess we have to look at these now. Shocking. So the FDA decided to conduct a big meta analysis looking at over 100,000 people. And the analysis revealed that the risk of just suicidal thoughts or behavior was twice as high in those taking antidepressants compared to those on the placebo. Twice as high suicidal thoughts when taking the medication compared to those that weren't. Gosh, I just don't know where I've heard that before. Oh, right. Oral contraceptives. Twice as high suicidal thoughts, three times as high suicidal completion. I didn't even see suicidal completion in the FDA's meta analysis that resulted in their black box warning on SSRIs. So why no black box warning on oral contraceptives? I don't know. I find it concerning. When I googled the Google machine, why is there a black box warning for SSRIs and not for oral contraceptives when it comes to suicidal thoughts? It came back. Well, while the evidence is clear because of randomized control trials, the evidence is less clear for oral contraceptives because it's based on meta analyses and observational studies and blah blah, blah, blah blah and kind of everything else that we hear. But yet no one's doing the studies. There are enough signals here that the conversation is significantly warranted and maybe I'm going to need to give a call over to the hhs. My buddies over there. You know Marty Makary, who is the commissioner of the new commissioner of fda. He was on Wellness and Mass last month talking about some things and how they're going to be cutting through the red tape and they are going to reassess the data because they're tired of settled science. They were just talking about hormone replacement therapy and black box warning that's scaring women away from hrt. Well, maybe we need to talk about oral contraceptives in teens. Seems like a good idea to me. We don't have a CDC director right now, so I can't reach out to anybody there. It would be nice to have one to kind of help guide us seeing as the CDC gives formal recommendations about things. I don't know, I guess the question I have from an ethical and regulatory question, mind you, I'm not a gynecologist, I'm not a psychiatrist. I'm not going to have these conversations with my patients and I have three sons, so I'm not having these with my daughters either. But if we are obligated as physicians to inform teens about the suicidal risk with antidepressants, is there not a parallel obligation to do the same thing with birth control? I mean, maybe this warning could help girls and parents monitor mood symptoms earlier. Maybe people would be less inclined to medicate as quickly as we do, knowing that there are legitimate risks. I personally think we are an over medicated society. I think far too many young girls are started on birth control. I do, I get it, we want to avoid unwanted pregnancies. I get it. For some, it's helpful with acne. I just think that this perpetual cycle of hormones, antidepressants, hormones, antidepressants, antibiotics, and all these other things that we just keep throwing at our kids, like, no wonder we're a messed up society. No wonder we have gut issues. No wonder we're overweight and have metabolic issues and infertility issues and all the other things that we're dealing with. I don't know. Again, you can see my, my little hole that I keep going down. I guess the important thing is I want to make sure that people are being told of these risks. Whether that is in the form of a black box warning, I don't really know. You know, one thing that I find incredibly interesting is that if you look in Europe, like several European countries forbid or severely curtail pharmaceutical advertising to children. Yet here in the United States, selling to children is just like business as usual. Whether it's the vaping, I mean, we're finally getting control on that, and the bubblegum flavors of vaping, Whether it's birth control, just medications, like, whatever it is. I mean, there's anti HIV medications just showing people, like, frolicking at poison parties, like, hey, we can have a good time again. There's a pill, like, I am so turned off by all of this. I just think we have gone so far from our moral compass and what is right when it comes to our pharmaceutical advertising and all of the other things that we need to really reign it in. RFK Jr has talked about, hey, we're going to pull back on pharmaceutical advertising. Hasn't happened. Pharmaceutical companies, I think, pay like $30 billion globally in advertising. Maybe that's part of the reason why. I don't know. I just think that. I think that we need to have a bigger conversation when it comes to contraceptive use in kids. And I think that as a medical society, we need to take a pause, take a step back and say, are we doing too much? Are we not acknowledging the risks? Because we're trying to push this mainstream agenda, and the mainstream agenda is reducing unintended pregnancies. But with that is a cascade of perpetual medication and hormone use, which are not benign. They have very significant risks. And those risks are not being talked about nearly enough. I'm Dr. Nicole Safire. Thanks for listening to Wellness Unmass on America's number one podcast network, iHeart. Follow wellness unmass with Dr. Nicole Safire and start listening on the free iHeartradio app. Wherever you get your podcasts and we will catch you next time.
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Dr. Nicole Safire
Hula?
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