Thursday, January 14, 2010

A new direction

One of the projects that is just getting off the ground in the Laboratory for Evolutionary Endocrinology is the study of hormonal contraception in young women. We will be exploring the science behind it -- when is it useful to young girls and women, when is it not, what future health implications does it have -- but also the relationships between health care providers and patients regarding this drug.

I am developing a hypothesis regarding when health care providers prescribe hormonal contraceptives. For now, and this is before I have delved into the literature on this, I would like to test the conditions under which it is prescribed for a health complaint, and the conditions under which the health complaint is further explored instead. My suspicion is that when a woman goes to her PCP with a reproductive health issue but is not currently interested in having children, she is often prescribed hormonal contraceptives. When a woman goes to her PCP with a reproductive health issue and is interested in having children, the possible health concern is explored.

I would like to test this hypothesis and others using an online survey in the coming months. As we work to put the survey together and obtain IRB approval, I would like to solicit your thinking. What kinds of questions should we ask? What population should we seek for answers? Should we survey doctors as well as patients? What hypotheses would you want to see tested?

Put your questions and comments in the comments section of this post. If I get a lot of clarification queries, I will post more information about what we're thinking to give you more ideas.


  1. Hormonal methods of contraception offers new perspectives to women for the control of their fertility.New systems allow only minimum dose required for effectiveness and there by reduce the level of unwanted side effects.

  2. I read this post a while back and have been meaning to comment on it... Anyway, I have a few questions first. Do progesterone-only vs. estrogen/progesterone contraceptives differ in their mechanisms? Is it important to distinguish between them? Also, what are the health complaints that hormonal contraceptives are prescribed for? Could going on hormonal contraceptives increase the chances that underlying health issues will go undiagnosed until the woman goes of contraceptives and is trying to have children?

    Regarding what populations to look at, I think it would be really important to try and get Planned Parenthood and similar women's clinics, as well as university health centers.

    As for question to ask, I'd be really interested in how many patients understand the mechanisms of the pill, and how that may effect them. For the doctors, I'd be interested to know how aware they are of possible behavioral effects (such as studies indicating changes in attraction in mate choice, as well as effects on mood) of the contraceptives, and if they communicate that to their patients.

  3. Thanks for your questions, Michelle! The mechanism is pretty much the same for progestin and progestin/estradiol contraceptives, but we should probably distinguish between them anyway (there is also a new kind of progestin, dsrp, which probably works a little differently -- it certainly leads to a totally different set of side effects). The health complaints that hormonal contraceptives are prescribed for are practically endless -- acne, depression, migraines, PCOS, irregular cycles, being an athlete, as prevention for osteoporosis in athletes, and of course birth control. And YES, I think that going on them increases the chances that underlying diseases either go undiagnosed or essentially untreated.

    We will definitely look at different kinds of providers (both in terms of PP vs women's clinics, but also general practitioners vs gynecologists).

    And I like your idea about asking patients how much they understand. Maybe a list of possible side effects (some real, some not) would also be a possibility, to see what they actually know of known side effects. And I would want to ask doctors about that too! So far I haven't met one who is aware of (or convinced of if they are vaguely aware) of the behavioral effects.

    Again, thanks for sharing your thinking!

  4. You hypo reminds me of something I'd not thought of in years. I attended a Catholic university and the only way to get BCP's from student health was to need them for treatment unrelated to preventing pregnancy. So women spoke to providers in code about migraines, painful or irregular periods, and other conditions in order to get contraception. This was 15 years ago - I'd hope providers in general aren't assuming that their female patients today are speaking in code, afraid to ask for BCP because they are ashamed to state that they sexually active, but who knows? Interesting ideas!

  5. Kris, I'm so sorry your comment got held up in moderation -- I thought it was automatically published!