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Birth Control and Depression

birth control and depression, toronto naturopath, naturopathic doctor toronto

Over the last couple of years birth control and it’s affect on mood, most commonly depression, has been in the news. Many are left wondering if birth control is safe for women. I’ve assessed a couple of studies, looking at various groups of women to get a better idea of what the research is saying. 

What is depression?

Like most conditions, a person must experience a certain number of symptoms to be diagnosed with a major depressive episode. 

 Five or more of the following symptoms must be present on most days for at least 2 weeks

  • Depressed mood*

  • Diminished interest or pleasure*

  • Significant weight loss or weight gain

  • Insomnia or hypersomnia

  • Psychomotor agitation or impairment

  • Fatigue or loss of energy

  • Feelings of worthlessness or excessive guilt

  • Decreased ability to think, concentrate, or ability to be decisive

  • Recurrent thoughts of death/suicide, or a suicide attempt

*One of these symptoms MUST be present

Select Populations & Birth Control

Adult Women 

A study conducted in Sweden (Zethraeus, 2017), looked at the effects of a combined pill (150 mg of levonorgestrel and 30 mg of ethinylestradiol) on general well being and depression in women aged 18-35. Compared to the placebo group, there was no difference in anxiety, depressed mood, general health. However, there WAS a significant reduction in in general well-being in women who used a levonorgestrel-containing OC, compared to women taking the placebo. 

Postpartum Women

A study by Horibe analyzed the connection between postpartum depression, drugs, and reported adverse events. They found that levonorgestrel was the top drug reported in connection with postpartum depression. This was followed by other progestins: etonogrestrol and drospirenone (further down in the list). The authors concluded that contraceptives or intrauterine devices with progestin might convey risk for postpartum depression.

With this in mind, I believe that postpartum women should be aware of the risk of depression with many of the pharmaceuticals they may taking during that first postpartum year. Moreover, it’s important to have these conversations with their doctors of what may happen, and what the next steps would be. Currently progestin-only contraception is considered first-line therapy for breastfeeding women. Estrogen-containing contraceptives are not started until breastfeeding is stopped as it may decrease milk supply. 

Adolescents

A groundbreaking study (looking at over a million women!) in 2016 by Skovlund, looked to investigate if hormonal contraception is associated with antidepressant use and a depression diagnosis. They ended up finding that adolescents (15 to 19 years) using hormonal contraception are more sensitive than older women (20 to 34 years old). when it came to getting a diagnosis of depression or using antidepressants. This effect was seen in both the combination pill as well as progestin-only pills (which was more predominant). The study also indicated that the incidence of depression and use of antidepressants decreased with age. 

For teens considering taking birth control, I would ask yourself why this might be. What is the outcome you are hoping to achieve? There are two conditions in which girls are given birth control as a treatment: endometriosis and acne (usually resulting from PCOS).

If you are experiencing heavy and painful periods (where you are unable on some days to go to school), talk to your medical doctor about endometriosis and if it’s a possibility. If you are experiencing acne, hair growth in places usually seen in males, and even irregular periods, talk to your doctor about PCOS as a possible explanation.  

Women with Bipolar Disorder and Depression

The study by Pagano aimed to look at the safety of contraception in women with depression and/or bipolar disorder. This was a meta analysis which looked at 6 studies that met their specific inclusion criteria. They found that oral contraception, levonorgestrel-releasing IUD and the depo shot, were not associated with worse clinical outcomes of depression or bipolar disorder in women who already had this condition. 

A couple things to note about this review: there was no 
standard definition or assessment of depressive and bipolar disorders or symptoms across studies, and the use of depression medication was unknown in three of the six studies. 

Final Thoughts on Birth Control and Depression

Overall, while there’s no clear cut answer on whether birth control causes depression – these studies still give you an idea of what the risk might be. Here are a couple of questions to think about if you’re considering taking birth control:

  • Why do you want to take birth control?

  • Are you considering birth control because of painful periods or ‘regulating’ your cycle?

  • Are you considering birth control because you want to prevent a pregnancy?

  • Are you willing to live with side effects (ie. a decreased quality of life)?

  • Are you an adolescent?

  • Have you given birth within the past year? 

While there isn’t a naturopathic alternative to birth control (I’m talking about supplements, not the fertility awareness method), it’s necessary to dive deeper into why you may be considering this option. This may also have you wondering what’s going on in your body and if you can help support it in other ways – perhaps with the assistance of Naturopathic Doctor as well!

References

Zethraeus N, Dreber A, Ranehill E et al. A first-choice combined oral contraceptive influences general well-being in healthy women: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2017;107(5):1238-1245. doi:10.1016/j.fertnstert.2017.02.120.

Horibe M, Hane Y, Abe J et al. Contraceptives as possible risk factors for postpartum depression: A retrospective study of the food and drug administration adverse event reporting system, 2004-2015. Nurs Open. 2018;5(2):131-138. doi:10.1002/nop2.121.

Pagano H, Zapata L, Berry-Bibee E, Nanda K, Curtis K. Safety of hormonal contraception and intrauterine devices among women with depressive and bipolar disorders: a systematic review. Contraception. 2016;94(6):641-649. doi:10.1016/j.contraception.2016.06.012.

Worly B, Gur T, Schaffir J. The relationship between progestin hormonal contraception and depression: a systematic review. Contraception. 2018. doi:10.1016/j.contraception.2018.01.010.

Skovlund C, Mørch L, Kessing L, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154. doi:10.1001/jamapsychiatry.2016.2387.

The Menstrual Cup and Toxic Shock Syndrome

May 14, 2018
menstrual cup and toxic shock syndrome, tss menstrual cup, toxic shock syndrome, toronto naturopath, naturopathic doctor toronto

Ask Alexsia: Can menstrual cups cause toxic shock syndrome?

Since switching to a menstrual cup years ago, I commonly get asked if toxic shock syndrome (TSS) is still a concern (spoiler alert: yes!).

How does toxic shock syndrome happen?

TSS is a rare, but severe disease. It commonly happens when tampons or menstrual cups cause the vaginal canal to colonized by Staph aureus, which produce a toxin called TSST-1. Toxic shock was first seen in women who used tampons made of high-absorbency fibres favouring the growth of Staph aureus and TSST-1 production 

Symptoms of TSS include: fever, hypotension (low blood pressure), a skin rash with subsequent peeling, and multiple organ dysfunctions.

Research on Menstrual Cups

Three reasons have been suggested to explain why bacteria grows:

  1. Accumulation of blood

  2. Increase of vaginal pH during menstruation from 4.2 to 7.4

  3. Oxygen and carbon dioxide are both present in the vagina during menstruation 

Few studies exist in relation to menstrual cups and TSS, but they have all come to the same conclusion that while menstrual cups do not absorb blood, they still put women at risk for TSS.

Many cups are made with medical-grade silicone. While silicone does not support bacterial growth, because of blood accumulation, menstrual cups provide a medium for bacterial growth. 

According to one study, because Staph aureus can form a biofilm (bacteria sticking to the surface of the cup), bacteria may be resistant to water. Therefore, it has been recommended to have 2 cups on hand during the menstrual cycle, and to boil them in water in between uses. 

Final Thoughts

At the end of the day, I’m still sticking with my beloved menstrual cup. I like using them because I can keep track of my monthly blood loss, I always forget to buy pads and tampons, and I don’t like the waste associated with the disposable options!

Therefore, you still want to be cautious when using a cup. As mentioned above, think about purchasing 2, boiling between use, and most importantly – not forgetting about it! 

References

Nonfoux L, Chiaruzzi M, Badiou C et al. Impact of currently marketed tampons and menstrual cups on Staphylococcus aureus growth and TSST-1 production in vitro. Appl Environ Microbiol. 2018:AEM.00351-18. doi:10.1128/aem.00351-18.

Juma J, Nyothach E, Laserson K et al. Examining the safety of menstrual cups among rural primary school girls in western Kenya: observational studies nested in a randomised controlled feasibility study. BMJ Open. 2017;7(4):e015429. doi:10.1136/bmjopen-2016-015429.

Mitchell M, Bisch S, Arntfield S, Hosseini-Moghaddam S. A Confirmed Case of Toxic Shock Syndrome Associated with the Use of a Menstrual Cup. Canadian Journal of Infectious Diseases and Medical Microbiology. 2015;26(4):218-220. doi:10.1155/2015/560959.

Improving Period Pain with Yoga

May 7, 2018
period pain and yoga, dysmenorrhea yoga, period cramps, toronto naturopath, naturopathic doctor toronto

Whenever clients come to my office with period pain complaints, they usually expect to have some dietary and herbal recommendations. As I’ve been doing more research to see what other therapies would be helpful for this all too common condition, I’ve come across some research investigating yoga as a therapy for period pain. 

What the research says about period pain and yoga

There have been three studies looking at the effects of yoga on period pain. All studies looked at three specific poses – practiced alone or with others and results have shown an improvement in pain duration, pain intensity, and quality of life.  

The three specific poses that were studied were: cobra, cat, and fish pose. The duration of the yoga practice ranged between 20 minutes a day to 60 minutes once a week, and length of treatment ranged between 2 to 3 months respectively. Unfortunately, there wasn’t a follow-up in any of the studies to determine the lasting effects. Also, the studies did not keep track of any pharmaceutical use between the yoga groups and controls. 

yoga period pain, toronto naturopath, naturopathic doctor toronto 

Cobra Pose

This energizing pose, helps to increase circulation within the lower back and pelvic, and provide them with a fresh supply of blood.  

How do do this pose

Start by laying facedown with your forehead on the mat. Your feet should be close together with pointed toes. Place your hands beneath your shoulders, palms down and elbows tucked next to the your body.

Inhale and curl your upper body off the floor 2 to 3 inches as you slowly raise your forehead, nose, chin, shoulders, and chest. Your pelvis should remain on the floor.

Return to a neutral position by, slowly releasing your upper body back onto the floor.

Cat Pose

Often seen as a warm up stretch (paired up as cat-cow pose), this pose helps to increase the flexibility and strength of the spine and improve circulation overall. 

How do do this pose

Kneel in neutral “table position,” with your knees under hips and arms beneath the your shoulders. Your back should be flat, and face should be looking down at the floor. 

Exhale and slowly drop your head and tailbone. Arch your back and exhale further as you pull your navel up toward your spine

Fish Pose

This pose helps to stimulate the pelvic organs (like your uterus!). 

How do do this pose

With your legs extended and closed together, lie on your back. Your hands should be palm down, underneath your tailbone. 

On an inhalation, lift your upper body onto your elbows and bend your neck backward. You can rest the crown of your head on the mat. At this point, your back should be arched. Ensure your weight is mainly on your elbows, not your neck. Press both sitting bones firmly into the floor.

Return a neutral position by pressing your elbows onto the floor. Gently lift your head, tuck your chin, and lower your upper body

Note: This pose may be a bit more labour intensive than the others, if you practice yoga at a studio, you may want to ask your teacher to help you achieve the proper position of this pose, or how to modify it. 

Final Thoughts

When it comes to period pain, there are so many tools available to help alleviate pain. My go to recommendations are usually going dairy-free as well as acupuncture (my favourite!). But incorporating yoga is an easy at-home treatment. You can likely start to practice these poses before and during your cycle! 

Of course, if you’re finding that you need some additional support or guidance, certainly feel free to contact me to see how I can I help with your period pain!

References

Rakhshaee Z. Effect of Three Yoga Poses (Cobra, Cat and Fish Poses) in Women with Primary Dysmenorrhea: A Randomized Clinical Trial. J Pediatr Adolesc Gynecol. 2011;24(4):192-196. doi:10.1016/j.jpag.2011.01.059.

Yonglitthipagon P, Muansiangsai S, Wongkhumngern W et al. Effect of yoga on the menstrual pain, physical fitness, and quality of life of young women with primary dysmenorrhea. J Bodyw Mov Ther. 2017;21(4):840-846. doi:10.1016/j.jbmt.2017.01.014.

Yang N, Kim S. Effects of a Yoga Program on Menstrual Cramps and Menstrual Distress in Undergraduate Students with Primary Dysmenorrhea: A Single-Blind, Randomized Controlled Trial. The Journal of Alternative and Complementary Medicine. 2016. doi:10.1089/acm.2016.0058.

Miller O. Essential Yoga. Chronicle Books; 2014.