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We need to talk about the Pill and depression. And keep talking about it.

My initial reaction to reading the news a comprehensive study had linked the pill with depression in women was one of relief.

Not because this is ‘new’ information — at least, not according to the lived experience of millions of women worldwide — but because the breadth of the study, which is the largest of its kind, means it can’t be ignored.

Over 13 years, researchers from the University of Copenhagen tracked one million Danish girls and women, aged 15-34, using oral contraceptives.

Women on the combined pill were 23 per cent more likely to be treated for depression, while those on the progestin-only version were 34 per cent more likely.

By comparison, teenagers on the combined pill were 80 per cent more likely to be prescribed anti-depressants within the first six months of taking it.

This increased to 120 per cent for those on the progestin-only pill.

Teenage girls are significantly more likely to develop depression while taking the Pill. Source: iStock

Add this to what we know about the physical side effects of the Pill, which rank from the relatively minor (spotting, sore breasts, weight gain) to the far more serious (heart attacks, strokes and blood clots) and it paints a grim picture for women choosing to take it.

Despite this, around 50-80 per cent of Australian women will use some form of the pill in their lifetime and it is still by far our preferred form of contraception.

Millions of us will be prescribed either the combination pill, which contains a mix of oestrogen and progestin, or the progestin-only "mini pill" at some point in our lives.

Monash IVF's Professor Beverley Vollenhoven, a specialist in reproductive endocrinology and infertility, explains it's about balancing "risk vs reward".

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"Like any other drug, it doesn't work for everyone and it’s not free of side effects for everyone," Prof Vollenhoven told Mamamia.

"The vast majority of people who take the pill are actually quite happy with the contraception it provides, for starters, but also for the side effect profile that it brings."

Vollenhoven adds that in many of her patients early, minor side effects will disappear "if someone is able to persevere".

She also notes that some women actually report feeling better on the pill and pointed to another recent study which links it with a drop in ovarian cancer deaths globally.

what interferes with the pill

Like any other drug it's about weighing up the risks with the benefits. Source: iStock

I'd like to make this clear: this article is not intended to be alarmist.

Many millions of women take the Pill with little of no side effects at all. But the thing is, even a tiny shift in hormones can affect some women terribly and it's important we acknowledge that.

Australia was the second country in the world to give women access to the Pill in the early 1960s, which is something we should be proud of, but it certainly didn't create an overnight revolution for women's rights and many would argue the revolution is still incomplete.

From Day One, our relationship with it was vexed.

There's no denying the power of the pill. 

On the one hand, the side effects from early versions of the drug — like near-constant nausea, blood clots, heart attacks and breast cancer — were far more extreme than today. It was only available to married women, for almost two decades.

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On the other, increased access to it came hand-in-hand with women's sexual liberation; we could control our bodies, when — and if — we wanted to have children and it granted unprecedented access to the work force.

Its significance for women should not be understated, but that's not to say we shouldn't question whether or not administering a daily, hormone-altering pill is really the best way for women to avoid unwanted pregnancy.

More than five decades since the Pill first arrived on Australian shores, it's more than alright to stop insisting blindly that it is.

Michelle Arrow, Assoc Professor of Modern History at Macquarie University, discusses the Pill. (Post continues after video.)

Professor Jayashri Kulkarni, director of Monash Alfred Psychiatry Research Centre, is recognised internationally for her innovative work in women's mental health, including using oestrogen as a treatment in schizophrenia.

She and her team of researchers in Melbourne are currently in the process of creating a "league ladder", to rank different brands of the Pill according to their mental health effects.

"Someone how we’ve managed to miss the science of it all ... when you look at something like depression," she tells Mamamia.

"When you’re dealing with something vague like depression, people look for other things; the ratty boyfriend, the ratty job, stress, etc.

Many forms of depression are "sub-clinical" which means they can't be defined or diagnosed, Prof Kulkarni explains — it can be a simple as not feeling joy or happiness.

"Many times we’ve heard the story that [a woman has] gone to see her GP or other medical practitioner and talked about the fact that ever since she’s been on pill X she’s felt terrible, but hasn’t been listened to," she continues.

"The woman can then buy the line it’s not the Pill itself, it must be something else and then scratch the surface and, of course, you’ll find something to blame."

The continual invalidation of women's concerns about the pill is one of the reasons the Danish study is so significant, but there is still a lack of resources being given to find a viable alternative.

Watch: Some of the vital signs of depression. (Post continues after video.)

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"Cynically, I think it’s about a vested interest in who is pushing what agenda," Prof Kulkarni says.

"If you look at where investments go, they go into life-saving drugs, obviously, but there has been very little investment in women’s mental health and women’s health as well. I think we’re the bottom the priority list."

he other issue, according to Prof Kulkarni, is our silo approach to mental health and physical health. She believes a more holistic approach is required — and she's not alone in thinking that.

"We shouldn’t be looking at things as your mind and your body. It’s your body and your mind is part of it," Prof Vollenhoven agrees.

Ignoring for a moment that hormonal contraceptives offers no protection from STIs, we know that for many women taking the pill is considered a manageable, straightforward means of contraception. But that does not mean that for some women it comes with — sometimes unknowing — personal sacrifice.

The thing is, in an ideal world the responsibility for contraception would fall equally to both partners in a relationship, but a lack of reversible and effective form of male contraception — other than using condoms —means that at least at present, that's not an option. (Post continues after gallery.)

Many women also say they don't "trust" their partner enough with reliably managing contraception when, at the end of the day, it's women's bodies that will be affected by pregnancy.

Which leaves us a bit stuck, really. So what do we do?

The first thing is to be informed and know the risks. If you do choose to take the pill most clinicians, including Prof Vollenhoven, advocate a trial and error approach to finding the right one.

"It’s good to approach it with an open mind," she says. "If there's a problem it’s easy, you stop it and you look at alternative forms of contraception."

This relies on having a good prescribing GP or gynecologist who can properly inform you of the risks, including those related to depression, so best to find of those.

Of course, many millions of women take the pill without having an adverse reaction, but if you — like me — are not one of those women, that's OK too.

Speak to your doctor about it, but also speak to each other. Tell your female friends and family members if something feels wrong. Read other women's stories, too, because there's nothing more dangerous than thinking it's all in your head.

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