Studies suggest oral contraceptives alter brain regions involved in emotional processing and stress responses, such as the amygdala and hippocampus. However, most users are not informed about these potential effects when choosing contraception (Lisofsky et al., 2016)

Hormonal contraceptives influence neurotransmitters, neuropeptides, and brain systems related to emotional and cognitive processes. Animal studies suggest changes in social, cognitive, and emotional behaviors, with potential long-term impacts (Porcu et al., 2019).

Hormonal contraceptive use during adolescence and early adulthood may influence brain development, given the ongoing neurodevelopment during these stages. Studies suggest a potential impact on areas such as the prefrontal cortex and limbic system, which are critical for emotional regulation and decision-making (Gregory et al., 2023).

Adolescent girls using hormonal contraceptives exhibit a higher risk of psychological side effects, including the use of psychotropic medications for depression and anxiety, compared to adults. This highlights a potential vulnerability during neurodevelopment (Zettermark et al., 2018).

Hormonal contraceptives, particularly oral contraceptives, influence brain areas like the amygdala and prefrontal cortex, affecting emotional regulation and decision-making. Despite these effects, public awareness and clinical discussions regarding these changes remain limited (Brønnick et al., 2020)

Hormonal contraceptives have been linked to depression and altered stress responses, with younger users particularly vulnerable due to ongoing neurodevelopment (Gregory et al., 2023).

Oral contraceptive use altered connectivity in brain networks responsible for executive control and emotional regulation, such as the anterior cingulate cortex and left middle frontal gyrus. These changes could impair attention, conflict monitoring, and emotional regulation (Petersen et al., 2014).

Hormonal contraceptive users exhibit lower perseverance on cognitive tasks, potentially reducing performance, though these effects are context-dependent (Bradshaw et al., 2019).

Women on hormonal contraceptives show enhanced memory for the gist of emotional stories but reduced recall of specific details, indicating a shift in memory processing strategies (Nielsen et al., 2011).

Hormonal contraceptive users experienced altered patterns of brain activation during working memory tasks under stress, potentially disrupting normal cognitive processing (Herrera et al., 2020).

Hormonal contraceptive users demonstrated reduced cognitive persistence and problem-solving abilities, especially under conditions requiring sustained focus (Bradshaw et al., 2019).

Reduced stress responses in contraceptive users have been linked to altered emotional regulation and decreased startle reactivity, which can impact coping mechanisms in anxiety-prone individuals (Deuter et al., 2021).

Research indicates oral contraceptives can affect mood and personality traits, such as reducing emotional reactivity and altering stress responses. These findings are not typically part of contraceptive counseling, leaving many women uninformed (Sharma et al., 2020).

Hormonal contraceptive users show phase-dependent changes in brain regions involved in memory and emotional regulation, such as the amygdala and prefrontal cortex. These changes may impact stress resilience and emotional processing (Nasseri et al., 2020).

Women using contraceptives exhibit changes in gray matter volume in areas such as the amygdala and anterior parahippocampal gyrus, regions critical for emotional regulation. Altered connectivity in these areas correlates with negative mood and reduced emotional resilience (Lisofsky et al., 2016).

Hormonal contraceptive use was associated with a higher risk of psychotropic drug use among adolescent girls but not adults, indicating age-specific vulnerabilities (Zettermark et al., 2018).

Hormonal contraceptives may reduce the efficacy of exposure-based therapies for anxiety disorders, highlighting potential challenges in treating women using these methods (Raeder et al., 2019).

Past and current hormonal contraceptive users reported higher levels of stress and anxiety, potentially indicating lasting mental health effects (Brouillard et al., 2022).

Hormonal contraceptives may blunt the body's natural stress responses. Users show lower cortisol reactivity during acute stress, potentially disrupting the hypothalamic-pituitary-adrenal (HPA) axis and affecting resilience to stress (Hermans et al., 2007).

Hormonal contraceptives reduce testosterone levels, which can impair libido, energy, and mood regulation. Studies suggest a link between low testosterone and higher rates of depressive symptoms (Wingeier & Kim, 2019).

Lower testosterone levels in contraceptive users can exacerbate anxiety and stress sensitivity, as testosterone modulates fear and social reactivity (Bowman et al., 2004).

Elevated leptin levels observed in contraceptive users may influence mood and appetite regulation. While leptin has antidepressant-like effects in certain contexts, dysregulation can contribute to emotional and metabolic disturbances (Mantzoros et al., 1997).

Changes in leptin levels may alter HPA axis activity, which could have downstream effects on stress responses and overall mental health (Śliwowski et al., 2001).

Hormonal contraceptives may impair habituation to repeated stress, leading to heightened cortisol levels and a reduced capacity to adapt to stress over time (Bingham et al., 2011).

Long-term contraceptive users often fail to associate symptoms like mood swings, fatigue, and irritability with hormonal contraceptives because of their gradual onset, which obscures causality (Toffol et al., 2011).

Hormonal contraceptives have been linked to increased rates of antidepressant use and first-time diagnoses of depression, particularly in adolescents. Delayed symptom onset, sometimes up to six months, obscures the link between contraceptive use and mental health risks (Skovlund et al., 2016).

Hormonal contraceptives have been associated with increased rates of mood-related symptoms like depression, irritability, and fatigue. Many women attribute these changes to their personality or circumstances rather than the contraceptives, making the connection unclear. This phenomenon is compounded by insufficient counseling about potential side effects (Robinson et al., 2004).

A study assessing emotional and physical side effects noted that women often endured symptoms such as emotional blunting and fatigue without realizing they might be reversible by switching or discontinuing contraceptives. This can lead to a lasting impact on self-perception (Sanders et al., 2001).

In a study on hormonal contraception and mood, many women reported difficulty identifying that negative emotional changes were due to contraceptive use. The delayed onset of symptoms, often months after starting, masks the link and leads to misattribution to life stress or personality traits (Skovlund et al., 2016).

Women on oral contraceptives frequently cite fear of withdrawal symptoms or uncertainty about post-discontinuation effects as reasons for continuing use. Symptoms like mood swings, fatigue, and headaches during the hormone-free interval create apprehension about cessation, leading to prolonged use even in the presence of adverse effects (Sulak et al., 2002).

Symptoms during the placebo week of oral contraceptive regimens, including headaches and mood swings, are significant reasons for continuing hormonal use. Modifying regimens to reduce or eliminate hormone-free intervals has been suggested as a strategy to minimize such symptoms and improve adherence (Sulak et al., 2002).

A study highlighted that many women attribute mood changes to themselves rather than recognizing them as drug-induced, leading to hesitation in stopping contraceptives despite adverse effects. This misattribution compounds fear of withdrawal and adjustment challenges (Lundin et al., 2017).

A review of modern hormonal contraceptives, including oral contraceptives, patches, vaginal rings, injectables, and implants, demonstrates their evolution in hormonal content and delivery methods. Each has unique profiles, but misinformation persists about their efficacy and hormonal composition, leading to suboptimal patient understanding (Lobo & Stanczyk, 1994).

Over 100 different types of combined oral contraceptives (COCs) and progestogen-only pills (POPs) exist, each tailored for different needs, yet many patients struggle to distinguish between them due to insufficient counseling (Bitzer & Simon, 2011).

Studies show that many women are not fully informed about the varying hormone levels in contraceptives, contributing to widespread misconceptions about their side effects, risks, and benefits (Halpern et al., 2013).

Many women report a lack of understanding of the differences between hormonal contraceptives, including the distinction between estrogen and progestin components, due to inadequate guidance during consultations (Halpern et al., 2006).

Studies show that shortening or eliminating the HFI reduces hormone withdrawal symptoms, such as headaches, bloating, and mood swings. However, many women and healthcare providers still adhere to the traditional 21/7 regimen due to outdated perceptions and insufficient education about alternative regimens (Sulak et al., 2000).

The standard 21/7 regimen persists because it mimics a "natural" menstrual cycle, even though there is no medical necessity for monthly bleeding. Surveys suggest that many women remain unaware of the option to skip the HFI (hormone-free interval) due to a lack of proactive counseling from providers (MacGregor & Guillebaud, 2018).

Many women incorrectly believe that the HFI is necessary for health or fertility preservation, reflecting gaps in public knowledge and clinician-patient communication (Read, 2010).

Women expressing concerns about contraceptive side effects, such as mood swings or libido changes, are often dismissed or not believed by medical professionals. This exacerbates feelings of frustration and distrust (Hilger et al., 2018).

Women in trials for contraceptives have reported miscommunications, with their concerns minimized or overlooked. Researchers highlight the ethical need for full engagement and clarity in contraceptive studies (Sanchez et al., 2001).

Misinterpretation of women's complaints about contraceptive side effects (e.g., mood changes) as unrelated to the medication suggests a broader culture of minimization in medical settings (Robinson et al., 2004).

Studies suggest that skepticism from healthcare providers arises partly from the medicalization of reproductive health, which often emphasizes population control over individualized care and counseling (Casado-Espada et al., 2019)

Feminist critiques argue that the medical community has often framed women’s reproductive health concerns as irrational, which discourages critical examination of widely used treatments like birth control (Grigg-Spall, 2013).

When concerns are labeled as conspiracy theories, it delegitimizes patient experiences and fosters mistrust between patients and providers. For example, many women report feeling invalidated when suggesting connections between hormonal contraceptive use and mood changes or depression (Skovlund et al., 2016).

Research highlights systemic failures in ensuring informed consent, especially for low-income and minority women. Policies designed to protect against coercion often become barriers to access, compromising autonomy and fairness (Brown & Chor, 2014).

Physicians often fail to provide adequate information about rare but serious side effects, such as suicidality with hormonal contraceptives, which are legally mandated under comprehensive informed consent laws (Duttge & Meyer, 2020).

Documentation and verbal communication about risks and alternatives are inconsistently practiced in mental health care for women, suggesting systemic neglect in applying informed consent principles (Mothi et al., 2013).

Hormonal contraceptive users exhibit decreased preferences for masculine traits in male faces compared to non-users, potentially affecting long-term partner choice. This shift may reverse after discontinuing contraceptives, influencing relationship dynamics (Little et al., 2013).

Women using hormonal contraceptives report increased mate retention behaviors, such as jealousy and partner monitoring, which may stem from hormonal influences on social and emotional cognition (Welling et al., 2012).

Stopping hormonal contraceptives can enhance attraction to alternative mates, particularly around ovulation, possibly due to the restoration of natural hormonal cycles (Birnbaum et al., 2019).

Hormonal contraceptive use during mate selection can influence partner preference. Discontinuation often shifts sexual satisfaction, depending on whether contraceptive use was consistent at the relationship’s start (Roberts et al., 2014).

Long-term use of some contraceptives alters SHBG levels, with residual effects on libido even after discontinuation (Krychman et al., 2012).

Variations in hormonal levels due to contraceptive use are linked to changes in sexual function and pair-bonding behaviors, with some studies indicating reduced sexual satisfaction and altered neural responses to erotic stimuli (Casado-Espada et al., 2019).

Hormonal contraceptives have mixed effects on sexual function, with some users experiencing diminished libido or sexual satisfaction, which can indirectly affect emotional well-being (Burrows et al., 2012).

Changes in serum androgen levels and increased sex hormone-binding globulin (SHBG) contribute to sexual dysfunction in oral contraceptive users (Zhu et al., 2005).

A study found a higher risk of glioma among younger women who used hormonal contraceptives, particularly with long-term use of progestin-only pills. This underscores potential age-specific risks (Andersen et al., 2015).

Hormonal contraceptive use among women under 35 was associated with a higher relative risk of breast cancer, especially with high-dose estrogen preparations. This risk was more pronounced with early and prolonged use (Althuis et al., 2003).

Adolescents and young adults using hormonal contraceptives may face increased risks of venous thromboembolism and stroke. The risks are amplified in certain subgroups, such as smokers or those with pre-existing conditions (Sidney et al., 2013).

Hormonal contraceptives, especially those containing progestin, may reduce bone mineral density in adolescents and young women by altering levels of estrogen and insulin-like growth factors (IGFs), which are critical for bone development (Bachrach, 2020).

Hormonal contraceptives, especially those with higher estrogen doses, are associated with an increased risk of venous thromboembolism (VTE), deep vein thrombosis, and pulmonary embolism. Women with predisposing factors (e.g., smoking, obesity, genetic clotting disorders) are particularly vulnerable (Farley et al., 1998).

Use of combined oral contraceptives (COCPs) causes significant metabolic and inflammatory changes, including altered lipid profiles, increased triglycerides, and elevated markers of systemic inflammation (Wang et al., 2016).

Hormonal contraceptives may increase the risk of autoimmune conditions, such as lupus, and contribute to low-grade systemic inflammation, with long-term health implications (Williams et al., 2021).

Hormonal drugs, including contraceptives, can influence gut bacteria's ability to form biofilms and adhere to intestinal cells. This suggests a direct interaction between contraceptives and bacterial physiology, which may affect gut health (Hammouda et al., 2023).

The interaction between sex hormones and gut microbiota affects microbiome composition, metabolic pathways, and resistance profiles. Oral contraceptives influence these interactions, potentially modulating health outcomes (Sinha et al., 2018)