THE CONUNDRUMS OF CONTRACEPTIVES 1

The Conundrums of Contraceptives

Sophia Delatore, Riley Zawrotuk, Melena LaManna, Mikayla Shiels

Department of Nursing, Youngstown State University

NURS 3749: Nursing Research

Mrs. Randi Heasley

April 6, 2022
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The Conundrums of Contraceptives

Intro

How are females who take contraceptives affected physically, mentally, and culturally

compared to females who do not? The purpose of this research paper developed a better

understanding of what contraceptives are and how they affect the body of females physically,

mentally, and culturally. A recent research study conducted on an evidenced-based update on

contraception in the United States has revealed that “Contraception is widely used in the United

States, with an estimated 88.2% of all women ages 15 to 44 years using at least one form of

contraception during their lifetime.” (Alspaugh et al., 2020, p.1) Contraception is used to

prevent pregnancy and, in some cases, prevent sexually transmitted infections. There are a wide

variety of contraception methods to choose from, ranging from hormonal and non-hormonal

methods. Females must make a choice on which method is right for them based on numerous

factors.

Personal preferences (such as for a hormonal or nonhormonal method, ease and

comfort with mode of use, partner acceptance, effects on the sexual experience,

strength of desire to avoid pregnancy, and religious or spiritual beliefs and

practices), medical considerations (such as whether the method protects against

sexually transmitted infections [STIs], potential side effects), and structural

factors (such as immediate and ongoing costs, ability to begin or stop use without

needing access to health care)—all of these elements play a role. (Alspaugh et al.,

2020, p.2)
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Using CINAHL Plus with Full Text (EBSCO), a search was conducted using the terms

birth control or contraceptives, birth control side effects, mental health, physical health, spiritual

well being. Databases used included Cumulative Index to Nursing and Allied Health Literature

(CINAHL) and Medline. The search was limited to literature from 2000-2020, inclusion criteria

of articles that were written in English, expert peer reviewed, editorial board reviewed, and

academic journals. The search yielded 71,405 articles. 8 articles were selected based on

relevancy using abstracts and titles.

Types of contraceptives

Contraceptives are placed into two categories, non-hormonal and hormonal. Non-

hormonal contraceptives, which are methods or techniques used to prevent pregnancy and STI’s,

do not contain hormones. According to the Cleveland Clinic (2019), the following are common

non-hormonal contraceptives. Abstinence is refraining from sexual intercourse. It is the only

birth control that’s 100% effective and is the best way to protect against STIs. Female and male

sterilization are surgical procedures in which the fallopian tubes are tied in the female and vas

deferens in the male. Male condoms are thin covering made of latex over the penis and a female

condom is a lubricated plastic tube that has a flexible ring at each end. Male condoms are an

effective way to protect against STI’s. Copper Intrauterine Device (IUD) is a small flexible T-

shaped device that is placed into the uterus. It can be kept in place for 10 years. It stops the

sperm from making it through the vagina and uterus to reach the egg, preventing fertilization.

Diaphragm, Cervical Cap, and Sponge are used the same way; placed in the vagina against the

cervix using spermicide to prevent pregnancy. Spermicide and Gel have chemicals that stop

sperm from reaching an egg. They are put into the vagina before sex to prevent pregnancy.
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Hormonal Contraceptives are methods used to prevent pregnancy that contain estrogen

and/or progestin. According to (Cleveland Clinic, 2019, p.3) the following are common

hormonal contraceptives. The Implant is a single rod containing hormone that is placed directly

under the skin of the upper arm and can be kept in place for up to 5 years. Hormonal Intrauterine

Device (IUD) is a small flexible T-shaped device that is placed in the uterus. These contain the

hormone progestin ranging from a low to high dose. They can be kept in place for 3-5 years,

depending on the brand. The pill, vaginal ring, and patch are birth control methods that women

use to prevent pregnancies. The pill is taken daily, the vaginal ring is used once a month, and the

patch is changed weekly. The birth control shot is an injection given into the buttocks or arm that

provides protection against pregnancy for 12 to 15 weeks. Emergency contraception is a pill

taken up to 120 hours (5 days) after having unprotected sex to prevent pregnancy.

Physical effects of Contraceptives

Not only do contraceptives help women with the prevention of pregnancy it has also been

seen used in multiple other beneficial ways. Contraceptives can be used to regulate menstrual

cycles, make cycles less painful, help diminish acne, prevent unwanted hair and even decrease

the risks for various cancers. For that reason, contraceptives have become one of the most

commonly used medications in the world. Although women have taken them for decades and

will continue to, for some it may come with a price. As more research has been progressing on

contraceptive use it has shown an increase in reports of adverse effects on women's overall

health and wellness.

According to the Fennase & McEwen (2019), contraceptive pills has various adverse

effects on health, such as, breast tenderness, bloating, fluid retention, headache, nausea,

menstrual cycle irregularities, post-oral contraceptive amenorrhea, digestive disorders,

THE CONUNDRUMS OF CONTRACEPTIVES 5

cardiometabolic diseases, strokes, depression, sexual heath, decreased libido, and aggravation of

acne. They mention a study was conducted that compared the menstrual cycles of women after

discontinuing oral contraceptive pills to women who have never taken oral contraceptive pills.

Women post contraceptives showed a significantly prolonged cycle length and a higher number

of insufficient times between ovulation and their next period (luteal phase). All in all, cycle

disturbances such as, increased cycle length greater than 35 days or luteal phase lower than 10

days were seen in women who were in the post-oral contraceptive pill group. (Fenasse &

McEwen, 2019, p. 2).

An additional adverse physical effect that women experience while taking contraceptives

is sexual dysfunction. According to Mandal (2019), sexual dysfunction refers to any difficulty a

person or couple are experiencing with the various aspects of sexual activity such as attraction,

arousal, pleasure and orgasm. Sexual dysfunction can cause extreme distress and severely impact

a person’s quality of life. “In a study of 4,112 women, compared to non-oral contraceptive pill

users were less likely to experience peaks and troughs of well-being (well-being to be lowest

during the premenstrual and highest during the post menstrual week) and highs and lows of

sexual interest. (Fenasse & McEwen, 2019, p. 3).

As aggravation of acne was listed as one of the adverse effects of contraceptives some

women may experience an increase in when starting a contraceptive. In Fanasse’s (2019) studies

she explains thoroughly the reasoning behind the increase in acne in some when due to

contraceptives. Oral contraceptive pills that contain a high dose of estrogen reduce the sebum

excretion rate and reduce acne. However oral contraceptives that contain progestogenic may

aggravate acne (p. 3).

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A major increased risk that women may face from taking contraceptives is the increased

risk of breast cancer. Research by Lockwood (2018) supports that progestin-containing

contraceptives are linked to an increased incidence of breast cancer among current and past

users. Lockwood (2018) states “1.8 million women between the ages 15 and 49 from 1995

through 2012 for an average of 11 years of follow-up. Of these individuals, 11,517 ultimately

received breast cancer diagnoses. Compared with “never-users”, women receiving “any”

hormonal contraceptives had an adjusted RR of breast cancer 1.2 million.” (p. 2). Based on this

information provided by Lockwood it would be important to shed light on the education of

contraceptives. It may be beneficial for women to switch from hormonal contraceptives to non-

hormonal contraceptives such as copper IUDs, tubal ligations, or a vasectomy. Switching to a

non-hormonal contraceptive or choosing one at first may help with other adverse effects that a

woman may experience.

Mental effects

Not only is physical health affected by contraceptive use but there is evidence to state

that mental health is also affected. Many women of all ages have been told that mental illness is

just a part of life without being told some medications they are on, may cause these feelings to

occur. Many studies have been conducted in the use of contraceptives in relation to depression

and anxiety occurrence. For many women, prescribed contraceptives are started in adolescents

which is a time where women are still developing. There are many signs and symptoms that

women must be aware of such as “...depressive disorders are lowering of mood, reduction of

energy, and decrease in activity. Loss of appetite and weight, sleeping disorders, especially

waking up very early in the morning, and loss of libido often occur in patients with depressive

disorders” (Böttcher et al., 2012, p. 1).

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We don’t necessarily know the long term effects of prescribed contraceptives on a

woman's mental health. In a study put together by B. Bo¨ttcher (2012), they went through all

studies conducted on the relationship between mental illness and Contraceptive use in between

1976 and 2010 to try to identify a definitive relationship. During the study it was found that there

was no way to set an absolute definitive relationship due to every woman experiencing life

differently but it was noted, “10.3 % reported an increase, 5.7 % reported a decrease in

depressive symptoms” (Böttcher et. al., 2012, p. 4). In this study it was discovered that much of

the research was too broad to see a set correlation. Many of the studies have not distinguished the

types of contraceptives being used and on what scale the symptoms were being judged on. From

this study we were able to determine that further research is absolutely needed as there is still

this unknown of why we have a higher rate of depression in reproductive age women who are on

birth control. Doctors should discuss risks with their patients and evaluate their past medical

history in order to see if birth control is a good choice for them.

Another study conducted by Christine Anderl et. al (2019) set out to try to find if the use

of oral contraceptives in adolescents lead to an increase in depression in adulthood. They

conducted a survey of 1,236 women, with 561 first using birth control in adolescents, 353 in

adulthood and 322 women never using birth control, they found through their research that,” our

findings suggest that adolescence may represent a sensitive period during which the use of OCs

could increase women’s likelihood to develop depression until years after first exposure.”

(Anderl & Chen, 2019, p. 5). With this study there is undeniably evidence that birth control used

in adolescents can lead to a higher rate of depression in adults. With this being said women in

society run the risk of decreased mental health due to birth control. Many women are first

prescribed birth control in their adolescents, although some are getting due to sexual activity and
THE CONUNDRUMS OF CONTRACEPTIVES 8

decreased risk of preganancy but many are not. Many teens are given birth control to periods and

acne without fully explaining the risk.

Warnings are included on pack inserts in birth control packs but many go without being

read as the package inserts are long and full of words that some adolescents may not understand.

Studies need to be continued on this relationship as many women are expected to give up their

mental health to combat a negative effect on their body they may not be able to control. Both of

the studies discussed in this section have proven that there is still much research to be done on

this topic, as much of the research was very hard to come by or older. There has seemed to be a

decrease in research involving this topic which is unfortunate considering there is still so much

to learn. Mental health issues are not the only thing area birth control is affecting on a woman,

she is also facing cultural issues brought about by birth control which will be discussed in the

next section.

Cultural Effects

It can be recognized that women who take birth control benefit from its therapeutic

effects yet concomitantly endure its adverse physical and mental reactions. In addition to this,

women who take contraceptives also face cultural consequences. In regards to contraceptives in

the United States, women have the right to take birth control. It is up to their discretion,

regardless of their intentions; however, for the women who choose to pursue contraceptives, a

spectrum of consequences will fall before them. A community may accept their intentions, turn

them away or come to a verdict anywhere in between.

In the United States, many societies cling to tradition. In places where values and beliefs

are passed down through generations, tradition holds accountability for actions as well as

discourages deviations from the norm. This is predominantly evident in familial relationships
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and religious practices. When it comes to the dynamic of a young woman coming of age and her

parents, communication is often ineffective and trust is usually lacking or doubted. Many young

women, even after getting married, feel uncomfortable discussing the use of contraceptives

“...because they do not want their parents or other adults to know that they are sexually active,

while many fear ridicule, disapproval and hostile attitude from service providers and others”

(Banjo, 2021, p. 37). For this reason, young women withhold information from their parents,

which could potentially fragment the continuity of their health. It is important to educate families

on the importance of communication and education of the use of contraceptives and to withhold

judgment and accusations without learning of their child’s input and potential intention for

wishing to start or obtain a form of birth control. The article further discusses how each level in a

community can adapt to change for the wellbeing of the young woman while still holding onto

traditional core values. For example, in regards to religious views on contraceptives, instead of

discouraging the use of birth control for unholy reasons, preach education. Advocate for beliefs

in family planning and regardless of their decision, show compassion. Even if they may be

undeserving in the opinion of societies traditions and beliefs. “Medical Social Workers should be

involved at the Primary Health Care level to provide early psychological intervention for women

opting for birth control. Religious organizations should be encouraged to teach and educate their

members about the importance of family planning and contraceptive use to the children, mothers,

fathers, family, and the society at large” (Banjo, 2021, p. 41). When a culture and its traditions

begin to conform with a more progressive and understanding mindset, situations are recognized

from an individualized standpoint rather than standardized and compared to what is believed to

be traditionally appropriate. This is especially important when discussing youths girls

experiencing homelessness or YEH. With the group being an extremely vulnerable population,
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“...financial realities of homelessness are such that paying for birth control is not likely a priority.

Sex is more likely used as a survival strategy to get money to buy food, clothes, transportation,

and shelter” (Aparicio et al., 2021, p. 183). Their sexual partners show little to no respect and

society depicts them as outcasts and lost. Communities show prejudice towards YEH and turn

away resources for their “wrongdoing”. Even within the US Healthcare system, the types of care

provided is “... inefficient in helping vulnerable populations—specifically, YEH—with sexual

and reproductive health care because of the country’s nearly singular focus on curing diseases

and treating medical emergencies” (Aparicio et al., 2021, p. 183). If communities focused on

holistic and preventive services, the incidences of preventable diseases would reduce, thus

complementing current practices. The health care system needs to reduce barriers that YEH often

face when interacting with the health care system while also encouraging informed decision-

making practices. Aparicio et al (2021) further discusses that health care systems need to “…

work to improve the public’s perspective about sexual health through educating and reclaiming

stereotypes associated with sexual health. In particular, they noted a gap in knowledge about the

purpose, access, and proper use of contraceptives among YEH” (p. 183).

As mentioned earlier, the culture surrounding women on birth control impacts them just

as much as a physical side effect or mental adverse effect. It is important to respect the traditions

of a community such as family relationships and religious views, however, the women choosing

to obtain contraceptives deserve that same respect.

Conclusion

How are females who take contraceptives affected physically, mentally, and culturally

compared to females who do not? The purpose of this research paper developed a better

understanding of what contraceptives are and how they affect the body of females physically,
THE CONUNDRUMS OF CONTRACEPTIVES 11

mentally, and culturally. Contraception is used to prevent pregnancy, and in some cases,

sexually transmitted infections. There are a wide variety of methods for birth control and each

one has its contributing factors that affect the body. Although birth control has positive benefits,

it also has negative effects and it is important for women to understand before choosing the right

one for their body. Supported research in this article has unveiled the effects females experience

physically, mentally and culturally while taking contraceptives compared to those who do not.
THE CONUNDRUMS OF CONTRACEPTIVES 12

References

Anderl, C., Li, G., & Chen, F. S. (2020). Oral contraceptive use in adolescence predicts lasting

vulnerability to depression in adulthood. Journal of Child Psychology and

Psychiatry, 61(2), 148–156. https://doi-org.eps.cc.ysu.edu/10.1111/jcpp.13115

Aparicio, E. M., Kachingwe, O. N., Fleishman, J., Novick, J. (2021). Birth

control access and selection among youths experiencing homelessness in the United

States: A review. Oxford University Press Academic. Retrieved March 11, 2022, from

https://academic.oup.com/hsw/article/46/3/171/6296519

Banjo, O. O., Ajayi, O. S., Aina, M. I., & Abraham, M. O. (2021). Psychological Health and

Socio-Demographics as Correlate to Birth Control among Women of Reproductive Age

at Babcock University Teaching Hospital, Ilishan Remo, Nigeria. Ife PsychologIA, 29(2),

35–44.

Böttcher, B., Radenbach, K., Wildt, L., & Hinney, B. (2012). Hormonal contraception and

depression: a survey of the present state of knowledge. Archives of Gynecology

and Obstetrics, 286(1), 231–236. https://doi-org.eps.cc.ysu.edu/10.1007/s00404-012-

2298-2

Britton, L. E., Alspaugh, A., Greene, M. Z., & McLemore, M. R. (2020). An

evidence-based update on contraception. The American Journal of Nursing, 120(2),

22–33. https://doi.org/10.1097/01.NAJ.0000654304.29632.a7

Cleveland Clinic. (2019, April 12). Birth control options & types: Risks & effectiveness.

Cleveland Clinic. Retrieved April 1, 2022, from

https://my.clevelandclinic.org/health/articles/11427-birth-control-options
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Fenasse , R., & McKwen, B. (2019). Impact of the Oral Contraceptive Pill on Health and

Nutritional Status. Journal of the Australian Traditional-Medicine Society (J AUST

TRADITIONAL MED SOC), Summer2019; 25(4): 197-203. (7p)

Lockwood, Charles. (n.d.). (2018). Risks and Benefits of Hormonal Contraception: Despite

Hormonal Contraception Benefits, Use of Nonhormonal Methods May Be Wise in

Women after 35--and Even Younger in Those at Increased Risk of Breast Cancer.

Contemporary OB/GYN (CONTEMP OB GYN), May2018; 63(5): 4-6. (3p)

Mandal, D. A. (2019, February 27). What is sexual dysfunction? News. Retrieved April 4, 2022,
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