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-W. Bradford Wilcox
Associate Professor of Sociology, University of Virginia 

Oral Contraceptives—Bad for Relationships


Bryce J. Christensen and Nicole M. King


A little-appreciated fact for most is that women’s hormonal cycles are intimately connected to every physical system in their bodies, and thus also to their moods, cognition, and behavior. Researchers have long understood the value of understanding how hormonal changes may affect women’s day-to-day lives. In this vein, some German researchers have set out to better understand how oral contraceptive use affects one specific function: women’s ability to recognize the emotions of others.

The researchers open by acknowledging that “[a]lthough oral contraceptives (OCs) have been regarded as one of the best studied drugs in the history of medicine, remarkably little is known about the psychological and behavioral consequences of OC use.” This is a critical gap in the research, particularly when a handful of existing studies on the topic indicate that OC use seems to impair women’s abilities to accurately recognize the emotional expressions of others, a skill which “is essential for the initiation and maintenance of interpersonal relationships, in particular intimate ones.”

To better understand the relationship between emotional recognition and OC use, the researchers designed a study using a task “sensitive enough to detect even subtle impairments in women’s emotional recognition,” by having them identify very small facial changes that indicate emotional state. The researchers recruited a total of 95 women, 42 of whom used OC, and 53 of whom did not. They also asked the women (and, when the women themselves were unsure, took measurements of hormone levels) what point of their cycle they were currently in—follicular (day 0-15 of menses) or luteal (day 15-28)—in the hopes of determining what role, if any, natural cycle variations made in women’s emotional recognition. 

After a questionnaire and a screening interview, study participants then completed a series of tests to measure their distress levels, empathetic traits, and finally their ability to recognize complex emotional expressions on others’ faces. Participants were shown various black and white pictures, which focused on the eye region (crucial for emotional display), and asked to identify which of four descriptor words best labeled the emotion expressed in the face/eyes.

The researchers found a clear difference between the women who were using OCs and the women who were not. Specifically, their “mixed-design ANOVA indicated that participants with OC use were less accurate in emotional recognition than participants without OC use. . . . Across all participants, recognition accuracy was lower for negative than positive or neutral expressions as indicated by post hoc tests.” These differences “did not depend on the menstrual cycle phase of participants without OC use.” Furthermore, “all participants were less accurate in the recognition of negative than positive or neutral expressions”—but the OC-use group was clearly worse at the task.

The researchers speculate that OC use impairs emotional recognition by modification of estrogen and progesterone levels, which have been shown to “modulate activity and connectivity changes in prefrontal and temporal brain regions that are impacted in the processing of emotional expression.” In other words, hormones play a significant role in emotion recognition, and the use of oral contraceptives impairs the brain’s ability to recognize complex emotions by altering natural hormone levels. 

The researchers close by limning a series of limitations. Most interestingly, as theirs was meant to be a study seeking global vs. specific effects of OC use, they did not seek to assess whether duration of OC use, discontinued vs. continued use, or other factors had different implications for women’s ability to recognize emotions. Nonetheless, the researchers have learned enough to caution that, “considering that more and more women start using OCs shortly after onset of puberty . . . these types of studies are highly warranted to determine the positive and negative consequences of OC use on emotion, cognition, and behavior.”

(Rike Pahnke et al., “Oral Contraceptives Impair Complex Emotion Recognition in Healthy Women,” Frontiers in Neuroscience 12.1041 [February 2019]: 10.3389/fnins.2018.01041.)