The Effects of Hormonal Contraceptives on the Brain: A Systematic Review of Neuroimaging Studies

Abstract

Background: Hormonal contraceptive drugs are being used by adult and adolescent women all over the world. Convergent evidence from animal research indicates that contraceptive substances can alter both structure and function of the brain, yet such effects are not part of the public discourse or clinical decision-making concerning these drugs. We thus conducted a systematic review of the neuroimaging literature to assess the current evidence of hormonal contraceptive influence on the human brain. Methods: The review was registered in PROSPERO and conducted in accordance with the PRISMA criteria for systematic reviews. Structural and functional neuroimaging studies concerning the use of hormonal contraceptives, indexed in Embase, PubMed and/or PsycINFO until February 2020 were included, following a comprehensive and systematic search based on predetermined selection criteria. Results: A total of 33 articles met the inclusion criteria. Ten of these were structural studies, while 23 were functional investigations. Only one study investigated effects on an adolescent sample. The quality of the articles varied as many had methodological challenges as well as partially unfounded theoretical claims. However, most of the included neuroimaging studies found functional and/or structural brain changes associated with the use of hormonal contraceptives. Conclusion: The included studies identified structural and functional changes in areas involved in affective and cognitive processing, such as the amygdala, hippocampus, prefrontal cortex and cingulate gyrus. However, only one study reported primary research on a purely adolescent sample. Thus, there is a need for further investigation of the implications of these findings, especially with regard to adolescent girls.

Facial Emotion Recognition and Emotional Memory From the Ovarian-Hormone Perspective: A Systematic Review

“…OC use was shown to be accompanied with heightened emotional reactivity (depression, irritability), specifically in women prone to negative mood symptoms ( Sundström-Poromaa and Segebladh, 2012 ; for review see: Montoya and Bos, 2017 ; Lewis et al, 2019 ). In adolescents, there is evidence for a higher prevalence of depression and suicide when taking OCs as compared to non-user adolescents, especially during the initial intake (debut) of the pill (for review see: Brønnick et al, 2020 ). OC use is further associated with structural and functional changes in areas involved in affective and cognitive processing such as the amygdala, hippocampus, prefrontal cortex, and cingulate gyrus ( Brønnick et al, 2020 ).…”

“…In adolescents, there is evidence for a higher prevalence of depression and suicide when taking OCs as compared to non-user adolescents, especially during the initial intake (debut) of the pill (for review see: Brønnick et al, 2020 ). OC use is further associated with structural and functional changes in areas involved in affective and cognitive processing such as the amygdala, hippocampus, prefrontal cortex, and cingulate gyrus ( Brønnick et al, 2020 ). For example, there is data showing that gray-matter volume in prefrontal and hippocampal/parahippocampal regions is reduced in OC users compared to free-cycling women ( Brønnick et al, 2020 ).…”

“…OC use is further associated with structural and functional changes in areas involved in affective and cognitive processing such as the amygdala, hippocampus, prefrontal cortex, and cingulate gyrus ( Brønnick et al, 2020 ). For example, there is data showing that gray-matter volume in prefrontal and hippocampal/parahippocampal regions is reduced in OC users compared to free-cycling women ( Brønnick et al, 2020 ). In sum, uncovering the impact of OC use needs intensive research on its own.…”

“…Frontiers in Psychology | www.frontiersin.org in OC users compared to free-cycling women (Brønnick et al, 2020). In sum, uncovering the impact of OC use needs intensive research on its own.…”

“…Therefore, OC use has often been considered as a control condition for high-hormone phases during the natural menstrual cycle. However, OC use is not simply a state of low endogenous ovarian hormones: Synthetic ovarian hormones, i.e., ethinylestradiol and progestins, contained in the OCs, have the potential to modulate neuro-regulatory mechanisms involved in cognitive and emotional processing by interacting with E2- and P4- receptors in the brain (for review see: Montoya and Bos, 2017 ; Lewis et al, 2019 ; Brønnick et al, 2020 ). Thus, studies on the influence of OC use on emotional processing are informative in their own right.…”