Exploring the intricate link between contraceptive use and the immune system unveils a fascinating interplay that extends beyond the realms of reproductive health. The choices we make regarding contraception not only impact family planning but also potentially influence the body's immune defenses. Understanding this dynamic relationship is crucial, as it sheds light on how contraceptives may exert subtle (or maybe not so subtle) effects on our immune responses.
In a 2017 systematic review published in Linacre Quarterly, Williams summarizes some of the ongoing results on this topic. Early studies suggested a decreased risk of rheumatoid Arthritis (RA) while on treatment with Hormonal Contraception (HC) due to their similarity to pregnancy, however, more recent research contradicts this, even hinting at increased risks, especially for specific types of RA.
The studies also delved into inflammatory bowel diseases like Crohn's and ulcerative colitis, finding that HCs, especially current use, elevate the risk of Crohn's and slightly increase the chance of ulcerative colitis. Similarly, for systemic lupus erythematosus and multiple sclerosis, the use of HCs appears to heighten the risk of development. However, for thyroid diseases, the evidence is less conclusive, hinting at a decreased risk. Skin diseases, such as eczema and psoriasis, might also show an increased incidence with HCs, though more research is needed for confirmation.
Women using HCs often show signs of chronic inflammation, which can lead to increased risks of mood and autoimmune disorders. Surprisingly, both users and non-users of HCs tend to have similar levels of certain proinflammatory markers in their blood, which makes it challenging to understand how these contraceptives are linked to these health issues. To investigate this, a 2023 study published in the Brain, behavior, and Immunity Journal observed how women, some using oral contraceptives and others not, responded to a stress test. The findings showed that those using HCs had different reactions in terms of stress hormones and inflammatory markers when compared to women not using these contraceptives. Specifically, women using HCs were more likely to have increased stress and different hormonal responses to stress, possibly contributing to the variations in their mental and physical health.
Importantly, these findings aren’t usually mentioned in contraceptive prescription information. Even though there is not an obvious causal relationship, in recent epidemiological data, such as the one collected in the UK 2023 study about autoimmune conditions, it is observable that these conditions are on the rise, and women are a particular "at risk" group for an important sector of them, making up for more than 60% of the detected patients.
When it comes to hormonal contraception and autoimmune diseases, making an informed decision is crucial. While research suggests potential associations between certain hormonal contraceptives and an increased risk of autoimmune diseases, the evidence remains nuanced and evolving. The decision to use hormonal contraception should involve an informed conversation between individuals and their healthcare providers. Understanding the risks, potential implications, and the individual's health history becomes pivotal in this decision-making process. It's essential for healthcare providers to remain informed and updated, and engage in comprehensive discussions, highlighting both the benefits of contraception and the potential risks, enabling individuals to make informed choices that align with their health needs and preferences. While the link between hormonal contraception and autoimmune diseases warrants consideration, a balanced approach to decision-making, considering individual health profiles and preferences, remains paramount.
Sources
Williams W. V. (2017). Hormonal contraception and the development of autoimmunity: A review of the literature. The Linacre Quarterly, 84(3), 275–295. https://doi.org/10.1080/00243639.2017.1360065
Mengelkoch, S., Gassen, J., Slavich, G. M., & Hill, S. E. (2023). Hormonal contraceptive use is associated with differences in women's inflammatory and psychological reactivity to an acute social stressor. Brain, behavior, and immunity, S0889-1591(23)00333-1. Advance online publication. https://doi.org/10.1016/j.bbi.2023.10.033
Conrad, N., Misra, S., Verbakel, J. Y., Verbeke, G., Molenberghs, G., Taylor, P. N., ... Cambridge, G. (2023). Incidence, prevalence, and co-occurrence of autoimmune disorders over time and by age, sex, and socioeconomic status: a population-based cohort study of 22 million individuals in the UK. The Lancet, 401(10391), 1878-1890. https://doi.org/10.1016/S0140-6736(23)00457-9
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