Access to effective contraception methods has enhanced women’s autonomy by enabling independent fertility and family planning opportunities. Moreover, the effective adoption of family planning solutions has also contributed to the reduction of women’s health risks, infant mortality, and the incidence of abortion [1].

Birth control is commonly defined as the intentional control and prevention of conception or impregnation via the usage of drugs, chemicals, medical devices, surgical practices, natural techniques, and sexual practices [2]. Available contraception management solutions encompass intrauterine devices, tubal ligation for women, implantable devices, hormone-based oral pills, patches, vaginal rings, injections as well as condoms, diaphragms, birth control sponges, and procedure-based vasectomies for males.

Following the variety of different fertility management solutions, a study conducted by the United Nations revealed that the pill is the most common contraceptive method In Europe as well as in Northern America with 17.8% and 14.9% of women in the reproductive age (15 – 49 years) using it respectively [3]. The birth control pill primarily intercepts and averts ovulation by artificially increasing the hormonal levels of progesterone within the female body. The increase of progesterone simulates and mimics the hormonal state of pregnancy, leading to a disruption of the normal menstrual cycle of the body. As the body acts under the false conviction to be pregnant, any further ovulation is prevented, and no fertile phase is entered.

Scientific research has provided us with a clear framework to categorize the effectiveness of different contraceptive methods via the Pearl Index. In essence, the Pearl Index risk-stratifies and benchmarks available birth control options by considering the total number of pregnancies against the total number of women using an individual contraceptive method within a clinical trial setting [4]. Even though the Pearl Index poses as a viable framework for assessing the basic efficacy of birth control methods, the concept fails to include and reflect important parameters such as medication side effects and user dissatisfaction with the respective technique. Those shortcomings of the Pearl Index also hold true for the most prevalent birth control method in the western world, as outlined above.

Even though the birth control pill is recognized as one of the most reliable contraceptives for many women, it also holds significant downside risks due to its hormonal nature and impact on the individual body. Hence, we will investigate and outline both the potential pain points of oral contraception as well as viable alternatives and pioneering innovation in the space of contraception technology in the following part of the report.

Common research shows that hormone-based oral contraceptives have a multifold impact on the human body and its biochemical setup. A study conducted by the World Health Organization outlines the pill-induced depletion on the nutritional levels for the consumer involved [5].  The prolonged and consistent use of oral contraception (>1 year) leads to a proven reduction in key nutritional components such as Zinc, Vitamin B, and Magnesium that underlie the production of hormones and neurotransmitters essential for the stability and activeness of the central nervous system [6-8].

As the pill restricts ovulation, the female body is inhibited from producing progesterone. Even though oral contraceptives contain progestin, it does not substitute for natural progesterone. Progesterone converts to the neurosteroid Allopregnanolone which reacts with our GABA receptors in the human brain to decrease stress responses and adrenals in the process.

The differential effect of progesterone and progestin on the body also leads to an increased risk of exposure to depression. Compared to progesterone, progestin leads to a greater  increase in the enzyme production of monoamine oxidase [9]. An uprise of monoamine oxidase reduces the availability of serotonin and dopamine. Both of those hormones are key in balancing out eventual mood swings. Moreover, emotional and psychological instability becomes amplified, and can trigger initial states of depression [10].

Another effect associated with the reduction of serotonin levels through the uprise of monoamine oxidase lies in the disruption of the natural sleep architecture. As the sleep hormone melatonin relies predominantly on serotonin as one of its underlying building blocks, research shows that hormone-based oral contraceptives negatively affect healthy sleep states.

Up to 37% of women in the reproductive age (20 – 39 years) experience regular states of migraines and headaches [11]. Research shows that most women report and link those states of migraines and headaches as frequent side effects of hormonal contraception. As a result, studies show that the experienced suffering from migraines and headaches is one of the leading causes of contraceptive discontinuation [12].

A study by the Women’s Health Initiative states that the use of hormone-based contraceptives correlates to an increased risk exposure to the vascular system [13]. In detail, women using oral contraceptives face a higher prevalence of venous thromboembolism, ischemic and hemorrhagic stroke, as well as myocardial infarction. It needs to be noted that the above risk exposures are further determined and severed by lifestyle-related factors such as smoking, obesity, and diabetes [14].

The above risk factors do not cover the entirety of all risks associated with oral contraceptives. However, the outlined issues and complications underline both the serious hormonal impact of oral contraceptives as well as the potential consequences on the human body. Looking to reduce and manage the associated health risks, we will identify and explore new innovation and pioneering startups in the field of contraception management in the following section of the report.

Recognizing the various side effects associated with oral contraceptives, it needs to be noted that each individual brand offers a unique birth control pill that differs in composition and effect on the body. Therefore it is essential to find the right contraceptive pill that offers the lowest side risk while guaranteeing effectiveness as well. To ease the traditional trial-and-error decision-making process, AI can be used to combine hormonal data in order to recommend an adequate pill choice.

Digital applications that provide passive and active tracking of fertile windows can act as a data-driven support system that helps users to have insight, education, and reminders to succeed in cycle-based contraception. The following startups act as leading pioneers in the field of natural fertility management applications

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[2] Jain, R., & Muralidhar, S. (2011). Contraceptive Methods: Needs, Options and Utilization. Journal of Obstetrics and Gynaecology of India, 61(6), 626–634.

 

[3] United Nations. (2019). Contraceptive Use by Method 2019: Data Booklet. UN.

 

[4] Shelton, J. D., & Taylor Jr, R. N. (1981). The Pearl Pregnancy Index reexamined: still useful for clinical trials of contraceptives. American journal of obstetrics and gynecology, 139(5), 592-596.

 

[5] World Health Organization. (1975). Advances in methods of fertility regulation: report of a WHO Scientific Group [meeting held in Geneva from 9 to 13 December 1974]. World Health Organization.

 

[6]Palmery, M., Saraceno, A., Vaiarelli, A., & Carlomagno, G. (2013). Oral contraceptives and changes in nutritional requirements. European Review for Medical and Pharmacological Sciences, 17, 1804–1813.

 

[7] Grant, E. C. (1998). The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. Journal of nutritional & environmental medicine, 8(2), 105-116.

 

[8] Grant, E. C. (2006). Supplementing proven deficiencies of vitamins and minerals. The Lancet, 368(9533), 366.

 

[9] Grant, E. C., & Pryse-Davies, J. (1968). Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. Br Med J, 3(5621), 777-780.

 

[10] Skovlund, C. W., Mørch, L. S., & Kessing, L. V. (2016). Lidegaard Oslash. Association of hormonal contraception with depression. JAMA Psychiatry, 73, 1154.

 

[11] Stewart, W. F., Wood, C., Reed, M. L., Roy, J., & Lipton, R. B. (2008). Cumulative lifetime migraine incidence in women and men. Cephalalgia, 28(11), 1170-1178.

 

[12] Rosenberg, M. J., & Waugh, M. S. (1998). Oral contraceptive discontinuation: a prospective evaluation of frequency and reasons. American journal of obstetrics and gynecology, 179(3), 577-582.

 

[13] Grant, E. C. (1975). The influence of hormones on headache and mood in women. Hemicrania, 6, 2-10.

 

[14] Smelser, N. J., & Baltes, P. B. (Eds.). (2001). International encyclopedia of the social & behavioral sciences (Vol. 11). Amsterdam: Elsevier.

 

[15] Farley, T. M. M., Collins, J., & Schlesselman, J. J. (1998). Hormonal Contraception and Risk of Cardiovascular Disease: An International Perspective. Contraception, 57(3), 211–230.

 

[16] Fertility Awareness Methods | Natural Birth Control. (n.d.). Retrieved May 4, 2021, from https://www.plannedparenthood.org/learn/birth-control/fertility-awareness

 

[17] Scherwitzl, E. B., Danielsson, K. G., Sellberg, J. A., & Scherwitzl, R. (2016). Fertility awareness-based mobile application for contraception. The European Journal of Contraception & Reproductive Health Care.

 

[18] Photo by Camylla Battani on Unsplash