Abstract
It has been shown that physcial and psychological manifestations appearing very early after the commencement of oral contraceptive medication can hardly be attributed to oestrogen effects, but are more likely to be due to fear and the anticipation of ill effects. Of the multitude of physical and psychological manifestations complained of by women on the drug some are of somatic origin and others of psychological origin, and women who are emotionally well-adjusted are less likely to report side effects than those who are emotionally maladjusted. Some reasons for depressive spells and for decline in libidinal interest on oral contraceptive medication have been discussed. One factor which emerged is that some women who ask for safe contraceptives, in fact hanker for pregnancy and childbirth, while contraception signifies prevention of impregnation for the time being — temporary infertility. Infertility however temporary and however planned and the unwarranted dread of permanent infertility have a profound emotionally disturbing effect on many women.
The results obtained should be considered with due regard for possible methodological errors. For instance it might be objected that no control group was used, but to find a control group for studies of this kind is difficult and to use women on a placebo as controls is obviously out of the question. The general validity of the observation may be limited because the women in this study were either Jewish or Anglo-Protestants. Differences might have been seen had members of other ethnic or religious groups been studied. The retrospective nature of the investigation might imply some distortions, but the use of semi-structured interviews with specific items on a ranging scale partially obviated the possible impressionistic quality of the material. The ‘halo effect’ which occurs in a personal interview was corrected by the introduction of multi-raters and the experienced clinical judgment of the investigators.
At the outset the intention was to find out which side effects of anovulants are biological in origin and which are psychological. This objective has been accomplished to some extent, but more important perhaps are the practical implications of the research. On the strength of these observations a gynæcologist or a family physician may be well-advised to listen with the ‘third ear' to a woman who consults him, in order to make sure that she really wants a safe contraceptive and not a baby. Undue anxiety regarding the ill effects of the pill, fostered by alarming reports spread by the mass media, should be dispelled. Before prescribing the pill, evidence of emotional maladjustment in the woman or problems in her marriage (sexual or other) should be looked for. The physician should also look for reasons for depression and for decline in libidinal interest in the woman when placed on contraceptive medication. In others words, he should concern himself with the personality of his patient, rather than confining himself to her biological functions.