The effects of steroidal contraceptives on the well-being and sexuality of women: A double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods

doi:10.1016/0010-7824(95)00226-X

Contraception

Volume 52, Issue 6, December 1995, Pages 363-369

https://doi.org/10.1016/0010-7824(95)00226-X Get rights and content

Abstract

A placebo-controlled, double-blind study was carried out to assess the direct hormonal effects of combined and progestogen-only oral contraceptives on well-being and sexuality of women in two contrasting cultures. One-hundred-fifty women, who had been sterilised or whose partners had been vasectomised, were recruited from two centres—Manila, Philippines, and Edinburgh, Scotland. After one month pretreatment assessment, women were randomly assigned to one of three treatments (combined oral contraceptive (COC), progestogen-only pill (POP), or placebo; 50 within each treatment group, 25 per centre) and continued on treatment for four months. Assessment was by daily ratings, questionnaires and interviews.

The COC adversely affected sexuality in the Edinburgh women, with 12 of the 25 women in this group also reporting the side effect of reduced sexual interest. There were modest negative effects of the combined pill on mood, more noticeable in the Edinburgh women. The POP was associated with no adverse effects on sexuality and some improvement in well-being in both centres.

Possible explanations for the apparent lack of adverse effects in the Manila women are discussed. The negative effects reported may be less evident in women using the COC for contraceptive purposes but may lead to discontinuation in some women and warrant further investigation.

References (15)

AT Beck et al.
Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clin Psychol Rev
(1988)
CA Graham et al.
The relationship between mood and sexuality in women using an oral contraceptive as a treatment for premenstrual symptoms
Psychoneuroendocrinology
(1993)
J Trussell et al.
Contraceptive failure in the United States: A critical review of the literature
Stud Fam Plan
(1987)
CR Hammerslough
Characteristics of women who stop using contraceptives
Fam Plan Perspectives
(1984)
J Bancroft et al.
The effects of oral contraceptives on well-being and sexuality
Oxf Rev Reprod Biol
(1990)
J Bancroft et al.
The assessment of sexual problems in women
B J Sex Med
(1982)
G Tyrer et al.
Sexual responsiveness in diabetic women
Diabetologia
(1983)

There are more references available in the full text version of this article.

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Original research articleThe effects of steroidal contraceptives on the well-being and sexuality of women: A double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods

Abstract

Clin Psychol Rev

Psychoneuroendocrinology

Contraceptive failure in the United States: A critical review of the literature

Stud Fam Plan

Characteristics of women who stop using contraceptives

Fam Plan Perspectives

The effects of oral contraceptives on well-being and sexuality

Oxf Rev Reprod Biol

The assessment of sexual problems in women

B J Sex Med

Sexual responsiveness in diabetic women

Diabetologia

Original research article
The effects of steroidal contraceptives on the well-being and sexuality of women: A double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods