Effects of oral contraceptives and natural menstrual cycling on environmental learning

The Most Common Side Effects, Concerns and Discontinuation Patterns of Oral Contraceptive Pills Among Polish Women: A Cross-Sectional Study

Objective

Over the decade, variety and effectiveness of contraception methods have greatly improved, resulting in increased popularity of oral contraceptive pills (OCPs). However, hormonal contraception carries the risk of multiple side effects. The lack of sufficient knowledge often leads to the development of health concerns, which can affect patient's adherence. The aim of our research was to describe a side effect profile of OCPs and assess the most frequent concerns and discontinuation reasons in Polish women. The survey included questions regarding OCPs utilization patterns, side effects, health concerns and attitudes of the responders.

Materials and methods

This cross-sectional study was based on a survey, which was distributed online and open from 29 April to 15 May 2022. The survey included questions regarding OCPs utilization patterns, side effects, health concerns and attitudes of the responders.

Results

Out of 1699 respondents, the current OCPs intake was reported by two thirds of women and 22% had a history of using them in the past. Seventy-nine percent of all OCPs users experienced adverse effects while 9% reported having concerns about safety and potential adverse effects. Decreased libido and weight gain were the most significant reasons for ceasing hormonal contraception. Moreover, the most common concerns and the most unfavorable side effects varied in different age groups. The occurrence of anxiety depended on age and education.

Conclusion

Healthcare professionals prescribing OCPs should provide their patients with comprehensive counseling. Understanding and addressing concerns of young women can improve their compliance and reduce the number of unintended pregnancies.

Reproducible stability of verbal and spatial functions along the menstrual cycle

Recent studies have reported brain changes in response to ovarian hormonal fluctuations along the menstrual cycle. However, it remains unclear, whether these brain changes are of an adaptive nature or whether they are linked to changes in behavior along the menstrual cycle, particularly with respect to cognitive performance. To address this knowledge gap, we report results from 3 well-powered behavioral studies with different task designs, leveraging the advantages of each design type. In all three studies we assessed whether verbal or spatial performance (i) differed between cycle phases, (ii) were related to estradiol and / or progesterone levels and (iii) were moderated by individual hormone sensitivity as estimated by premenstrual symptoms. Overall, results of all three studies point towards a null effect of menstrual cycle phase and - to a lesser extent - ovarian hormones on verbal and spatial performance and provided no evidence for a moderation of this effect by individual hormone sensitivity. We conclude that there is substantial consistency in verbal and spatial performance across the menstrual cycle, and that future studies of intra-individual variation are needed.

Sex and gender correlates of sexually polymorphic cognition

BACKGROUND

Sexually polymorphic cognition (SPC) results from the interaction between biological (birth-assigned sex (BAS), sex hormones) and socio-cultural (gender identity, gender roles, sexual orientation) factors. The literature remains quite mixed regarding the magnitude of the effects of these variables. This project used a battery of classic cognitive tests designed to assess the influence of sex hormones on cognitive performance. At the same time, we aimed to assess the inter-related and respective effects that BAS, sex hormones, and gender-related factors have on SPC.

METHODS

We recruited 222 adults who completed eight cognitive tasks that assessed a variety of cognitive domains during a 150-min session. Subgroups were separated based on gender identity and sexual orientation and recruited as follows: cisgender heterosexual men (n = 46), cisgender non-heterosexual men (n = 36), cisgender heterosexual women (n = 36), cisgender non-heterosexual women (n = 38), gender diverse (n = 66). Saliva samples were collected before, during, and after the test to assess testosterone, estradiol, progesterone, cortisol, and dehydroepiandrosterone. Psychosocial variables were derived from self-report questionnaires.

RESULTS

Cognitive performance reflects sex and gender differences that are partially consistent with the literature. Interestingly, biological factors seem to better explain differences in male-typed cognitive tasks (i.e., spatial), while psychosocial factors seem to better explain differences in female-typed cognitive tasks (i.e., verbal).

CONCLUSION

Our results establish a better comprehension of SPC over and above the effects of BAS as a binary variable. We highlight the importance of treating sex as a biological factor and gender as a socio-cultural factor together since they collectively influence SPC.

The Effects of Hormone Contraceptives and Menstruation on Object Memory and Spatial Ability in Young Women

The aim of this study is to examine the relationship between hormone contraceptive use and menstruation on cognitive performance in young women. The object array task assessed object memory and a mental rotations test assessed spatial ability in women taking hormone contraceptives and naturally cycling women. Women taking hormone contraceptives were significantly better than naturally cycling women at identifying novel objects on an object array, but not on performance of a mental rotations task. There were also no significant differences in either task between naturally cycling women who were menstruating and those who were not menstruating during testing. The results of this study suggest that women taking hormone contraceptives outperformed naturally cycling women in recalling the identities of objects. The findings from this study help to further demonstrate the relationship between ovarian hormones and cognitive performance and add to the understanding of how hormone contraceptives affect cognition.

Sex/gender differences in cognitive abilities

Sex/gender differences in cognitive sciences are riddled by conflicting perspectives. At the center of debates are clinical, social, and political perspectives. Front and center, evolutionary and biological perspectives have often focused on 'nature' arguments, while feminist and constructivist views have often focused on 'nurture arguments regarding cognitive sex differences. In the current narrative review, we provide a comprehensive overview regarding the origins and historical advancement of these debates while providing a summary of the results in the field of sexually polymorphic cognition. In so doing, we attempt to highlight the importance of using transdisciplinary perspectives which help bridge disciplines together to provide a refined understanding the specific factors that drive sex differences a gender diversity in cognitive abilities. To summarize, biological sex (e.g., birth-assigned sex, sex hormones), socio-cultural gender (gender identity, gender roles), and sexual orientation each uniquely shape the cognitive abilities reviewed. To date, however, few studies integrate these sex and gender factors together to better understand individual differences in cognitive functioning. This has potential benefits if a broader understanding of sex and gender factors are systematically measured when researching and treating numerous conditions where cognition is altered.

Heat shock protein response during fixed intensity and self-paced exercise in the heat in young, healthy women on oral contraceptives compared with young healthy men

Background

Heat shock proteins respond to a variety of physiological and environmental stresses, including heat stress, ischemia and endotoxic shock. Hormonal changes during the female menstrual cycle can have a thermogenic effect on body temperature. The monophasic oral contraceptive (OC) pill provides low doses of progesterone and oestrogen over the course of the normal menstrual phase. There is little evidence regarding the combined effects of OC on exercise performance and heat stress with respect to heat shock protein response.

Objectives

This study aimed to determine the response of heat shock proteins (Hsp72) during fixed-intensity and self-paced exercise in the heat in young, healthy women on oral contraceptives compared with young healthy men.

Methods

Sixteen physically active men and women performed 30 min fixed-intensity cycling at 50% of maximum workload, followed by 30 min of a self-paced time trial (TT) interspersed by 30 s maximal sprint at 9, 19 and 29 min respectively. Trials were undertaken in cool (20°C; 48±3% relative humidity (RH)) and warm (32°C; 66±2% RH) ambient conditions. Core (T _c) and skin temperature, heart rate (HR) and subjective responses were measured before, during and post exercise.

Results

The distance, mean and peak power output, mean and peak speed during the self-paced time trial showed no difference between the ambient temperatures for men and women. Hsp72 in females was higher than males at all sample points at both 20°C and 32°C, except for pre-exercise at 20°C (p< 0.04). Women also attained a higher T _c than men at the end of the TT in the heat (38.5°C v 37.9°C for women and men, respectively; p<0.03), higher mean HR and perceived exertion.

Conclusion

This study indicates that females who use oral contraceptives (OC) had higher levels of Hsp72 than males when tested under the same environmental conditions.

Combined oral contraceptives and mental health: Are adolescence and the gut-brain axis the missing links?

Combined oral contraceptives (containing synthetic forms of estradiol and progestins) are one of the most commonly used drugs among females. However, their effects on the gut-brain axis have not been investigated to a great extent despite clear evidence that suggest bi-directional interactions between the gut microbiome and endogenous sex hormones. Moreover, oral contraceptives are prescribed during adolescence, a critical period of development during which several brain structures and systems, such as hypothalamic-pituitary-gonadal axis, undergo maturation. Considering that oral contraceptives could impact the developing adolescent brain and that these effects may be mediated by the gut-brain axis, further research investigating the effects of oral contraceptives on the gut-brain axis is imperative. This article briefly reviews evidence from animal and human studies on the effects of combined oral contraceptives on the brain and the gut microbiota particularly during adolescence.

Combined effects of the contraceptive hormones, ethinyl estradiol and levonorgestrel, on the use of place and response memory in gonadally-intact female rats

During maze navigation rats can rely on hippocampus-mediated place memory or striatum-mediated response memory. Ovarian hormones bias whether females use place or response memory to reach a reward. Here, we investigated the impact of the contraceptive hormones, ethinyl estradiol (EE) and levonorgestrel (LNG), on memory bias. A total of 63 gonadally-intact female rats were treated with either 10 μg/kg of EE alone, 20 μg/kg of LNG alone, both 10 μg/kg of EE and 20 μg/kg of LNG together, or a sesame oil injection with 5% ethanol as a vehicle control. Rats in the control condition were tested during the diestrus phase of the estrous cycle in order to control for the low circulating levels of gonadotropin and ovarian hormones that occur with oral contraceptive administration. Rats treated with LNG alone had a bias towards the use of place memory compared to diestrus phase control rats. This bias was not observed if LNG was administered in combination with EE. Rats treated with EE or EE+LNG did not have a statistically significant difference in memory bias compared to rats in the control group. These data show that synthetic hormones contained in oral contraceptives administered to females influence which cognitive strategy is predominantly used during navigation.

Oral contraceptives and cognition: A systematic review

Oral contraceptives (OCs) are widely used. While the physical impacts of OCs have been well researched, there is increasing interest on potential impacts of OCs on brain, behaviour and cognition. We systematically reviewed the literature to determine the influence of OCs on cognition, including neurocognition, social cognition and emotional processing. Inclusionary criteria were: (a) premenopausal females taking OCs; (b) a control group of naturally cycling women or OCs users in their inactive (i.e. 'sugar pill') phase; and (c) at least one measure of performance on a neurocognitive or social cognitive task. The systematic review found that OC use was associated with some differences in performance on all cognitive domains examined (with the exception of basic auditory attention and psychomotor performance). Several factors were identified that are likely to modulate the way OCs influence cognition, including task related factors, OC type and control group characteristics. Directions for future research are highlighted.

What is there to know about the effects of progestins on the human brain and cognition?

Progestins are an important component of hormonal contraceptives (HCs) and hormone replacement therapies (HRTs). Despite an increasing number of studies elucidating the effects of HCs and HRTs, little is known about the effects of different types of progestins included in these medications on the brain. Animal studies suggest that various progestins interact differently with sex steroid, mineralocorticoid and glucocorticoid receptors and have specific modulatory effects on neurotransmitter systems and on the expression of neuropeptides, suggesting differential impacts on cognition and behavior. This review focuses on the currently available knowledge from human behavioral and neuroimaging studies pooled with evidence from animal research regarding the effects of progestins on the brain. The reviewed information is highly relevant for improving women's mental health and making informed choices regarding specific types of contraception or treatment.

Modeling hormonal contraception in female rats: A framework for studies in behavioral neurobiology

Research on hormonal contraceptives (HC) in animal models is lacking, and as a result, so is our understanding of the impact of HC on the brain and behavior. Here, we provide a review of the pharmacology of HC, as well as the methodology and best practices for designing a model of HC in female rats. We outline specific methodological considerations regarding dosing, route of administration, exposure time/timing, and selecting a control group. We also provide a framework outlining important levels of analysis for thinking about the impact of HC on behavioral and neurobiological outcomes. The purpose of this review is to equip researchers with foundational knowledge, and some basic elements of experimental design for future studies investigating the impact of HC on the brain and behavior of female rats.

Hormonal contraceptive influences on cognition and psychopathology: Past methods, present inferences, and future directions

In the last decade, there has been a remarkable surge in research on the neural and behavioral correlates of hormonal contraceptive use, particularly oral contraceptive use. Questions have evolved swiftly and notably, with studies no longer revealing if hormonal contraceptives matter for the brain and behavior, but rather how, when, and for whom they matter most. Paralleling this shift, the goal of this review is to move beyond an average synthesis of hormonal contraceptive influences on human cognition and psychopathology (and their neural substrates) in order to consider the nature and specificity of effects. Accompanied by an evaluation of study methods and informed by findings from animal models, this consideration uncovers promising areas of research in the next ten years, including potential activational and organizational effects of hormonal contraceptive use, individual differences in effects that matter for the wellbeing of unique individuals, and correlates of intrauterine device use.

Age and sex impact on visuospatial working memory (VSWM), mental rotation, and cognitive strategies during navigation

This study assessed the impact of sex and typical aging on visuospatial working memory (VSWM), mental rotations, and navigational strategies using behavioral information. Fifty healthy participants regrouped in older (OA) and young adults (YA) performed the Walking Corsi test (WalCT) and the Redrawn Mental Rotation Test (MRT) to explore mental rotation abilities. We recorded kinematic data such as locomotion trajectories, and spatial orientations during navigation. We created a new method of data analysis for the WalCT performances and compared it with the classical approach. This original method allowed us to identify cognitive strategies based on errors analysis. Our data suggested that VSWM and mental rotation capacities in locomotion were modulated by age (YA scored higher than OA), and sex (Young Adult Males (YA-M) having higher performance than Young Adult Females (YA-F). We observed a preferential use of cognitive strategies related to sex; YA-F relied more on egocentric strategies whereas YA-M relied more on allocentric strategies. The preferential use of cognitive strategies in the YA group was not observed in the OA group producing more random errors per sequence. The results suggest the effects that age and sex have on VSWM, cognitive strategies, and mental rotation during navigation and highlight the importance of navigational strategies training.

“Where am I?” A snapshot of the developmental topographical disorientation among young Italian adults

In the last decade, several cases affected by Developmental Topographical Disorientation (DTD) have been described. DTD consists of a neurodevelopmental disorder affecting the ability to orient in the environment despite well-preserved cognitive functions, and in the absence of a brain lesion or other neurological or psychiatric conditions. Described cases showed different impairments in navigational skills ranging from topographic memory deficits to landmark agnosia. All cases lacked a mental representation of the environment that would allow them to use high-order spatial orientation strategies. In addition to the single case studies, a group study performed in Canada showed that the disorder is more widespread than imagined. The present work intends to investigate the occurrence of the disorder in 1,698 young Italian participants. The sample is deliberately composed of individuals aged between 18 and 35 years to exclude people who could manifest the loss of the ability to navigate as a result of an onset of cognitive decline. The sample was collected between 2016 and 2019 using the Qualtrics platform, by which the Familiarity and Spatial Cognitive Style Scale and anamnestic interview were administered. The data showed that the disorder is present in 3% of the sample and that the sense of direction is closely related to town knowledge, navigational strategies adopted, and gender. In general, males use more complex navigational strategies than females, although DTD is more prevalent in males than in females, in line with the already described cases. Finally, the paper discusses which protective factors can reduce DTD onset and which intervention measures should be implemented to prevent the spread of navigational disorders, which severely impact individuals’ autonomy and social relationships.

Walking on a minefield: planning, remembering, and avoiding obstacles: preliminary findings

Travel planning (TP) is a kind of planning devoted to spatial orientation that is distinguishable from general planning (GP). It is crucial to reach a destination, since it allows to select the best route according to the environmental features (e.g., the one with little traffic or the safest). TP is also needed to avoid obstacles along the way and to put in place effective strategies to support navigation. TP involves several cognitive processes, such as visuo-spatial and topographic memory as well as other executive functions (i.e., general planning, cognitive flexibility, problem solving, and divergent thinking) and it is affected by internal factors (such as gender, cognitive strategies, age). Here, we focused on the effects of visuo-spatial (VSWM) and topographic (TWM) working memory on TP, using the Minefield Task (MFT), a new tool aimed at testing TP. We tested VSWM, TWM, GP, and TP in 44 college students. First, we checked for gender differences in all the tasks proposed and then assessed the relation among VSWM, TWM, GP, and TP. Results showed that even though gender difference could be found on TWM, GP, and TP, significative correlations emerged among TP, VSWM, and GP as well as a tendency to significance for VSWM and GP in the regression analyses. Though more evidence is needed, these results suggest that when a brand-new route is computed, GP and VSWM can be the most relevant processes, whereas topographic memory was less involved, probably because the MFT does not require to recall a route from memory. The implications of these results in clinical settings are discussed.

Do Advanced Spatial Strategies Depend on the Number of Flight Hours? The Case of Military Pilots

BACKGROUND

Military pilots show advanced visuospatial skills. Previous studies demonstrate that they are better at mentally rotating a target, taking different perspectives, estimating distances and planning travel and have a topographic memory. Here, we compared navigational cognitive styles between military pilots and people without flight experience. Pilots were expected to be more survey-style users than nonpilots, showing more advanced navigational strategies.

METHOD

A total of 106 military jet pilots from the Italian Air Force and 92 nonpilots from the general population matched for education with the pilots were enrolled to investigate group differences in navigational styles. The participants were asked to perform a reduced version of the Spatial Cognitive Style Test (SCST), consisting of six tasks that allow us to distinguish individuals in terms of landmark (people orient themselves by using a figurative memory for environmental objects), route (people use an egocentric representation of the space) and survey (people have a map-like representation of the space) user styles.

RESULTS

In line with our hypothesis, military pilots mainly adopt the survey style, whereas nonpilots mainly adopt the route style. In addition, pilots outperformed nonpilots in both the 3D Rotation Task and Map Description Task.

CONCLUSIONS

Military flight expertise influences some aspects of spatial ability, leading to enhanced human navigation. However, it must be considered that they are a population whose navigational skills were already high at the time of selection at the academy before formal training began.

Modulation of premotor cortex response to sequence motor learning during escitalopram intake

The contribution of selective serotonin reuptake inhibitors to motor learning by inducing motor cortical plasticity remains controversial given diverse findings from positive preclinical data to negative findings in recent clinical trials. To empirically address this translational disparity, we use functional magnetic resonance imaging in a double-blind, randomized controlled study to assess whether 20 mg escitalopram improves sequence-specific motor performance and modulates cortical motor response in 64 healthy female participants. We found decreased left premotor cortex responses during sequence-specific learning performance comparing single dose and steady escitalopram state. Escitalopram plasma levels negatively correlated with the premotor cortex response. We did not find evidence in support of improved motor performance after a week of escitalopram intake. These findings do not support the conclusion that one week escitalopram intake increases motor performance but could reflect early adaptive plasticity with improved neural processing underlying similar task performance when steady peripheral escitalopram levels are reached.

Cognitive function in association with high estradiol levels resulting from fertility treatment

The putative association between hormones and cognitive performance is controversial. While there is evidence that estradiol plays a neuroprotective role, hormone treatment has not been shown to improve cognitive performance. Current research is flawed by the evaluation of combined hormonal effects throughout the menstrual cycle or in the menopausal transition. The stimulation phase of a fertility treatment offers a unique model to study the effect of estradiol on cognitive function. This quasi-experimental observational study is based on data from 44 women receiving IVF in Zurich, Switzerland. We assessed visuospatial working memory, attention, cognitive bias, and hormone levels at the beginning and at the end of the stimulation phase of ovarian superstimulation as part of a fertility treatment. In addition to inter-individual differences, we examined intra-individual change over time (within-subject effects). The substantial increases in estradiol levels resulting from fertility treatment did not relate to any considerable change in cognitive functioning. As the tests applied represent a broad variety of cognitive functions on different levels of complexity and with various brain regions involved, we can conclude that estradiol does not show a significant short-term effect on cognitive function.