All posts by Frances Cates

All, Women's Health

Does emergency contraception affect fertility?

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Emergency contraception, better known by its brand name, Plan B, can be taken after unprotected sex to prevent pregnancy. It can be purchased over the counter at your local pharmacy. However, on social media, there is some sense of worry that emergency contraception will affect future fertility, especially if taken repeatedly. Let’s think twice: does emergency contraception affect fertility?

Emergency contraception typically consists of the hormone levonorgestrel, which is a synthetic form of the hormone progesterone (1). Progesterone is a natural hormone in the body that helps regulate the menstrual cycle and increases during pregnancy (2). Levonorgestrel delays ovulation to prevent pregnancy (3).

A 2022 systematic review of levonorgestrel emergency contraception analyzed 33 studies and found that it did not affect fallopian tube mobility, ectopic pregnancy, miscarriage, stillbirth, or subsequent menstruations (3). Another systematic review of 47 studies found that adverse outcomes like ectopic pregnancy and miscarriage were not significantly associated with taking levonorgestrel emergency contraception (4). Researchers reported that “the most common adverse effects of levonorgestrel were not serious.” Temporary side effects reported after emergency contraception use include nausea and vomiting, vaginal bleeding, and fatigue (7). In one observational study of 232 participants reported transient changes in their menstruation (6).

A 2014 systematic review of 22 studies evaluated the repeated use of emergency contraception as the primary source of contraception and reported that the most common side effect was menstrual irregularities (5). The researchers concluded that more investigation is required since the existing studies on repeated usage were not methodologically sound. Also, many menstrual cycles are irregular and pregnancy alone might alter them, making objective measurement of the cycle for several months before and after important, which is difficult and perhaps impossible.

Emergency contraception can reduce the probability of conception after unprotected sex (8) and is a safe and effective medication that does not impact future fertility.

Sources

Gillson, George. “Clarifying hormone terminology.” Canadian family physician Medecin de famille canadien vol. 53,1 (2007): 29-30.

Cable JK, Grider MH. Physiology, Progesterone. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558960/

Endler, M et al. “Effect of levonorgestrel emergency contraception on implantation and fertility: A review.” Contraception vol. 109 (2022): 8-18. doi:10.1016/j.contraception.2022.01.006

Leelakanok, Nattawut, and Janthima Methaneethorn. “A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive.” Clinical drug investigation vol. 40,5 (2020): 395-420. doi:10.1007/s40261-020-00901-x

Halpern, Vera et al. “Repeated use of pre- and postcoital hormonal contraception for prevention of pregnancy.” The Cochrane database of systematic reviews vol. 2014,9 CD007595. 26 Sep. 2014, doi:10.1002/14651858.CD007595.pub3

Gainer, Erin et al. “Menstrual bleeding patterns following levonorgestrel emergency contraception.” Contraception vol. 74,2 (2006): 118-24. doi:10.1016/j.contraception.2006.02.009

World Health Organization. “Emergency Contraception.” (2021). https://www.who.int/news-room/fact-sheets/detail/emergency-contraception#:~:text=Emergency%20contraception%20(EC)%20can%20prevent,assault%20if%20without%20contraception%20coverage.

All, Recent posts

Does weather affect mood?

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References to the connection between weather and emotion pervade our culture, whether it’s “sunshine on a cloudy day,” “singing in the rain,” “somewhere over the rainbow,” or “rainy day blues” (1). But does weather really affect mood? Let’s think twice.

Some people experience seasonal affective disorder (SAD), a type of depression that occurs most often during darker months in fall or winter (1). According to Johns Hopkins, chemical changes in the brain may be associated with symptoms of depression when the days are shorter and there is less daylight (5).

Regarding mood and weather, most of the experimental evidence suggests there is no relationship. A study of mood using data collected from participants’ online diaries and weather station data found that daily weather was not associated with mood (6). Another study collected questionnaire data from 97 participants regarding their current mood, activity level, and how much time they spent outside on the day they came to the lab and concluded that mood was not directly related to outside temperature or barometric pressure (7). A study of daily mood ratings and diary entries of 18 students analyzed the prevalence with which diary entries mentioned different types of weather and found no association between weather and mood (8). Another study used data from 14,478 people in a depression-screening program combined with meteorological data found no association between weather and mood (9).

Among the studies that found an association, one studied 497 people using 3 weather indicators from meteorological data and 3 self-reported mood indicators and identified four groups with a modest relationships between weather and mood: summer lovers, unaffected, summer haters, and rain haters (2). Another study that analyzed 38 million posts from 3 million users of a social media site and details regarding the weather during the time of the post in the region of the poster found that sentiments consistent with low mood were associated with weather conditions of high humidity, precipitation, fog, and temperature extremes below 50°F and above 70°F, while high mood was associated with clear skies, high atmospheric pressure, and sunlight temperatures between 50°F and 70°F (3). Because this study relied on time zone and location fields in users’ profiles, it is not certain whether the meteorological data they collected was accurate for all users. A third study that found an association recruited 4,548 people representative of the general population of Japan to complete baseline measures and keep a daily health record regarding physical and mental symptoms for a month and compared those with meteorological data found that self-reported agitation and anxiety were associated with higher temperatures, while depressed mood was associated with lower temperatures (4).

If there is a relationship between mood and weather it seems limited given the small magnitude when there is an association and the inconsistent detection of an association. Our perceived association between weather and mood may relate to cultural expressions and associations, automatic mental associations, or other factors. But it seems that the weather may not cause and perhaps cannot cure low mood.

1) Swaim, E. (2022, August 12). Yes, Weather Can Affect Mood and Energy- and So Can Climate Change. Healthline. https://www.healthline.com/health/mental-health/weather-and-mood#risk-factors

2) Klimstra, T. A., Frijns, T., Keijsers, L., Denissen, J. J., Raaijmakers, Q. A., van Aken, M. A., Koot, H. M., van Lier, P. A., & Meeus, W. H. (2011). Come rain or come shine: individual differences in how weather affects mood. Emotion (Washington, D.C.), 11(6), 1495–1499. https://doi.org/10.1037/a0024649

3) Gilette, H. (2024, April 26). Weather Can Affect Your Mood- but How? PsychCentral. https://ojs.aaai.org/index.php/ICWSM/article/view/14451/14300

4) Lee, M., Ohde, S., Urayama, K. Y., Takahashi, O., & Fukui, T. (2018). Weather and Health Symptoms. International journal of environmental research and public health, 15(8), 1670. https://doi.org/10.3390/ijerph15081670

5) Johns Hopkins. (n.d.). Seasonal Affective Disorder. https://www.hopkinsmedicine.org/health/conditions-and-diseases/seasonal-affective-disorder#:~:text=Seasonal%20affective%20disorder%20(SAD)%20is,antidepressants%20can%20help%20treat%20SAD.

6) Denissen, Jaap J A et al. “The effects of weather on daily mood: a multilevel approach.” Emotion (Washington, D.C.) vol. 8,5 (2008): 662-7. doi:10.1037/a0013497

7) Keller, M. C., Fredrickson, B. L., Ybarra, O., Côté, S., Johnson, K., Mikels, J., Conway, A., & Wager, T. (2005). A Warm Heart and a Clear Head: The Contingent Effects of Weather on Mood and Cognition. Psychological Science, 16(9), 724–731. https://doi.org/10.1111/j.1467-9280.2005.01602.x

8) Clark, L. A., & Watson, D. (1988). Mood and the mundane: Relations between daily life events and self-reported mood. Journal of Personality and Social Psychology, 54(2), 296–308. https://doi.org/10.1037/0022-3514.54.2.296

9) Huibers, Marcus J H et al. “Does the weather make us sad? Meteorological determinants of mood and depression in the general population.” Psychiatry research vol. 180,2-3 (2010): 143-6. doi:10.1016/j.psychres.2009.09.016

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Are plant-based milk alternatives as good for you as cow’s milk?

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Plant-based milk alternatives, like almond, soy, and oat, have taken grocery stores by storm in recent years. With some people removing cow’s milk entirely from their diets, the question arises, does plant-based milk offer the same nutritional benefits as cow’s milk? Let’s think twice.

The nutritional value of plant-based (PB) milk alternatives is variable compared to cow’s milk, particularly in terms of protein. Research indicates that PB milk alternatives generally have lower protein content than cow’s milk. A 2022 systematic review of PB milk alternatives (1) found that only 7.7% of PB milks met USDA standards for protein. Furthermore, a 2021 study (2) reported that almond and soy milk provide less than half the protein content of cow’s milk.

Despite differences in protein content, PB milk alternatives can provide other nutrients, such as calcium, Vitamin A, and Vitamin D, and B12, in sufficient amounts. For example, the same 2021 study reported that almond milk contained the highest calcium content compared to oat, soy, goat’s, and cow’s milk (2). Fortification of PB milks with nutrients can help them meet the necessary standards (1). In a 2021 study by Johnson et al. (3,4), analysis of 233 PB milks revealed that half were fortified with vitamin D and 2/3 with calcium.

Additionally, some PB milk alternatives, especially almond milk, are desirable for their lower calories (5). For example, according to Baylor College of Medicine (6), almond milk is a lower-calorie option than cow’s milk due to its low protein and carbohydrate content, and it can provide small amounts of unsaturated fats.

Though fortification and other strategies can increase the nutrient content of PB milks, some research refutes their nutritional value. The same study by Johnson et al. found that only 12% of milk alternatives contained comparable or greater amounts of calcium, vitamin D, and protein when compared to cow’s milk (3). This result demonstrates a need for further research investigating nutritional outcomes of PB milks and the roles that the various key nutrients play.

While there is a long way to go before we fully understand the differences between milk products, it remains important to read milk labels and educate ourselves on the milks that are best for us.

References

Drewnowski A. (2022). Most Plant-Based Milk Alternatives in the USDA Branded Food Products Database Do Not Meet Proposed Nutrient Standards or Score Well on Nutrient Density Metrics. Nutrients, 14(22), 4767. https://doi.org/10.3390/nu14224767

Collard, K. M., & McCormick, D. P. (2021). A Nutritional Comparison of Cow’s Milk and Alternative Milk Products. Academic pediatrics, 21(6), 1067–1069. https://doi.org/10.1016/j.acap.2020.12.007

American Society for Nutrition (2023, July 4). Nutritional content of most milk alternatives doesn’t measure up to cow’s milk. https://nutrition.org/nutritional-content-of-most-milk-alternatives-doesnt-measure-up-to-cows-milk/#:~:text=Compared%20to%20cow’s%20milk%2C%20only,%2C%20vitamin%20D%2C%20and%20protein

Lamotte, S. (2023, July 25). Good or bad? Plant-based and cow’s milk are not always nutritionally equal, study says. CNN. https://edition.cnn.com/2023/07/25/health/plant-milk-nutrition-labels-wellness/index.html

Vanga, S. K., & Raghavan, V. (2018). How well do plant based alternatives fare nutritionally compared to cow’s milk?. Journal of food science and technology, 55(1), 10–20. https://doi.org/10.1007/s13197-017-2915-y

Warren H. (2023, October 4). Cow milk vs. Alternative milk: what’s the best? Baylor College of Medicine. https://www.bcm.edu/news/cow-milk-vs-alternative-milk-whats-the-best#:~:text=Almond%20milk%20is%20a%20lower,with%20calcium%20and%20vitamin%20D.