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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.

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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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Is carbonated water as healthy as regular water?

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Is carbonated water as good for you as regular water? - National | Globalnews.ca

IMG via Global News 

Some say that carbonation in water may limit hydration, reduce gastrointestinal symptoms, and increase satiety. But let’s think twice about those claims.   

Regarding hydration, a randomized trial found no difference in urine volume after consumption of still water compared to sparkling water (1).  

Regarding gastrointestinal health, a small (21 subjects) double-blind randomized trial found fewer symptoms of indigestion with carbonated water compared to tap water (2). Another double-blind study of 40 elderly people found fewer symptoms of constipation among people who consumed carbonated water compared to those who drank still water (3). One question about both of these studies is how blinding was accomplished, since subjects can sense carbonation. The small number of study subjects decreases confidence in each experiment.  

It is also speculated that carbonated water can improve satiety, or sense of fullness. Two very small uncontrolled studies reported that people felt satiated after drinking carbonated water (4,5). But that might be the case for still water as well. There is also no good evidence that sparkling water can cause gas and bloating (6) and no evidence that it erodes tooth enamel, even though these symptoms have been reported anecdotally (7).  

While experimental evidence from randomized controlled trials is required to determine the relative health benefits of still and sparkling water, it is a good option for hydration, particularly compared to sugary drinks.  

References:

  1. Maughan RJ, Watson P, Cordery PA, et al. A randomized trial to assess the potential of different beverages to affect hydration status: development of a beverage hydration index. Am J Clin Nutr. 2016;103(3):717-723. doi:10.3945/ajcn.115.114769 
  2. Cuomo R, Grasso R, Sarnelli G, et al. Effects of carbonated water on functional dyspepsia and constipation. Eur J Gastroenterol Hepatol. 2002;14(9):991-999. doi:10.1097/00042737-200209000-00010 
  3. Mun JH, Jun SS. J Korean Acad Nurs. 2011;41(2):269-275. doi:10.4040/jkan.2011.41.2.269 
  4. Suzuki M, Mura E, Taniguchi A, Moritani T, Nagai N. Oral Carbonation Attenuates Feeling of Hunger and Gastric Myoelectrical Activity in Young Women. J Nutr Sci Vitaminol (Tokyo). 2017;63(3):186-192. doi:10.3177/jnsv.63.186 
  5. Wakisaka S, Nagai H, Mura E, Matsumoto T, Moritani T, Nagai N. The effects of carbonated water upon gastric and cardiac activities and fullness in healthy young women. J Nutr Sci Vitaminol (Tokyo). 2012;58(5):333-338. doi:10.3177/jnsv.58.333 
  6. Welstead L, Schuchmann C. Is sparkling water good for you? What about hard water? University of Chicago Medicine. 10 May 2023. 
  7. Parry J, Shaw L, Arnaud MJ, Smith AJ. Investigation of mineral waters and soft drinks in relation to dental erosion. J Oral Rehabil. 2001;28(8):766-772. doi:10.1046/j.1365-2842.2001.00795.x 
  8. https://globalnews.ca/news/4286475/is-carbonated-water-good-for-you/