• New study looks at the “nocebo effect” among users of oral contraceptives
• Negative expectations of the pill linked to some side effects
• Two in three women stop taking the contraceptive pill within two years of starting it, with many switching to alternative but less effective forms of contraception
• Psychological interventions may help

Side effects experienced when taking oral contraception may be affected by women’s expectations and beliefs about the pill, according to an exploratory study by psychologists.

Researchers at the University of Sheffield identified a “nocebo effect” in relation to the contraceptive pill, where psychological factors such as negative expectations or anxiety about using a medicine drives a physical response in the body when the medicine is taken.

Nocebo responses to the oral contraceptive pill are real and can include feelings of depression, anxiety and fatigue. The nocebo effect is the “evil twin” to the placebo effect, where people get a positive boost from taking a dummy tablet or pill.

In their study, the Sheffield researchers highlight international studies which suggest around two in three women stop taking the contraceptive pill within two years of starting it, with many switching to alternative but less effective forms of contraception. In many cases, side effects were central to their decision to discontinue using oral contraception.

Across England, the pattern is similar, with women choosing to stop using the pill in large numbers. Figures from NHS Digital show the number of prescriptions issued for oral contraceptives dropped from 7.2 million in 2012 to just over 6 million a decade later.

Dr Rebecca Webster, from the University of Sheffield’s School of Psychology, who supervised the research study, said: “The contraceptive pill gets a lot of negative attention, particularly on social media, and we were interested in how these negative views could be influencing the way women are experiencing oral contraception.

“The side effects are very real, but could some of them have a psychological component? If they do, that means we could develop interventions to help people deal with them.”

The researchers recruited 275 women aged between 18 and 45 to the study. All had been taking the pill at some point over the previous 18 months. They were asked to take part in an online survey.

They were also asked to respond to questions about any side effects they were experiencing. In addition, they were asked questions designed to assess their attitude to medicines and medicine use.

Statistical analysis revealed four psychological factors that were associated with the likelihood the women experienced negative side effects. In order of magnitude, the psychological factors were:

• A negative expectation from the outset that the medicine would be harmful
• Low confidence in the way medicines are developed
• A belief that medicines are over used and harmful
• A belief that they are sensitive to medicines

Expectations that a medicine will have a negative effect from the outset are likely to be self fulfilling. Negative expectations can be heightened if people believe medicines are generally harmful or overused or by negative messaging in the media.

Nearly every woman in the study (97 per cent) reported at least one side effect. Over the 18 month study period, 149 women (54.2 per cent) continued with the oral contraception. A total of 126 women (45.8 per cent) discontinued using the pill, with 42 of them switching to an alternative form of contraception.

The nocebo effect has been recognised in other health conditions but the study at Sheffield is believed to be the first to investigate how the nocebo effect may be impacting on women’s experience of taking oral contraceptives.
Lorna Reid, lead author of the study from the University of Sheffield, said: “It is important to acknowledge how some women’s experiences of oral contraception are impacted by the nocebo effect. With this information, women can make more informed decisions about their use of oral contraception.
“This is particularly so with younger women who may be exposed to more negative messaging around use of the pill through greater use of media platforms.”
The researchers say a limitation of their study is that the participants were predominantly young white women. But they add that the exploratory study paves the way for future studies to investigate ways of improving women’s experience of oral contraception.


The exploratory study is reported in the journal Perspectives on Sexual and Reproductive Health: Exploring the relationship between medicine related beliefs and Side-effect experience among white oral contraceptive users in the UK.

It can be downloaded from: https://doi.org/10.1111/psrh.70012