Millions of American women use hormonal birth control – even more than you may think.
According to the Centers for Disease Control, about 11 million women are currently taking an oral birth control pill to prevent unwanted pregnancy or to take advantage of other health benefits. And four out of every five “sexually experienced” women have used the pill at some point, according to a study from the CDC.
Now, a new study suggests hormonal birth control (which includes the pill, as well as other forms of birth control like the implant, patch, hormonal IUDs and the vaginal ring) may triple the risk of suicide among women using the contraceptives compared to women who had never used them.
The study, published in the American Journal of Psychiatry, tracked nearly half a million women in Denmark for about 8 years. The researchers found the risk of attempting suicide was nearly twice as high for women taking hormonal birth control compared to those who did not. The risk of committing suicide was more than three times as great.
The researchers added that adolescent women experienced the greatest relative risk, and that the association between hormonal contraceptive use and the first suicide attempt peaked after about two months of use.
The findings are backed up by some previous research, including another much-publicized Danish study in 2016 that found a significant correlation between hormonal birth control and the risk of depression. In that study, women between the ages of 15 and 19 were as 80 percent more likely to be depressed, reported Quartz. The results were less extreme for older women, but still measurable.
Although the numbers may sound extreme, the absolute risk of suicide is still quite low. Out of the hundreds of thousands of women tracked in this latest study, there were a total of 71 suicides, according to the researchers.
There may be other factors at play as well, such as a higher rate of emotional turmoil among women taking contraceptives compared to those who do not, Karin Michels, professor and chair of epidemiology at University of California Los Angeles, told TIME.
Still, the researchers said it was worth exploring the possibility of side effects, and making sure patients and doctors are aware of the risks while discussing options.
“Women and their doctors should be aware about mood reactions as a potential side effect, so they can quit their hormonal contraception if they feel affected,” Charlotte Wessel Skovlund, lead author of the paper, told TIME. “Doctors should be more reluctant to prescribe hormonal contraception to young girls unless there are medical reasons to do so.”