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Birth control pills may affect the body’s ability to regulate stress, say researchers
Scientists measured the stress hormone ACTH, making it possible to observe and analyse rapid changes in a woman’s stress response
Contraceptive pills may have an impact on the body’s ability to regulate stress, a new study has found.
Researchers from Aarhus University and the United States have studied the stress response of 131 young women by measuring the levels of the stress hormone ACTH in the their blood. Some of the participants were on birth control, while others were not.
The study showed that 15 minutes of social activity after having a blood sample taken lowered stress hormone levels in women who were not on birth control. In contrast, women on birth control did not experience any reduction in their ACTH levels.
To avoid causing any additional stress to the test subjects, a small intravenous catheter was inserted in connection with the first blood sample. The researchers could then draw blood after the social activity without having to prick the women with a needle again.
After having a blood sample taken, they could then participate in one of six different group activities such as playing board games, getting to know each other in a group session, singing songs together or attending a church service.
“Being with other people is one of the most effective ways of reducing stress,” explained Michael Winterdahl, a visiting scholar at the translational neuropsychiatry unit at the department of clinical medicine.
“Our results are important because they indicate that people who use birth control pills do not experience the same reduced stress hormone levels in connection with social activity as people who don’t.”
It has long been established that birth control pills affect the stress response in women. However, looking at the stress hormone ACTH in connection with a social activity is a new approach.
The research differs from previous studies that have primarily focused on the stress hormone cortisol in extreme circumstances.
In this study, scientists measured the stress hormone ACTH, which changes significantly faster than cortisol, making it possible to observe and analyse rapid changes in a person’s stress response.
“By studying ACTH levels, we take another step towards understanding how the brain regulates stress as ACTH acts as a neurotransmitter from the brain to the adrenal cortex, which produces cortisol,” said Winterdahl.
“When we analyse ACTH levels, we can gain insight into the quick-response mechanism that controls the body’s reaction to stress.”
Birth control pills are known for being able to affect the hypothalamic-pituitary-adrenal (HPA) axis. As the name indicates, the stress signal travels from the hypothalamus in the brain through the pituitary gland that releases ACTH to the adrenal glands that release cortisol.
However, researchers still need an explanation to why women on birth control do not experience the same reduction of stress hormone levels in connection with social activities as those who are not on the pill.
Winterdahl said there are several competing hypotheses that try to explain the lower cortisol levels in women on birth control.
“Our research has pushed us closer to an explanation that centres on the brain and the ACTH dynamics. The biochemistry is complex, but we are working based on the assumption that birth control pills can suppress the body’s own production of progesterone.”
The study additionally revealed that the stress response in women who did not take birth control pills depended on where they were at in their menstrual cycle.
The stress-reducing group activities had no effect on the ACTH levels of the women who were in the proliferative phase of their cycle – just after their period has ended and the body begins producing hormones to get ovulation started.
“Progesterone levels are very low during the proliferative phase of a natural cycle. This leads to a minimal conversion of progesterone into the hormone allopregnanolone,” said Winterdahl.
“Since allopregnanolone is important for activating the receptors that regulate the stress response, we don’t see a reduction in ACTH levels in women with a natural cycle who have just had their period.”
He pointed out that women also tend to be more physically active during the proliferative phase which could be seen as an adaption in which the stress response and behaviour change in step with the cycle.
In women on birth control, he said, the stress response is “disconnected”, meaning it can not be adapted to a given situation.
Research still can’t explain exactly how this affects women. Additional studies are needed to clarify the complex mechanisms involved in the correlation between hormone levels and the stress response.
“There are different generations of the pill, each with its own chemical structure due to the hormones used, which means the pills have different side-effect profiles,” Winterdahl concluded.
“It’s therefore crucial that our experiments are reproduced with a larger and more diverse group of test subjects.”
Australia’s drug advisory committee has recommended wider funding of triptorelin for women with breast cancer or endometriosis.
The recommendation comes after AstraZeneca announced plans to remove Zoladex from the market, risking leaving more than 7,500 women with breast cancer without an alternative treatment.
Both medicines block the release of oestrogen and testosterone and can be used as part of treatment, or for fertility preservation, in some forms of cancer.
The Pharmaceutical Benefits Advisory Committee met urgently in July and recommended making triptorelin unrestricted under the Pharmaceutical Benefits Scheme (PBS), which would mean it was funded for all uses.
The drug has been listed on the PBS for prostate cancer since 2006.
Triptorelin and Zoladex can also be used to treat endometriosis and to block puberty for either precocious puberty or gender-affirming care.
Vicki Durston, director of policy and advocacy at Breast Cancer Network Australia, described the recommendation as “a significant step forward” and said access to the medicine could mean the difference between life and death for some patients.
She said some women had already chosen to have their ovaries removed because of uncertainty over Zoladex supplies.
Marilla Druitt, Victorian state chair of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said it remained unclear whether triptorelin would work exactly the same way as Zoladex, but the recommendation was likely to be positive for patients with endometriosis and pelvic pain.
She said: “I’m glad we’ve got an alternative.”
“That’s fantastic, and it remains to be seen whether or not it will be as good, but pain is so complex, pain is a really hard thing to study because it’s got so many contributors.”
Druitt said further research would be needed after the medicine was introduced.
If accepted by the federal government, the recommendation would also allow PBS funding of triptorelin for puberty suppression in precocious puberty and gender-affirming care.
This would make gender-affirming care federally funded through the PBS for the first time and would remove a financial barrier for transgender children in Queensland and the Northern Territory.
Stuart Aitken, medical director of Gender Health Australia, said the recommendation had sparked “absolute joy” among his patients.
He said: “It takes away a huge barrier to accessing evidence-based care.”
“It means that the ban has a very limited effect.”
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Sahar Abid is a Science Associate at Ema EQ, where she works on cultural sensitivity and bias in AI.
A woman asks an AI health assistant about postpartum depression.
She mentions that her in-laws are telling her to “push through” and skip medical help, even as her symptoms get harder to manage. She never says where she is from or names her background.
The assistant describes the condition and gives her a hotline number. It sounds correct, but it misses what she needs.
That gap is more common than the industry admits, and it points to a blind spot in how we test health AI for bias.
Most bias testing looks at what people explicitly say.
The typical way to check an AI for bias is to label a prompt with someone’s demographic details and see if the answer changes. That catches some problems but misses a bigger one.
Most people do not lead with their identity. They lead with their situation. The woman above told the assistant everything it needed to help her, just not in the form of a label.
Her real question was not only “what is postpartum depression?” It was “how do I get care when the people around me don’t want me to?
When family members hold sway over health decisions, and in many communities they do, advice that asks someone to overrule their family is not something they can act on.
The AI didn’t say anything factually wrong. It answered a different question than the one she was living.
We call this culturally implicit bias, meaning the AI misses the cultural context a situation implies rather than the context a person spells out.
When systems are trained to notice only the explicit cues, they fall back on a default answer built for the majority. For everyone else, the response can feel generic, off-target, or discouraging enough that they stop looking for help.
In health, that is not small. The people most likely to be missed are often the ones the system already underserves.
What we set out to test.
At Ema, we wanted to know how well AI picks up on cultural context that is implied but never stated. So we built our own way to test for it, across a range of communities and real situations like postpartum depression and fertility, using questions that carried cultural meaning without announcing it.
The patterns were consistent. Models often missed the meaning underneath the question. They dropped the specific details a person did share and smoothed them into something generic.
And even when they pointed toward real care, they tended to offer one option instead of choices that might actually fit a person’s life. Any one of those can be the difference between someone following the advice and walking away from care.
Why this matters for anyone building health AI.
Getting this right is the right thing to do, and it also works better.
When an answer reflects a person’s real context, people trust and act on the recommendations more, so they get the help and support they need.
Testing for it is harder than the shortcut most teams use. Swapping a name or a demographic label in and out is easy. Checking whether a model actually understands the human context around a question takes more care.
The shortcut teaches models to perform cultural competence instead of practicing it. No matter how much or how little someone chooses to share, they deserve an answer that is warm, complete, and usable.
A better question.
The bar for equitable health AI should be “does it serve someone who never told you who they are?” It is the harder test, but it determines whether real people get help.
The work of getting there is far from finished, and it is exactly what we are building toward at Ema.
Sources: Naidoo, V., & Chadha, K. K. (2025), Culturally responsive AI chatbots: from framework to field evidence, Computers in Human Behavior: Artificial Humans. Souligne, N., & Subbian, V. (2026), FairLogue: A toolkit for intersectional fairness analysis in clinical machine learning models.
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