Jul 31, 2023Forskning

Amani Meaidi on Safe Choice: The largest study on contraception

“I don't see this as a feminist project. I'm a doctor – and it's a question of patient safety.”

Doctor and researcher Amani Meaidi speaks with as much enthusiasm as determination when she explains to me why she helped start the Safe Choice research project:

A national study to map side effects of hormonal contraception among Danish women. Safe Choice is, in short:

National Danish study of hormonal contraception
Up to 1 million women are invited to participate
Women between 15 and 45 years old
Supported by the Danish Health Insurance (6.5 million DKK)
Examines both side effects and general well-being

The article is written based on an interview with Amani Meaidi - by Cathrine Wichmand.

A new generation of women is demanding contraception

In 2020, 416,810 Danish women were prescribed hormonal contraception . With 268,390 prescriptions for the pill, it was – by route length – the most widely used method of preventing pregnancy.

Since the birth control pill was introduced in Denmark in 1966, the little round pill has changed the lives of millions of women.

Despite its modest size, it practically revolutionized the lives of half the world's population – at least those who had access to it.

The pill made it possible to plan a family, get an education, participate in the labor market, and live a sexual life on new terms. For many women – and for many of our grandmothers – it stands as a symbol of a historic expansion of the right to decide over one's own body.

But in recent years, new trends have begun to emerge.

A new generation of women is increasingly asking questions about the products they use in their bodies – both when it comes to menstrual products and contraception.

Whereas many previously reached for tampons and pads without further thought, more are now choosing menstrual cups or menstrual panties. And when it comes to contraception, more women are challenging traditional solutions.

Some choose hormone-free methods. Others use apps to identify their fertile window. And then there are those who turn to the older but safe methods of observing biomarkers: temperature measurement, observation of cervical mucus, and cervical checks to better understand their own cycle.

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The side effects of the contraceptive pill are lacking in mapping.

Since 2012, the number of prescriptions for birth control pills in Denmark has decreased significantly – from 388,258 to 268,390 .

The numbers reflect a clear trend: More women are turning against hormonal contraception - perhaps because they want greater insight into how hormonal contraception affects their body, perhaps as a no-no to accepting side effects.

There are plenty of side effects if you read the package leaflet for hormonal contraception. Depression, migraine, weight gain and changes in mood. In rare cases, serious side effects such as blood clots or an increased risk of suicidal thoughts may also occur.

I personally remember a major case involving the 3rd generation birth control pill Yasmin, which turned out to significantly increase the risk of blood clots, a pill I myself took for about a decade.

But according to physician, researcher and postdoc Amani Meaidi, we actually know far less about the side effects than many people think - despite the long package inserts.

A large national study has never been conducted that systematically maps women's experiences with hormonal contraception.

And that's remarkable when you consider that the vast majority of women of reproductive age will use hormonal contraception at some point in their lives .

But Amani Meaidi and her colleagues are now trying to change that.

👉 You will also find Meaidi on our list of 8 women who, despite opposition, have made major discoveries in women's health.

Safe Choice: The largest study of its kind

Together with two colleagues, Amani Meaidi has started the research project Safe Choice .

The purpose is to investigate and map side effects of hormonal contraception in the Danish population .

The project is ambitious. A total of one million Danish women between the ages of 15 and 45 are invited to participate in the survey via e-Boks.

The study is supported by a donation of 6.5 million kroner from the Danish Health Insurance Fund .

But the researchers' biggest challenge isn't funding. It's the response rate.

Currently, only 10–15% of the invited women respond to the questionnaire. In order to conduct robust analyses, at least half of the participants must respond.

And this applies to all women – both those who use hormonal contraception, those who have used it in the past, and those who have never used it.

Even if you have not experienced side effects .

It is crucial for researchers to have a broad comparison group.

“It is a question of patient safety”

When Amani Meaidi talks about the project, her commitment is clear. She emphasizes that in her eyes the project is not about ideology – but about medical responsibility: “I don’t see this as a feminist project. I’m a doctor. And I can see that the research in this area is lacking. Therefore, this is first and foremost a question of patient safety.”

She continues: "As a doctor, I advise women about contraception every day. But I also have to admit that the evidence is not as strong as it should be." Many women do not experience an explanation of what side effects they can expect from hormonal contraception, and this is also due to a lack of knowledge. Women also say that they only associate their symptoms with contraception much later. Some experience changes in mood, others headaches or anxiety - but without knowing whether it is related to the hormones.

👉 Understand what the health gap is and why we still don't know as much about the female body as we do about the male body.

Amani continues: "When we prescribe medication to patients, we should know both the benefits and the drawbacks – and we still lack that knowledge in several areas within hormonal contraception."

It confirms what we already know: the historical bias in medical research affects research, understanding, and patients to this day. “Women have been underrepresented in medical research for centuries. Drugs have often been tested on men. In laboratory experiments, male mice have been used rather than female mice. The whole of medical science has been largely based on what is called the ‘reference male.’ This creates a clear gender bias.”

But she is also experiencing a shift, “We are seeing a generational shift – both among doctors and patients. Many younger women are making new and completely reasonable demands on the medicine they use.”

One could safely say: It's about time.

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Researcher on a voluntary basis

In her research, Amani Meaidi has, among other things, investigated hormonal IUDs.

In a recent publication, she found that the IUD with the lowest hormone level may be associated with a higher risk of ectopic pregnancy compared to other IUDs.

Ectopic pregnancies can be life-threatening in the worst case scenario. Ironically, this is the type of IUD that is often recommended for younger women.

Much of this research has been carried out by Meaidi without funding - without any strings attached: without being paid for it. She herself estimates that around 80% of her research is done on a voluntary basis .

This also applies to her work with medical abortion, where she has helped develop an e-course for gynecologists. A relatively simple intervention – but with great effect: the number of complications from medical abortion decreased by 60% after the e-course.

Tailored contraception in the future?

The researchers behind Safe Choice hope that the project will eventually lead to a more individualized approach to contraception. The goal is, among other things, to develop a digital tool where women can enter information about their health and receive recommendations for the form of contraception that best suits them.

A kind of personalized medicine in contraception . “I want to create as much evidence as possible in this area,” Meaidi continues, “and maybe also start a debate among doctors about whether the benefits of all contraceptives always outweigh the disadvantages.”

She concludes: “If we can show that some forms of contraception have an unfavorable side effect profile without clear benefits, then perhaps we should reconsider which contraceptives are on the market.”

Let it stand as more than a call.

What can you do yourself?

If you receive the invitation to Safe Choice in your e-Box, you can make a big difference by participating.

The questionnaire takes about 20 minutes to complete .
It is important that both women with and without side effects participate.

When you talk to your doctor about contraception, you can also help ensure better advice:

Tell us about all your symptoms and discomforts – even those that seem minor.
Mention the family's medical history, e.g. blood clots or migraines.
Ask about both the benefits and risks of different forms of contraception.

Hormones affect the entire body – and it is important that you have the necessary knowledge to make the right choice for you.