Oral contraceptives and cognition: Advancing methodology, measurement, and knowledge translation in sex and gender-informed neuropsychological research
Date
2025
Authors
Doucette, Madeline
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Objectives: Despite evidence suggesting oral contraceptives and female sex hormones are associated with cognitive effects, research has been hindered by inconsistent methodologies, a lack of real-world assessments, and limited attention to sex- and gender-based factors. My dissertation addresses these gaps through five interrelated chapters: (1) a literature review summarizing the state of research on oral contraceptives and cognition, specifically executive function, (2) a published scoping review evaluating the integration of sex and gender and the use of cognitive Ecological Momentary Assessment (EMA) in clinical populations, (3) an original study assessing the feasibility of utilizing EMA to capture the effects of OC use on cognition, (4) a knowledge translation chapter focused on increasing evidence-based OC information online, and (5) an overall conclusions chapter. Methods: Scoping Review (Chapter 2): A scoping review of cognitive EMA studies in clinical populations was conducted following JBI scoping review methodology. The review described EMA designs, feasibility, and integration of sex/gender factors in cognitive research. Research Study (Chapter 3): An 8-day EMA feasibility study was conducted with 37 OC users (ages 18–24), assessing executive function (inhibition, updating, shifting), subjective cognition, mood, stress, and physical activity. Feasibility was assessed across five key domains: (1) recruitment, (2) data collection and measures, (3) acceptability of study procedures, (4) resource demands, and (5) preliminary data analysis. Knowledge Translation (Chapter 4): Based on survey results on OC knowledge, attitudes, and perceptions given to participants from Chapter 3, as well as the broader research landscape, I translated evidence-based OC information, into accessible formats, including media articles, an interactive quiz, and social media content. Results: Scoping Review (Chapter 2): EMA was found to be a promising tool for capturing cognitive fluctuations in clinical populations, though only 45% of studies explicitly considered sex/gender, and just one accounted for hormonal therapy. Studies demonstrated variability in EMA protocols, with inconsistent reporting of key methodological factors. Research Study (Chapter 3): Our study demonstrated EMA is a feasible approach for investigating OCs and cognition, with good adherence (83%), high quality data, and positive participant feedback. Preliminary analyses revealed OC-related cognitive fluctuations, including phase and androgenicity. Knowledge Translation (Chapter 4): Findings from the survey aligned with broader research indicating knowledge gaps in OC mechanisms, risks, and benefits, and thus, interactive and accessible materials were created for dissemination. Conclusions: This dissertation contributes to the growing literature on hormonal influences on cognition, emphasizing the necessity of sex- and gender-informed approaches in neuropsychological research. We establish EMA as a feasible and acceptable method for studying OC-related cognitive effects. While our findings suggest cognitive performance may fluctuate based on OC phase and formulation, future research must employ rigorous methodologies, consider additional contextual factors (e.g., stress, time of day, pill ingestion timing), and improve recruitment strategies.
Description
Keywords
executive function, cognition, neuropsychology, ecological momentary assessment, oral contraceptives, sex/gender differences, women's health