c Department of Obstetrics and Gynaecology,
Notre Dame Medical School, Fremantle, Western Australia 6160
Corresponding author:
Jack Lowe-Zinola
Email: jack.lowe-zinola@nhs.net
Professional address: Good Hope Hospital, Rectory Road, Sutton
Coldfield B75 7RR
Telephone: 0121 424 2000
Dear Sirs,
We found the above recent article produced a most diverse and engaging
discussion based within the present day pandemic of mental health
issues.
The aforementioned Swedish population based study was at odds with its
Nordic neighbour Denmark where the opposite effect of oral hormonal
contraceptives upon depression was found [1]. As intimated by the
authors, the confounders are endless, but what sprung to our minds was
that Nordic countries are famous for two specific cultural items, diet
and sauna bathing.
To illustrate the first of these two potential confounders, the
Norwegian (MoBa) study in pregnancy, examining the dietary intake of
over 50000 mother baby pairs linked to pregnancy outcomes, demonstrated
a significant decrease in pre-eclampsia and preterm birth in women who
consumed greater amounts of both pre and pro biotics [2].
Furthermore, recent data shows a potential reduction in the gut
microbiome diversity amongst some hormonal contraception users that may
be explain the heterogeneity in psychiatry and increased anxiety scores
[3].
The second potential confounder is Sauna bathing or hyperthermic
exposure. Sauna bathing has also been linked to an improvement in both
physical and mental welling status across all genders and ages [4].
Anecdotally, there appears to be an increased incidence and use of
saunas in Sweden in comparison to Denmark.
Perhaps these two common unique Nordic cultural factors are contributory
confounders for the result of the findings. If so, should we be
counselling our patients to examine lifestyle issues to avoid any
potentially negative impact of hormonal contraceptives upon their
wellbeing?
We would be most interested to hear the view of the authors but
congratulate the group upon their work and perseverance to publish.