Manuscript under review for Psychological Science. Oral Contraceptives Suppress Ovarian Hormone Production

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1 Oral Contraceptives Suppress Ovarian Hormone Production Journal: Psychological Science Manuscript ID: PSCI-0-0.R Manuscript Type: Letter Date Submitted by the Author: Complete List of Authors: Fleischman, Diana; University of Texas, Austin, Psychology Navarrete, C.; Michigan State University, Psychology Fessler, Daniel; University of California, Los Angeles, Anthropology Keywords: Neuroendocrinology, Face Perception

2 Page of Manuscript under review for Psychological Science 0 Oral Contraceptives Suppress Ovarian Hormone Production Diana S. Fleischman, C. David Navarrete, Daniel M. T. Fessler In The Cutest Little Baby Face: A Hormonal Link to Sensitivity to Cuteness in Infant Faces, Sprengelmeyer et al. (00) report results from three fascinating studies investigating the ability to discriminate among infants on the basis of cuteness. The first study indicates that women of reproductive age are superior to both men and older women in this regard, while the second study reveals that pre-menopausal women perform better than age-matched postmenopausal women. As the authors compellingly argue, taken together, these findings strongly implicate a role for female reproductive hormones in sensitivity to cuteness, and Sprengelmeyer et al. point specifically to two principal hormones, estradiol and progesterone. The authors sought to explore this possibility through the natural experiment that occurs when women take exogenous hormones in the service of contraception, finding that women using hormonal contraceptives are better at differentiating cuteness in infant faces compared to naturally cycling women. The authors interpret this result as consonant with their proximal hypothesis, premising this interpretation on the notion that, as they put it, oral contraceptives raise hormone levels artificially. Although hormonal differences between the two groups may be at root, it is unlikely that this is because women who use oral contraceptives have raised levels of estrogen and progesterone. Contrary to the belief of many researchers, oral hormonal contraceptives actually have the effect of suppressing ovarian production of these hormones. Combined hormonal contraceptives ( the pill ), so called because they contain both synthetic estradiol and progesterone, inhibit the production of these hormones, essentially flatlining any menstrual cycle variability (see figure ). Hormonal contraceptives effectively alter the hypothalamic-pituitary-ovarian feedback loop, preventing the maturation of the ovarian follicle, precluding ovulation, (Frye, 00) and inhibiting the rise in estradiol that occurs during the first half of the menstrual cycle (Van Heusden & Fauser, 00). The rise in progesterone that occurs after ovulation is mainly produced in the empty ovarian follicle (Hatcher & Namnoum, 00), thus this rise in progesterone does not occur in pill-taking women, who exhibit lower serum estradiol and progesterone than do naturally cycling women (Arnold, Tóth, & Faredin, ; Basu et al., ; Thorneycroft & Stone, ). Likewise, the pill has been shown to lower serum hormone levels even after discontinuation (Balogh, Ditroi, & Lampe, ; Panzer et al., 00). Moreover, post-menopausal women who have used the pill have lower levels of androgens and estrogens than those that have never used it (Chan et al., 00). Thus, the evidence clearly shows that combined hormonal contraceptives actually reduce levels of estradiol and progesterone. Although total levels of estrogen and progesterone are not elevated in women using hormonal contraceptives, it is theoretically possible that the contraceptive users in Sprengelmeyer et al. s study displayed superior cuteness detection not due to net increases in these hormones, but due to some direct action of the synthetic exogenous hormones themselves. Indeed, exploring the role of olfaction in mate selection, Wedekind et al. () and Roberts et al. (00) found reversed preferences in pill users relative to normally-cycling women, a pattern that the former speculated may be due to pregnancy-mimicking effects of exogenous hormones. However, the relevance of this example is limited by the absence of measures that directly or

3 Page of 0 indirectly tie the respective hormones to the phenomenon at issue. In contrast, research exploring hormonal mediation indicates that oral contraceptives do not substantially increase performance in a variety of domains of social judgment thought to be affected estradiol and progesterone. Preferences for facial masculinity, thought to be moderated by estradiol, are expressed with less frequency in women on the pill (Little, Jones, Penton-Voak, Burt, & Perrett, 00). A preference for healthiness in faces, presumed to be moderated by progesterone, is expressed by oral contraceptive users at a level halfway between the level of women in the low progesterone/high estriadol phase of the menstrual cycle and the level of women in the high progesterone phase (Jones et al., 00). Likewise, salivary progesterone is positively correlated with disgust sensitivity in naturally cycling women, and pill users exhibit less disgust sensitivity than do nonusers in the high progesterone phase of the menstrual cycle (Fleischman & Fessler, 00). Thus, prior research suggests that the pill does not enhance psychological processes thought to be linked to either estrogen or progesterone. Indeed, for precisely these reasons, women using the pill are often employed as a quasi-control group for research investigating hormonal and menstrual cycle effects on behavior (Kuukasjarvi et al., 00; Miller, Tybur, & Jordan, 00; Puts, 00). Hormonal contraceptives lower total circulating levels of estrogen and progesterone. A preponderance of evidence indicates that exogenous forms of estrogen and progesterone do not enhance other forms of social evaluation known or thought to be mediated these hormones. Taken together, these observations call into question Sprengelmeyer et al. s explanation for their finding that contraceptive users display elevated sensitivity to infant cuteness relative to nonusers. A number of alternative explanations exist. First, systematic differences between the kinds of women who do and do not choose to take the pill (e.g., relationship status, sexual activity, cultural or genetic factors, etc.) may underlie the evident differences in sensitivity to cuteness. Second, because Sprengelmeyer et al. s sample of naturally cycling women was relatively small (n=), it is possible that most of these women were tested in a menstrual phase in which interest in infants was substantially diminished. Third, consonant with the compelling pattern of results in their other studies, it is possible that the core of Sprengelmeyer et al. s interpretation is correct, but that the observed patterns are not due to direct effects of estrogen and progesterone on the mind rather, hormonal contraceptives may alter other aspects of physiology that, in turn, may influence sensitivity to infant cuteness.

4 Page of Manuscript under review for Psychological Science 0 References Arnold, M., Tóth, I., & Faredin, I. (). Radioimmunological study of the effect of hormonal contraceptives upon the progesterone level of saliva (author's transl). Zahn-, Mund-, und Kieferheilkunde mit Zentralblatt, (),. Balogh, A., Ditroi, F., & Lampe, L. G. (). LH, FSH, estradiol and progesterone levels after discontinuation of hormonal contraception. Acta Univ Palacki Olomuc Fac Med,,. Basu, J., Mikhail, M. S., Palan, P. R., Thysen, B., Bloch, E., & Romney, S. L. (). Endogenous estradiol and progesterone concentrations in smokers on oral contraceptives. Gynecol Obstet Invest,, -. Chan, M., Dowsett, M., Folkerd, E., Wareham, N., Luben, R., Welch, A., et al. (00). Past oral contraceptive and hormone therapy use and endogenous hormone concentrations in postmenopausal women. Menopause, (),. Drife, J. (). The Benefits and Risks of Oral Contraceptives Today (st ed.). Informa HealthCare. Feinberg, D. R., Tiddeman, B. P., Whiten, S., Pitman, R. M., & Hillier, S. G. (00). Menstrual cycle, pregnancy and oral contraceptive use alter attraction to apparent health in faces. In Proc. R. Soc. B (Vol., pp. -). Fleischman, D.S. & Fessler, D.M.T. (00) Progestin Effects on the psychology of disease avoidance: support for the compensatory behavioral prophylaxis hypothesis. Manuscript in preparation Frye C.A (00) An overview of oral contraceptives mechanism of action and clinical use. Neurology, (Suppl ):S-S Hatcher, R. A., & Namnoum, A. B. (00). The menstrual cycle. Contraceptive Technology,, -. Jones, B.C., Perrett, D.I., Little, A.C., Boothroyd, L., Cornwell, R.E., Feinberg, D.R., Tiddeman, B.P., Whiten, S., Pitman, R.M., Hillier, S.G., Burt, D.M., Stirrat, M.R., Law Smith, M.J., Moore, F.R., (00). Menstrual cycle, pregnancy and oral contraceptive use alter attraction to apparent health in faces. Proc. R. Soc. London, B Kuukasjarvi, S., Eriksson, C. J. P., Koskela, E., Mappes, T., Nissinen, K., & Rantala, M. J. (00). Attractiveness of women's body odors over the menstrual cycle: the role of oral contraceptives and receiver sex. Behavioral Ecology, (), -. Little, A. C., Cohen, D. L., Jones, B. C., & Belsky, J. (00). Human preferences for facial masculinity change with relationship type and environmental harshness. Behavioral Ecology and Sociobiology, (), -. Little, A. C., Jones, B. C., Penton-Voak, I. S., Burt, D. M., & Perrett, D. I. (00). Partnership status and the temporal context of relationships influence human female preferences for

5 Page of 0 sexual dimorphism in male face shape. Proceedings: Biological Sciences, (), -0. Miller, G., Tybur, J. M., & Jordan, B. D. (00). Ovulatory cycle effects on tip earnings by lap dancers: Economic evidence for human estrus? Evolution and Human Behavior, (), -. doi:./j.evolhumbehav Panzer, C., Wise, S., Fantini, G., Kang, D., Munarriz, R., Guay, A., et al. (00). Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: A retrospective study in women with sexual dysfunction. Journal of Sexual Medicine, (), -. Penton-Voak, I. S., Perrett, D. I., Castles, D. L., Kobayashi, T., Burt, D. M., Murray, L. K., et al. (). Menstrual cycle alters face preference. Nature, (), -. Puts, D. A. (00). Cyclic variation in women's preferences for masculine traits: potential hormonal causes. Human Nature, (), -. Roberts, S.C., Gosling, L.M., Carter, V., & Petrie, M. (00). MHC-correlated odour preferences in humans and the use of oral contraceptives. Proceedings. Biological Sciences / The Royal Society, ():. Sprengelmeyer, R., Perrett, D. I., Fagan, E. C., Cornwell, R. E., Lobmaier, J. S., Sprengelmeyer, A., et al. (00). The cutest little baby face: A hormonal link to sensitivity to cuteness in infant faces. Psychological Science, 0(), -. Thorneycroft, I. H., & Stone, S. C. (). Radioimmunoassay of serum progesterone in women receiving oral contraceptive steroids. Contraception, (), -. Van Heusden, A. M., & Fauser, B. (00). Residual ovarian activity during oral steroid contraception. Human Reproduction Update, (), -. Wedekind C, Seebeck T, Bettens F, & Paepke AJ. (). MHC-dependent mate preferences in humans. Proceedings. Biological Sciences / The Royal Society, 0(), -.

Page of Manuscript under review for Psychological Science 0 Luteinizing hormone, follicle stimulating hormone, estrogen and progesterone in normally cycling women,

6 Page of Manuscript under review for Psychological Science 0 Luteinizing hormone, follicle stimulating hormone, estrogen and progesterone in normally cycling women, pregnant women and women on hormonal contraceptives. Taken from Drife, J. (). The Benefits and Risks of Oral Contraceptives Today (st ed.). Informa HealthCare. xmm (0 x 0 DPI)

7 Page of 0 Letter to the Editor: Oral Contraceptives Suppress Ovarian Hormone Production Diana S. Fleischman, C. David Navarrete, Daniel M. T. Fessler In The Cutest Little Baby Face: A Hormonal Link to Sensitivity to Cuteness in Infant Faces, Sprengelmeyer et al. (00) report the fascinating finding that women using hormonal contraceptives are better at differentiating cuteness in infant faces compared to women who do not. The authors posit this difference may be due to hormonal differences between the two groups, because they claim that oral contraceptives raise hormone levels artificially. Although hormonal differences between the two groups may be at root, it is not likely that this is because women who use oral contraceptives have raised hormone levels. Contrary to the belief of many researchers, oral hormonal contraceptives actually have the effect of suppressing ovarian hormone production. Combined hormonal contraceptives ( the pill ), so called because they contain both synthetic estriadol and progesterone, inhibit the production of these hormones, essentially flatlining any menstrual cycle variability (see figure ). Hormonal contraceptives effectively alter the hypothalamic-pituitary-ovarian feedback loop, preventing the maturation of the ovarian follicle, precluding ovulation, and inhibiting the rise in estrogen that occurs during the first half of the menstrual cycle (Van Heusden & Fauser, 00). The rise in progesterone that occurs after ovulation is mainly produced in the empty ovarian follicle (Hatcher & Namnoum, 00), thus this rise in progesterone does not occur in pill-taking women. Furthermore, research shows that, in healthy non-smokers, the progesterone and estradiol of women on the pill are lower than in naturally cycling women (Arnold, Tóth, & Faredin, ; Basu et al., ; Thorneycroft & Stone, ). Likewise, the pill has been shown to lower hormone levels even after discontinuation (Balogh, Ditroi, & Lampe, ; Panzer et al., 00) and post-menopausal women who have ever used the pill have lower levels of androgens and estrogens than those that have never used it (Chan et al., 00). Thus, the evidence clearly shows that combined hormonal contraceptives actually suppress levels of ovarian hormones. For these reasons, women using the pill offer a quasi-control group for research on hormonal and menstrual cycle effects on behavior (Chavanne & Gallup, ; Kuukasjarvi et al., 00; Wedekind C, Seebeck T, Bettens F, & Paepke AJ, ).

8 Page of Manuscript under review for Psychological Science 0 In light of this evidence, the interpretation that Sprengelmeyer et al. provide for their findings is implausible. To be viable, any such interpretation must explain either how lower hormone levels in pill-using women yields increased sensitivity to facial cuteness, or how higher hormonal levels in ovulating women leads to decreased sensitivity. Alternatively systematic differences between the kinds of women who do and do not choose to take the pill (e.g., relationship status, sexual activity, cultural or genetic factors, etc.) may underlie the evident differences in sensitivity to cuteness. Theories regarding how hormone levels influence perceptions of infant cuteness are intriguing, but work on this and similar topics cannot progress if it is built on the unsupported premise that the pill raises hormone levels.

9 Page of 0 References Arnold, M., Tóth, I., & Faredin, I. (). Radioimmunological study of the effect of hormonal contraceptives upon the progesterone level of saliva (author's transl). Zahn-, Mund-, und Kieferheilkunde mit Zentralblatt, (),. Balogh, A., Ditroi, F., & Lampe, L. G. (). LH, FSH, estradiol and progesterone levels after discontinuation of hormonal contraception. Acta Univ Palacki Olomuc Fac Med,,. Basu, J., Mikhail, M. S., Palan, P. R., Thysen, B., Bloch, E., & Romney, S. L. (). Endogenous estradiol and progesterone concentrations in smokers on oral contraceptives. Gynecol Obstet Invest,, -. Chan, M., Dowsett, M., Folkerd, E., Wareham, N., Luben, R., Welch, A., et al. (00). Past oral contraceptive and hormone therapy use and endogenous hormone concentrations in postmenopausal women. Menopause, (),. Chavanne, T. J., & Gallup, G. G. J. (). Variations in risk taking behavior among female college students as a function of the menstrual cycle. Evolution and Human Behavior, (), -. Hatcher, R. A., & Namnoum, A. B. (00). The menstrual cycle. Contraceptive Technology,, -. Kuukasjarvi, S., Eriksson, C. J. P., Koskela, E., Mappes, T., Nissinen, K., & Rantala, M. J. (00). Attractiveness of women's body odors over the menstrual cycle: the role of oral contraceptives and receiver sex. Behavioral Ecology, (), -. Panzer, C., Wise, S., Fantini, G., Kang, D., Munarriz, R., Guay, A., et al. (00). Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: A retrospective study in women with sexual dysfunction. Journal of Sexual Medicine, (), -. Sprengelmeyer, R., Perrett, D. I., Fagan, E. C., Cornwell, R. E., Lobmaier, J. S., Sprengelmeyer, A., et al. (00). The Cutest Little Baby Face: A Hormonal Link to Sensitivity to Cuteness in Infant Faces. Psychological Science, 0(), -. Thorneycroft, I. H., & Stone, S. C. (). Radioimmunoassay of serum progesterone in women receiving oral contraceptive steroids. Contraception, (), -. Van Heusden, A. M., & Fauser, B. (00). Residual ovarian activity during oral steroid contraception. Human Reproduction Update, (), -. Wedekind C, Seebeck T, Bettens F, & Paepke AJ. (). MHC-dependent mate preferences in humans. Proceedings. Biological Sciences / The Royal Society, 0(), -.

B.C. Jones a, *, A.C. Little b, L. Boothroyd c, L.M. DeBruine c, D.R. Feinberg c, M.J. Law Smith c, R.E. Cornwell c, F.R. Moore c, D.I.

B.C. Jones a, *, A.C. Little b, L. Boothroyd c, L.M. DeBruine c, D.R. Feinberg c, M.J. Law Smith c, R.E. Cornwell c, F.R. Moore c, D.I. Hormones and Behavior 48 (2005) 283 290 www.elsevier.com/locate/yhbeh Commitment to relationships and preferences for femininity and apparent health in faces are strongest on days of the menstrual cycle