Some women avoid these methods because of possible side effects. Others use them precisely because of those side effects – for example fewer menstrual complaints – even when they are not sexually active. ‘There is a clear mismatch between supply and demand,’ says Zwiers (Amsterdam School of Economics, Quantitative Economics section). The findings have been published in the economics journal ESB.

In recent years, Dutch media have reported that fewer women are using the pill or hormonal IUDs because they prefer not to take hormones. To better understand this development, researchers from the University of Amsterdam and Vrije Universiteit Amsterdam conducted a survey among 2,000 Dutch citizens. For their analysis, they focused on 992 women who were not pregnant at the time; of these, 890 were sexually active.

Concerns about side effects

Over a third of sexually active women who do not use contraception say this is due to concerns about side effects. Young women under 24 are especially likely to mention this. ‘Most of these women want to avoid hormones,’ explains Zwiers. ‘And there is research that shows a possible link between hormonal contraception and mood problems.’

Positive effects

At the same time, more than three-quarters of teenage girls who do use hormonal contraception say they also do so for the positive side effects, such as fewer PMS symptoms or less acne, even if they are not sexually active. ‘Hormonal contraception reduces hormonal fluctuations, which makes cycles more regular and lowers blood loss. For some women, it also helps with skin problems and PMS complaints,’ Zwiers says.

Mismatch and risks

The researchers identify a clear mismatch: women who want reliable contraception but do not find it in the current range of hormonal options, and women who use hormonal contraception mainly to ease menstrual complaints rather than to prevent pregnancy.

‘If women avoid contraception out of fear of side effects, this could mean that many are at risk of unplanned pregnancies,’ Zwiers warns. The researchers also raise questions about whether it is wise for young women who are not yet sexually active to start hormonal contraception, given the possible link to mood problems.

Female-focused medical innovations

‘This shows once again how the medical field is lagging when it comes to women’s health,’ says Zwiers. ‘Half of the world’s population menstruates for decades of their lives, yet innovation in contraception is still falling behind.’

This is why the researchers are calling for more attention and investment in female-focused medical innovations. ‘There is a need for treatments that address complaints without relying on hormones, as well as more reliable non-hormonal contraceptive methods.’

Publication details

Wendy Janssens, Nadine Ketel and Esmée Zwiers, 2025, Markt voor anticonceptie sluit niet goed aan op behoeften, ESB, 9 September 2025. Please note that his publication is in Dutch.