Different hormonal contraceptives can affect people in a variety of ways. There are currently 28 brands of contraceptive pill available in the UK, which can be split into two distinct types – ‘combined’ pills containing oestrogen and progesterone, or ‘mini’ pills which are progesterone only.
Even within these subcategories, the different pills each have their own unique hormonal and chemical makeups. Finding the one which will lead to the fewest complications in an individual patient is something of a minefield, with many women testing various drugs through trial and error before they settle on one they’re happy with.
Side effects like acne, weight gain, nausea and anxiety, to name but a few, mean patients may find certain hormonal contraceptives intolerable while others have few or no complications.
Historically, there hasn’t been any reliable litmus test to ascertain an individual woman’s response to a certain pill before she starts taking it. Now, the minds behind healthtech start-up Pexxi are using artificial intelligence (AI)-powered genetic testing to try and help patients avoid months – or even years – of contraception roulette.
Pexxi founder and CEO Shardi Nahavandi says: “Our core belief is that everyone has a different hormonal baseline, but more importantly no one actually has any idea what their baseline is. Once you understand that, you understand what risks you carry.”
By understanding their unique hormonal and genetic makeup and how it is likely to interact with certain contraceptives, women can make a more informed decision about their birth control choices. According to Pexxi, 50% of women will get at least one side effect which could have been avoided if the right pill was chosen.
“It’s all about what your hormone profile is doing,” Nahavandi says. “What does it mean that you have acne, what does it mean that you experience PMS? Does anything in your genetic profile make it risky for you to take oestrogen or progesterone, or do you metabolise things quicker so then the effects are different?”
Just like the women she aims to reach, finding appropriate contraception hasn’t been an easy task for Nahavandi. She spent 15 years struggling with health issues such as gastric problems, hair loss and even a three-day spell of severely impaired vision, all of which was later tied to contraceptive side effects. Now, her business has the potential to help prevent others from going through the same painful process.
In spitting distance of success
To use Pexxi, patients initially undergo a personal assessment via a chatbot questionnaire, which explores their unique mental and physical profile. This questionnaire is designed to pull up any red flags which may prohibit somebody from taking contraceptive pills altogether. Factors like having recently given birth, a history of blood clots or migraines can all mean a patient is unable to take oestrogen, which is found in combined contraceptive pills. Having this flagged from the beginning saves them from going through the genetic testing part of the process when it isn’t suitable for them.
If no red flags are found, users then have the option of ordering Pexxi’s genetic and hormone test. It’s a simple spit test which can be delivered to their door, which gives the company’s algorithm an accurate idea of where their progesterone and oestrogen levels naturally sit. The results are then mapped onto the index of hormonal contraceptives the AI knows about, which is constantly updated with the latest research, to find the best match for the person in question.
If they have a genetic or hormonal predisposition to the potential side effects of certain contraceptive pills, the AI can provide them with a list of ones which they will be hormonally compatible with and rule out those which they may struggle to tolerate.
Making a difference
Pexxi’s database currently contains information solely about contraceptive pills, but the company is looking to incorporate the contraceptive patch and ring further down the line. However, it doesn’t have plans to incorporate invasive contraceptive devices like the coil and the implant into its assessments.
Nahavandi says: “Based on our research, the medical system seems to be providing these invasive devices as a cost-cutting strategy, and to be honest the ingredients are not that different to certain pills. So from that point of view, we are sort of staying away from anything invasive.”
The technology is currently in beta-testing stages, which so far have been oversubscribed by 300%. Pexxi plans to eventually reach customers through a B2B model that will give customers the option to pay a fee for its services, rather than accessing them through a primary care provider.
Nahavandi says: “In our focus groups, 80% of women said that they don’t trust their doctor when it comes to contraception. We believe we need to work with the healthcare system, but to start with, because the hunger for it was there, we made the decision to go B2B.”
In 2019, patients don’t have the same unfaltering trust in hormonal contraceptives that they did in decades previous – and that’s putting it mildly. With more and more media outlets running op-eds on the side effects many women say they have endured for years in order to prevent pregnancy, contraceptive scepticism has become increasingly common.
Some commentators have described this phenomena as being on par with vaccine hesitancy. Yet, when the medical system has been proven to repeatedly minimise the suffering of women, it comes as no surprise that companies like Pexxi are starting to pin contraception down under the microscope and take a closer look.