The Pill. That’s right, only one drug in the world has been important enough to earn such a title - not just any pill, but the pill. Since its introduction in 1950, there’s no denying that the combined contraceptive pill led the way in granting females sexual autonomy and choice surrounding their reproduction, signalling a step forward for feminism. However, its previous and current history reflects a lack of reliable information, full disclosure, and thorough clinical research. The negative side effects and sexist disparities associated with the contraceptive pill have been quiet discussions for far too long - I’m angry, and it’s time to demand change. Hormonal birth control is essentially one of the largest scale in vivo experiments on women of our time. Before telling us the pill is totally safe, we deserve more research into the long term, intergenerational health consequences.
In the first large-scale trial of the contraceptive pill in 1956, it wasn’t deemed necessary to give women information on the safety of the drug, designed to arrest ovulation. When women described side effects like nausea, blood clots and headaches, they were dubbed “unreliable historians.” Nearly 70 years later, with over 100 million users of the pill worldwide, side effects are irrefutable. Over 50% of new pill users discontinue use within the first six to twelve months as a result. These drugs have become safer, with lower doses of hormones, and better information on benefits and risks. However, after all this time, the side effects remain downplayed. There’s a highly problematic “pain bias” that’s been observed in the medical industry, where a woman’s pain is more likely to be dismissed than a man’s, despite the fact that women are more likely to feel pain more often and more intensely (which could be an entire feature on its own...google it if you don’t believe me). Males may not be aware of this, but ask any woman who’s had issues associated with their period - even as serious as endometriosis (abnormal tissue growth on the uterus, associated with extreme menstrual pain) - and they’ll tell you how many doctors they’ve had to go to before receiving a diagnosis, how often doctors have said our symptoms are completely normal, how we just need to wait a little longer and the pill will help or how taking an ibuprofen or two should be enough to fix it - we’re very often left feeling that our issues aren’t taken seriously. The downplaying of women’s pain results in a health inequality rarely discussed in the medical industry, but when studies are showing that we’re waiting on average longer than our male counterparts in ER rooms, and that 80% of pain studies are conducted using male humans or mice despite 70% of chronic pain impacting women, we can justify being angry about it. When it comes to the pill, we need to change the tone of conversation - stop saying women have “perceived” or “reported” side effects from the pill, and start saying women have “experienced” or “suffered” side effects.
The pill has been sold to us as a one-size-fits-all approach: want birth control? Have painful periods? Endometriosis? Acne? Sexually active? Not currently sexually active but you potentially could be? Take the pill! While our doctors are genuinely trying to help, this pill-pushing can get exhausting; the pill won’t work for everybody, and it won’t fix all of your symptoms. As somebody who’s had a terrible experience with the pill (and a family history of bad experiences on the pill) I’m tired of my doctor insisting that I take hormonal contraception each time I go for a visit, even after having reported my history of hormonal-induced problems. Our hormones form a biochemical system that is incredibly complex, and not yet fully understood by scientists. The tiniest amounts of hormone surges can reverberate entire body-wide effects. It therefore appears baffling that a pill of the same formula can be prescribed for millions of women, each of whom has a hormonal system as unique as their genetic fingerprint.
There are, of course, benefits to the pill. Contraception, in general, is critical; unplanned or unwanted pregnancies cost women and babies their lives and affect society as a whole through overpopulation, poverty, family dysfunction, and environmental burden. Additionally, women who would normally bleed for weeks at a time, or who suffer from conditions such as endometriosis, may be able to manage these painful issues using the pill. In saying that, keep in mind that the pill is not a 100% effective birth control method (with typical use, it’s about 91%), and that the pill is modifying, not treating. That means it won’t actually ‘fix’ period problems if that’s what you’re using it for, it’ll just mask your symptoms and provide relief - but we need root solutions. Where’s the incentive to seek therapies that directly target the root problem? Why would we encourage pill dependency if there could be an alternate solution? Note that some women will experience no obvious issues while taking the pill, whilst others will have poor experiences; we’re all genetically different and experience different environmental factors, accounting for those differences.
Have you ever actually been taught how the menstrual cycle works? How women’s hormones fluctuate? How to manage your painful symptoms? Until university biology classes, I sure hadn’t. We’re taught that our mood swings and painful periods are our body betraying us; that we need the pill to ‘fix’ what’s wrong with us. That narrative is wrong. A female’s period gives us vital insight into her physical health; taking the pill removes that data. Unusual symptoms should be investigated, not covered up. For example, light menstruation can be a sign of lower than optimal oestrogen levels. Short cycles could indicate low progesterone. Heavy or long periods are commonly a result of oestrogen dominance and thyroid problems. Factors such as fibroids, ovarian cysts, infection or endometriosis could be causing especially painful periods. Learning to track our menstrual cycles and support our symptoms through individualised treatment (for example, bioidentical hormone therapy: i.e. using hormones identical to those that we naturally make, rather than using synthetic hormones) is the future we need to work towards in medicine. After all, menstrual blood isn’t something to be ashamed of, it’s fascinating - just look to studies which indicate that stem cells present in menstrual blood flow can be used to regrow damaged tissues, like lungs. Our periods can literally save lives; that deserves respect.
If you aren’t familiar with the side effects of the combined contraceptive pill, Dr. Beth Messenger from Family Planning informed us about some which we know to be true (see the page 33 for research-backed risks involved in taking the pill). “The big one that we actually have evidence for is a change to bleeding, and this is sometimes a thing in our favour...but, on both the combined pill and on the progestin-only pill you can get irregular and unpredictable bleeding” says Dr. Messenger. There are other reported side effects which appear similar to PMS symptoms; “things like breast tenderness, acne, bloating, weight gain, some women experience nausea.” So, what about women who experience issues on hormonal contraception (we’re talking things in the range of period bleeding that lasts for over a month, severe acne that spreads down the chest and forms facial scarring, and amenorrhea - a loss of one’s period - that persists for 18 months after discontinuing pill use - speaking from experience)? “If they have struggled with things like the pill or Depo, then sometimes the hormonal IUD is still worth trying, because the level of hormone is so very very low, but certainly women have reported hormonal side effects from that as well...they can try a copper IUD and then they’ve got no hormonal contraception at all but they have a very effective form of contraception. But, the copper IUD can make periods heavier or crampier, so there’s always a concern with women whose periods are bad to start with that they can get worse. If that’s not suitable and they’ve struggled with lots of different contraception, they’re very left with very very few things, like condoms and not having sex, or sterilisation if their family’s complete.”
Male Birth Control
The burden of the expense, responsibility and health risk of contraception falls firmly on women the majority of the time. Across all contraceptive methods as a whole, including male condoms, women are involved in negotiating over 90% of any contraceptive use. This shows our sexual partners are not respecting the fact that we may not wish to get pregnant as equally as we are; the burden mainly falls on us. The frustration only builds when, in casual conversation, men so often complain about how they hate wearing condoms - I know a lot of women who take birth control (bearing in mind the side effects they risk facing) in lieu of using a condom, because their partner has complained about how it feels. Despite many studies on male contraception having taken place since the 70s, no hormonal methods are on the market yet. One example is a method that combines androgen shots every 3 months with a yearly implant of progestin. Non-hormonal methods have also shown promise, such as using injected gels to block sperm passage, or ultrasound to temporarily destroy sperm. So, why after around 60 years of the pill, has there been no significant advances in male treatment? Furthermore, women are concerned that men wouldn’t take it even with options there. After all, if it doesn’t work out and the woman falls pregnant, they can choose to leave - we can’t (unless we choose abortion, which sparks another entire debate).
Women are only fertile for five or six days per menstrual cycle whilst men are fertile every day without question, so it appears that it would make sense to control sperm production rather than dictate female hormones. It’s especially infuriating when progress in male contraceptive methods has been held up due to concerns over “messing with hormones” or affecting emotional wellbeing, when no such concerns appear to have impeded the pill. A 2016 trial of injectable male contraception was suspended after 20 out of the 320 male participants complained of side effects such as acne and depression, despite the trial showing 96% effectiveness. Sound familiar? Women experiencing these symptoms and more, and have been for decades (in early trials, three women died, without investigation). This isn’t to wish the same side effects upon males - it’s simply to highlight the disparity between what is deemed acceptable for males to have to endure compared to females.
The Pill and Mood Disorders
Mood swings, anxiety, depressive episodes, numbness, general feelings of low moods - these symptoms are downplayed in contraception brochures in the doctor’s office, but ask around any women who have taken the pill, and the anecdotal evidence suggests a much bigger issue. In fact, a fairly recent study tracked one million Danish women of reproductive age over 13 years and found results that validate our experiences as birth control users. Women taking the combined oral contraceptive were 23% more likely to be diagnosed with depression, and 34% more likely if they were on the “mini-pill” (progestin-only). Teens on the pill were a whopping 80% more likely to be diagnosed with depression, as the most at-risk group. Any individuals with pre-existing depressive symptoms may find these symptoms worsen with use of the pill, or individuals who have family members that had depression are more susceptible to depression themselves when using the pill (did your doctor ask about your personal and familial mental illness history before prescribing the pill? Mine sure didn’t). Other hormone-based contraceptive methods had even more concerning figures. Another study found that young women using hormonal contraceptives have three times the risk of committing suicide compared to non-users. That’s shocking. We already know that females are twice as likely to experience depression as men, potentially due to our fluctuations in progesterone and oestrogen (read: natural biological rhythms). However, do
we not believe that a drug made from synthetic hormones, taken every day and among millions of women, could be a causative factor?
The Pill and Mate Selection
Dr. Jolene Brighton, nutritional biochemist and women’s health expert, makes some fascinating points in her book, Beyond the Pill (I encourage any person currently taking, considering or coming off the contraceptive pill to read it). Scent has a role to play in our attraction to potential mates. This is because a person’s scent contains a major histocompatibility complex (MHC), otherwise known as a set of genes that play a role in our immunity by detecting foreign substances. These MHC genes have been linked with our susceptibility to autoimmune diseases (where a person’s immune system mistakes its own cells for foreign invaders, and attacks itself). In a typical pairing, Dr. Jolene writes that “women preferentially select men who have MHC genes different from their own...a mate with different MHC genes will provide our children with a more varied MHC profile and, therefore, a more robust and well-regulated immune system.” This would have given us an evolutionary advantage by preventing us from being attracted to our relatives, which would cause inbreeding in the gene pool. Interestingly, research has shown that women taking the pill will have a scent preference that shifts towards men with more similar genetics and MHC profiles to her own, whilst becoming less interested in men who are more genetically different. It’s thought to have something to do with how the hormones of the pill disrupt our hypothalamic-pituitary-gonadal axis. In essence, yes there are many variables to consider when it comes to autoimmune disease, but if the pill causes us to create babies with less optimal immune systems, and this is repeated over many generations, it could explain the increasing incidence of autoimmune disease.
The responsibility of taking a pill every day (or going to the doctor for an IUD insertion, etc) takes constant planning, access to healthcare and hence expenses. In addition to other pressures on women (we’re talking beauty standards, weight-shaming and judgments based on promiscuity or lack thereof) which simply don’t exist in the same way for men, these are all constant drains on our women. The idea of giving men more accountability, the ability to support their partner, and a future where the responsibility and risks involved with birth control are distributed equally between sexual partners, is hardly too big of an ask. I believe in a woman’s right to prevent pregnancy, and I also believe in the right to being informed. Each woman is different, and for some, the pill will be the best fit. All I’m saying is that we need better options, more research, and we need the medical industry to listen to us.
I’m not telling you to burn your pill packets right now, if that’s what works for you. I’m saying that for those of us who have previously or who are currently struggling with the pill, don’t let your concerns be hushed. Ask questions, see the value in our complaints, and validate the experiences of real women (especially where the research doesn’t appear to agree with us). Women have been carrying the lion’s share of the birth control problem for far too long, and putting up with health risks and negative side effects since the 1960s. I recall a physiology lecturer who said earlier this year that the fact insufficient research has been invested into a pill for males “says more about society than it does about research,” and his statement stuck with me. This is one of the greatest challenges for new-wave feminism. It’s high time to demand greater education on how our body works and safer, more fair contraception for everybody.
Problematic Side Effects of the Pill
(Informed by Dr. Jolene Brighton’s Beyond the Pill)
The pill comes with an increased risk of:
- Blood clots (hence stroke - women with the factor V Leiden gene have a 35-fold increase in stroke risk when taking oral contraceptives)
- Elevated blood pressure
- Venous thromboembolism (VTE); risk is 3x higher in pill users compared to female non-users
- Cervical cancer (risk increases when the pill is taken for more than five years - proposed that oestrogen in the pill is metabolised into 16-alpha hydroxyestrone (16OHE1), which works together with HPV to aid cancerous growth)
- Breast cancer (a recent study found that, of 1.8 million women studied, pill users had a 20% increased likelihood of developing breast cancer compared to users of non-hormonal contraception)
- Liver cancer (including a significant increase in the diagnosis of benign liver tumours - hepatic adenomas - which were rarely reported prior to the 1960s)
- Adrenal dysfunction (e.g. adrenal fatigue)
- Thyroid dysfunction and disease
- Depression and anxiety
- Nutrient depletion (we’re talking depleted vitamins, minerals and antioxidants)
- Vaginal dryness and pain during sex
- Hair loss, dry skin
- Fatigue, headaches
- Multiple sclerosis
- Leaky gut, pelvic inflammatory disease and other problems associated with digestion (long-term pill use can damage and compromise intestinal lining, causing leaky gut that’s more susceptible to infections and nutrient malabsorption, which has a flow-on effect to issues with thyroid hormone conversion)
- Increased inflammation (associated with chronic disease), indicated by elevated high-sensitivity C-reactive protein (hs-CRP), fibrinogen and ceruloplasmin
- Hormonal problems such as missing or irregular periods, short cycles, infertility (though this is debated) and lighter or heavier periods than normal
- Crohn’s disease (300% increased risk)
- Low libido, which may never restore to pre-pill levels (synthetic hormones = approximately quadrupled increase in sex hormone-binding globulin (SHBG) produced by the liver = binds more testosterone = lower libido = potential for long-term problems if synthetic oestrogen changes expression of liver genes to produce higher SHBG...for the rest of your life)
- And more!
Extra: The active hormone ethinyl-estradiol (EE2) present in many birth control pills is affecting aquatic organisms via wastewater - male fish are expressing female traits, i.e. producing eggs, experiencing a reduced sperm count, and reduced population numbers. Not only is the ecological impacts of drugs passing through us and into our wastewater systems a problem, but because sub-lethal effects are much harder to distinguish, what changes is synthetic oestrogen causing in our pill users?