The Problem with The Pill: Why Women Should Question the Contraception We Fought For

The contraceptive pill was hailed as a breakthrough for women, but questions about the health effects are now being raised. areeya_ann/Shutterstock.com

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By creating a false cycle and stopping a woman’s natural hormonal process, the Pill—and other forms of hormonal birth control—can cause a slew of side-effects and health problems…even death. It’s time that women can begin questioning this method of birth control and given a true choice when it comes to taking care of their sexual health—without being labeled as anti-feminist.

Since 1960, when the FDA first approved hormonal birth control, women have fought for our collective right to use it. It took 12 years, and a Supreme Court decision, for unmarried women to enjoy the convenience of the pill. Most recently, this past July, new federal guidance was passed to ensure that all women have access to no-cost birth control no matter where they work, in response to employers refusing to cover contraception options they disagree with for religious reasons.

Because the issue of access to contraception, particularly the contraceptive pill, is so directly tied to women’s rights—from making decisions for our bodies and health to having agency over our sex lives—and completely politicized, feminist-leaning women are expected to embrace hormonal birth control. To not do so would be anti-woman and, actually, speaking out against hormonal contraception could even help the case of those who disagree with women having access to it.  

However, while the invention of hormonal birth control was a huge milestone for women, and for science, this contraceptive method is far from perfect. In fact, its numerous—yet highly unpublicized drawbacks—can be downright harmful to the millions of women who use it every day.

If our concern is indeed women’s health, it’s time to prioritize our right to make an informed choice about HBC over the potential political fallout that comes from critically examining it.  

SIDE EFFECTS YOU NEVER HEAR ABOUT

All drugs come with side effects, and HBC is no exception. Essentially, it shuts down a woman’s natural cycle by halting ovulation, which prevents pregnancy from happening.

The consequences of this, according to wellness doctor Michael E. Platt, MD, is that a lack of ovulation prevents women from making progesterone, which is essential for a number of reasons. “This is the hormone that prevents cramps, PMS, breast tenderness, fibroids and endometriosis,” he says. “The number one reason that women are infertile is because of a low progesterone; the number one reason for miscarriages is a low progesterone.”

This lack of progesterone production has another significant consequence—masking the presence of polycystic ovarian syndrome (PCOS), which is the most common endocrine disorder among women in their fertile years, according to certified women’s health coach Maria Claps, CHHC, FDN-P.

In addition to affecting progesterone production, HBC also keeps women from producing their own estrogen, says surgeon and gynecologist Prudence Hall, MD, who now focuses on integrated healing and functional medicine.I have measured pill users’ hormone levels for the last 15 years, and I am very disturbed by what I see. I find estrogen levels to be extremely low; on par with women who are in menopause,” she explains. “These drastically reduced hormone levels cause weight gain, ADHD, brain fog, depression, anxiety, low sex drive, hair loss, and sleeplessness.”

Claps adds that she’s worked with 19-to 21-year-old girls on HBC who have the hormone levels of 60-year-old women.

While Hall believes that HBC was created with good intentions, the long-term medical problems it can create shouldn’t be ignored. “Widespread use of the Pill in the United States is doing harm on many levels to women,” she says. “Many women never return to having normal estrogen levels after taking the Pill. For others, the return is slow taking six to 18 months. In my opinion, the negative effects of the Pill greatly outweigh any positive benefits.”

Many HBC users to seem to agree. While 80 percent of women have taken or will take oral HBC at some point in their lives, the CDC reports that 63.7 percent of women who stop using the Pill do so because of the numerous side effects.

But aside from the aforementioned consequences of HBC, which are rarely, if ever, mentioned to women upon prescription, there are some far graver concerns. As Vanity Fair reports, doctors dispensing hormonal contraception methods rarely take family medical history into account or understand the implications of HBC when they dispense it to patients. In fact, various forms of HBC, from pills to implants, have been linked to severe medical conditions (namely blood clots) and even deaths. As the article states, more than 1,000 lawsuits had been filed against Merck & Co., the manufacturer of the NuvaRing, and more than 13,000 more cases have been filed against Bayer by users of its HBC pills, Yaz and Yasmin, for these very reasons.

THE OPTION NO ONE TALKS ABOUT

If HBC has so many side effects, and could be life-threatening to some women, then why do so many of us still use it and why do so many doctors continue prescribing it?

In short, HBC is easy to distribute and easy to use, making it the option that physicians most recommend. (Certainly, there’s also an argument to be made about pharmaceutical companies incentivizing doctors for prescribing HBC as well.)

But the main reason HBC prevails is because there isn’t another option. At least, that’s what many women—and doctors—believe.

“To look for actual alternatives to the Pill, [I found that] you had to be very determined since the medical community agrees that the Pill is really the only option for young women,” writes women’s health advocate Tal Ron, who works at Planned Parenthood, Israel. “Any questioning of that premise and search for alternatives were met with skepticism at best and outright rejection at worst.”

There actually is an extremely effective birth control option that doesn’t require women to take hormones, has zero side effects and costs nothing to use. Called the Fertility Based Awareness Method, or FABM, it involves daily observation (and recording) of fertility signs, namely temperature and cervical discharge, to determine when you are fertile and infertile throughout your monthly cycle. When used correctly, FABM has a failure rate of only 0.4 to 0.5 percent, yet there are a number of misconceptions that keep people from even considering it.

“People don’t know that there is a constellation of methods known collectively as Fertility Awareness Based Methods, or they think FABM is the Rhythm Method or Natural Family Planning. Because of this, people think FABM don’t work well for prevention of pregnancy—this is the biggest and most problematic misconception,” says Ilene Richman, the director of the Association of Fertility Awareness Professionals, a professional membership organization for Fertility Awareness Educators who teach in a secular context.

People think these methods should only be practiced by monogamous, STD-free couples and they don’t understand the concept of fertility management, let alone [the importance of] gaining insights into one’s reproductive health.”

As well as telling women exactly when they are fertile (and not), FABM gives women critical insight into what’s going on with their bodies that HBC cannot.

“Charting your fertility is a direct window into your health—it can be used to diagnose a myriad of health conditions including PCOS, endometriosis, ovarian cysts, and much more,” says Lauren Risberg, who provides content and customer support at Kindara, a popular fertility awareness app. It can also confirm pregnancy and tell you exactly what day you will get your period, as well as, Richman says, give you insight that can help you determine if you have irregular cycles and why.

How to properly use FABM falls outside the scope of this article—in fact, the topic warrants a whole book.

Aside from the prevailing misconceptions, the fact that learning FABM takes far more time than simply swallowing a pill is the main reason that it’s rarely taught in school sex-ed classes or recommended by gynecologists. (Another, of course, is that many schools teach abstinence-only rather than cover any forms of birth control at all in their curriculum.)

“Fertility awareness admittedly has a large barrier to entry for new users—they need to learn how to practice the method and then observe their fertility signs daily for the method to be effective,” Risberg explains. “It’s hard for sex educators to trust young girls especially with that kind of responsibility.”

Given FABM’s confusing reputation and steep initial learning curve, it’s no wonder that most women have never heard of it, let alone considered it as a birth control option.

Of course, it’s not the only alternative to HBC. Condoms and diaphragms are also hormone-free contraception choices with high effective rates. (These options can also be used as part of FABM during the fertile days of a woman’s cycle as barrier methods.)

In fact, in Japan, condoms are actually more popular that HBC when it comes to birth control method, since the Pill was only legalized in the country in 1999.  

“[Japan’s] contraception culture has women seeing condom use as a sign of love and commitment and a shared belief that men should also shoulder the burden of pregnancy prevention,” writes Holly Grigg-Spall, author of Sweetening the Pill, which details her negative experiences with HBC and questions the widespread prescription of it.

This burden that Grigg-Spall writes about is significant: As she discusses in her book, men would likely reject (or at least question) the idea of having to take a powerful drug every day—when they are not sick—that can significantly alter their sex drive and mood, as well as potentially causes a host of health problems. Why should women bear the burden of birth control alone, and also jeopardize their well-being in the process?

A QUESTION OF CHOICE

The argument here is not that women should choose FABM instead of HBC, it’s that women deserve to be made aware of HBC’s side effects, physically and psychologically, and to have equal education and access to the various forms of available birth control in order to make an informed decision.

However, it’s FABM’s ability to provide women with body literacy, to borrow reproductive health advocate Laura Wershler’s term, that makes this method at least worth knowing about. By helping women understand themselves on a deeper level, FABM allows women to reclaim ownership of their bodies and their sexuality.

“Fertility awareness represents a massive wealth of knowledge about their own bodies that most women are kept in the dark about,” says Risberg.Women who chart are better educated about what their bodies are doing and have a more accurate understanding of what is ‘normal.’ All women would benefit from learning more about how their bodies work, whether they ultimately decide to use fertility awareness for birth control or not.”

On a more theoretical level, embracing FABM can be extremely empowering. “While women think that taking the Pill is liberating, many of them have not stopped to think about how it disembodies them from a uniquely female experience, from a psychological point of view,” Claps says.

Grigg-Spall agrees: “Socially and culturally we think women’s bodies are a problem that need to be fixed—that women’s bodies are inherently unruly,” she says. “[HBC] suppresses what makes you female.”

In her opinion, the way HBC unnaturally controls a woman’s cycle and dulls the sex drive is akin to numerous ways society in general expects women to cover up and otherwise regulate their bodies, from not having armpit hair, to not crying at “inappropriate” times, to hiding the fact that they have periods.

Grigg-Spall’s book has inspired a forthcoming documentary of the same name, which is being produced by Ricki Lake and Abby Epstein (who previously produced the groundbreaking film “The Business of Being Born”). She hopes that by getting information about HBC’s negative effects to the masses, women can make a more informed choice about what’s best for their bodies.

“I hope that women will feel supported in choosing a different option for their contraception,” she says. “Like how ‘The Business of Being Born’ impacted the midwife and doula industry, it would be great to see support building up around more comprehensive, contraceptive care.” After all, there’s far more to a woman’s well-being than simply avoiding unwanted pregnancy.

When it comes to birth control and their health, women should have more options—not fewer. Instead of encouraging women to indubitably embrace HBC, and its numerous side-effects, workable alternatives—and the necessary education women need to understand them—should be made available.  

Feminism is about empowering women and advocating for their interests,” Riseberg says. “The world’s contraceptive needs are still not met—we need better options for women, more options for men, and as a society we need to give women permission to question the social norm of using hormonal birth control.”