I first took the contraceptive pill when I was 19 years’ old. At the time, it felt exciting to me, the kind of thing that grown-up women in love did. Gone were my days of awkward condom fumbles, now I would have the swift, sophisticated sex I’d seen people do on TV. I was basically Sarah Jessica Parker. Until, of course, the side effects kicked in.

It’s fair to say that I’m an emotional person, having experienced depression and anxiety throughout most of my life, but this was a different ball park altogether. Things that would make me burst into tears included, but were not limited to: dropping an egg, running out of toilet roll, trying to pick an outfit, my boyfriend only putting one kiss and not three at the end of a text (the shit), any kind of sporting victory or defeat (the 2012 Olympics were a trip). Things that previously provoked mild annoyance or upset became matters of total despair.

It was only when I started talking to friends who had also been on the pill who’d had similar experiences, that I realised it might not be the best birth control option for me. I’d been warned by my (male) doctor that I might experience “low mood” that should “pass in a few months”, something that sounded light and manageable, and in reality had me sobbing into my cereal.  

It only takes a quick google to see that reported side effects of the pill include mood swings, breast tenderness, weight gain, decreased libido, headaches, nausea and vomiting. According to the Office of Women’s Health, research has shown a correlation between the pill and an increased risk of blood clots, which can cause heart attacks and strokes, and in turn death. DEATH. In an analysis of data from more than 150,000 women who participated in 54 epidemiological studies, women who were currently using oral contraceptives had a 24% increase in the relative risk of breast cancer. The fact that my GP failed to discuss any of this with me, the fact that my GP didn’t consider a history of depression a factor in prescribing me the pill in the first place, irks me - to say the least.

“I think too often women and people with uteruses are accustomed to having to try five or more birth control options and experience the side effects,” explains Dallas Barnes, CEO of Reya Health, a Canadian digital health platform helping women find suitable birth control. “It’s just brushed off as common, normal. ‘Oh you have acne from your IUD? That’s normal, it happens to so many women, deal with it’. It should not happen, birth control should not make you feel uncomfortable.”

 Companies like Reya Health and the The Lowdown, a British-based contraception review platform, were set up to fill a void of knowledge and experience in women’s health. Both founders had gone through their own struggles with birth control and wanted to take action.

Alice Pelton, Founder of The Lowdown, explains: “I built The Lowdown because I personally struggled for years to find a method of contraceptive that didn’t negatively impact my mood. In my search for the right method I realised I couldn’t find useful data on real women’s experiences and side effects from contraception at scale, anywhere. This information is simply not available in the public domain. You either speak to friends, read an intimidating internet forum, or ask your doctor. All of these are small sample sizes, and you’re never sure whether one person’s experience is the norm or the exception.”

The Lowdown offers an incredibly useful side effects page for each method of contraception, summarising the overall trends in user reviews. The contraceptive pill is rated as the fifth best method of birth control on The Lowdown, with an average rating of 2.7/5. For comparison, the number 1 rated method is the hormonal coil, with an average of 3.6/5. A whopping 49% of The Lowdown’s combined pill users reported a loss of sex drive, with 34% reporting a somewhat negative impact on their mood and 29% reporting a very negative impact.

Before you go and flush your pills down the toilet - it’s important to stress it’s not all bad press for the contraceptive pill. There are plenty of four and five star reviews for the combined and mini pill, and many people report lighter periods, better skin, a reduction of PMDD and endometriosis symptoms, and some even report an increase in sex drive.

“We have over 2800 reviews for both the combined pill and mini pill and they are a complete mix of good and bad experiences,” Alice says. “But that's why our platform exists, to help women make informed decisions about whether certain methods of contraception are right for them.”

In recent years, more varieties of the pill have also become available, offering differing levels of hormones which can help reduce adverse side effects. The problem seems to lie less in the pill itself and more in the hasty prescribing of it, in the failure to explore different options and what this could mean. 

“I think when people have these extreme side effects - you know up to death - when using the pill, it’s largely because we are failing them on the contraceptive counselling process to begin with,” Dallas says.

Compared to a decade ago, it’s fair to say things have improved in the contraceptive industry, though there’s still a long way to go. On the one hand we have more options, with even previously controversial concepts such as natural cycles entering the mainstream, whilst on the other we still have extremely limited contraception for men.

“Hormonal contraception has always been the responsibility of a female, meaning they suffer the side effects, have to manage the logistics and go through procedures such as coil fittings or getting an implant,” Alice says. “Male contraception allows us to share that experience, as well as have equal responsibility for not getting pregnant. Today, the only contraceptive methods available to men are condoms, vasectomy and withdrawal.”

Huge excitement ensued when, in 2016, a trial of a contraceptive injection for men was conducted, only for it to be cancelled due to side effects of depression, mood disorders, acne and decreased libido - to name a few. Sound familiar? It was depressing to watch as the very same side effects women had been told they should endure for decades were deemed too detrimental for men. The message was clear: women’s health is less important than men’s health. Better birth control options for men also means better reproductive rights for men and in turn, a more equal society, but with the male pill and a contraceptive gel for men still in early trials, we could be waiting a while yet.

In the meantime, the responsibility falls to those of us with a uterus. The good news is that with platforms like The Lowdown and services like Reya Health, it’s possible to find birth control that works for you without enduring months of side effects. According to Dallas, it’s all about considering your own specific needs and establishing your boundaries.

“I often find that people try various types of the pill kind of pulling blindly out of a hat, and this is very problematic when we do not take the time up front to look at all of the different pieces about a person’s lifestyle, preferences, hormonal profile, menstrual cycle. All of these things that can help us identify a really perfect match for somebody,” Dallas explains.

“I think people need to be more aware of what hormonal birth control is actually doing within their body, and then, having that information to their advantage within this decision making process. So you know, what are they comfortable with?”

After taking the pill for two years, I realised I was definitely uncomfortable with its side effects. Enough was enough. I couldn’t have another breakdown because I missed the bus. Yet, it’s unfair to our old friend the pill to cancel her completely. We cannot blame the failure of healthcare systems to adequately support women with birth control on the pill.  

Women are statistically more likely to be dismissed by healthcare professionals. A 2021 study showed that even when rating their pain at the same level as male counterparts, women were perceived to be in less pain. A 2003 study 'The Girl Who Cried Pain' showed that women were less likely to receive treatment for pain, and were more likely to have pain dismissed. It’s no surprise then, that women reporting side effects of the pill are having their concerns minimised.  

“I think within women’s health and reproductive health across the board there’s a lack of information, there’s a lack of research, there’s a lack of funding dollars towards these issues, so that we just don’t have the facts or the evidence-based research to validate somebody’s experience,” Dallas says.

We can at least take ourselves seriously. If you’re taking the pill and experiencing side effects that impact your mental, physical or emotional health - you don’t have to put up with it. When we speak up about our experiences and refuse to be ignored, we raise awareness, and through awareness comes change. After all, the contraceptive pill came into existence in the first place because of women demanding change. That same activism can improve birth control for women today.

Dallas continues: “At the end of the day, we just need more - we need more information, we need more research, we need more people demanding this. It starts with people trying to advocate for themselves in a clinic setting, looking for solutions to help them to get the information that they need, to move the needle forward and request improvements in women’s health.”

References

Womenshealth.gov. 2022. Birth control methods | Office on Women's Health. [online] Available at: <https://www.womenshealth.gov/a-z-topics/birth-control-methods> [Accessed 20 March 2022].

The Lancet, 1996. Breast cancer and hormonal contraceptives: collaborative reanalysis of individual data on 53 297 women with breast cancer and 100 239 women without breast cancer from 54 epidemiological studies. 347(9017), pp.1713-1727.

Thelowdown.com. 2022. Combined pill | Reviews, Side Effects | The Lowdown. [online] Available at: <https://thelowdown.com/contraceptives/combined-pill?tab=side-effects> [Accessed 20 March 2022].

Thelowdown.com. 2022. Buy Progestogen-only / Mini pill | Reviews, Side Effects | The Lowdown. [online] Available at: <https://thelowdown.com/contraceptives/progestogen-only-mini-pill?tab=side-effects> [Accessed 20 March 2022].

Npr.org. 2022. NPR | Male birth control study killed after men complain about side effects. [online] Available at: <https://www.npr.org/sections/health-shots/2016/11/03/500549503/male-birth-control-study-killed-after-men-complain-about-side-effects?t=1647785777910> [Accessed 20 March 2022].

Zhang, L., Reynolds Losin, E.A., Ashar, Y.K., Koban, L. and Wager, T.D. (2021). Gender biases in estimation of others’ pain. The Journal of Pain, 22(9) 

Hoffmann, D.E. and Tarzian, A.J. (2003). The Girl Who Cried Pain: A Bias Against Women in the Treatment of Pain. SSRN Electronic Journal, 29(1).

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Natalie Beech is a freelance writer based in Manchester. She mainly writes scripts and articles, with commissions from organisations such as the international HeforShe campaign and plays performed at theatres including The Arcola, The Pleasance, Attenborough Arts Centre and more. She has been selected for several writing competitions, including the Young Pleasance Playwriting Competition and Sheer Height Theatre's Women Redressed, among others. Find out more about her work at https://www.nataliebeech.com