After 10 years of taking it religiously, I started to wonder exactly what it was that I was putting into my body every day.
I remember the first time I asked for the pill. The GP who attended to me – I avoided the family doctor out of teenage awkwardness – talked relentlessly about how women always complained about their boobs getting bigger when they were on the pill when really it was just water retention and it should subside after a few months.
I hadn’t heard of this before and frankly, it wouldn’t have deterred my gangly 16-year-old self from taking it. Aside from that, I don't remember any discussion about the side-effects or the other options available to me or an explainer of exactly how the pill works.
It makes total sense for the pill to be the first thing suggested to teenage girls who are thinking about becoming sexually active. It’s highly effective (unlike the tracking apps or pull-out method) and far less invasive than the coil or an IUD.
However, after 10 years of taking it religiously, I started to wonder exactly what it was that I was putting into my body every day.
How much do you know about how the pill works or about what it contains? Aside from ensuring you don’t get pregnant, cleaning up residual teenage acne and the supposed “boob bloatage”, what do you know about the side effects?
"I managed to keep the ball buried in my throat all day until a close friend pulled me in for a birthday hug and I burst into tears."
Frankly, I knew almost nothing. It wasn’t until I took a six-month break from it and then returned to it, that I began noticing some of them in me. Every once in a while, I would turn out the light at night and a black wave would wash over me. “What am I worried about?” I’d ask myself, unable to find any source for the concern, but at the same time able to feel the anxiety crawling up through my lungs.
I thought, maybe this is just what being an adult looks like; maybe I’m worried about finding a job and somewhere to live, about making friends in a new place. I disregarded it until one day I was at work. It was my birthday and everyone was being so lovely, wishing me happy birthday. Every time the words came out of someone’s mouth, “Happy Birthday!”, I welled up.
I managed to keep the ball buried in my throat all day until a close friend pulled me in for a birthday hug and I burst into tears. I hadn’t ever really thought that much about ageing, but I thought I must really care about it because I was having such a visceral reaction. I convinced myself I was terrified of getting older.
All of my emotions were telling me something was wrong, so there must be, right?
Back on the pill
It took me another month and another low-point for me to question what had changed and realised I was back on the pill. I brought the idea to my doctor and she suggested I come back off it and see if anything changes. A few months later, I realised I felt like myself again.
Correlation is not causation and the stress of moving to a new place might have been equally to blame, or perhaps one was feeding the other. The truth is, we can’t really know because scientific research into women’s reproductive health is woefully under-researched.
However, a recent Danish study, looking at one million women with an average age of 24, found that first-time prescriptions for anti-depressants significantly increased for women using any form of hormonal contraceptive compared to non-users, with the highest spike occurring in the first six months of taking it. It also found that adolescent girls were by far the most at risk, with an increase of 80% of teenagers diagnosed with depression while on the combined pill than those not on anything.
"It’s 2019, and we’ve only just started to take those pesky 'baby blues' seriously. By contrast, Viagra has been around since 1998."
Depression is only one potential side effect of hormonal contraceptive. According the HSE, other effects include nausea, acne, migraines, blood clotting, spotting, mood swings, vaginal dryness, and an increased or decreased sex drive. I was lucky in that I had an understanding doctor who listened to my concerns and trusted me when I suggested they might relate to the pill.
A friend of mine, who had recently swapped pills following a bout of spotting, went to the doctor after experiencing discomfort during sex. The doctor assured her that everything looked okay and perhaps her partner just needs to “work a bit harder”. She eventually swapped the pill for an implant and the discomfort went away.
The lack of scientific investment isn’t just in regards to the pill either. For context, in March of this year, the American FDA approved the first-ever drug to specifically tackle post-partum depression. It’s 2019, and we’ve only just started to take those pesky “baby blues” seriously. By contrast, Viagra has been around since 1998 and a study on a male contraceptive pill was halted when it was judged to have "unacceptable side effects", including – you guessed it! – depression, acne, and libido issues.
"When the symptom is a feeling, when there’s an inexplicable and irremovable lump in your throat that you just can’t shake, it’s much harder to explain to yourself or anyone else."
Women are used to physical pain. It comes as part of the monthly cycle and it actually markers the fact that everything is working fine, rather than pointing to anything unusual. But typically, a reaction to medication is a physical one – you break out in hives or a rash, you start vomiting, or worse, you get thrush – it’s easy to pinpoint.
Not only can you easily put two and two together, but you can more comfortably present that issue to a doctor. But when the symptom is a feeling, when there’s an inexplicable and irremovable lump in your throat that you just can’t shake even though you don’t really know why it’s there, it’s much harder to explain to yourself or anyone else. Because we put so much stock in our emotions, they are the core of our being, it’s hard to consider them as an outside effect.
I’m not at all suggesting that the pill is bad. It worked for me until it stopped working with me and I had the support and flexibility (much of that was granted through privilege) to choose another option. But there needs to be more conversation around how contraceptives and the female body works and the effects they can have. This can be done through greater scientific research and an overhaul of sexual education.
How much do you know?
How aware are you of your own reproductive function? Take ovulation, for example, it’s the point of every month at which you are most fertile. Do you know how long ovulation lasts? Do you know how your body feels and looks during ovulation? Do you know what “most fertile” actually means?
In case you don't have the answer to these questions, ovulation occurs approximately two weeks after the start of your period and lasts about three days (typically days 12, 13, and 14). You can get pregnant prior and during these days (sperm can survive about five days) but not after and even then you have about a 30% chance of getting pregnant if you have sex during ovulation. None of this is a suggestion for an alternative to the contraceptive pill (the pill and condoms are still by far the best pregnancy preventatives) but merely to point out how little we really know about ourselves.
If you're like me, you’re only stumbling across this information through your 20s. (Editor's note: Interestingly as a woman in my mid-30s, my journey was very different. I feel we were well informed about ...except any information about mental health, the emotional toil of ingesting daily hormones).
Depression and mental health issues are really only the tip of a very large and unknown iceberg for most women when it comes to our own bodies. For most doctors, their primary care is to their patients physical and mental health and preventing unplanned or unwanted pregnancy is key to that, and perhaps the pay off of “mood swings" is worth it.
But women and the larger medical community can’t weigh up those options without a complete picture, and that’s one that won’t be filled if we continue to minimise and ignore women’s health.
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