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Image / Self / Health & Wellness

MARLENE WESSELS

Why you should know more about the contraception options for women in Ireland today


by Leonie Corcoran
14th Sep 2022

Read time: 6 minutes

The contraceptive pill has been heralded as one of the greatest inventions of the 20th century. It has empowered generations of women – but is it still the golden ticket to female freedom that it once was? Leonie Corcoran investigates the contraception options open to women today.

This is something I have taken for granted throughout my 38-year-old life: sex does not need to lead to pregnancy. It’s such an accepted thought to me that it seems almost, well, natural, in an entirely non-natural sense. For my mother, this wasn’t the case. She married in 1975 when contraception was still illegal in Ireland – until 1979, Irish law prohibited the importation and sale of contraceptives and it was not until February 1985 that the Irish government approved the sale of contraceptives. Given I have two sisters and we arrived at three-year gaps, I suspect she and my dad were using birth control, but I’ve actually never asked. In the 1960s and ’70s in Ireland, many women were taking the pill, which was marketed as a “cycle regulator”. To get a prescription, women had to complain of heavy periods or irregular cycles and it required coded language, a hopefully sympathetic doctor, and could mean going against your Catholic faith. 

The global impact of the pill on women’s empowerment is well-documented. It wasn’t just another form of contraception; it was an equaliser, a liberator and it was easy to take. For the first time in human history, a woman could determine her readiness for reproduction. Despite critics warning the pill would spawn generations of immoral women, what it has enabled are generations of empowered women who are better equipped to make choices about their lives. Alongside other societal changes, it had a part to play in the increasing numbers of women completing third-level degrees, attaining higher positions in corporate structures, and a more secure level of financial independence.

There have been tweaks and changes to the pill over the past decade – most notably a reduction in the amount of synthetic progesterone and oestrogen contained – and it remains one of the most popular forms of birth control in Ireland. “Most patients come to me for the combined pill,” says Dr Sonja Bobart, GP at D4 Medical in Dublin. “They are not aware of the other options until I introduce them,” she says. Of those options, many of her patients are now choosing an IUS or NuvaRing. “IUS are an intrauterine system; a small T-shaped plastic device that is fitted by a doctor following a health screening. It releases progesterone and can last for three or five years depending on the brand,” she explains. In the past, hormonal coils were seen as a birth control option after having children, but smaller sizes and new brands mean they are also used by younger women who want a “fit and forget” type of birth control, says Bobart. The copper coil is a non-hormonal coil but, like all contraceptives, it doesn’t suit every woman and is linked to heavier periods for some.

Alongside other societal changes, the pill had a part to play in the increasing numbers of women completing third-level degrees, attaining higher positions in corporate structures, and a more secure level of financial independence.

“The NuvaRing is another type of ‘fit and forget’ – you insert it yourself and remove it after three weeks, before inserting a new one a week later. If you are comfortable using tampons, it’s easy,” she says (I can personally concur after using it myself for a number of years in the late noughties). Other options include the implant, which lasts three years; the progesterone injection, which lasts 8-12 weeks; and the progesterone-only (mini) pill. Despite patches being chiefly associated with HRT, there is also a contraceptive patch that is as effective as the pill when used correctly. For couples who will not be having more children, Bobart sees male vasectomy as a very suitable solution.

With the exception of the copper coil, some of the most popular birth control methods are hormonal. This means that they involve introducing artificial sex hormones into a woman’s body. Sex hormones, despite common belief, do not only affect sex organs – they are picked up by hormonal receptors throughout the body, including our brain. A knowledge of our hormonal health in relation to our wellbeing is something we don’t know enough about, according to pharmacist Laura Dowling (@fabulouspharmacist). “We have very little education around hormonal health… and we need to be talking about it because our sex hormones are of such utmost importance for us all,” she says. 

There are some hormonal side effects that women are aware of when it comes to birth control, such as the potential impact on libido, lowering sex drive. “Women go on the pill to have sex and enjoy sex, but the irony is that it can actually make your libido quite deadened,” says Dowling. “A lot of women don’t realise until they speak to someone like me about it or speak to other women about it.”

Our sex hormones play a key role in orchestrating all kinds of psychological experiences – our emotions, our energy regulation, how much we eat, how much we want to exercise or sleep; they influence mood, who we’re attracted to, our stress response.

Less well known is how the pill impacts the way women think, feel and behave. It is these impacts that prompted Dr Sarah E Hill, a US evolutionary social psychologist, to write This is Your Brain on Birth Control. Hill is not against the pill and was on it for over a decade of her life. “I was studying how women’s sex hormones influence women’s brains, but it never occurred to me the hormones I was taking every day, in the form of the pill, were going to change what my brain was doing. And then I went off them,” she says. She describes it as akin to waking up from a nap. “Over the next three months, I started to notice I felt more energised… I felt different – my life felt brighter and more interesting,” she says. This led her to research on what psychology and neuroscience knows about the way that the birth control pill influences women’s brains. 

The pill works by holding the body in the luteal phase of the cycle, as opposed to working through all four stages of the natural cycle, as daily doses of progestin (the synthetic version of progesterone) tell the body that it doesn’t need to initiate the hormonal changes to lead to ovulation. “Oestrogen levels vary in a naturally occurring cycle,” explains Hill. “When oestrogen is relatively high, women report feeling more energetic and open to new experiences. And so it is this sort of nice point in the cycle where women tend to feel relatively vibrant, alive and energetic.” Given that the pill keeps levels of oestrogen lower in women’s bodies, Hill sees it as “robbing women of this natural energy and mood booster”.

“Our sex hormones play a key role in orchestrating all kinds of psychological experiences – our emotions, our energy regulation, how much we eat, how much we want to exercise or sleep; they influence mood, who we’re attracted to, our stress response,” she says. Although much of the research is in its infancy, data contained in Hill’s book and her TED Talk shows how the pill influences who you’re attracted to; how you respond to your partner’s face; the dynamics of your relationship; and the quality of your sex life. She also highlights almost three decades of research that shows women on the pill lack a cortisol response to stress, a pattern often observed after sustained exposure to trauma.

What Hill advocates is not that women abandon the pill, but that they make informed decisions about what is the right birth control for them and to track any emotional changes to maintain a personal awareness. And that there is more research. “There is a lack of science around women and women’s issues due to rampant sexism, so we need more,” she says. Dowling agrees and notes the lack of investigation around the impact of the Covid-19 vaccines on menstrual cycles as a recent omission in scientific research (for more on the omission of women in medical research, I recommend Invisible Women by Caroline Criado Perez).

But despite scientific research only starting to catch up, both Bobart and Dowling reference positive changes they have seen in Irish society in the past decade – an openness to talk. “It is important that we keep that conversation going,” urges Dowling. “If you notice something is not right for you, trust yourself and keep asking the right sources – health experts – until you find someone who can give you the advice you need. Keep talking.”

Digital illustration by Marlene Wessels. This article originally appeared in the Spring issue of IMAGE Magazine.

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