Oral contraceptives are not a one-size-fits-all

It is hard to find someone who has taken the pill and never experienced some of its many side effects. Accompanied by an enormous leaflet listing dozens of minor to severe side effects - ranging from insomnia to vomiting - the pill is still seen as “the bread and butter” of gynaecology. Through vigorous marketing efforts, the pill became known as a lifestyle drug in the 60s, changing gynaecology for years to come. The industry has since moved away from birth control research, leaving hormonal contraceptives as a leading medication for pregnancy prevention and treatment of various disorders. 

In recent years, a number of diverse women have been sharing their truly horrifying experiences with the pill and shining light on how easily severe side effects get brushed off at the doctor’s office. It is worth noting that conditions like migraines, dangerously low moods, anxiety and lack of sex drive are typically perceived as a “normal” part of womanhood rather than health complications caused by hormonal contraception. Not too long ago, these symptoms were attributed to “hysteria”, which was considered a psychological disorder up until the 1980s.

The idea that hormonal birth control suits every woman leads to mass overprescription, as the pill is handed out routinely with little to no thought about long-term consequences. It becomes obvious that the pill is used for “managing” female biology, disorderly or not, and prevalent mental health complications are often ignored.

Women with various mental health disorders are simply not a part of this conversation, as the effects of oral contraceptives on mental health are overlooked due to being understudied. Moreover, the prevalence of stereotypes about “hysteria” is haunting women up to this day, which explains why women’s mental health is often not taken seriously.  However, it is worth focusing on depression when discussing mental health complications linked to the pill, as depressive symptoms stand out amongst others. Limited research shows that there is a temporal relationshipbetween oral contraceptive use and the worsening of mood disorders, while it was proven that hormonal contraceptives are linked to participating in depression. Being on the pill also increases the risk of being diagnosed with depression and needing to use antidepressants in the future.Some researchers admit that the trend of simultaneous antidepressant and hormonal contraceptive use is alarming.

Oral contraceptives can change brain structure in areas that are responsible for processing negative emotions, causing sadness and increased anxiety. The same study also suggests that effects on cognitive abilities and neuroplasticity should be investigated, as they raise serious concerns. Other research has found a link between long-term oral contraceptive use and future alcohol dependency. Furthermore, studies also found a higher prevalence of sleep disturbances among women who take hormonal birth control. All of these alarming implications can contribute to causing or worsening disorders like Major Depressive Disorder, Generalised Anxiety Disorder and Bipolar Disorder.

Additionally, some studies tend to overstate that the pill has negative effects primarily on women with a history of depression, which unfairly singles out those with mental health disorders. All of this indicates that there are gaps in scientific research which raise many questions about the pill’s effects on mood that can’t be answered.

As a 16-year-old teenager, Rebecca was prescribed Levlen to regulate “erratic” moods and anxiety. She then developed depression and an eating disorder but continued to use hormonal birth control through her twenties due to lack of professional guidance and care, resulting in insomnia, panic attacks and severe mood swings. 

In an attempt to alleviate these symptoms, a General Practitioner (GP) changed her combined contraceptive pill to a progestin-only pill, yet it landed Rebecca in her first manic episode. The GP then prescribed a hormonal implant, believing her mental health complications are a result of an unregulated menstrual cycle. Conversely, the implant worsened her mood symptoms, leading to a bipolar disorder diagnosis. Despite this, Rebecca’s doctor insisted on keeping the implant, suggesting it is necessary for managing her mood. 

With few other options, Rebecca removed the implant and discontinued hormonal contraception for several years, which led to severe depression and suicidal ideation. She later sought help from a mental health professional, who diagnosed her with Pre-Menstrual Dysphoric Disorder (PMDD) and redirected her to another GP. The doctor merely repeated what Rebecca was being told for years and insisted on the pill being the only solution to her struggles, without considering her individual needs and medical history.

Rebecca’s story is an example of redundant and misogynistic treatment often experienced by women with mental health disorders. Prescribed treatments were ineffective, but they worsened Rebecca’s depression, as her symptoms were wrongly attributed to the menstrual cycle instead of an emerging mood disorder. This appalling case of medical sexism highlights the need for more attention and consideration for women’s mental health. It is essential for healthcare professionals to stop seeing female biology as a problem to be solved and finally adopt a holistic approach to women’s health and well-being.

With the trend of overlooking the struggles of the general population of women, it is not surprising that healthcare providers consider implications for diverse groups irrelevant. For instance, race is often ignored as a factor when prescribing hormonal contraception, while symptoms and concerns can be dismissed due to bias i.e. the “angry and irrational black woman” stereotype. 

Black and Hispanic women are less likely to use branded hormonal birth control due to financial concerns, which sometimes results in abrupt discontinuation or switching. Moreover, diverse racial groups tend to receive inaccurate information about birth control and tend to have limited access to mental health support services, all of which can result in dangerous outcomes for their well-being. Another important aspect of oral contraception use is that of transgender and non-binary patients. Trans youth are at an increased risk of experiencing depressive symptoms and other mood-related conditions but are also in need of taking oral contraceptives to minimise gender incongruence caused by menstruation, and to prevent pregnancy.

As more and more women are quitting the pill due to persisting side effects, it remains unclear why alternative methods are still unavailable. Despite the obvious need for more options, the pharmaceutical industry directs most of its funding and attention to other types of research. Contraception has not seen major innovation for many decades and has mostly made adjustments to existing methods. It is incredibly restricting and leaves women with little to no choice, not due to the inability to invent new methods, but simply due to lack of initiative.

From a feminist perspective, this level of hesitation can be seen as the essence of sexism in medical research. With the pill’s proven contraceptive effectiveness and the overall prevalent use, this male-dominated industry sees no reason to do further studies or invent new treatments.

This dehumanising and belittling approach is further highlighted by the failed invention of male contraceptive pills. Despite all available resources and funding, male contraceptive research is often shut down due to uncomfortable side effects experienced by participants which are similar to the ones women endure daily. Male and female bodies are not viewed in the same way and are treated with completely different considerations. 

It is time for the industry to finally acknowledge that the pill is not the solution, but perhaps a problem that requires more attention, research, and innovation.