Long Reads

Why are so many women turning their backs on the pill?

Posted by
Natasha Preskey
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The pill was once a liberating invention. But with the male version potentially on the way, have women had enough of hormonal birth control once and for all?

A GP once told me that women can’t expect “something for nothing” when it comes to contraception. Older women, she said, are more likely to be “pragmatic” about the physical and mental side effects of the pill. I tried my best to be “pragmatic” about the mood swings I experienced on the combined pill but, two years and several different brands later, it became apparent that “something for nothing” really wasn’t on the table.

Men are rarely asked to make compromises for the greater contraceptive good. A few years from now, however, a sprinkling of male pragmatism might just see more couples able to share the load of pregnancy prevention. Earlier this week, a new study by researchers at the University of Washington suggested that the male pill is not only effective, but also safe to use. In a trial involving 83 men, there were side effects of mild weight gain and acne. Most importantly, however, was the finding that participants didn’t share the depressive effects and liver and kidney issues observed in a well-publicised 2016 study into the male contraceptive injection.

This innovation could not have come at a better time. Women are less likely than they once were to take on full responsibility for protection, or to put up with the pill’s now-proven effects on mood. According to NHS stats, the proportion of women opting for user-dependent contraception like the pill has fallen from 79% to 61% in the last decade. Meanwhile, use of the withdrawal method almost doubled in the US between 2002 and 2015. In 2016, the British Pregnancy Advisory Service found that almost half of women who had an abortion were using no contraception at all.

“Women are less likely than they once were to take on full responsibility for protection”

Before the advent of the pill and legal abortion, female pragmatism meant accepting that if you had sex, you might find yourself packing an extra school lunch in five years’ time. When single women were first allowed to access the pill from family planning clinics in 1974, it not only liberated us from our uteruses, but also represented the first small step towards recognising women’s sexual autonomy. So why are we turning our backs on it now?

“In my clinical practice I’ve seen a significant movement away from the use of oral contraceptives like the combined and progesterone-only pills, particularly over the last decade,” Dr Anne Henderson, a gynaecologist, tells me. “There are various reasons behind this, including safety alerts relating to synthetic hormones, and the availability of alternative options like the Mirena IUS, which is not only more effective but also safer.”

In addition, an increasing number of women are turning to the withdrawal method over hormonal contraception – rejecting the possible side effects of mood changes, weight gain, acne, migraines, decreased libido, nausea and an increased risk of blood clots that come hand-in-hand with the latter.

“I had a nightmare experience on the pill,” Lauren, 28, tells me. “I developed severe hormonal migraines after taking it for a year and, although I’ve been off it for five years, they’ve never gone away.” Lauren says she was prescribed the combined pill after “very little conversation at all” and that several doctors failed to make a connection between the symptoms and her contraception. She was subsequently told that the 18 months she spent on the pill were likely responsible for her long-term struggle with migraines.

Lauren has used the withdrawal method since she came off the pill and has recently started using a fertility app as well. “It works for me because my periods are very regular and conveniently, I always get a headache, if not a migraine, when I ovulate,” she says.

The Natural Cycles app has been made an EU-certified form of birth control, but experts warn that digital contraception is only right for those who are dedicated to recording the required data. Earlier this year, Natural Cycles was reported to Swedish authorities after being linked to 37 unwanted pregnancies in women who had abortions at the same hospital in the country.

“Apps aren’t a fail safe option - although they can be effective for women who are very much in tune with their body and cycles,” advises Dr Shazia Malik, consultant obstetrician and gynaecologist at The Portland Hospital. “If you aren’t able to use these apps and record the data regularly and properly, then they can be ineffective.”

“Lauren was told the 18 months she spent on the pill were likely responsible for her long-term struggle with migraines”

Zoe*, 35, also turned to the pull-out method after experiencing bad side effects from the pill, including “extreme, uncontrollable emotional lows”, acne and weight gain. “Two or three months after coming off it I started to notice a real positive effect,” she tells me. “My anxiety and mood all improved and continued to just get better and better.”

While withdrawal can work for some women like Zoe, who has relied on it for nine years, around one in five women who use this method will get pregnant each year, according to Planned Parenthood.

“I’ve noticed an increase in women using riskier contraceptive methods and with that I see more unwanted pregnancies and STDs than ever before,” says Dr Malik. “It’s really important for women to be aware that if they decide to use alternative contraceptive measures than the ones recommended to them by their GPs, they’re putting themselves at greater risk of an unwanted pregnancy.”

However, when constantly presented with some form of contraceptive trade-off, many women decide this risk is worth it. And, as condoms or a vasectomy are the only options currently at men’s disposal, we’re often the ones taking on both the responsibility and the consequences that come with flawed birth control.

If the male pill can offer effective contraception with fewer side effects than its female counterpart, women will no longer be faced with a choice between dicey contraception and risking their physical and emotional wellbeing. And, after generations of enjoying “something for nothing”, isn’t it only fair that our male partners give “something for very mild side effects” a shot?

* Names have been changed

Images: Getty / iStock