By Jasmine Edge | Contributor
Put very simply, hormonal contraception works by thickening the cervical mucus or preventing ovulation (and sometimes both!). It does this by introducing synthetic versions of both oestrogen (ethinylestradiol is most common) and/or progesterone (progestins) into the body.
However, as Dr Sarah Hill points out in her book, How the Pill Changes Everything, although contraception was originally designed to be used as a form of birth control, its effects are not limited to this single goal:
“The brain and the rest of the body are too flush with hormone receptors for the pill not to change women. And it’s not just the areas of the brain and body that are directly responsible for orchestrating your cycles and coordinating pregnancy. We’re talking about areas of the brain that are responsible for things like emotional processing, social interactions, attention, learning, memory, facial recognition, self-control, eating behaviour, and language processing. And we’re also talking about non-brain body parts like the immune system, the stress response, and your gut hormones. This means the pill will have a ton of different effects on your body, from top to bottom.”
It’s useful to look at pregnancy prevention as one of many side effects of contraception—one that is obviously desired by millions across the world. However, after speaking to a handful of people it’s fair to surmise that, whilst there are an array of reasons to use contraception, its side effects aren’t always the ones desired.
Below are some of the stories shared with me which demonstrate a broad range of experiences on hormonal contraception. As you will see, a pattern seems to emerge where individuals are facing similar struggles when trying to manage and understand how contraception influences the way they feel.
What are the side effects for hormonal contraception?
Physical side effects of hormonal contraception tend to receive more focus than the mental health impacts, likely because more is known about the physical effects to date. However, ignoring a problem does not make it go away, as is demonstrated below.
Alice Moore tells me how she expected the physical, but not mental side effects of birth control, “The negative effects on my mood, however, were not as expected; I feel like I felt worse gradually over the 3 years I’ve been on contraception rather than all in one go, so it was harder for me to pinpoint that my contraceptives were the thing causing this.”
Another interviewee, who preferred to remain anonymous, recalls that, “I’ve had conversations with friends on similar hormonal contraception and we all say we don’t really know our own moods anymore, we can’t differentiate between our own natural emotions and ones perhaps bought on by the contraception”
“I’ve had an overall negative experience with the implant/progesterone-based forms of contraception. Since insertion I’ve bled lightly near enough everyday (nearing 3 years of being on it) with only a handful of breaks. This is obviously quite debilitating when it comes to having sex, exercising […] and even just affecting what I feel I can wear”.
They rightly point out the added cost of buying extra tampons, and additionally highlight that the physical side effects of birth control can also contribute to the way a person feels daily. Therefore, although indirectly, this impacts their mental health.
Lydia Bourton notes how she initially started considering her contraceptive options at 15 to help with painful periods; however, after hearing about issues others had faced with the combined pill, which she had been prescribed, she delayed taking them until she was older.
After unfortunately having a negative experience on the pill when she finally made the decision to trial it, Bourton tells me that she had the implant fitted in October 2020. Since, her cycle (characterised by long periods of bleeding and sudden breaks), sex drive and anxiety have been in a constant state of unpredictability.
“[O]verall, as cliché as it sounds, I’ve been on an emotional roller-coaster. I’ve not felt completely myself in the past two years, but I don’t know what to turn to next. I’m currently in the process of getting in touch with the doctor, again.”
Edie Halstead adds, “[I] worry that birth control has altered my personality and sense of self […] having been on birth control my whole adult life, I feel like some side effects may have become my ‘normal‘”.
Furthermore, Anna Evans struggles to find the words to explain how she feels on hormonal contraception, “I think the best way to describe how I feel is very emotionally unstable. I have constant mood swings, one minute I’m really happy and energetic and the next I’m really sad and tired.”
She also shines light on how hormonal contraception can impact pre-existing health conditions, “I’m currently recovering from an eating disorder and it [has] become clear that the implant is causing my appetite to fluctuate which isn’t ideal for someone who’s recovering from an ED.”
“Stick with it, it will get better”
It is hard to foresee the individual effects hormonal birth control may have, but if patients are unhappy, why are they reluctant to reach out for help and feel like they have nowhere else to turn?
“[T]he doctors gave me a lot of unwanted advice like weight gain and pregnancy difficulties, which felt a bit misogynistic.” A comment from someone, who also preferred to remain anonymous, sharing their experience at the doctors. They touch upon the often-skewed approach to women’s health, where people frequently make their own assumptions about what is important to a woman, without first asking them.
Moreover, Bourton explains how her worst fear of being told to put up with the difficulties she was facing came true when she reached out to her doctor for help, “[I] explained my situation but he replied with ‘stick with it, it will get better’. But I went off the pills immediately.”
Evans’s response is consistent with the feelings of others—that raising her concerns will only lead to the trivialisation of the side effects she’s experiencing, “I’d be conscious that people would just dismiss my experiences as side effects that should wear off as my body adapts more”.
Additionally, another interviewee says, “[I] was told to wait at least 9 months for my body to adjust to it [the implant], and after this I would be fine. This was not the case and have had a nightmare trying to make my frustrations be taken seriously.”
The consensus is that sexual health products and services don’t seem overall catered to the people using them, and when users raise their concerns, rather than being supported in trialling another option (which itself, is often exhaustive) they are told, for a lack of better term, to suck it up.
‘The Lowdown’ – The world’s first contraception review platform
Alice Pelton who founded The Lowdown in 2019, the world’s first online reviewing platform for contraception, has made it her mission to provide a resource for people which she didn’t have when she first started using birth control:
“[M]y decision making process early on was very much influenced by just an absolute fear of being pregnant. So, I sort of put that above everything else and that’s why I suffered with side effects for so long.”
She tells me how as she got older her priorities changed, “I really started to think more about the impact that my contraception was having on my mental health.”
The Lowdown website offers a reviewing feature, that currently has over “5,000 reviews for every method and brand”, offering users the option to read up on other’s experiences, or write about their own.
The website also features a contraception recommender that can help people understand what method might be best for them, an advice service where you can book an appointment to speak with a GP who all have a diploma in sexual and reproductive health, a prescription service that offers the delivery of the pill or patch, and there’s a selection of blogs covering a variety of sexual health topics.
“I guess we’re kind of like sex ed. But, you know, for people who are out of school, because as women get into their twenties, they really start to learn more about their reproductive and sexual health.”
Pelton urges people not to give up, “it’s worth trying things out, and what works for you at one age might not necessarily work for you at another—really listen to your body, like you know [it] better than anyone else, and really learn how to advocate for yourself with healthcare professionals to push for any tests, or changes, or brands or things that you want to try.”
It’s clear that people are fed up with waiting for doctors, researchers, and pharmaceutical companies to listen to them. Instead, they are creating their own solutions.
What might the future of hormonal birth control look like?
The experiences of those mentioned in this article may seem overwhelmingly negative. However, I did get to hear the positive impacts birth control has had in people’s lives, such as the relief it provides by protecting people from pregnancy, as well as the necessity of contraception in the lives of others as it helps keep debilitating period pain at bay. Some people feel the best versions of themselves on hormonal birth control!
Moore highlights that she did eventually find the right method for her, “My initial experience with oral contraception was a bit worrying […] However, I was so relieved when Lucette [oral contraceptive] was successful that I didn’t mind the initial blips of being on the pill (acne flair ups, unstable mood etc.).”
Additionally, whilst some people had a negative experience at their doctors’ (sadly this was commonly the case) others had a positive one. It’s important not to dismiss the negative or positive experiences, but rather ensure there is a line of support and communication there to help people when these negative experiences occur, which unfortunately has not yet been set up in a broad and accessible way.
Hormonal contraception has allowed people autonomy over their bodies, which is amazing—but it remains strikingly obvious that the same people are fed up with the trade-offs they are often required to make to have this freedom.
Additional non-hormonal birth control options, and an increased range of birth control options for men were common answers from individuals when asked what improvements they wanted to see in the future:
“For girls like myself, who can only use specific types of contraception, I think there can be more advice offered on what types of non-hormonal contraception can also be used. I remember being around 15/16 and it seemed like the only viable or ‘safe’ method of birth control was hormonal, which just isn’t an option for some people.” – Anonymous
“I hope in the future there will be more readily available contraceptive methods that don’t include the use of artificial hormones.” – Bourton
“I’d like to normalise contraception not being a women’s issue, and [rather] something that only women have to take responsibility for in a relationship” – Revell
A few considerations on the physical and mental effects of hormonal contraception
Unfortunately, there is no alarm that goes off in our heads to tell us we’re feeling happy, or sad because of our birth control. The cause of these thoughts and feelings can be difficult to understand and are often overwhelming.
Mood trackers are a great form of self-help when starting contraception. Implementing a mood tracker into your daily routine before and after you start a new method of contraception can help you monitor any changes in the way you feel and recognise the source of these changes. It also gives you physical evidence of the problems you might be experiencing to show your doctor to help you advocate for yourself.
Telling friends and family that you are starting a new form of hormonal contraception can also be helpful, so they can keep an eye on how you are doing and speak to you if they spot you struggling.
The aforementioned book by Dr. Sarah Hill is also a great resource and is written in a friendly and often satirical style, which makes it an accessible read for anyone wishing to understand what is (and might be, as research is still ongoing) happening to their brain on hormonal contraception.