Chemical contraception: Hormones, hysteria, and how to get rid of 'bacne'

One night, the April before last, I was standing in my bathroom, brushing my teeth and scrutinizing my face in the mirror. As usual, I was assessing the many pimples splotched across it, and checking for others that might be threatening to breakout, too. I’d had mild but perpetual acne since my teens, and nothing I did seemed to make any improvement. In fact, it had gotten worse - in recent years it had spread out over my cheeks and shoulder-blades. This puzzled me - surely acne isn’t meant to get worse as you get further away from puberty, is it? I cast my crappy memory back in time, and reckoned that this change for the worse had started just after my hormonal IUD had been inserted four years prior.

Suddenly, I realized a series of very important things. Thoughts that had occurred to me before, but never all clearly and in a row:

1. The changing patterns of my acne over the last decade might very well have all been tied to my different forms of birth control.

2. All the kinds of birth control I had been on had been a varying combination of hormones. Artificial hormones. That you had to go to a medical facility to obtain. Which made these actual drugs, not just magical, miraculous silver bullets.

3. I'd not been off of artificial hormone doses, for any substantial length of time, from the ages 19 to 29; an entire decade.

4. I'd never experienced my own body, on its own terms, since I'd finished puberty. I didn't know what 'normal' was, what it felt like to be in my own body with only its own naturally-occurring hormones coursing through it.

So I looked up the side effects of my hormonal IUD on the brand’s official website. Then I Googled the common side effects of progesterone - the active ingredient in the IUD, as well as in most of the different brands of birth control pills I’d ever taken. Some of the common side effects included:

Acne, depression, breast pain, nausea, nervousness, fatigue, headache, weight increase, decreased sex drive, anemia, hair growth or loss, skin irritations (such as hives, rash, eczema, itching, etc.), dizziness, low energy/weakness, water retention, stomach cramps, stomach upset, vomiting, diarrhea, cysts, clots.

I was 29 at the time, and I’d felt, both physically and emotionally, a little like garbage, for about as long as I could remember. I’d experienced chronic depression, fatigue, irritable stomach, and lightheadedness, as well as the acne. I’d spent the last two years trying everything I could think of to clean out my body, in the hopes of feeling ‘right’ for a change. I’d given up meat, cut out most dairy and junk food. I’d made my own cleaning and grooming products, even switched from using hair conditioner to vinegar. I’d given up smoking, drinking, partying. Given up staying in bad relationships and even dating, really. I’d made a sincere effort to start sleeping more than five hours a night. I’d given up working jobs that I loathed. I’d moved to Portland, moved in with my mother. I’d taken up yoga. I’d tried cleanses. I’d even gotten a life coach, for fuck’s sake – I mean, I was really trying to make holistic, conscientious choices about my body and my life.

And yet, in spite of all this thought and effort, I had somehow remained completely, mentally disconnected from the fact that I’d been carrying around a stash of artificial chemicals the whole time - in my womb. I’d never really thought that there might be any connection between those hormones and anything going on with the rest of me.

I've used several different types of birth control over the years, starting at age 19 and continuing straight through to my present age, which is 30. I've gotten it from nurses in England, Ireland, California, Oregon. I've queued up at university clinics, NHS clinics, and Planned Parenthood clinics to get it. I've worked and volunteered with reproductive health groups, studied health issues at universities on two continents, gone to conferences and protests, and talked to a lot of women from a lot of places about their own personal experiences with birth control.

Pills, rings, implants, patches, shots, and devices, sterilization, emergency contraception, abortion – I’d heard stories of both horror and adulation, and shared many of my own. I thought I was pretty knowledgeable about birth control. So it was a hell of a surprise to realize that there was such a big, fundamental hole at the heart of my understanding of the subject.

The fact that I so totally failed to think of the hormones used in birth control as a kind of actual drug, for years, I put down largely to my own folly. I’d seen the pamphlets on possible side effects years before, ignored them willfully, and thrown them in the bin. Because that’s what 20-somethings generally do, isn’t it? Like seeing the pictures of blackened lungs on cigarette packets, but lighting up anyhow. Like knowing tequila makes you vomit, always, but taking the shot anyways. Like knowing someone is terrible, but sleeping with them nonetheless. You want what you want, you need it, and now, and any potential repercussions seem very far away.

But much more than that, in my case, was the fact that access to and responsible use of family planning was (and is) so very much at the foundation of modern feminism. And feminism was the only thing that I really believed in for a long time. I therefore allowed myself an uncharacteristically unquestioning faith in the powers of birth control, in its beneficial properties and the wisdom of its purveyors.

And anyhow, what was the alternative? To not use birth control, and put myself at risk of pregnancy? I genuinely could not conceive (so to speak) of such a thing. Unplanned pregnancy has run rampant through generations of my family, and I dreaded falling into that tradition.

Also, I’d grown up in the US, in the heart of western consumerism, where holistic thinking about well-being isn’t something we do. Where we’re told the answer to any and all of life’s problems can be found in some combination of pills and products, acquired ad-hoc along the way. And where, failing pills, the answer to all complaints of feeling poorly is that you really should cut out gluten. (No, Mom, and I’m not going to.)

* * *

When I finally had my lightning-bulb moment in the bathroom last spring, and really thought about the constant barrage of hormones I’d been putting myself through, and how I didn’t really know myself without them, I decided I wanted to stop. Just stop, completely, cold turkey, as immediately as possible.

This meant getting my IUD removed – something I was not looking forward to. Getting my IUD put in was one of the most memorably unpleasant ordeals of my life. In order to get any IUD in place inside the uterus, a doctor has to pry the cervix open, which causes the whole uterus to contract. This feels pretty much exactly like someone is punching your uterus in the face. A friend once assured me that the experience is less painful after you’ve given birth vaginally once or twice; something about passing a human head through the cervix apparently really helps to loosen it up. However, with my relentless, bordering-on-paranoid, and successful use of birth control since losing my virginity, I’d avoided pregnancy entirely. Therefore the pain of getting the IUD in, while brief, was a bitch.

So I was worried that having an IUD removed would be similarly unpleasant, that there would be pain, bleeding, cramping, etc. But no - it turns out the modern ‘T’ shaped IUDs are actually built to fold in on themselves when they get pulled downwards (pretty damn clever, huh?). The doctor just gave mine a tug and it slipped right out.

I looked at it laying on the little steel tray there in the exam room. It seemed a little sad to throw it out, after it had been inside of me for so long. It actually felt a little reminiscent of losing a tooth, and I had a strange impulse to take it with me. But what would I have done with it? Put it under my pillow? For who, the Fanny Fairy? That's not an actual thing, so far as I know. Although, it really should be, and Good Vibrations is missing a golden opportunity here. (What would a Fanny Fairy leave under one's pillow? Chocolate? A vibrator? A Kate Bush mixtape?)

But I chickened out, and left the little device behind as I walked out of the doctor’s office and into the spring sunshine, feeling absolutely fine. I continued to feel totally fine over the next week or so. No bleeds, no cramps, no pain. Nothing. What a relief!

Until, very suddenly and violently, I went into heat.

No. Joke.

Holy. Shit.

My body went into a wicked comedown from the progesterone my IUD had been uninterruptedly feeding it for four years. And the timing really could not have been worse. Because it was now May, in Portland, Oregon. Anyone who has ever seen Bambi, or Camelot, or anything narrated by David Attenborough, will know that spring is Rutting Season, no matter where you find yourself. Portland, however, is in a league of its own. All manner of trees and flowerbeds explode into bloom, streets heave with birds and bees and brunch queues, and whole swaths of pavements are buried in drifts of petals from plum blossoms, cherry blossoms, rhododendrons. I genuinely cannot recall seeing such a thorough and jovial display of fecundity in any other place in my entire life.

And there I was, in heat, in a mating season paradise, and utterly, utterly single. Which I had been for a long while, and why I thought it would be a reasonable time to finally go off birth control. But no, there was nothing reasonable about it. I was practically clawing at the walls in a mania of mind-melting lust and frustration. I even Googled ‘female hysteria’, and found myself nodding my head in recognition of a condition I’d once dismissed as Victorian nonsense. I tried to write about my ‘condition’ as I was going through it, but my notes are just broken ramblings. One afternoon it was so bad, I actually just sat in my car and screamed for awhile. Mostly though, I just burned through a lot of AA batteries, and waited for the storm to pass. Which it did, thankfully, after a couple of weeks.

* * *

However, the Universe has a pretty far-out sense of humor. Within three months of having my IUD removed, and just as my body was getting used to being off birth control, I found myself entering a very unexpected and intense courtship, and then head-over-heels in love, and then co-habiting. With a man. Which meant I’d sworn off birth control at the exact time when I was more gloriously in need of it than ever.

So now I have an IUD again. But it’s made of copper, and it’s hormone free. I’d heard about the copper option before, back when I got my first IUD. That doctor simply told me that there were two types of IUDs: a copper one, which would make my periods much worse, and a hormonal one, which would make them lighten up or maybe go away completely. This seemed like an obvious choice; who on earth would queue up for worse periods? But I’ve had the copper IUD for nearly a year now, and the grisly horror-film carnage I’d pictured has not come to pass. I bled a lot by my standards in the first few months, but even then had only minimal cramps. The bleeding has tapered off and gone back to normal, and no other side effects have presented themselves since.

It turns out there was a completely viable, over 99% effective, absolutely fuss-free and absolutely hormone-free form of birth control that I could have been using the entire time. I’m annoyed it took my this long to try it, but thrilled with it now that I have.

And yes, as I said, I fell very much in love, just as I rid myself of progesterone. And then I changed continents, occupations, and most of my lifestyle. Which makes it hard to know which improvements to my overall wellbeing are a result in going off hormonal birth control, and which should be attributed – at least in part – to love and other changes. I have more energy, and have lost weight. I’m still an irritable and neurotic human being (aka ‘writer’), but not nearly as depressed. I get far fewer stomach aches. And most noticeably, my skin has cleared up amazingly; I get only the very occasional spot on my face, and have stopped getting them on my back altogether. This, at least, is a ‘clear’ sign that some of the improvement is definitely down to getting rid of the hormones, so I am extremely glad that I did.

This isn’t to say I’m against hormonal birth control now. That would be ridiculous. My body doesn’t react well to antibiotics or antihistamines either, but there’s obviously no sane argument to be made that those aren’t really good things for humanity. What I am saying is that we should be absolutely clear that these types of birth control are medications, and be aware that they effect our bodies in very real, nuanced ways. As with all other kinds of medicine, there is no silver bullet, no one size fits all solution, and what is good for some may be shitty for others. Progesterone wasn’t the end of the world for me, but I wish I’d been smarter about recognizing it as a drug, and noticed and respected my body’s distaste for it sooner. I might have saved myself a lot of money and strife if I had.