Why are young women giving up on the contraceptive pill?

In 2016, the Journal of Clinical Endocrinology & Metabolism reported that a study into a male contraceptive injection was halted after participants experienced adverse side-effects such as acne, injection site pain, increased libido, muscle pain, depression and mood changes. The injection itself was found to be highly effective as a means of preventing unwanted pregnancy, but the trial was stopped after the research project review panel determined that “the risks to the study participants outweighed the potential benefits to the study participants”.

The news was met with raised eyebrows by women all over the world. Acne, depression, altered sex drive? Those side-effects sounded awfully familiar. "This is literally what we go through," said podcaster Aminatou Sow on an episode of feminist podcast Call Your Girlfriend, sounding incredulous. "They are – as every single woman who has ever taken hormonal contraception knows – 100 per cent normal," added co-host Ann Friedman.

Since the oral contraceptive pill was first introduced, hundreds of millions of women across the world have used it at some point in their lives. From preventing unwanted pregnancies to treating medical conditions such as heavy periods, acne and endometriosis, it has been credited with heralding a new era of social, economic and sexual freedom for women.

While most women who take it do so without incident, a number report side-effects. According to the HSE, these can include mood changes; an increase or decrease in libido; headaches; nausea; rise in blood pressure; fluid retention; and breast tenderness or enlargement.

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I eventually came off my pill because it was exacerbating my mental health [negatively] and making me actively suicidal

For many women, these side effects can be alleviated by consulting their doctor and switching to a different pill. More and more, however, women are deciding that the risks outweigh the benefits and going off the pill altogether, sometimes opting to switch to a different form of contraceptive.

Recently I asked women on social media to get in touch with me if they had stopped taking the pill due to negative side-effects. I received dozens of responses from women in their 20s and 30s, each outlining their own personal experiences with the pill. The side-effects and pills prescribed varied from individual to individual.

Among the most common complaints were mood disturbance, migraines, weight gain, breast tenderness, low sex drive and nausea. Some described in detail how they felt the pill had negatively impacted on their day-to-day wellbeing and put a strain on their personal relationships. Most swore off ever trying it again.

Stomach cramps

Vanessa Ifediora was 19 years old when she first started taking the pill. She soon started experiencing dizziness, stomach cramps, weight loss and restless legs, and took the decision to come off that particular pill. Over the next few years, she experimented with different versions, but decided to come off it altogether in 2016.

“I eventually came off my most recent pill because I realised that it was massively exacerbating my mental health [negatively] and making me actively suicidal,” she says. “As soon as I came off I noticed a major improvement to my moods.”

Ifediora, now 29, says she now takes antidepressants and is reluctant to ever try the pill again lest her progress come undone. Asked to sum up how the pill had affected her mental health, she said, “It exacerbated things like depression and anxiety and just made me feel woeful. Realising it was the pill that was causing so much of it and that it wasn’t ‘me’ was honestly a relief.”

“Coming off it and seeing myself get better physically and mentally – it felt like I regained control of myself.”

Ifediora is far from the only person to experience such side effects. In 2016, a landmark Danish study of one million women concluded that “use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use”.

For some, the extent of the side-effects don’t become clear until after they stop taking the pill.

Last year, Jodie*, 23, came off the pill after breaking up with her long-term boyfriend. After four years, she decided she no longer needed it for contraceptive purposes. Once she came off it, however, she experienced a lightbulb moment.

For four years, she says, she had experienced a low sex drive and debilitating headaches that meant she couldn’t risk leaving the house without painkillers. Her emotions were dulled and neutralised. “I very rarely lost my temper and even more rarely was I that giddy kind of happy,” she recalls.

‘Stressed and overtired’

Initially, she attributed her headaches and low moods to being “stressed and overtired” as a result of studying for her undergraduate and masters degrees while working two jobs. After she stopped taking the pill, she noticed an immediate improvement in her mood and wellbeing. Her headaches subsided and she no longer felt “neutral”.

“For the first time in four years I experienced that happy-for-absolutely-no-reason feeling and those days where you just need a good cry,” she says. “I can’t believe I allowed myself to think that such a limited range of emotions was normal, but I suppose hindsight is 20/20.”

It's a story Dr Caitriona Henchion, medical director of the Irish Family Planning Association, has heard from numerous patients over the years. But can the pill really be blamed for depression, anxiety, fatigue, low sex drive and headaches?

In some cases, yes, explains Dr Henchion. For instance, there is a “definite evidence-based link” with migraine headaches.

The evidence is not clear that the pill causes a lot of the things that it's accused of causing

“If someone is getting worse migraines on the pill, then they should stop it, no question about it,” says Dr Henchion. “Something that is progesterone-only should not cause that, so that’s either an implant or a progesterone coil or a hormone-free coil. Any of those things will be safe and better for them if they have migraine.”

In other cases, however, it’s a little more ambiguous.

“The evidence is not clear that the pill causes a lot of the things that it’s accused of causing,” she says. “But that doesn’t mean in an individual case that you might not see a very clear pattern of something not being there before and being there afterwards and actually resolving again.”

“You will have things that aren’t logically explainable like a woman taking one pill and then switching to another that contains almost exactly the same thing and have no symptoms on the second one. It’s really difficult.”

Henchion does acknowledge that some women will experience mood disturbance taking any kind of hormones, particularly if they are predisposed towards depression or anxiety.

“I would be very cautious if someone was saying they had a history of anxiety or depression,” she says. “If I was putting them on anything hormonal, I would say to them to really keep an eye on things for the first few months and if you think that things are taking a turn for the worst then come back.”

That said, she encourages patients to consider what else is going on in their life before placing the blame on the pill.

“Things like mood and sex drive are hugely multi-factorial. Yet people will lock into ‘it’s the pill that did it’ and ignore everything else that’s going on in their life.”

Noticeable difference

Still, many women were adamant that there was a noticeable difference in their wellbeing after coming off the pill.

Anna*, 31, says she experienced a multitude of side-effects when she started taking the pill – everything from high-level anxiety to low sex drive. “My nipples were practically numb,” she recalls. “It was like being in someone else’s body.”

If I forgot one of the ingredients for making dinner I could weep or freak out or start an argument

After a period of experimentation, she found a pill that had minimal side-effects, but nonetheless decided to come off it recently.

She recalls that the low moods, in particular, took a toll on her personal relationships.

“Sometimes I’ll get anxiety as part of PMS. This was like having super-high-level PMS anxiety, but every day for three months,” she says. “I lived with my sister at the time so she was there often when I would be debilitated by the tiniest surprise or disappointment. If I forgot one of the ingredients for making dinner I could weep or freak out or start an argument with her. She never knew what would set me off. I didn’t know either.

“It was the same for my boyfriend. We were very close – we’re now married – so I would go to him a lot for emotional support. But the level of support he had to provide at that time was unprecedented. I would often end up sitting on the floor of his room with sunglasses on, completely overwhelmed because we had planned to meet his friends, and now I couldn’t handle it or the guilt of not meeting them.”

Around this time, Anna says she lost all interest in sex. The idea of initiating anything exhausted her and she didn’t respond to her boyfriend’s advances.

“It all just felt like strange and foreign and uninteresting,” she recalls. “It’s hard to explain. My body just didn’t respond to anything. It was impossible to arouse me.

“Bit by bit we just gave up and avoided the whole thing because it made us both so frustrated and sad, and caused arguments and guilt.”

More of a choice

Dr Henchion says the reason women are more vocal about their experiences with the pill may be down to the fact that it is no longer the only game in town; women now have more of a choice when it comes to contraception.

“There was less choice if you go back 20 years,” she says. “It was either be in the position to control your fertility or not, so you were either going to use it or you weren’t.”

In recent years, there is evidence that more women are seeking out long-acting reversible contraception (LARCs) such as the copper coil, contraceptive implant or hormonal coil, with notable increases reported in both the UK and US.

According to the HSE, the number of Irish women opting for LARCs has steadily increased even as condoms and the pill have remained the dominant forms of contraceptives.

"With regard to use of LARC among women in Ireland, the most recent general population data available suggests that uptake is at a low level, but increasing across all age groups," said the HSE in response to a query. "The Irish Contraception and Crisis Pregnancy research studies found that between 2003 and 2010 (the last year for which data is available) there was an increase in the proportion of women (18-45) using the coil, the IUD or the IUS from 5.7 per cent to 10.9 per cent.

“There was also an increase in the numbers of women using the ring, the patch, injections or capsules from 3 per cent to 8 per cent.”

Dr Henchion says any uptick can partly be attributed to medical professionals in Ireland making a concerted effort to promote alternative forms of contraceptives to women.

Clearly for a lot of people, if they are even willing to consider it, long-acting contraceptives are better

“Promoting long-acting contraception is part of what we do and it’s become much more promoted generally among both nurses and GPs, so an increase in uptake is probably because more people – maybe some of whom are having side-effects or having difficulty remembering to take it or don’t want to keep taking it – are now being offered alternatives,” she says.

“Clearly for a lot of people, if they are even willing to consider it, long-acting contraceptives are better. They don’t have to remember them; they are getting a much lower dose of hormones if they are getting a hormonal one; and they are quite often getting extra benefits in terms of reduced periods or reduced period pains.

“If someone wants really good contraception with no hormonal intake, they can get a copper IUD and their cycles will continue completely normally and they will have really good contraception.”

In the meantime, women can take solace from the fact that there are three methods of male contraceptives currently in various stages of development: a gel, a male contraceptive pill, and a non-surgical vasectomy. Buckle up, fellas. It might soon be your time to shine.

* Full name is known to editor