The complications, stigmas, and stresses of hormonal birth control
A deeper look into the implications that can arise around prescription contraception
The scent of metallic tools and stale latex gloves struck Vanessa Raine as she lugged herself into her local women’s health clinic. The dreariness of the clinic’s cold, grey decor matched her mood. Raine started taking hormonal birth control pills at 16 and her health began declining three months afterward, leaving her frustrated and desperate for answers.
Raine felt unrecognizable to her pre-birth control self — 60 pounds heavier, thinning hair and a face checkered with red acne, battling daily debilitating stomach cramps. The only light shining through her constant brain fog was hope from the young, female doctor she was about to chat with would acknowledge something was wrong with her hormonal health.
Raine’s light of hope quickly faded as the doctor repeatedly questioned her about diet and exercise. Blood rushed to her face as she explained how she is a vegetarian who never drinks alcohol and goes for walks daily. After the doctor told Raine there was nothing wrong with her hormonal health, she asked if her symptoms had anything to do with birth control. The doctor promised Raine birth control can’t lead to these health issues.
It took Raine three years for a health care practitioner to address her symptoms, which were diagnosed as polycystic ovarian syndrome (PCOS), an untreatable chronic illness she’s convinced her birth control pills triggered.
“I had no symptoms prior in my life [to taking birth control],” Raine says. “It felt as though my body was falling apart. So much of my femininity was stripped along with positive mental health.”
“All of these symptoms came on within one year of being on the birth control pill. It was the root of my weight gain, my hair falling out, all these big hormonal changes.”
Although there are no studies confirming hormonal birth control use can lead to PCOS, Jerilynn Prior, founder and scientific director for the Centre for Menstrual Cycle and Ovulation Research (CeMCOR), says it is possible.
“Anything that disrupts [normal] ovulatory cycling, in particular use of … combined hormonal contraceptives … can cause the body, in its effort to create a normal cycle, to go through a temporary PCOS-like situation,” Prior says.
More than half of people who menstruate using hormonal birth control report having negative side effects, a study by the Society of Obstetricians and Gynaecologists of Canada found.
When informing their physician about such effects, many birth control users feel their medical concerns aren’t taken seriously, leaving them feeling gaslighted and questioning their health.
“I would say many ‘experts’ out there are not inclined to believe women,” Prior says.
“[Birth Control] can affect you in more ways than we can even imagine. There’s receptors for estrogen and progesterone in the brain, in every tissue, skin, gut, liver, and kidneys,” she says.
Sixty-five per cent of women aged 15 to 49 in the United States use some form of hormonal contraception, the National Center for Health Statistics found.
Birth control was first introduced in May 1950 as a contraceptive pill available only for married women who were usually over 20 years of age. This medical innovation has provided people who menstruate with freedom and reproductive autonomy, forcing change in societal, political, and religious viewpoints. Today, there are various forms of hormonal birth control, including the oral pill, intrauterine devices (IUD), injections, skin patches, and implants.
“People seek birth control for a number of reasons,” says Kristen Gilbert, education director for Options for Sexual Health.
“The main [reason] is that people are planning to or are currently engaging in a type of sex that might cause a pregnancy, and they want to use something reliable to prevent that. Some people need it to control their acne … some people really suffer with their periods … and often using prescription birth control is a way to manage that successfully.”
Although birth control can offer people who menstruate freedom from pregnancy and periods, they may also experience unwanted side effects due to hormonal changes.
Women who use hormonal contraceptives are at an increased risk to need antidepressants and be diagnosed with depression, says a study conducted by JAMA Psychiatry in Denmark on one million women. Adolescent users are the most at risk.
“What we know for sure, based on randomized trials, is that there’s a lower testosterone level in women on the pill, and also that there’s an increased risk of depression, particularly in women younger than 20,” Prior says.
“There’s also other evidence that says, even if they don’t become depressed as teenagers on the pill, their lifetime risk of depression may be increased.”
Adolescents who use the pill are also at risk to experience developmental issues. CeMCOR conducted a study and found the birth control pill prevents normal bone growth in teens as the high doses of estrogen suppress bone formation in the body, making them more at-risk to develop osteoporosis.
“We should never use the birth control pill in adolescence because … the pill prevents the gain to peak bone mass that’s happening around that time,” Prior says.
“The birth control pill was designed for adults. We’re using something that was formulated for adults in adolescence, and the brain and bone are vulnerable at that point.”
Although often recommended by physicians, the decision to go on prescription contraception is up to the individual. However, some birth control users feel they were not properly equipped with enough information about the effects of the medication to make a well-informed decision.
Jessica Hasson, a social worker from Coquitlam was prescribed birth control pills and later an IUD. While she’s had positive experiences with her contraception, she felt ill-informed about the insertion procedure of her IUD.
What Hasson was told would feel like a “pinch” by her physician, left her feeling sick and in pain for days.
“I can confidently say that was the worst pain I’ve experienced in my entire life, and I have a very high pain threshold,” Hasson says. “Immediately after I felt nauseous. My vision went black. Every time I tried to sit up, I [would] throw up because it was so painful.”
“They made it sound like it was going to be a really pain free, easy process. I couldn’t even believe it just because they really downplayed how bad [it was].”
Raine also says her physician did not inform her of the possible side effects that can come from taking prescription contraception.
“I wasn’t given any real information on what I was taking, what it could do, any side effects that could occur, any health concerns that could be triggered by taking it,” Raine says.
“[The doctor] basically told me a lot of people are on [the pill] right now. The only thing I was really told was I might miss a menstrual cycle or two, but I’d be good to go.”
When Hasson and Raine started to have concerns about their birth control and sought out medical advice, they both felt their doctors did not take their health issues seriously.
“About a year after I got [my IUD], I started having these really terrible cramps, beyond what I’ve felt with a period,” Hasson says.
Hasson went to the nearest emergency room in fear the device had moved out of place.
“I waited there forever and finally saw this male doctor who was just so dismissive,” Hasson says. “He was like, ‘Oh, it’s just period cramps,’ but I couldn’t feel my [IUD] strings, so I was very concerned.”
Hasson says she convinced the doctor to do an x-ray of her lower abdomen, to which the doctor started sharing his thoughts about IUDs.
“He was like, ‘I don’t know why women get these things. Anyone that’s ever asked me [about IUDs], I’ve told them not to do it. I don’t know why women keep doing this to themselves, if I could feel the strings right now, I would just pull it out for you.’”
Hasson says she left the hospital feeling horrified by her conversation with the doctor and as though the doctor didn’t take her pain seriously.
Raine says she’s been through similar experiences when seeking medical advice.
“I feel like I was very gaslighted by physicians because I was told, ‘Oh, it’s all stress, it’s all coming from stress, that’s why your hair’s falling out, that’s why you’re gaining weight,’” Raine says.
“I definitely went to a good handful of doctors, and I would say some of my most traumatic experiences dealing with [birth control] have been around physicians. I still to date have never met a doctor I found to be compassionate, and I know that’s not their job, but it’s hard.”
Prior says much of the dismissal women may feel when explaining their medical concerns to doctors can be linked to prejudices.
“There is a cultural sort of bias that women aren’t really to be trusted, that you can’t believe what they say, or it’s not valuable,” Prior says.
“I think any physician should listen [to their] patient because [they] can’t live in someone else’s body. They need to try to understand what they’re experiencing, but many feel stressed for time and do not listen. Remember that doctors are just humans.”
To help empower patients when seeking advice from their physician, Prior created a variety of diaries to help people who menstruate track their hormonal changes. These diaries are posted to CeMCOR’s website and are free to download and use.
“Women need to know what’s changed [hormonally] themselves, so they can describe it clearly and without exaggeration [to doctors], and the diary helps you do that. It helps you make the connections between the stress in our lives and what you’re experiencing,” Prior says.
From an educational standpoint, Gilbert says those interested in picking an effective method of birth control should choose one that improves their life.
“If they’re using a method of birth control and they’re unlucky enough to be suffering while they take it, they should be empowered to speak to their clinician about that and change their method of birth control because … no one needs to take a method of birth control that causes them to suffer,” she says.
As birth control users, both Hasson and Raine say there needs to be more transparency and accountability around prescription contraception.
“Find the right medical professional, somebody that actually takes your concerns seriously … because I feel across the board there’s a huge dismissal for women’s pain and we’re just expected to tolerate it,” Hasson says.
“Don’t give up on advocating for your health,” Raine says.
“Keep fighting for your answers, because when you’re living in your own body, you really know when there’s a problem…. You need to take it upon yourself to make sure that you’re doing the right things for you so that you can live a long and happy life, the way you deserve to.”