A couple years ago, I had gone on a birth control break, mainly for financial reasons. When my work started offering health insurance, I was quick to get in for a wellness check and use that opportunity to start birth control again. When I told my new doctor that I wanted to get on birth control, his response was “what do you mean by that?” I was confused. I had been on the pill before, but I didn’t really know if that was the best choice for my body. So that’s what I told him. He said, “Well, if you didn’t have any bad side effects with that, that’s probably your best bet. We’ll just put you on the same pill as before”.
I was relatively fine with this, but I felt uncomfortable with the fact that I had no clue what possible side effects could be, or what options might be better. Add to this that the women in my family all have histories of high blood pressure and reproductive issues as they get older, and I was a little nervous about what the hormones could do to my body.
Birth control pills are probably the most common form of birth control. Consistent hormone regulation is very effective at preventing pregnancy. Though effectiveness rates go down over time, meaning the longer you take the pill, the less effective it will be, most failures result from missing a dose, or taking antibiotics that negate the pill’s effect.
Of course, there’s not just one birth control pill. There are many brands on the market. But they all contain the same active ingredients, which are synthetic versions of the hormones progestin and estrogen. Because our bodies already produce estrogen, the introduction of more can cause health problems, particularly in people who have a history of diabetes, heart problems, or liver disease. For this reason, there are two main types of birth control pills: combination pills with both progestin and estrogen, and progestin-only pills for people who negatively react to estrogen.
When my mom was in her early 40s, she started experiencing severe bleeding during her periods. Her periods were lasting weeks and she wasn’t able to manage the cramps with pain medication. Her general practitioner just put her on a combination of birth control pills to manage the bleeding. This helped to an extent, but raised her already high blood pressure even more. When she started seeing a new doctor, she was told to immediately stop taking the birth control pills and see a gynecologist. Eventually, they found a fibroid in her uterus that was causing the severe bleeding. After a hysterectomy that removed the fibroid, the bleeding and period problems stopped and she was able to focus on lowering her blood pressure and managing her general health. By defaulting to birth control to manage periods, her first doctor missed the real cause of the problem and risked aggravating her other health issues.
I have a friend who wanted to stop taking the birth control pill because she suspected it was causing her severe migraines. For a while, she had a chip in her arm that introduced hormones into her bloodstream. Unfortunately, that stopped working after about a year, which she discovered when she started getting periods again. The chip causes most people to stop getting periods, which seems like a win, but it does come without a downside. Women are generally less prone to high blood pressure, and one of the reasons for this is that they lose a significant amount of blood every month, causing the body to produce more. This cycle leads to healthier blood and better blood flow. The same effects are seen for people who donate blood regularly. So having a period isn’t the only way to improve blood health, but it is something that should be considered when starting birth control methods that halt the menstrual cycle.
After her chip stopped working, my friend got a hormonal IUD. It was initially painful, but for a few months she didn’t mind the new method. Then her periods became very heavy and very frequent. Then she realized she was experiencing spotting after every time she had sex. So now she’s talking with her doctor again to find out if her IUD is actually working, and if there might be a better method for her body. In researching her symptoms, she found out that many people are experiencing side effects from IUDs like Mirena, including device expulsion or migration, ectopic pregnancies, and pelvic inflammation.
IUDs and chips are pretty invasive ways to prevent pregnancy, but they work for many people. It’s important for people to be informed about all the pros and cons of their birth control options. This requires personal research as well as detailed discussions with your doctor. Unfortunately, many of us don’t know what questions to ask. This leads to doctors running the conversation, which increases the likelihood of them prescribing the option that gives them (and their place of employment) the best financial deal.
We all want to trust our doctors, and for the most part, we should. But doctors are human, and unfortunately healthcare in the United States is a business. This sometimes leads to medical treatment that is more profitable than effective. For example, many doctors recommended Essure as an effective birth control option. This is another highly invasive form of birth control, requiring soft mesh inserts to be implants throughout the vagina, cervix, uterus, and fallopian tubes. Unfortunately, instead of being the permanent birth control solution so many doctors touted it as, it resulted in ectopic pregnancies, severe pelvic pain, and allergic reactions to nickel. Many inserts also moved around inside people’s bodies, causing other health complications. Now, along with many class action lawsuits, there is a bill calling for Essure to be banned. Had proper testing and research been conducted, this could have been avoided. Unfortunately, many treatment options are rushed to market, because they’re not making money until they are being sold.
There are non-hormonal birth control options, like some IUDs, the diaphragm, condoms, and vasectomies. Vasectomies are experiencing a rise in usage, as the procedure has become simplified and is also reversible in most cases. I’ve even started hearing vasectomy ads on the radio, trying to convince men to get a vasectomy because it will give them a few days off work to watch basketball. Though the ads are stupid at best and sexist at worst, I am happy to see birth control options marketed towards men as well as women. Condoms are reliable and are one of the few birth control methods that also help to prevent STDs. Unfortunately, many people don’t like the feeling of sex with a condom as much as sex without. Luckily, despite this, a lot of people do value their health over temporary physical sensations, so condom usage is still highly advocated in schools and condoms are easily available and relatively accessible to low income people. Diaphragms are a great non-hormonal option and don’t require a potential cost-prohibitive monthly refill, but have fallen out of popularity since they are a bit cumbersome, reduce the chances for spontaneous sex, and are not quite as effective or convenient as options like the pill, or even condoms.
The conversation around birth control has evolved greatly in the past century. There was a time in the United States when even talking about contraception with your doctor was illegal. Now, birth control is readily available and relatively accessible, but that doesn’t mean the conversation needs to stop. In fact, it’s only in recent years that birth control options that target men have been actively researched. With scientific studies currently being done on gels and serums that prevent sperm from leaving the penis and switches that allow sperm production to be turned on and off, there may soon be a day when birth control is marketed toward people of all genders, rather than just women. The great news about the new methods being researched is that many of them are both non-hormonal and reversible. Of course, side effects still need to be studied, but this opens a lot of doors for people in general, and reduces the number of women who will have to choose to take pills and hormones that negatively affect their health in order to prevent an unwanted pregnancy.
Reproductive control is important to everyone’s quality of life, but people need to know the side effects of any medication they take. If people speak up to their doctors and voice their concerns, the conversation around birth control can move toward overall quality of life, rather than being focused solely on pregnancy prevention.