Kate Sloan was on Aviane, a hormonal contraceptive method known as the combination pill, for only five months before she called a distress center to keep from killing herself. She had gone from being a creative, social 18-year-old to someone who could barely go out in public. A young journalism student, she was unable to make calls to sources as her assignments required, and her performance as a musician completely diminished. "Prior to being on birth control, I used to write two to three songs a month," she says. But on birth control, she claims, her productivity severely decreased. "I only wrote about four to five songs during the entire three and a half years I was on birth control."
Sloan started taking the pill when she met her first boyfriend. Soon after, she found herself constantly enraged over little things, like her boyfriend being late for dates or her parents complaining about dirty dishes on the kitchen counter. "I felt irrationally upset," she says. It was unlike her to be so easily agitated, but she didn't know why it was happening.
Then, not even two months into using the pill, the depression started, and Sloan could no longer get out of bed to perform simple daily tasks like showering or eating. She'd cry for days at a time, often for no reason. "A lot of the time, I wanted to die, but not enough to actually kill myself," she says. "Sometimes I'd be out walking, and I'd see a big truck and think, If that hit me right now, I'd be okay with it."
Sloan went off the pill the day after her relationship ended, but it wasn't until months later that she noticed a change. "It was only after I'd been off birth control for a few months that I began to realize I felt completely different—much happier, more productive and more capable," she says. "And then I realized: It must have been the birth control that was causing my mental health problems."
According to CDC statistics, 62 percent of women of reproductive age are using some form of birth control. Many women use primarily hormonal methods (the pill, implant, patch, injection, vaginal ring, non-copper IUDs); 30 percent of women have tried at least five of these. The combination pill is still the most popular choice, with four out of five women trying it at least once. A 2012 National Health Statistics report on contraceptive trends and usage over the years found that of the 45 million women who have used the pill, 30 percent discontinued due to dissatisfaction. When it comes to the 12.5 million women who use the Depo-Provera shot, almost half discontinued, as with the 5.6 million women using the contraceptive patch. According to these findings, side effects were the main cause of dissatisfaction. The report didn't include IUDs, although a separate study in 2015 found that IUD usage has increased almost five-fold in the last decade.
Sometimes I'd be out walking, and I'd see a big truck and think, If that hit me right now, I'd be okay with it.
Hormonal birth control (HBC) can help with a variety of health problems affecting women, and is often advertised as such; there are pills that claim to help with endometriosis, PMS and PMDD, and migraines with aura. But, despite the benefits HBC may bring to some, many women who choose to take it still experience miserable—sometimes debilitating—side effects.
One of the most common side effects of hormonal birth control is weight gain. Mina* gained 80 pounds while taking Demulen, an oral contraceptive, in 2012. "I wasn't skinny, but I worked out three times week and ate healthy," she recalls of her time on the pill. She thought her weight would be steady, but instead, "my weight just kept climbing."
Mina eventually saw five doctors about her weight gain, but they all dismissed her, saying the pill wasn't the issue. "Their responses made me feel insignificant, as if I wasn't trying to have a healthy lifestyle," she says. "It was like they thought I was lying to them about actually trying to lose weight."
After eight months, Mina finally stopped taking Demulen. Now, she's staying away from any hormonal birth control—instead, she's using condoms with her fiancé, although it's not ideal or as pleasurable, she says. Mina is even planning to have bariatric surgery to control her weight, which stopped climbing once she went off the pill (but has remained the same). She believes that doctors could have done more to take her concerns seriously. "It just feels like this surgery is such an extreme for something that could have been prevented."
Vanessa Yard also gained weight after a short period of time on the Jaydess IUD, which she decided to try after several other types of birth control caused various unpleasant side effects. Yard first began using hormonal birth control five years ago, when she was 17. She tried Marvelon, but her libido had noticeably decreased. "I started birth control at a time when I was still becoming a woman, so I didn't know my sexual self," she says. "When I went off [Marvelon], I felt like a completely different person." She then tried the NuvaRing, but it gave her yeast infections and she could feel the ring inside of her. Soon after, she tried Alesse, but she found herself anxious and depressed on the oral contraceptive; she would cry all the time. It wasn't until she discontinued use that she felt much better, according to her.
Then, in August 2015, Yard had the Jaydess IUD inserted. Within weeks, she noticed a physical change. "I looked very large and bloated even though I exercise a lot and eat healthily," she says. She also started having irrational thoughts as the bloating increased. "I started feeling very maternal. I felt like there was a growing baby inside of me," she says. "I had frequent thoughts of having a family, which is the exact opposite of my personality."
Like Mina, she went to see a doctor about her weight gain and was dismissed. The doctor told her there was absolutely no evidence linking weight gain to the IUD. A month later, Yard got it removed. She's currently on Ortho Tri-Cyclen Lo, and again, her libido has decreased. "I find health practitioners overall do not inform you of [hormonal birth control's] potential side effects and dismiss your experiences with it [if what you experience] is not listed on the brand's information sheet."
Acne, weight gain, mood swings, nausea, decreased libido, and breast tenderness. These are just the "minor" side effects associated with any standard hormonal birth control pill. But they also come with the potential for more severe problems, most of which are categorized under the acronym "ACHES": abdominal or stomach pain; chest pain or shortness of breath; headaches, dizziness or numbness; eye and speech problems; or severe calf or leg pain. This doesn't even include the psychological effects that are rarely discussed.
Reflecting on my own experiences with HBC is no better: I've tried seven different brands in a span of six years, and have experienced rage and explosive anger; severe depression to the point that I'd lock myself in my apartment for days and not shower or clean; anxiety so crippling that I refused to cross the street on a pedestrian sign because I thought a car would come out of nowhere and hit me; breasts that were so sore that I winced when I walked; clothes and bras that didn't fit anymore; cystic acne that took over my face until I started looking at the ground when I walked; sharp pains in my arms and abdomen; and constant bleeding. My mother once dragged me into our doctor's office and demanded he find me an alternative because I had "become the devil." I've tried low dosage and progesterone-only methods, all to no avail (I remained as devilish as ever).
While being unable to take hormonal birth control—for whatever reason— is actually a common problem child-bearing bodies face, debates are ongoing about whether it can cause mental health and mood issues, and experts can't come to a consensus. A 2013 study found that they don't, but Dr. Ellen Wiebe, a Canadian clinical professor at the University of British Columbia, disagrees.
Wiebe, who has studied mood issues in women on HBC and written several journal articles on the topic, says HBCs can absolutely interfere with mental health and wellbeing. "They cause irritability and mood swings which are not the same as clinical depression, but make life miserable and interfere with relationships," she tells me. "This happens in twenty five percent of women." For her study, "Characteristics of Women Who Experience Mood and Sexual Side Effects With Use of Hormonal Contraception," Wiebe interviewed 1,311 women, 77 percent of whom had previously used hormonal birth control. Of that group, 51 percent said they experienced at least one mood effect while on hormonal contraceptives. These "mood effects" included crying more easily, feeling depressed or sad, feeling angry or irritated, and experiencing more anxiety than usual. "The most common thing women often say [to me] is 'the [birth control] pills are making me crazy,'" says Wiebe.
OB/GYN and Reproductive Health Advocacy Fellow, Dr. Pratima Gupta specializes in family planning, and she believes limited data might deter doctors from asking their birth control patients specifically about mental health. "The existing data that we have doesn't support any increase," she says, which can make some experts skeptical. Gupta also says that patients are more likely to only describe the physical side effects caused by HBC. However, she believes that doctors should always take the time to educate women on all their birth control options and their respective side effects. She adds that women with preexisting mental health concerns should be able to take hormonal birth control—it's just a matter of finding the right type.
Sevonna Brown, Human Rights Project Manager at the Black Women's Blueprint, says societal stereotypes about women as emotional and hormonal are so normalized that physicians don't take complaints of anxiety and depression from women on HBC seriously. "The medical world—and society at large—often suggests that women are inherently emotional and irrational," she says. "This definitely impacts how we medicate and protect our bodies."
And then I realized: It must have been the birth control that was causing my mental health problems.
So what can you do if you choose not to "protect" your body with synthetic hormones? Condoms, the only form of birth control that can effectively prevent both pregnancy and STIs, are 98 percent effective when used perfectly every time, but they have an 18 percent failure rate for typical use. Still, many women are unnerved when condoms are their only choice. Sloan, who experienced anxiety and depression on the pill and eventually stopped using hormonal birth control altogether to avoid the negative side effects, currently only uses condoms. Her partners have occasionally complained, but she gives them an ultimatum: Use a condom, or no sex. Still, she fears an accidental pregnancy. "It does make me nervous to have sex using just condoms, because it feels like there's still a decent chance I might get pregnant." she says. "I just worry about the future, when I might want to ditch condoms with a long-term partner."
While the only acceptable option for some women, not taking HBC can also come with negative stigma. I've been off of HBC since 2010 (although I tried the mini-pill for two months in 2014), but male partners often think I'm trying to "trap" them with pregnancy. I am met with dismissal each time I explain the horrible side effects HBC has caused me. Being a woman of color makes this predicament even tougher; I have found that racist "baby mama" and "welfare queen" stereotypes become part of the conversation when I mention that I'm not on the pill. (As if I came this far in life to decide my main purpose as a woman was to turn my uterus into a venus flytrap in order to hold some man hostage for the next nine months—and 18 years.)
Thankfully, other contraceptive alternatives do exist for women sensitive to hormones, and awareness regarding these options is on the rise. Dr. Gupta says cervical caps, diaphragms, and sponges (to be used with spermicide) are effective methods. ContraGel, a natural, vegan alternative to spermicide (which women use to avoid Nonoxynol-9, known to cause vaginal irritations) and Lea's Shield are also part of the non-HBC family. The "pull-out method" has been revisited as a form of pseudo-birth control, which, if done absolutely right, has a failure rate of 4 percent compared to condoms' rate of 2 percent. Fertility awareness-based strategies are also a popular option, but can be difficult to track. "The exact day when you're going to ovulate can vary from cycle to cycle," Dr. Gupta says. "So because you can't predict that, it can put you at risk for an unintended pregnancy."
So what's a child-bearing body to do? Not much, it seems. All HBC alternatives come with their own set of side effects and higher chances of pregnancy. Women are beginning to combine their methods just to stay baby and STI-free.
We've built robots, we send people to space, we've mastered real-time video chatting with people across the world, but we've yet to create safe and effective birth control for people with child-bearing bodies. Right now, our only choice is deciding which method will hurt us less.
When I ask women what they'd like to see change when it comes to hormonal birth control, their answers vary: more affordable methods; more non-hormonal options; more attentiveness and empathy from doctors; more comprehensive knowledge of their options; less social and doctor scrutiny for not using HBC and more discussion and development of male birth control (which, apparently, is "coming" soon—so he can, too). Together, these could help us get birth control to the standard and quality that it should be. Until then, one thing is certain: Women are trying to take control of their sexual health while listening to what their body needs. Now the medical world needs to take the hint.
*Names have been changed