Why Can’t We Be More Critical of the Pill?

Like an inflatable penis pool toy at a hen's party, for many women the Pill has been a license to go wild.

Simply by taking a tiny tablet every day, a woman can outsmart her inbuilt baby-making equipage and enjoy worry-free sex.

But while the majority of the 100+ million women worldwide who currently take the Pill say they're satisfied on it, many also experience unpleasant and sometimes frightening side effects that impact their physical and mental health, their relationships and their zest for life.

Sadly, many of these women don't even realise the Pill is to blame, and battle on for years, their sparkle dulled, their sex drive muted, before making a change.

British author and women's health advocate Holly Grigg-Spall had been taking the Pill for a decade before she realised it was making her sick. In her 2013 book, Sweetening The Pill: or How We Got Hooked on Hormonal Birth Control, Grigg-Spall tells how taking the popular brand pill Yasmin gave her "terrifying" side effects including anxiety, depression, panic attacks and "debilitating brain fog".

"My experience taking Yasmin drew my attention to hormonal contraceptives as a whole," she says. "I had not until that point considered exactly why I took the pill since I had always asked my partners to use condoms. I spent so long blaming myself for my breakdowns, not considering they could be down to the drug I was taking every day."

Since then Grigg-Spall has become something of a poster girl for a movement of women abandoning the Pill in favour of contraceptives that don't wreak havoc on their body and mind.

I'm one of them. I was on the Pill for nine years before I realised the side effects – crazy mood swings, decreased libido, anhedonia – were actually side effects, and not hallmarks of my personality.

I'd regularly drop my bundle. Without ever being able to identify a trigger, I'd toboggan into days-long bouts of depression and despair. The smallest of problems turned me into a psychopath; I'd spend weeks at a time on the verge of tears. My partner only had to look at me 'the wrong way' and I'd cry for an hour, while the colour story on the evening news would see me burn through a box and a half of Kleenex. Sex? Meh.

And then, after months of deliberation, I stopped taking it. I wanted to know: who was I when I wasn't on the Pill? It was like a light being switched on; like taking too-small shoes off after a night out clubbing. I was a completely different, more levelheaded person.

Grigg-Spall wants more women to understand these sorts of consequences. To be clear, she's not anti-Pill, nor is she about to stage Pussy Riot-style protests outside Bayer's headquarters. She is, however, encouraging women to ask: is there a better solution for me?

"I don't want to tell people they can't use it or ban it," she told me over the phone. "I believe that the Pill should be available over the counter, without prescription, and free. But I also think that it doesn't really help anybody, and many, many women would be better off without it."

It seems the issue has struck a chord. Earlier this year her book caught the attention of filmmakers Ricki Lake and Abby Epstein, who in June launched a Kickstarter campaign to fund the production of a documentary film of the same name. The campaign recently reached its $100,000 funding goal with three days to spare.

The film will build on Grigg-Spall's book to explore the more-common-than-you-realise complaints of women using hormonal birth control and pose the question: why can't we be more critical of the Pill?

Indeed, health professionals, educators and the media peddle the Pill as a "simple, safe and effective" form of contraception and a cure for everything from acne to PMS. The Pill is a wonder drug, we're told. It's a success story for women's empowerment.

And it was, and is. It's still the most commonly used method of contraception – 50-80 per cent of Australian women will use it at some point during their reproductive years – and, when taken consistently and correctly, it can be up to 99.7 per cent effective in preventing pregnancy. (Obvious disclaimer about STIs and condoms here.)

Apart from rare and tragic incidences of stroke, heart attack and thromboembolism, most women on the Pill have no issues with it and enjoy the benefits of spontaneous sex, better skin and lighter, less painful periods. And for many sufferers of PCOS and endometriosis, it makes life more liveable. For others, however, it's more trouble than it's worth.

Krista, a 34 year-old professional artist from Sydney, first started taking the Pill for contraception in her early twenties. She and her partner had grown tired of using condoms, and thought the Pill would be a more convenient solution.

"I swung wildly from irritable to horny to tearful in the space of a few hours," she recalls. "In hindsight I think my twenties were already fairly volatile - most people's probably are - and [the Pill] made me feel unbalanced and out of control."

In the end Krista and her partner agreed she'd stop taking the Pill (though she later went back on a different brand). "It wasn't worth the change to my moods and sense of wellbeing," she says.

While a few small studies have sought to determine the neurological affects of the Pill, their findings thus far are still largely unproven. Like many areas of women's health, the field remains disappointingly understudied.

Professor Jayashri Kulkarni, Director of the Monash Alfred Psychiatry research centre (MAPrc) in Melbourne, has dedicated her career to researching the effects of hormones on women's mental health and wellbeing. "Depression is one of the most prevalent and debilitating illnesses affecting the female population today," she says.

A pilot study conducted by Professor Kulkarni in 2005 found that women taking the Pill were almost twice as likely as non-Pill-users to suffer from feelings of depression. Fluctuations in hormone levels – which occur when women take the Pill – can be "potent triggers" for mental illness, she explains.

"I'm urging clinicians and patients to look at the psychological side effects, which are not as easy to see sometimes, but can be devastating, even more devastating sometimes than the physical side effects," Professor Kulkarni told the ABC.

Loss of libido is another common side effect of taking the Pill, which is ironic given the sense of sexual freedom it purportedly offers women.

A review published in the European Journal of Contraception and Health Care in 2013 analysed 36 studies between 1978 and 2011 and found 15 per cent of women who used oral contraceptives reported a decrease in libido. The findings suggest that if 100 million women worldwide currently take the Pill, then 15 million could be suffering from low sex drive. How depressing!

In another small study published in the Journal of Sexual Medicine in 2006, Dr Irwin Goldstein and Dr Claudia Panzer analysed blood samples of women who used the Pill regularly, women who had just come off the Pill, and women who had never used oral contraceptives. The blood tests found women who regularly used the Pill had four times the amount of sex hormone-binding globulin (SHBG), which binds testosterone and takes it out of circulation, potentially crippling libido.

Hannah*, a 33 year-old scientist from Melbourne, began taking the Pill for contraception as a teenager. For the first six months or so, she'd feel fine, but was always inevitably hit with unpleasant side effects: weight gain, feelings of depression and diminished sex drive.

"I think the combination of the side effects over quite a long time has really impacted on my self confidence and comfort in my appearance," Hannah explains. "This then has flow on effects including decreased interest in sex.

"I'm very lucky in that I have a very perceptive partner who was the one who suggested that maybe the pill was the problem. I imagine there are many women who are not so lucky and that these side effects may have affected or ended otherwise good relationships."

But going off the Pill is not always easy. When I complained to my doctor about my side effects, she recommended dropping to a " lower dose" pill, which I did, reluctantly, and bled for two weeks. Hashtag failing.

I told her I didn't want to be taking hormones anymore – weren't there any other options? Not in my doctor's books: it was the Pill or condoms.

Sensing my frustration and perhaps a hint of 'fuck you, I'm going to go off the Pill anyway', she basically said, "Don't come crying to me if you fall pregnant." Is it any wonder Australia's rate of unintended pregnancy is so high?

But us Pill Refugees have options. What my doctor didn't tell me, but should have, is that I had numerous alternatives for contraception that are actually more effective and have fewer side effects than the Pill. They're called long-acting reversible contraceptives (LARC), and include hormonal and copper intrauterine devices (IUDs), injection and implant. Lasting between 3-8 years, these methods are 20 times more effective in preventing pregnancy and have higher continuation rates than the Pill. And as the R in LARC implies, they're also completely reversible and can be removed at any time.

Thanks to large-scale national public health campaigns, the use of LARC has become more popular with women of all ages in the US and UK. But in Australia we have a disappointingly low uptake of these methods and a similar push is only just getting underway.

Associate Professor Kirsten Black, joint head of obstetrics, gynaecology and neonatology from the University of Sydney, is currently working on several initiatives to increase the use of LARC in Australia, including a major four-year trial in which Victorian GPs will be trained to provide "LARC First" contraceptive counselling and fast referrals for LARC insertion.

"I think that LARC methods should be offered first up," Professor Black told me. "The Pill shouldn't be the first option … our strategy should be that all women should have LARC discussed with them when they go to the GP."

"Nothing in life is without side effects," she adds. "But [LARC methods] have side effects that are potentially more minimal or well tolerated such that the continuation rate of those methods is much higher."

For Grigg-Spall, it all comes back to giving women comprehensive information about all options so they can make informed decisions about their body. "The best contraceptive for a woman is the one she wants to use," says Grigg-Spall, who personally favours the Fertility Awareness Method (FAM) and condoms.

It's condoms for me, too. They're not the ideal solution, but right now they're a hell of a lot more ideal than a baby. For the past year, I've also been exploring the Fertility Awareness Method and track my fertility using the nifty, data-based app, Glow.

Understanding how your body works – a side effect of FAM – can be hugely empowering, insists Grigg-Spall. "Knowing your body, charting your cycle, is not just for women in committed relationships. To know when you're fertile should be seen as essential for those women desiring no-strings-attached sex," she says in her book. "A woman can use a condom for protection from STIs but know with confidence from her own personal reading of her body that she can not get pregnant at that time.

"Combined with an unsuppressed sex drive and emotional well-being – what could be more liberating?"

*Names have been changed.

Follow Hayley on Twitter: @Hayley_Gleeson