Four years ago I was struck by the unwelcome onslaught of adult hormonal acne. No one wants to deal with unsightly blemishes on their face, but as an adult supposedly far removed from the awkward braces-and-acne phase that usually marks adolescence, I wanted a solution—fast!
So, I went to my doctor and ended up with a prescription for the Pill. The promise of clearer skin and claims that oral contraceptives can prevent ovarian cancer sold me. I didn’t even bother researching the side effects.
It wasn’t until a while later that I began to question my treatment. A friend shared how fertility awareness methods had helped her understand and treat her reproductive and hormonal health. Her alternative to popping a pill intrigued me, so I took her advice and began researching.
Over the next year, the more I learned about oral contraceptives and their side effects, the more unsettled I became. Researchers are increasingly finding that the Pill comes with serious side effects—side effects that do not affect every woman, of course, but are certainly worth knowing about as informed consumers.
The Pill Takes Over
In 1960 the Pill was officially approved by the FDA. It’s no exaggeration to say that this daily dose of hormones was revolutionary. Feminism, the sexual revolution, religion, marriage—the Pill was the impetus for so much change and controversy in all of these arenas and more. The Pill was a game changer; there’s no denying that.
Fast-forward to today, and the Pill is ubiquitous—and for most, unquestioned. For many women, taking the Pill even brings a sense of community. Your coworker’s cell alarm randomly sounds at 3 p.m., and you know that it’s her Pill reminder. Many women give no pause to whipping out that little punch card at a restaurant—or anywhere, really. We kind of feel bonded by it.
That doesn’t mean that all women are using the Pill to prevent pregnancy. Doctors prescribe women hormonal birth control pills for an increasingly wide variety of reasons, from managing reproductive system issues such as polycystic ovarian syndrome and endometriosis to far more tangential uses such as hormonal acne and fibrocystic breast disease. In fact, millions of women take the Pill not simply as a contraceptive but to remedy symptoms of things that may or may not be related reproductive health. Hormonal birth control has become the standard of care, the go-to drug no matter the issue.
But a half century in, modern medicine is starting to question what has become the new normal. While the Pill is largely viewed as the wonder drug of women’s health, the facts show that, if anything, oral contraceptives work in ways tangential to women’s fertility and overall health. The original hype surrounding the Pill is starting to give way to convincing and frightening evidence that the Pill we’re popping to prevent babies, acne, or even cancer might actually being doing us harm, not good—and that’s a hard pill to swallow.
The Go-To Answer in Women’s Health
While birth control pills may seem like the best solution to painful cramps and irregular cycles, the fact is that they only mask symptoms. Hormonal contraceptives contain synthetic estrogen and progestin; these hormones inhibit the production of natural cyclical hormones, which in turn prevents ovulation. Not ovulating means there’s no egg to fertilize if you’re having sex, and your risk of ovarian cancer is reduced, as not ovulating—either via hormonal birth control, because you’re pregnant, or from breast-feeding—lowers your risk of ovarian cancer.
But for all the other things the Pill is prescribed for, it’s simply masking the symptoms, not treating the underlying condition. For instance, the Pill is frequently prescribed to manage serious conditions such as endometriosis and PCOS. For those with endometriosis—when uterine tissue has been displaced from the uterus and attaches to other reproductive organs, such as the fallopian tubes and ovaries—the pain that comes from those displaced cells being aggravated by your cycle is reduced on hormonal birth control. For those with PCOS, there are often prolonged periods of time where their bodies do not produce progesterone; during this time the endometrium is continuously exposed to estrogen and will therefore continue to build without shedding (like in a normal period). According to the Androgen Excess and PCOS Society, “When the endometrium is exposed to estrogen for prolonged periods of time, cell changes can occur in which the cells of the endometrium become abnormal and, if not treated appropriately, can develop into cancer of the uterus.” Prescribing the Pill ensures that excess blood does not build up in the uterus.
But oral contraceptives are not a cure for these conditions. “There is much we still don’t understand about women’s reproductive health and infertility,” said Dr. Elizabeth Jensen, Ph.D., in a recent Verily article. “For example, why some women experience endometriosis or why some couples experience infertility.” If left untreated, conditions such as endometriosis and PCOS contribute to permanent infertility. Countless women have been prescribed oral contraceptives for these disorders, and no wonder; aside from surgery, hormones offer the closest thing to a “cure.” But the fact is, it isn’t one.
A 2011 study found that 14 percent of women who have been prescribed the Pill—approximately 1.5 million women—use the medication solely for non-contraceptive reasons, such as menstrual pain, the treatment of acne, and endometriosis. Fifty-eight percent of the women who take the Pill as a contraceptive say they also depend on it for reasons other than pregnancy prevention.
Plenty of Side Effects
As long as doctors prescribe the Pill as a panacea, grave reproductive health conditions remain uncured. But what choice do these millions of women have?
“After the advent of hormonal contraception in the 1960s, Americans have gradually become desensitized to the risks associated with these agents,” said Dr. Bradley Fossier, MD, family medicine physician and NaPro medical consultant in Indianapolis, Indiana. “Often overlooked, the risks of life-threatening blood clots, ectopic pregnancy, cancer, weight gain, and [miscarriage] after conception are by no means insignificant to those who experience these complications.”
Despite protecting against endometrial and ovarian cancers, long-term use of the Pill does seem to increase a woman’s risk of developing liver, cervical, or breast cancer. To put these statistics in perspective, 12.1 per 100,000 women each year will develop ovarian cancer, while 124.8 per 100,000 women per year will develop breast cancer, the most common cancer in women worldwide.
In 2006, the Mayo Clinic Proceedings published a meta-analysis, which found that oral contraceptives increased the risk of breast cancer in premenopausal women younger than 50 by 19 percent. Furthermore, women who had taken the Pill before their first full-term pregnancy were 44 percent more likely to develop breast cancer than women who had never used oral contraceptives before having children.
Blood clots caused by oral contraceptives can double a woman’s risk of heart attack and stroke. The odds of an average woman developing a blood clot while on birth control pills remain small, about one in a thousand women, but when it happens, it can be deadly. Last May, 26-year-old Jordan Ward and 21-year-old Fallan Kurek suffered strokes; Kurek’s was fatal, and oral contraceptives were deemed the cause in both cases.
In addition to affecting our bodies, researchers have found that birth control pills change the way women think—in particular regarding whom women find attractive. Research from The Proceedings of the Royal Society B says that women who take birth control pills become more attracted to the scent of genetically similar men, versus our natural attraction to the scent of men genetically different than us. In addition, a woman who stops taking birth control pills may find her partner less attractive, as those previous hormones no longer influence her preferences.
Also worth noting is the fact that some women with mental health issues such as depression, mood swings, and anxiety find their symptoms magnified by the hormonal contraceptives.
Because the general medical community uses birth control as a Band-Aid solution, women feel they can simply trust the process without being more proactive about researching and finding true healing for underlying health conditions that they face. "The problem modern medicine is faced with is not only a medical issue, but also a philosophical one,” Fossier said. “Rather than delving into the underlying causes of their disease, physicians are apt to jump to shutting down the reproductive system with hormonal contraception. Difficulties arise when years later, desiring pregnancy, women shed the hormonal agents but find themselves facing the original problems they experienced early in their reproductive lives, and now discover the added problem of infertility.” Because contraception only masks symptoms, the treatment only lasts as long as you take them.
So, What Happens Next?
Exploring my own health and my options opened my eyes to the fact that, despite its popularity, the Pill is far from being the best option women have for addressing the variety of things that affect their reproductive health. Sure, we have choices in which pill to take, as the many pills available on the market deliver different doses of hormones. Yet all oral contraceptives essentially function the same, though the side effects vary, especially from woman to woman. This “fix-all” prescription does not cater to individual cases or even different conditions. I was shocked to learn just how risky the Pill actually is. Thankfully, while nontraditional methods are less well-known and less practiced, they are viable alternatives.
One alternative that is gaining steam is NaProTechnology, which “works cooperatively with the procreative and gynecologic systems” to treat fertility-related issues while avoiding problematic side effects of the Pill. NaProTechnology, for instance, has shown progress in undoing the irregular cycles previously experienced by PCOS patients by monitoring the natural hormonal cycles and providing natural hormone replacements at the right times.
I believe that these technologies, aiming to solve the root problems that many women are facing, point us in the right direction. I hope that as more women keep turning to treatments beyond the Pill, more resources and research will focus on methods conducive to women’s complex health issues, beyond just lessening symptoms.
I’m on my way to treating my hormonal acne without the Pill—and to better understanding the reasons behind it. Without synthetic hormones controlling my body and my brain, I feel like I have a clearer grasp of the nuances of my health needs and how to address them in as effective, but less risky, methods.
The Pill was a breakthrough, but it’s time for a new one. Women deserve real cures—as well as the activism, funding, and research necessary for them to happen. And we deserve treatments that respect, not suppress, our fertility. Anything less devalues much of what makes us women.
This article has been updated for wording clarity.