The contraceptive pill: blessing or curse?

Updated: Jun 8

Oral contraceptives (OCs) have been in women’s lives since the 60s, when the first generation of hormonal methods to prevent pregnancies were released. Since then, the “pill” provided women with an immense control over their own bodies, reproductive choices, and lives, as they could avoid getting pregnant when they weren’t ready or didn’t want to.

According to a United Nations report in 2019, oral contraceptives are one of the most popular choices for women of reproductive age (15-49 years) who want a reversible contraceptive method (16% of women worldwide) - female sterilization (24%) and intrauterine devices (17%) are the first and second most popular choices, respectively.

Combined oral contraceptives are exactly that, a combination of synthetic versions of natural sex hormones, progesterone and estrogen, that block the maturation of an egg inside your ovaries. If you want to know more about hormones and how they change during the menstrual cycle, don’t miss our recent post on the topic! The most common format of OCs is a 21-day hormone intake with the same dose of hormones each day, followed by 7 days of placebo (no active ingredients) - during placebo use, you will bleed like during your period. Many women use this 21-7 format for years without a rest because it's very convenient and relatively cheap.


However, like most medicines, the pill has a long list of side effects that you have to watch out for before even deciding to choose this contraceptive method for yourself. Keep reading to find out 5 things that might happen to your body and brain when you are taking hormonal contraceptives.



1. Your period is not real

The period is used by your uterus to get rid of all preparations for a pregnancy, including the egg that wasn’t fertilized. Because your hormonal levels are high throughout the entire cycle, you don’t really ovulate. The week you take the placebo pills (with no hormones, they are just there so you keep the habit of taking one pill everyday), your hormone levels suddenly drop and your uterus receives the sign that normally would start the period (low hormones = start bleeding). However, there is nothing to get rid of, because your uterus didn’t really prepare for any pregnancy.


The downside is that you will be bleeding for “nothing”, but the good news is that the bleeding will probably be less painful and abundant than a real menstruation. So if you have your Ready tampon case with you, 2 regular tampons per day will, most likely, be enough 😉


2. Your sex life might not be the same

And here we start with the bad news. There is very little information (and interest) about undesired side-effects of OCs on women’s sexuality, but the research that exists is gloomy. For example, one study found that reduced frequency of sexual thoughts and low sexual arousal was related to a drop in testosterone after starting the pill (yes, women produce testosterone too! just in much smaller amounts than men). Even though this doesn’t happen to every woman, it seems that some of us are more sensitive to testosterone's behavioural effects, and their sex life might be significantly impacted if they keep using oral contraceptives. Indeed, another study discovered that low sexual desire and reduced arousability were two of the most common reasons for women to stop using the pill.

Other side-effects reported are decreased lubrication and vulvar pain, especially in women with the longest duration of pill use and in those women who initiated use of OCs at a young age. Doctors often prescribe the pill for contraceptive use or to treat other issues, such as endometriosis or polycystic ovary syndrome, but the lack of research done, combined with the taboo around sex (and particularly, around women’s sexuality), might prevent them from telling you about this.



3. Increased risk of heart attack

This is another negative consequence that has been consistently proven: oral contraceptives and hormone replacement therapy increase the ability of your blood to coagulate, which puts you at a higher risk for the formation of blood clots and thrombosis. If you combine the pill with other habits or health problems that also increase this risk (smoking, high-cholesterol diet, diabetes, hypertension, migraines), you will have many more chances of suffering from any arterial malfunctioning, like brain strokes or heart attacks. For example, strokes in young women are very rare (0.003%), but they are 2-4 times more frequent in women using OCs that also smoke, and 7-8 more frequent if they suffer from hypertension.


A typical symptom of bad blood circulation is that you get bruises or broken little veins in your skin very easily. So if you are not willing to quit smoking or you have been diagnosed with something that affects your blood circulation, please, don’t choose hormones as contraceptives!


4. No mood swings, but you are at risk of depression

If you are taking the format of OCs with the same dose of hormones everyday, a very nice outcome of having high hormone levels all the time is that your mood doesn’t change that much depending on the time of the cycle (basically, because you are not cycling). So you will probably avoid the premenstrual syndrome, the motivation drop in the luteal phase, or the bad-body-image days.

But here is the catch: long-term hormonal contraception reduces the levels of serotonin, a crucial chemical in your brain that is often called “the happiness hormone”. In some types of depression, the underlying cause is that the brain does not produce enough serotonin, and women taking the pill have a much higher risk of being diagnosed with depressive disorders than other women, especially during teenage years. Adolescent girls using OCs also report more mood-related symptoms, like crying, hypersomnia, and issues with food. So if you decide to choose this type of contraceptive method, particularly if you are young, you should also monitor your mental health and watch out for signs of depressive symptoms:

  • lack of motivation and apathy

  • overall sadness and pesimistic thinking

  • sleeping problems (either insomnia or hypersomnia)

  • sudden weight changes (either significant weight loss or weight gain)

  • fatigue and low energy

5. You may have poor sense of smell (and poorly chosen romantic partner)


Like many other animals, humans can know a lot of things (even subconciouslly) about other individuals just by the way they smell, including their health status or how good of a fit they are to be the parent of their children. A very common strategy in nature is to choose a partner that is genetically different from you, because this will increase the chances that your offspring will be healthy. Because this odour information is related to reproduction and mating, the levels of sex hormones can influence your sense of smell and, ultimately, who you choose to spend your life with (even without you knowing about it!).


In fact, heterosexual women with normal menstrual cycles tend to choose different men than women using oral contraceptives. Among other reasons, that is because OCs impact negatively in how well these women are capable of identifying smells. But it seems that OC users choose romantic partners that they wouldn't have chosen if they were cycling normally🤯.


In conclusion, if you are in a relationship and starting/stopping using the pill has changed the way you think of your partner, changes in your sex hormones are probably at the root!



We hope you enjoy learning about this particular method of contraception. Remember that oral contraceptives do not protect you from sexually transmited infections, so you should always use a barrier method (preservatives) unless you and your sexual partner are 100% free of STIs.


Make sure you #getready before committing to this or any other long-term medical treatment. It is important to check verified sources of information by yourself, but you should also ask your doctor directly, they are obliged to inform you properly!



References:

1. Graham, Cynthia A (2019). The pill and women’s sexuality. BMJ, 2019;364:l335 doi:10.1136/bmj.l335

2. de Wit, Anouk E.; Booij, Sanne H.; Giltay, Erik J.; Joffe, Hadine; Schoevers, Robert A.; Oldehinkel, Albertine J. (2019). Association of Use of Oral Contraceptives With Depressive Symptoms Among Adolescents and Young Women. JAMA Psychiatry, doi:10.1001/jamapsychiatry.2019.2838

3. Burrows LJ, Basha M, Goldstein AT. The effects of hormonal contraceptives on female sexuality: a review. J Sex Med. 2012 Sep;9(9):2213-23. doi: 10.1111/j.1743-6109.2012.02848.x. Epub 2012 Jul 12. PMID: 22788250.

4. DeLoughery, T.G. Estrogen and thrombosis: Controversies and common sense. Rev Endocr Metab Disord, 12, ****77–84 (2011). doi: 10.1007/s11154-011-9178-0

5. Kollndorfer K, Ohrenberger I, Schöpf V (2016) Contraceptive Use Affects Overall Olfactory Performance: Investigation of Estradiol Dosage and Duration of Intake. PLoS ONE 11(12): e0167520. https://doi.org/10.1371/journal.pone.0167520

6. Roberts SC, Gosling LM, Carter V, Petrie M. MHC-correlated odour preferences in humans and the use of oral contraceptives. Proc Biol Sci, 2008;275(1652):2715-2722. doi:10.1098/rspb.2008.0825

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