Journalist Áine Kenny reflects on women's complicated and long-running relationship with the contraceptive pill.
Thinking of coming off the pill? You're not alone.
Scrolling through TikTok a few months ago, I was bombarded with videos of women documenting their experience of stopping the pill. Weirdly enough, I was considering doing the same - the algorithm can be a little too accurate sometimes.
Taking it as a sign from above (or more likely the corporations mining my data), I stopped taking my daily dose of Microlite nine months ago, after being on the pill for six years. After stopping, I felt more in tune with my body; I had emotions again, and a fog had lifted. I felt happy, sad, and even hungry in a way I had forgotten. On the pill, it seems, everything was dulled.
It wasn’t all plain sailing. I did get very frequent periods (I once had a 14-day cycle!) and I feel very tired the day before my period, but nothing unmanageable so far.
When was the pill invented?
But what are the origins of that tiny pill I used to throw back every day? The first FDA-approved pill was called Enovid. It contained a much stronger dose of hormones than our modern-day pills and was first sold in the US in 1960.
It was developed in the 1950s by the American biologist Dr. Gregory Pincus and obstetrician John Rock, at the behest of Margaret Sanger, the founder of Planned Parenthood, with funding from Katharine Dexter McCormick, a philanthropist.
When taken correctly, the pill is thought to be over 99% effective at preventing pregnancy. This means that fewer than 1 in 100 who use the combined pill as contraception will get pregnant in one year.
However, while the pill liberated many, its origin cannot be ignored; the first pill was tested on low-income women in Puerto Rico, who were not properly informed of what they were taking, and whose complaints of side effects were dismissed by the researchers.
Side effects included nausea, dizziness, headaches, and blood clots.
While we have come a long way with the pill, these side effects remain throughout the various brands of contraception. There are also mood swings, nausea, breast tenderness, and headaches, as well as the possible risk of blood clots. All this is on top of the anecdotal reports of weight gain.
Oral contraceptive use is also linked to an increased risk of breast and cervical cancers, but conversely, it can reduce the risk of endometrial, ovarian, and colorectal cancers.
The contraceptive pill can also help those with acne, heavy periods, period pain, endometriosis, premenstrual dysphoric disorder, polycystic ovarian syndrome, along with a range of other health conditions whose symptoms get worse during menstruation. Not to mention it prevents pregnancy.
Irish women’s experience with the pill
For some women, the pill had very negative side effects. Michelle, who started taking the pill at 16, says she developed severe depression, which she believes was linked to the contraceptive as her symptoms were alleviated when she stopped taking it.
Interestingly, although the contraceptive pill has been linked to mood swings, and some pill brands list depression as a possible side effect, many researchers say they can neither prove nor disprove a link to depression.
However, there are many anecdotal stories that would suggest more research is needed.
Charlotte had a similar experience. She started taking the progesterone-only pill at 18, but feels that her doctor did not inform her about the potential side effects. "I was a generally happy person, but my mental health started to decline, it took me a while to link it to the pill."
Fiona, who gets migraines, started taking the progesterone-only pill in her late teens. "After a while, I decided to go off it, to see if my low mood and headaches were linked to the pill."
As soon as she stopped taking it, Fiona realised that her migraines were triggered by hormonal changes, because they only came around when she was on her period. "The pill was really messing my migraines up in that sense, it was chronic."
Fiona says she would consider taking the pill again, now that she has found an effective treatment for her migraines: "The security of being on the pill is a major benefit. I’m very interested in trying the copper coil."
For some women, the pill was great. Geraldine says she would definitely consider taking the pill again in the future. She was on the pill for almost 10 years, but decided to come off it for two reasons: she developed a serious issue with her endocrine system that required surgery, and she was experiencing unwanted bleeding mid-cycle.
"It is annoying not being on the pill, I have found that I have more facial hair, and I am hungrier."
Geraldine also misses being able to control when she gets her period. She swims regularly and finds that she isn’t up for much during her time of the month. "My cramps are worse now. For at least one day, I have to take painkillers and I am exhausted. It can be harder to plan things."
How does it work?
Dr. Monica Peres Oikeh, a GP based in Cork, says the combined pill is often the first contraceptive doctors prescribe to women. The combined pill contains a form of estrogen and progesterone, which suppresses ovulation, and the progesterone keeps the lining of the womb thin, to prevent implantation.
However, this pill isn’t suitable for everyone. Those who can’t take the combined pill include people who get migraines with aura, people with active breast cancer, high blood pressure, and/or a family history of blood clots. In addition, people over 35 who smoke are advised against taking it. Instead, they can opt for the progesterone-only pill.
"Everyone reacts differently, what is suitable for one person may not work for others," she said.
Other contraceptive methods include the patch and the ring, the latter of which is inserted into the vagina; both contain the same hormones as the pill but at a reduced dose. There are also long-acting reversible contraceptives, such as the injection, the implant (aka the bar), and the hormonal IUD.
Dr. Monica says the copper IUD is becoming more popular. "It is non-hormonal, you still get your period, although they can be heavier for the first few months, and it is cheap as chips. It can stay in place for ten years."
What about male contraceptives?
It’s clear there is a whole host of mainly hormonal contraceptive options for women, but what about men? Right now, they only have two options: condoms and a vasectomy.
Scientists have been running trials on male contraceptives, such as pills, injections, and gels, since the 1970s. While some recent studies show promising results for a non-hormonal male pill, and a hydrogel injection that blocks sperm, we still have a long way to go before these are widely available.
This is a bit disappointing, considering the female pill has been around for just over 60 years, and studies have shown that women are more likely to take on the burden of organising and paying for contraception.
There is no doubt that, in many ways, the pill liberated many women - this is especially important to keep in mind in an era where women’s reproductive choices can be limited - but I think most women would agree that we could do with some more non-invasive and non-hormonal options.
For more information on contraceptive options in Ireland, visit HSE.ie.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ.