Cruel irony of taking the contraceptive pill

I’m 25 and started going out with my boyfriend two years ago. Shortly after that I started taking the combined pill. Could it be to blame for my low libido?

Although the pill does what it is supposed to (if you remember to take it every day), few women escape the smorgasbord of side-effects, such as irregular bleeding, nausea, breast tenderness, weight gain, headaches, mood swings, blood clots, varicose veins, and thrombosis.

Taking the pill is such a lottery that many of the 100m women worldwide who do would argue that the real reason they don’t get pregnant is because oral contraception makes them so fat and irritable that no one wants to have sex with them.

If your libido has always been low and you only started taking the pill two years ago, then the issue is probably not related to your contraceptive. The female libido is a mysterious beast that retreats into its cave if it feels stressed, bored, angry, ill or unloved. If, however, your libido began to decline around the same time as you began to take the pill then, yes, it could be the problem.

It seems a cruel irony that the pill, designed to liberate women from reproductive consequence, can simultaneously eliminate their desire to have sex, but there is increasing evidence that this is the case. Oral contraceptives raise levels of sex hormone-binding globulin (SHBG), which inhibits androgen production and binds to “free” testosterone. Androgens (such as testosterone) modulate sexual function and decreased libido is one of the hallmarks of androgen insufficiency.

Dr John Bancroft, a former director of the Kinsey Institute, estimates that one in four users of oral contraceptives has sexual side-effects. He was involved in a 2001 study that found a significant decrease in frequency of intercourse in women on the pill.

Many women go on the pill as soon as they become sexually active and if this is true of you, you might not be able to identify your baseline level of libido.

In 2005, Dr Claudia Panzer, of Boston University Medical Centre, led a study that examined levels of SHBG in women on the pill, and found that they had four times the level of women who had never taken it. When you go on the pill, doctors tell you that the effects will reverse as soon as you stop taking it, but women in Panzer’s study who quit taking the pill still had about twice the normal SHBG levels after six months — some even after a year.

The only real way of knowing if the pill is responsible for your low libido is to stop taking it, but Panzer’s research suggests that you would need to do this for up to a year to point the finger of blame with accuracy. Unfortunately, reliable alternatives are limited. Implants, patches or pills are just different delivery systems for the same hormonal stew.

You might have more luck with an IUS (the coil), a T-shaped device that is inserted into the uterus, which is currently considered to be the most effective long-acting, reversible contraceptive option available, and with none of the side-effects of the pill.

Research in Silesia, Poland, found women using the Mirena coil experienced better general health, greater sexual desire, greater arousal and less sexual dysfunction. It can be a little uncomfortable having a coil fitted, but if the coil agrees with you it can be left in for five years and, frankly, it’s the best of a bad lot.

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