Bitter pill: Everything you need to know about hormonal contraception
Pic: iStock
LAST week, Channel 4 broadcasted Pill Revolution, a compelling documentary that revealed serious problems in how contraceptives are prescribed and administered to women in Britain. Presented by Davina McCall and produced by Kate Muir, it compared women’s choice of contraception to a game of roulette. Because women are not educated about the range of options available to them, most choose blindly, usually opting for the familiar contraceptive pill.
Lack of education is merely the first problem. According to a Channel 4 poll of 4,000 women, 77% of women experience side effects as a result of taking the pill. Some 36% suffer from anxiety, depression or low mood and 21% have low libido. The side effects were so severe for 33% of women that they stopped taking the pill altogether.
“There were other surprising findings,” says Muir. “A third didn’t know what pill they were taking. They didn’t realise there were 40 different types available and that they all react differently in different people. Women aren’t educated about contraception, about the choice available or the possible side effects. Nor are they listened to when they have problems with it.”
Muir was first alerted to the issues surrounding contraception by her daughter. “Molly was depressed but because she was home from university due to the pandemic, we thought it was lockdown misery,” she says. “But then she came off the pill and felt better within weeks. I thought back to when I was on that same pill and how it was only when I came off it years later that I realised I felt more creative and alive.
“When I told Davina about it, she said her daughter had also had a bad time on the pill. That left us wondering how many more women were suffering as a result of their contraception, which is why we got Channel 4 to carry out its poll.”
Delving into scientific research lead Muir to a 2016 study. “This looked at over one million Danish women and found that they were more likely to start antidepressants for the first time or be diagnosed with depression if they were currently using or had recently used hormonal contraception,” she says.
That study proved that Molly wasn’t alone in her mental health struggles. So too did the enormous online response to last week’s Channel 4 documentary.
Women shared their experiences of how hormonal contraception had affected their mental health over social media and also expressed shock that they learned more about contraception from a one-hour documentary than from years of interactions with health professionals.
Help not a hindrance
Muir is keen to acknowledge just how much hormonal contraception has done for women. “The pill is a godsend, preventing pregnancy and regulating the ups and downs of periods and PMS, but many women are still as in the dark about it as we were when it was first introduced 60 years ago,” she says.
“The pill should work for us, not against us, and for this to happen, women have to be informed, heard and supported.”
The documentary’s findings relate to women in Britain but what of those in Ireland? A study published by the Dublin Well Woman Clinic in 2020 found that 31% of women use the contraceptive pill, patch or vaginal ring, 16% use long-acting reversible contraceptives (LARCs) and 28% use condoms.
Despite the wide range of contraceptive options available to women in Ireland, like our counterparts in Britain, we too may have a problem with education. A study carried out by the Irish College of General Practitioners (ICGP) in 2014 found that misconceptions about the negative health outcomes of LARCs were common. Other studies including one published by researchers at Oxford University this year have shown that hormonal contraception in general is hampered by misinformation about its safety.
So, what is the range of contraception available to women in Ireland? “The contraceptive pill, patch and vaginal ring are examples of short-acting hormonal contraceptives,” says Dr Ciara McCarthy, the ICGP and HSE clinical lead in women’s health. “They last for less than a month and have to be taken or used regularly to ensure they are effective.”
The contraceptive implant and intrauterine devices, also known as coils, are examples of LARCs. Once fitted, they can protect against unwanted pregnancy for up to eight years.
Non-hormonal options include copper coils and condoms — the only contraceptive method that also prevents transmission of sexually transmitted infections.
There are pros, cons and potential side effects associated with all options. “The biggest difference between the pill and other short-acting contraceptives and LARCs is the higher risk of unintended pregnancy with the former,” says McCarthy.
“The implant and coils are 99.9% effective while the pill has only been shown to be 91 to 94% effective with typical use. For patients with busy lifestyles who may not be in a position to reliably remember to take a pill or change a patch or ring, a LARC may be a safer choice.”
All hormonal options usually help to make periods lighter and less painful. Some even allow women not to have periods altogether.
Possible side effects include the impact on mental health and libido that can come from taking hormonal medication, as highlighted by the Channel 4 survey.
Dr Caitríona Henchion, medical director of the Irish Family Planning Association, says: “Some women who were prescribed the pill come back to us saying that it’s affected their mood or made them feel depressed.”
Dublin-based pharmacist Laura Dowling, aka @fabulouspharmacist on Instagram, has heard stories from Irish women who believe their sex life declined while they were on the pill.
“These are women who were on it for a long time and who didn’t discover their true libido until they came off it to start a family,” she says. “The leaflet that comes with the pill, which nobody reads, does tell you that it can affect your libido, but their doctor had never mentioned such a thing. They didn’t get to experience the highs and lows of a libido until they stopped taking the pill.”
Other possible side effects include painful periods as a result of fitting a copper coil, acne, weight gain, headaches, nausea, increased blood pressure and more.
Focus on side-effects
While it’s important to be aware of such potential side effects, it’s just as important to keep them in perspective. Henchion worries that the increased focus on side effects is turning a growing number of young women off hormonal contraceptives.
“They’ve heard that hormones will affect their mood or make them depressed or put on weight,” she says. “They then become resistant to using any form of hormonal contraception, to the extent that they are happier to use less reliable forms of birth control.”
Dowling is concerned that some women will have unplanned pregnancies as a result. “I come across lots of girls online saying they don’t want to take hormonal contraceptives and while I think it’s all well and good that they are aware of potential side effects, they need to be just as aware of the risk of unplanned pregnancy and the impact it can have on a woman’s life.”
Like those surveyed for the Channel 4 documentary, many Irish women don’t realise there are different types of pill and that a consultation with their doctor should help identify which one will suit them best. “If you’re suffering side effects, tell your doctor,” says Henchion.
“Some pills are better for skin for example while others reduce periods more. Once your doctor knows what it is about a particular pill that isn’t suiting you, it will help them find one that will.”
The ICGP wants women to know that they have choice and control when deciding on contraception. “That decision should always be shared between the patient and the healthcare professional,” says McCarthy.
“To help women decide, GPs start by asking screening questions to assess for medical conditions that might preclude the use of certain methods. Then they ask about lifestyle, periods, whether the women are planning a family shortly or have finished their family, and what contraceptives they have used previously. Armed with this information, the GP can then advise suitable contraceptive options. The patient can consider which ones would be acceptable to her and a plan can be made to commence or fit the chosen method.”
A follow-up appointment should then be arranged to review how well the contraception is working.
“We make sure to warn women about side effects and things that might go wrong in the meantime,” says Henchion. “It’s important that they know to come to us if there’s a problem. They don’t just have to put up with it. There are alternatives.”
Help and advice is available
It’s vital women know there is a choice, says Dowling. “There’s still so much women aren’t told about their own bodies,” she says. “ We should be telling our young women that there are lots of different forms of contraception available and if they don’t get on with one, they can simply try another. They should know that help and advice is always available from their physicians and pharmacists.”
The introduction of free contraceptive care for women up to the age of 26 has helped promote this sense of empowerment, according to Henchion. “Women now realise they have nothing to lose by asking their doctor about contraception or approaching another healthcare professional if they aren’t happy with what their GP offers them,” she says.
“It’s great that it’s being extended to include women up to the age of 30 from September.”
Muir would like to see the medical system go even further and offer a bespoke service to all women. “We don’t have the same hormone levels, so we won’t react the same way to hormonal contraceptives,” she says. “I take HRT, so I know first-hand how hormones can make a real difference to your life if you get them right. I’d like all women, young and old, to be informed about this when it comes to contraceptives just as much as menopause.”
McCarthy urges women in Ireland to seek reliable information about contraception from their GP or local family planning clinic or to check out the HSE’s website, www.sexualwellbeing.ie.
“There’s a large amount of misinformation being circulated online,” she says. “This HSE website has recently launched a series of videos called Spotlight on Contraception, which aim to provide bite-sized, evidence-based information on the types of contraception available and to address some potential concerns patients may have.
We are fortunate to have access to a wide variety of contraceptives in Ireland, just as they do in Britain, and we want patients to be able to make an informed decision about the method that’s right for them.”
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