Read an Excerpt

Sweetening the Pill

or How We Got Hooked on Hormonal Birth Control

John Hunt Publishing Ltd.

CHAPTER 1

In The Habit

"The issue was whether any woman would take a pill every day to prevent the chance she might get pregnant. They believed no one's going to do that, not when they're not even sick, and they're not even sick!" - James Balog, Merck Pharmaceuticals

(The Doctor's Case Against The Pill, Barbara Seaman)

"I'd been on the pill for ten years, having originally been prescribed it for my teenage acne, then I carried on taking it for extra double strength contraception. Then, when I was twentysix, I suddenly decided I'd had enough and stopped taking it. I felt like a cloud had been lifted, as if before I had been living in black and white and now I was living in full color. I know this sounds mad, but it felt like I was just more alive. I also had these feelings of being more womanly, more attractive and more sexual and sexually powerful. People commented that I had blossomed. I felt more confident, my creativity overflowed in my work as a textile designer. I'd been awakened creatively. The emotional changes I felt when I came off the pill were huge, I would go so far as to say life changing. That is how I would describe the experience of coming off the pill - an awakening" - Laura

Who am I when I'm not on the pill?

I took the pill even when it wasn't for the purpose of preventing pregnancy. Throughout my teens, which I spent at an all-girls grammar school, I wasn't having sex. When I eventually did have sex the pill was my back-up method and used with condoms. Taking the pill each morning was an unthinking habit that began when my mother took me to the family doctor, having decided it was the right time to start. I had two older sisters; both on the pill, and my mother had the ingrained fear of unwanted pregnancy plus the sensibility of someone who came of age as the pill arrived.

I would not say I chose to take the pill but I can not say I protested or that I would have not made the decision independently. It felt like a right of passage, a kind of gateway to adulthood. If you were not having sex, taking the pill was the next best thing. I had not particularly minded the heavy, painful periods I had endured for the previous three years. They got me out of the gym classes I hated and allowed me to lie down in the school's quiet, dark sick room instead of taking a math test.

I accepted taking the pill in the same way that I accepted that I would go to school each day or take my exams or apply for college. No other options were discussed so taking the pill became something I just had to do, something every woman eventually did. I had no clue how the pill worked and I had no clue how my body worked. My science classes covered the minimum details of the menstrual cycle but I didn't ask for the connection between that and the pink packets of tablets I kept in my make up bag and that information was not offered.

Studies show that young women are less likely to get pregnant using a combination of condoms and spermicide than the pill because they will use them with more regularity. This is partly because condoms have a clear connection to their purpose. We know how they prevent pregnancy and so when taught to use both properly the effectiveness rate is high. The pill is prescribed carelessly and taken thoughtlessly. It is prescribed to teens who do not have a real understanding of its actions.

Women are not trusted by their doctors with more information than is viewed as strictly necessary. This tablet will "regulate" your periods, is often the first description of the pill's impact we hear and it is the first half-truth told to women about how the pill works.

I used condoms when I was supposed to, but when I was supposed to forgo them I didn't. I didn't trust the pill to do what it was made to do. I felt it was essential to take the pill regardless of my decision to continue conscientiously using condoms in my first committed relationship.

I knew that my reliance on this drug extended beyond contraception. I understood that taking the pill was what I had to do as a woman, like shaving my legs or wearing make-up.

Even when I began to suspect the pill was making me ill, I still found it immensely difficult to stop performing the ritual. Making the connection between my physical and emotional health issues and the pill was not simple or easy. I blamed everything but the pill for a long time.

My struggle with stopping made me think that I had a psychological, if not a physical, dependency on this drug. I had developed a reliance on what the pill was doing for me. In order to stop I had to unravel this complex relationship with a medication that had been at my side for over a decade. The pill had been assimilated into my sense of self; it had become a part of my life and of me. It was an adaptation that had seen me through my transition from girl to woman.

I was, I felt, addicted to the pill.

The crux was that I knew who I was on the pill and I didn't know whom I'd be if I came off. At that time, I hoped that I would be happier, relaxed, and healthier, but my pre-pill years were a long time ago. I had started on it before I even had an idea of who I might be; back when I was still physically and mentally coming into form as a young woman.

Yasmin ruined me, and retrospectively I could see how all of the brands of pill I had taken had had an insidious effect on my body that wore me down and eroded my emotional and physical strength. I could also see how certain brands might have caused me to react in ways similar to Yasmin. The realizations came slowly.

It wasn't until some two years off the pill I recalled that my inability to sit in the exam hall at school without a panic attack had come about in the first year of the pill. From that point on, through college, I requested to be sat at a desk in the back corner of the room so I would not feel trapped. I had gone away to college and, depressed and anxious, asked to transfer to my hometown university within a month. It was an experience that seemed so out-of-character to friends, family and myself. To think about how a drug may have impacted on my experience of events big and small makes me angry.

I wonder – what would I have done if I'd not been on the pill?

Many of the women who went through what I did on Yasmin or Yaz found it ended their relationship. When I explained my Yasmin-stoked behavior to my boyfriend, he related the realizations I was having to his struggle to stop smoking cigarettes. It was an analogy that resonated with me as I'd seen how stopping and restarting cigarettes changed his personality. I got that the easily irritated, emotionally-wrought, foggy-headed, out-of-it feelings that taking the pill gave me were similar to the way he said he felt in a state of consistent nicotine withdrawal.

After reading my blog a friend wrote to me and expanded on this thought. When a person smokes for long enough, he speculated, they become "a smoker" and as such "a biological extension of a medicinal parasite." Smoking, he argued, hijacks your personality and your sense of self. The smoking becomes a routine you have to stick to and as you go about that routine the chemicals meddle with your emotions.

When a woman takes the pill for however many months, years or decades she is unlikely to see herself as 'a pill-taker.' She is unlikely to consider taking the pill in the same way she might think about taking another drug, like painkillers, every day.

There are few drugs, although the list is ever expanding, that people who are not sick take every day for large portions of their lifetimes.

The marketing technique Bayer adopted is known as the "Virginia Slims model" of advertising. The cigarette brand's commercials co-opted the language of the women's liberation movement to appeal directly to young women. This focus gained them a significant increase in profits. Smoking these cigarettes was linked to ideas of glamour, modernity, independence and attractiveness. The adverts went so far as to suggest it was a woman's duty to honor her hard-won independence by smoking Virginia Slims.

Every time I had a health issue caused by the pill my doctor would suggest I just try another brand. The complaints I took to my doctor prior to Yasmin ranged from migraines to constant bleeding to nausea.

Like many young women, I was petrified of pregnancy. I believe the intensity of this anxiety had much to do with the length of time I took the pill. Through a decade of pill taking I was completely cut off from any sense of my body's true physicality. In fact, I had come to fear the potential of my body. My fertility was something I felt needed to be fought constantly. I was suspicious of my body's capabilities and felt they needed to be restrained at any cost. I had no idea how my body would feel if I were pregnant, or how it would feel if I were not. I only knew of one state, that produced by the pill. If I used condoms I could see that they had worked, but the pill left me constantly wondering if the day I forgot to take the tablet until the evening would be my undoing.

When I came off the pill for a couple of months after using Yasmin and switching to Femodette I was saying to myself that being on the pill was making me very sick, but that I still felt that getting pregnant would be worse. I assumed that my only sensible contraceptive choice was the pill. It was the pill or nothing. I had received this message loud and clear from all the parties invested in preventing me from getting pregnant – my parents, my doctor, and my friends. If the condom broke, I took the morning-after pill too, something I did twice during my decade on the pill.

Over the years I felt no connection between my self and my body, between my self and the world around me, between my femaleness and myself. I was blocked somehow, cut-off and isolated. My instincts, both physically manifested and emotional, were non-existent.

When I came off the pill it was like the lights got switched back on for me. I soon had the capacity to feel deeply and fully in a way I had not felt for many years and with that I had the capacity to truly connect.

When I started taking the pill again it was because my life had started to change very quickly. When my routine was threatened, the pill ritual seemed like a reassurance and a comfort. I was all too ready to hear that I ought to stay on the pill. Going back on the pill felt like taking control at a time when I felt things were spinning out of control in the rest of my life. I didn't believe in my ability to cope with the necessary upheaval I was facing. The feeling was similar to how I felt the need to police my eating habits during times of high stress in order to experience a sense of order in my life. I felt uncertain about the depth and complexity of my newly awakened emotions and thoughts. My own experience, my own desires were not stronger than the pressure I felt internally and externally to continue with my pill taking.

When I finally came off the pill for good, I had months of intense withdrawal. It was a state similar to my worst times on Yasmin. A friend who came off the pill a year prior described her experience to me when I was in the midst of this experience and was unbelieving that this could be down to oral contraceptives. She said she had experienced a strongly a feeling of "intuition gone wrong" during her withdrawal, a creeping paranoia that built into dread. I felt at that time, as she had been through, that I should be wary and suspicious of all that had before brought comfort and happiness, especially people close to me. My body was flooded with chemical messages of danger telling me to hide or run as my endocrine system rebooted.

I kept one packet of Femodette pills on hand just incase I changed my mind, but the more I read and wrote about the pill the clearer it became that I could never take it again.

When a woman takes the pill for over a decade events will occur to make her rightfully sad and angry. I have frequently been told I shouldn't blame any changes to my physical or mental health on the pill just because I happened to be taking it when they came about.

During that time of withdrawal, when I was thinking about the difference between my mood changes on the pill and my mood changes off the pill I would visualize myself as a boat tied to a dock. On and off the pill the sea can get rough and choppy, but when I was on the pill that anchor was no longer there and the boat would be pummeled and pushed out to sea. Now I am off the pill however rough the sea gets there is still that anchor, the mooring to that solid land that is tangible.

I was sick, and then, I was well. That this is not enough evidence of the pill's impact reveals so much about why women are encouraged to take this drug in the first place.

In writing about my experience I came to understand that taking the pill was bound up with how I felt about myself and about being a woman. I was a "pill-taker" for a decade and when I came off it was life changing.

The pill-takers

The pill's rise in popularity was rapid. Between 1962 and 1969, the number of women taking the pill rose from 50,000 to one million. In the US, 1.2 million women used the pill within two years of its launch.

Today eighty percent of women will take the birth control pill at some point during their lifetimes. Three hundred million women have used the pill across the globe; one hundred million are currently taking the tablets each day. Three and a half million women in the UK and fourteen million women in the US are on the pill. Twenty-eight percent of all of the women that are using birth control in the US take the pill, which makes it the most popular non-permanent form of contraception.

Sixty-four percent of women between twenty and twenty-four in the UK use the pill. Fifty percent of women under age twenty-five use the pill in the US – fifty-three percent of those are aged fifteen to nineteen and forty seven percent of those are aged twenty to twenty-four.

Tens of millions more use the derivatives of the pill, known as LARCs or long-acting reversible contraceptives (such as the injection Depo Provera, the implant NexPlanon, the vaginal ring Nuvaring and the hormonal IUD Mirena). A US federal study from the National Center for Health Statistics found that the use of long-acting hormonal methods has increased by seventy-five percent since 1995, and IUD use (the study did not differentiate between the hormonal Mirena or the non-hormonal copper IUD ParaGard) had increased six hundred percent since 2006. However, oral contraceptives still dominate as these methods only retain a relatively small percentage of birth control use – seven percent of women overall use the patch or ring and only five percent use the IUD.

Taking hormonal contraceptives is an experience shared by the majority of women.

Only forty-two percent of American women on the pill admit to using it solely for contraceptive purposes. Fifty percent say they want to regulate their periods and are prescribed the pill for this reason first.

More and more of these women will take the pill continuously from mid-teens to menopause with breaks for children.

Studies suggest that half of women on the pill are aware of suffering from depression and anxiety. A 1998 study from the University of North Carolina, a 2001 Kinsey Institute study, a 2005 Monash University study, and 2008 Lakehead University research all show dissatisfaction with the pill is widespread as a result specifically of its negative impact on emotional well-being.

The survival factor or drop-out rate in studies suggest that there are a large number of women who stop taking the pill after a few months due to intolerable side effects. There are not many published research studies into the emotional impact of hormonal contraceptives considering the number of years the drug has been in existence, and even fewer that are released and published in the mainstream media.

In contrast, the World Health Organization held a six-country study into the potential impact of a male hormonal contraceptive on men's well-being and sexuality and the possibility of such a drug's acceptance and success. A drug that prevents a man from producing sperm is seen as more radical than a drug that prevents women from releasing eggs. The WHO study suggested there is concern over how a male hormonal contraceptive would impact attributes of masculinity.

It is often hard to discern the onset of insidious depression and anxiety. As they develop, they become part of life and a person gets used to living with feelings that seem to have always been there. If a woman takes the pill for years she may not be consciously aware of its impact on her mental health. She may think she feels a certain way "naturally," that it is just in her character to be nervous or to cry at the slightest thing. She may assume her problems are due to her circumstances. If a woman has taken the pill since her teens it is even harder for her to know if her emotional outlook has changed.

Health problems caused by hormonal contraceptives can appear a few months, a few years or longer into use as each woman processes the synthetic chemicals differently.
(Continues...)

---

Excerpted from Sweetening the Pill by Holly Grigg-Spall. Copyright © 2013 Holly Grigg-Spall. Excerpted by permission of John Hunt Publishing Ltd..
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

---