A hard pill to swallow: women deserve better contraception

The contraceptive pill needs a makeover, one that doesn’t destroy the mental health of the women who rely on it.

The moment I started taking the contraceptive pill for the second time, I was at rock bottom. Whilst my first attempt at hormonal contraception was for a feeling of control over my sex life, the second attempt was more of a medical emergency. I wouldn’t have ever gone through it all again, had it not been for the worst case of premenstrual dysphoric syndrome. 

Throughout the years, my poor mental health has been a faithful partner that has never let me go. When I realised that the peak of fear and distress reached intolerable levels around one week before my period, an alarm finally rang into my head. Could my misery not be a personality trait? Could the suicidal thoughts trapping in my bed at specific times be short of a bodily function?

An appointment with a dermatologist for a lasting acne problem, who immediately asked about my experience of low mood, pushed me to get a blood test. The hormonal imbalance in my body stared at me from the results paper: an excess of testosterone and prolactin was now to blame, not my character. It was a liberation to no longer feel guilty for giving up on life once a month.

Ever since the discovery a year ago, I have been on a combined pill of ethinylestradiol and drospirenone. At first, I thought my life had changed forever, as the depression disappeared in less than four weeks. For around six months, I was in control of my body, my mood, and my energy. Then anxiety, somehow, replaced the dysphoric syndrome and made it worse.

I have never been this close to a literal bundle of nerves. The physical sickness of constant tension, no matter how amplified by the impact of the coronavirus frenzy, is short of a chronic disease. I have been obsessing over small leg aches and feeding into the terror of dying from a blood clot, the big enemy of women on the pill. The feeling is present all month long.

I have been overly concerned about my heartbeat, the occasional chest and arm pain, the chance that my calves might swell and turn black. I check my skin too often for someone who has never had a good relationship with mirrors. Despite repeated medical checks which prove I am in good health, my brain is now struggling to focus on the objective truth.

As the pill leaflet became an endless list of my imaginary symptoms, it also listed some terribly real ones. Turns out I am one of many women accusing Eloine, or any other birth control for that matter, of being the real reason behind either recovered or out-of-the-blue anxiety. While depression no longer seems to be there, the pill has triggered new problems.

As much as I would like to stop taking the pill, I find myself in the decisional trap of choosing between either a shorter, extremely serious bout of depression once a month, or constantly live with low-level anxiety until it leaves me bursting into tears with worry. I have yet to find a valid answer, one that would see me in power. Studies on the mental consequences of the pill are few, but they all suggest that we should not underestimate these less-known side effects. Some hint at the possibility that as the pill causes mood swings, your existing anxiety will be pushed further. Others have found that sections of the brain cortex responsible for emotional responses are thinner in users of the pill. Danish researchers have found that the combined pill has a significant impact on prescriptions for antidepressants and anxiety medication.

But, it is the lack of research that worries me the most. I did not decide to be on the pill out of sheer independence. For years, I have been a victim of a permanent hormonal imbalance which has no other palliative care but contraceptive methods. And yet, in spite of an increasing number of accounts on its second nature, we continue to believe that the pill is perfect the way it is.

I do not wish to destroy in any way the emancipatory value of the pill. In that sense, it is probably the most effective, empowering tool for sexual activity that could be conceived. However, I am sure that it can be improved for those who, like me, depend on it for something as far-reaching as mental health.

Is it possible to not see it as a simple reproduction issue? As we wait for research to determine what can be done, I have the fervid hope that at some point we will see the pill as a powerful means in need of a makeover. Limiting its potential to pregnancy prevention or cure painful cramps does not reflect the many aspects of life as a woman. We deserve better from our bodies and brains, let alone medication to make them work in sync.