Why Do We Still Know Nothing About Birth Control?

08.10.19

When it comes to the Pill, there are a few things we know to be true: We know that it works by releasing artificial versions of our sex hormones, thus tricking our brain into thinking our body is at a point in the menstrual cycle when the ovaries don’t need to release an egg. We know that, unlike the bleed we have when we’re ovulating, a Pill bleed is simply a withdrawal from the pharmaceutical steroids in the Pill. These steroids look similar to our hormones estradiol and progesterone but they’re not the same. And when we don’t experience the full expression of our endocrine system, we miss out on all the benefits estradiol and progesterone have on our bones, muscles, metabolism and mood. We also know that the Pill is not the devil, it’s popular because it works. And if you suffer from debilitating conditions like endometriosis or extremely heavy periods, the Pill can be life-changing and should be celebrated.

But there’s still a huge amount we don’t know about the oral contraceptive that is being consumed by a staggering 100 million women globally – something that Dr. Sarah Hill is determined to change. Dr. Hill is a researcher of women’s health, a professor of evolutionary social psychology and the author of ‘This Is Your Brain On Birth Control’, a science-based book that landed on shelves last week. In particular, Hill’s research seeks to understand the effects of hormonal birth control on women’s brain chemistry and behaviour. Her research included the Pill, the IUD, the patch and the arm implant (all these different varieties work by changing the hormonal message to the brain, Hill says, so they often have similar side effects). I haven’t had the chance to read her book yet so instead I’ve been scouring the Internet reading interviews and excerpts, and the most consistent message I’ve found is not the potential side effects of hormonal birth control on our brains and bodies (although it is a little terrifying) but rather the complete lack of funding that has been provided to conducting any meaningful research on the topic. This isn’t surprising, Hill says, as doing this kind of research on women is far more expensive and time-consuming than doing similar research on men. She told The Lily: “It’s because our hormones change cyclically. Women have three distinct phases of the menstrual cycle, and during each phase each kind of sex hormone is at a very different level. Sometimes, for example, estrogen is high relative to progesterone, and sometimes it’s the other way around. So this means that, if scientists want to show a relationship between variables, using women as participants, they have to systematically control for hormonal phase. Which means you have to have three times as many female participants, to account for cycle phase, and you have to keep track of it all. It ends up being really expensive, and takes at least three times as long.” Makes sense, right?

I’m 26 years old and first went on the Pill at age 15. I’ve since tried two different oral contraceptives and a hormonal IUD. Two out of the three of those gave me significant and hugely uncomfortable side effects. One worked perfectly. And, as Hill reminds us, “The crappy thing is that the science isn’t yet in a place where we can make good predictions about which camp you’re going to fall into.” But I think what concerned me more, was that in the eleven years I’ve controlled my endocrine system in order to control my period and prevent pregnancy, I hadn’t once heard even half the research Hill has mentioned in recent interviews – and that’s because the psychological effects of birth control have gone largely unexplored. I knew it influenced hunger, energy levels, libido and our emotions, but I had no idea it affected things like who we are attracted to, our sensitivity to smells, our likelihood to display aggression or the culture around us.

Hill doesn’t have a hidden agenda with this book – she isn’t using scare tactics to get women off the Pill, in fact it’s quite the opposite, “Aside from legalising safe abortions, I can’t think of anything that has done more to better the lives of women than the Pill.” She is simply advocating for better research and a women’s right to make an informed decision. InStyle magazine called this book “a rallying cry for more information, more research, and more control of a person’s body and emotions.” It’s now on my summer reading list and you might add it to yours too. In Hill’s interview with The Lily, she said: “I wrote this book to get women to have conversations with their doctors and their daughters and their friends. I also wrote it to help us push for more science. Better science.”

Amen to that.


Header image by Holly Burgess for The Twenties Club