Feature: The Risks and Benefits of Hormonal Contraceptive
The following article functioned as my final project in Advanced Reporting: Women in Journalism at the University of Cincinnati
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A 14-year-old girl visits her family physician because her monthly period cramps are too excruciating to get out of bed for school. Somewhere, in contrast, an 18-year-old makes her first gynecologist appointment because her period has been missing for half a year. Somewhere else, another teenager desperately schedules a doctor’s appointment, seeking some sort of solution to their acne-dotted complexion, accosted by the demands of a lofty beauty standard. All these situations are hypothetical, of course, but certainly possible, and all would raise the question that likely anyone with a uterus in their body has heard from a doctor, friend, or family member before: Why don’t you just go on the Pill?
The Pill: a supposed cure-all for debilitating period pain, irregular menstrual cycles, and so on. Of course, “the Pill” refers to hormonal birth control pills, the contraceptive method with a 91% success rate that has come to be used for a lot more than preventing pregnancy.
Hormonal birth control, which also comes in the form of an arm implant or intrauterine device (IUD), can be prescribed for problems as simple as acne. It pauses ovulation, the stage of the menstrual cycle where impregnation is possible. This is also the time of the month where one typically feels the most energized. But the medically induced disruption of this cycle is not without drawbacks. Overwhelming research provides strong evidence that a link exists between oral contraception and cervical and breast cancers. A 2003 study found that those who take birth control for longer than five years have nearly a 60 percent increased risk of getting cervical cancer. Taking it for more than ten years offers a doubling of the risk, according to the results. This is because the Pill contains man-made versions of naturally occurring estrogen and progesterone, which can stimulate the growth of cancers.
However, these findings are based on large-scale studies, where any number of factors can affect the participants at any moment. According to Dr. Meredith Pensak, an OB-GYN at the University of Cincinnati’s medical campus, hormonal birth control has the capacity to be an amazing tool. She often prescribes it to her patients who experience disruptive menstrual pain, polycystic ovarian syndrome (PCOS), or those who simply wish to not have a period because it is costly and inconvenient. But Pensak acknowledges the side effects that come with pausing ovulation. “For the combined hormonal contraceptive pill [birth control containing both estrogen and progesterone], probably the most common side effects occur as you first start to use them,” She explains. “You can initially have some bloating, some fatigue, maybe some slight mood changes. They do improve after time.”
These side effects range from mild to extreme and differ widely per individual. Jenn Tomak, a third-year UC student majoring in environmental studies, describes her first week on birth control as “hell:” “I had never been more depressed and suicidal as my body was adjusting to the hormones,” Tomak says. “I couldn’t believe I was feeling that way outside of my normal period cycle. I stuck with it, and the suicidal ideations were reduced after that one-and-a-half-week mark. But that week and a half was still a haunting experience.”
Tomak began taking birth control at age 16 after experiencing depression and anxiety during menstruation, along with debilitating cramps that could make her vision go black. However, the male gynecologist she saw at the time only took her physical pain into consideration. Tomak never could’ve imagined that going on The Pill would affect her teenage mind like it did, until a different gynecologist – a woman – diagnosed her with Premenstrual Dysphoric Disorder (PMDD). Miraculously, her PMDD symptoms began to decrease after a couple of months on the Pill. “I’m grateful every single day for hormonal birth control’s impact on my mental health,” Tomak says. “A side effect that’s followed is a decreased sex drive. It sucks, a lot, but having my life in my own hands without the extreme downs of my period, to me, is a sacrifice that’s worth it.”
Adriana Arias, also a UC third-year in environmental studies and a friend of Tomak’s, says she also has a complex relationship with hormonal contraception. She’s been on some form of birth control for roughly eight years, and received her prescription to help manage detrimental menstrual cramps. After a few years on the Pill, Arias switched to Nexplanon, an Etonogestrel implant that’s inserted in the arm. Nexplanon lists the typical array of birth control side effects on its website: Mood swings, weight gain, depression, breast pain, and so on. But after getting the implant, Arias found herself seized by one of the more serious side effects: Ovarian cysts.
“The first time I got a cyst I went to urgent care, and I was in really excruciating pain,” Arias recalls. I couldn’t even bend down to put on my shoes. They told me I probably had a kidney stone and told me to go see my primary care provider. I went to my doctor – who was a man – and he asked me ‘Are you sure you’re not just on your period?’” Arias was sure that she wasn’t experiencing typical period cramps, and asked to get a CAT scan, to which the doctor replied, “You’ll probably be fine.” A week later, after ordering a CAT scan on her own volition, a 4.1cm (about 1.6 in) cyst was found on her ovary. She wasn’t aware of this right away, though, because a MyChart message from her male healthcare provider claimed her scan turned out “fine.” “It really showed me how feminine issues can be totally disregarded in the medical world,” Arias says.
Arias got her Nexplanon implant removed and is back on the Pill. When asked if she would recommend hormonal contraception to a friend, she replied: “Really, no. Not unless you need it for medical reasons. But I also understand if somebody needs to be on it out of fear of becoming pregnant, because it can be really difficult to get an abortion in a lot of places. And even if it is legal, it’s also really terrifying to get one.”
An overarching theme present in both Tomak’s and Arias’ accounts is dissatisfaction with their male gynecologists. Both women expressed a feeling of not being taken seriously, or their issues being swept under the rug. “It was almost two and a half years before I was told the proper method of taking my birth control to help my PMDD,” Tomak says. Initially, she would take a week off the Pill every three weeks to experience withdrawal bleed, but now she takes it every day. “I had to see a female gynecologist who took my concerns seriously,” Tomak says. “Without being on the proper prescription, I didn’t feel that it was right.”
The root causes of intense cramping, PCOS, and other ailments are frustratingly shrouded in mystery, which leads many professionals to prescribe contraceptives. “Reproductive healthcare and women’s health care in general is an area that for many years has had less funding for research, so we definitely have a lot of questions,” says Dr. Pensak. “We obviously want to rule out that there isn’t an underlying cancer or other disorder of the uterus that’s causing [these issues]. Some people just have really heavy periods, but a completely normal workup. That’s when we turn to some of these other things, like hormonal birth control, to shut down your ovulation, to prevent a period from happening, to help with that.”
The sources of menstrual ailments can have surprising causes, according to a 2021 study The South Korean study, conducted by affiliates of The Research Institute of Nursing Science at Seoul National University and the Wonju College of Medicine at Yonsei University, found that dietary modifications had significant effects on period pain in a group of female college students throughout three menstrual cycles. Those with lower levels of Bisphenol A (BPA, a chemical produced in the production of plastics) in their urine experienced less severe menstrual cramps. This study provides damning evidence about the effects of endocrine-disrupting chemicals’ (EDCs) on reproductive health. EDCs mimic estrogen and adhere to the estrogen receptor; a potential cause for extreme cramps.
Drawing broad conclusions from this study, one might think that hormonal contraception is a sort of “Band-Aid solution” to debilitating period cramps, and lifestyle adjustments can ease the symptoms of an unpleasant cycle. When discussing the subject of holistic solutions, Dr. Pensak refers to a sort of middle ground: “I think they have to work together,” she says. “Lifestyle modifications, medications: it all has to work together.”
While many holistic health advocates oppose hormonal birth control for wellness reasons, this is often rooted in purity culture. Since the fall of Roe v. Wade, many religious anti-abortion groups have shifted their gaze to hormonal birth control, using social media to peddle medical misinformation and insist that these methods cause abortion. The slew of conflicting information makes it difficult to categorize hormonal contraception as “good” or “bad.” Holistic “healers” with massive draw on social media platforms like Tik Tok promote cycle tracking to prevent pregnancy. Cycle tracking, which relies on the observation of biological signals to determine when ovulation takes place, can be effective and may help one get more in tune with their body, but it’s very risky for those with irregular menstrual cycles, according to Dr. Colleen Denny, a New York City-based OB-GYN quoted in a Vice article about these Tik Tok “healers”.
Before prescribing hormonal contraception to a patient, Dr. Pensak figures out the person’s “goals” first. What’s important to them? Do they want to experience withdrawal bleed, or are their cycles so heavy that they’d rather not bleed at all? Most importantly, does the patient plan to have children? “I know it sort of looks like we’re just throwing hormonal birth control at people and saying ‘Well, we have nothing else,’” Says Pensak. “But we really do that because we know it works for a lot of people.”
Tomak describes her present relationship with hormonal contraception, following almost five years of ups and downs: “I am still on hormonal birth control,” she says. “I would love to not be on it and give my body a chance to do her thing, but I do not want to revert to my un-medicated self. There are consequences to almost any medication you put in your body. As long as they’re aware of the possibilities and the impacts it may have, I’ll always support someone discussing hormonal birth control with their doctor to see if it’s right for them.”