Beyond the Pill: The Untold Side Effects of Birth Control

 Cara Leonard

Beyond the Pill: The Untold  Side Effects of Birth Control

Going into my first year of college, I was looking to help regulate some of my menstrual symptoms and prevent pregnancy. My healthcare provider prescribed me Norethindrone, a progesterone-based birth control. Although he assured me it would help with symptoms including menstrual cramps, bloating, and hormonal imbalances, there was very little conversation about the potential side effects on my body. A few months into taking this medicine, my anxiety had increased and I developed a depressive mood, which combined with seasonal depression, made my mental health worse. I decided to stop taking this birth control drug and noticed a dramatic positive increase in my mood. This experience led me to look into birth control and its effects on mental health. I decided to look at the side effects sheet in the packaging that my provider gave me.

Figure 1. An Example of a Side Effects Sheet for an Oral Contraceptive

The sheet, such as the one shown in Figure 1, had made me question why very few people tell women about the side effects. I spoke to Professor Amber Benezra, an anthropologist specializing in the science of sexuality and the human microbiome. According to her, birth control is typically described as a “cure-all for any type of reproduction issue: cramps, acne, etc,” (Benezra). This was a very similar experience with my healthcare provider, who had grouped all of my symptoms together and stated that hormonal birth control would essentially fix all of them. 

Looking at the history in greater detail, the concept of oral contraceptives had been established in the scientific community by the 1920s. However, it took the efforts of social reformer Margaret Sanger and biologist and philanthropist Katharine McCormick to “persuade reluctant scientists and physicians to create preparations of oral contraceptives” [1]. The first clinical trials for the pill finally took place in 1956 and was finally approved in 1960 [1]. The hesitancy within the scientific community could have most likely been the result of lack of previous medical research into women’s health as well as the taboo surrounding the topic. In other words, the way that women were seen by American society at this time as essentially silent and behaviorally modest housewives affected the way that women’s healthcare was spoken about.

Figure 2. Structures of Estradiol and Progesterone, active ingredients in oral birth controls

Scientifically, the specific forms that focused on were the combination (estrogen and progestin) and progestin-only pills. Estradiol as shown in Figure 2 is the “principal intracellular human estrogen”[2] and is produced by the granulosa cells in the ovaries. This birth control tricks the body into thinking that it is pregnant, preventing ovulation. Progesterone, as shown on the left in figure 2, is a core component of not only the combination pill but the progestin-only pill. This birth control primarily thickens the mucus of the cervix, preventing sperm from passing through the “cervical canal and endometrial cavity”[2] and therefore the fertilization of the egg. In order for these pills to be effective, they must be taken on a consistent basis.

These pills have positive results, including decreased menstrual cramps, lower risk of uterine and ovarian cancer, lighter periods, and significantly decreased chances of getting pregnant [3]. Though the drug was initially prescribed to prevent pregnancies, many healthcare providers prescribe it to their patients to alleviate cramps, hormonal acne, and other menstrual symptoms associated with hormonal imbalances. Additionally, in the 1950s the drug was seen as empowering for women since they could have more bodily autonomy and freedom to potentially pursue careers outside the home.

Despite the positive intentions of hormonal birth control, it led to many side effects. From research, the most common side effects included but were not limited to weight gain, changes in mood, hormonal acne, decreased libido, loss of menstruation, nausea, headaches, and ovarian cysts [3]. As expected, the unnatural intake in hormones would affect several organs and functions in the body (such as the reproductive system) that rely on a normal regulation of estrogen and estradiol. 

This can also lead to very severe side effects, especially an increase of breast cancer and blood clots. For example, a 2018 observational study from 150,000 women concluded that 24% had an increased risk of developing cancer that did not increase with the duration of using hormonal birth control [4]. In other words, individuals who had begun birth control could see an increased risk in breast cancer once they had used the drug for several months of use and would remain the same whether they had used it for 1 year or 10 years. Breast cancer generally occurs based on issues with estrogen receptors, and an imbalance in that specific hormone could alter the risk. Additionally, estrogen influences the way the liver makes pro-clotting factors, which clot the blood when a wound needs to be repaired. However, the increased estrogen could lead to clots developing in the legs, lungs, and even the brain. While this specific side effect is rare, it still occurs in 10 in 10,000 people who take estrogen-based pills only [5]. 

The most shocking discovery while researching hormonal birth control was how little people actually knew about a drug that they were taking. In fact, Dr. Benezra had brought up an extremely important point that “No one tests your hormones before putting you on a hormone-based birth control, no blood sample or anything” (Benezra). 

To look further into this, I conducted a survey of 24 women who were either currently using oral contraceptives or have previously used them. For this survey, I asked the participants a series of questions based on their experiences with oral contraceptives, specifically highlighting their knowledge on how birth control worked. Out of the questions that were asked, two specific ones stood out the most regarding research into hormonal birth control.

Figure 3. Image of Results of Question 5 from Surveying Experiences on the Pill

From Figure 3, a staggering 70% of the 24 participants (with 79.2% using or previously used hormonal birth control) had birth control immediately prescribed to them without any kind of blood test to determine their hormonal levels. This could be extremely detrimental to someone who, for example, has very sensitive hormone levels where any change could cause side effects.

Figure 4. Image of Results of Question 8 from Surveying Experiences on the Pill

Additionally, as shown in Figure 4, a staggering amount of individuals on the pill only had some idea of how it worked. In their responses, they included how they prevent pregnancy in addition to what should and should not be taken with this pill. In fact, 77.3% of individuals had noted that they received most of their information from friends or family members and the internet especially as a result of their lacking conversations from their providers. Additionally, 60% also stated that only some of their side effects were mentioned to them by their provider, with 15% saying none of their side effects were mentioned.

The lack of transparency around birth control side effects stems from the lack of representation for women in the medical field, whether as professionals in fields such as gynecology or as subjects in clinical trials. Additionally, there is a lack of research devoted to women’s health. Furthermore, it was founded by the father of gynecology, Marion Sims, who  performed many experiments on his female slaves without anaesthesia that were key in the development of the speculum[6]. Additionally, for a long period of time, treating women was considered “distasteful and rarely done”[6], a societal attitude that would hinder women from getting the forms of care that they needed.  The lack of acknowledgement for this sexist history continues to plague the medicinal field and affects any research into hormonal contraceptives, whose chemical composition has not changed much in 50 years.

In my meeting with Dr. Benezra, she referenced President Biden’s executive order on a $12 billion women’s health initiative. . The majority of that money had gone to infertility treatments such as IVF. Additionally, out of the 5% of R&D research dedicated to women’s health, 4% focuses on cancers while only 1% focuses on other issues, with 25%of that last category being infertility [7]. So, the research that is being undertaken places an intense focus on pregnancy. In many societies the only purpose of women is to have children, so the emphasis of this kind of research subconsciously conforms to traditional gender roles. Other forms of research I found were mainly observational studies, including the breast cancer research from earlier. These forms of trials can only determine so many things about the data but very rarely touch upon potential side effects of hormonal birth control on a cellular level.  

Addressing these issues requires shifting the field to improve women’s experiences and their body autonomy. This stems from representation, whether as professionals or in clinical trials, especially in the gynecology field: “you can’t simply learn everything about a system from a book, especially when you don’t have that body” (Benezra). Teaching individuals to advocate for their reproductive health is extremely important, as is teaching providers to encourage women to become involved in all aspects of women’s health, from being prescribing physicians, to being engaged in clinical studies and in doing basic research. With these tools, they can implement ways to better care for their patients through extensive conversations and actual tests to prescribe the correct medicine. With more informed care and a broader understanding of birth control, future generations of women will not have to face the same difficulties with going on birth control as I did. 

[1] Oral contraceptive, Encyclopædia Britannica. (n.d.). https://www.britannica.com/topic/oral-contraceptive (accessed December 5, 2024). 

[2] Oral contraceptives - oral contraceptives, Merck Manual Professional Edition. (n.d.). https://www.merckmanuals.com/professional/gynecology-and-obstetrics/family-planning/oral-contraceptives (accessed December 5, 2024). 

[3] Birth control side effects and risks, WebMD. (n.d.). https://www.webmd.com/sex/birth-control/birth-control-side-effects-risks (accessed December 5, 2024). 

[4] Oral contraceptives (birth control pills) and cancer risk, Oral Contraceptives (Birth Control Pills) and Cancer Risk - NCI. (n.d.). https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-sheet#what-is-known-about-the-relationship-between-oral-contraceptive-use-and-cancer (accessed December 5, 2024). 

[5] Cleveland Clinic, Can birth control cause blood clots?, Cleveland Clinic. (2024). https://health.clevelandclinic.org/yes-your-birth-control-could-make-you-more-likely-to-have-a-blood-clot (accessed December 5, 2024). 

[6] Funding research on women’s health, Nature News. (2024). https://www.nature.com/articles/s44222-024-00253-7#:~:text=Research%20related%20to%20women%E2%80%99s%20health%20is%20critically%20underfunded.,of%20that%20further%20limited%20to%20fertility%20research%201 (accessed December 5, 2024). 

[7] The “father of Modern Gynecology” performed shocking experiments on enslaved women, History.Com. (n.d.). https://www.history.com/news/the-father-of-modern-gynecology-performed-shocking-experiments-on-slaves (accessed December 5, 2024).