When I was in my twenties, health was about fixing problems, not listening to my body. Got a mild breakout? Well, birth control pills can help. Can't fall asleep? Pop an Ambien. Need to wake up? Drink a latte.
I didn’t spend much time learning about my body or listening to it. That was for people who were sick or had “health issues.” So I ignored signs that I was out of whack. I’d go out partying all night, then expect to fall asleep immediately. I’d toss and turn, confused as to why, after 5 drinks and 4 hours of dancing, I felt restless.
And then I’d wake-up early, chug a Gatorade, drink a lot of coffee, and go on a 12-mile run. I thought that being able to finish a half-marathon with so little rest was a testament to my health. I didn’t realize it was just another way of creating stress in my body.
While most of these habits didn’t cause too much long-term damage to my body (or so I hope), one of them almost killed me. I had a life-threatening pulmonary embolism, blood clots in the lungs, precipitated by years of taking birth control pills, which I have written about here.
Only after I wound up in the ER did I start to ask questions about the pill and what, exactly, I'd been putting in my body every day for a decade. It had never before occurred to me to do my homework about these powerful drugs. Like all my friends, I'd grown up believing that the pill was proof of social progress, a sign of our empowering ability to invest more time in careers, and to choose when (and if) to start a family.
Also, I hadn’t given much thought to birth control pills because it seemed like everyone was taking them. And in fact, they were: nearly 12 million women in the US, and about 90% of all college-educated sexually experienced women have used the pill.
Here’s what I wish I’d known about birth control pills back when I was a 20-something:
1. Taking the pill can reduce your risk of endometrial cancer and ovarian cancer.
Taking birth control pills is one of the few things known to reduce your risks of endometrial cancer and ovarian cancer. According to Dr. Sara Gottfried in The Hormone Cure, “five years of birth control pill use is associated with a 90% reduction in future ovarian cancer.”
2. But taking the pill might increase your risk of other types of cancer.
While studies have shown that birth control pills can reduce the risk of ovarian and endometrial cancer, there are questions about an increased link to breast cancer, cervical cancer and liver cancer. A 1996 study found that women who had used the pill had a slightly higher risk of developing breast cancer compared to women who had never taken the pill. Other doctors find the increased risk of breast cancer for women on birth control pills is not that significant, while others say the risk decreases after being off the pill for ten years.
3. The pill is classified as a carcinogen.
Yup, it's in the same class as toxins such as tobacco and asbestos according to the World Health Organization. There’s a reason that New Yorkers don’t want the remnants in their water supply and are reaching for their water filters.
4. It’s more than 99% effective if used correctly.
Note: If and only if, it’s used correctly.
5. It can cause blood clots in women, especially if you are a smoker, overweight, or over 35.
The risk of blood clots is lower if you don’t fall into these categories, but it’s hard to truly understand the total risk since Denmark is the only country in the world with a national registry of all women who've experienced blood clots.
One study looked at healthy Danish women over a 10-year period and found that birth control pill users were twice as likely to experience a blood clot compared to women who did not use birth control pills. While the risk is still statistically small—approximately 6 out of 10,000 women—it's still a risk, and it's a life-threatening one.
If you’re worried about a genetic pre-disposition to clotting, some doctors will screen for common genetic risk factors, such as Factor 5 Leiden, which affects roughly 5% of Caucasian females. Factor 5 Leiden is also a routine pre-natal test as pregnancy increases the risk of clotting due to hormone changes. A negative Factor 5 test doesn’t mean that you're out of the woods from a genetics standpoint, as other genetic mutations (such as MTHFR, Protein C and Protein S to name a few) can also increase your risk of clotting.
6. Newer pills aren’t necessarily safer.
Some “newish” pills on the market, contain drospirenone (DRSP), a synthetic form of progesterone. A 2012 study by Kaiser Permanente found a 77% increase in the risk of hospitalization for blood clots and doubling of the risk for blocked arteries compared to the risk associated with low-dose estrogen pills. Just as you know to read the ingredient panel on your food, see if your pill contains drospirenone so that you are aware of any potential increased risk.
7. Some types of pills may increase your risk of heart attack and stroke.
Estrogen-Progestin birth control pills showed a higher correlation with heart attack and stroke. The overall risk is still pretty low, but it’s still a risk.
8. The pill depletes your B vitamins.
Our B vitamins are our neuroendocrine system’s BFFs. They help us live happier and healthier lives by reducing stress, boosting memory, and reducing heart disease. All good things, right? But birth control pills can further increase the needs for folic acid and the B family. Dr. Sara Gottfried recommends adding a B vitamin if you're going to take the pill. Marketing savvy Bayer has recently introduced a pill with folic acid, also know as vitamin B9. Interesting…
9. The pill can help with some acne.
The pill lowers androgens, a group of hormones that includes testosterone, which can help with some acne. Sounds good, but....
10. The pill may lower your sex drive.
The same hormonal changes that clear up that pesky pimple may also decrease your libido. It tinkers with your ability to know if you're just not that into him – or if the amount of testosterone your body can use has been lowered. Dr. Christiane Northrup writes in Women’s Bodies, Women’s Wisdom that “the pill suppresses the midcycle testosterone surge, thus decreasing sex drive in many women.”
11. Taking the pill could explain why you've been bringing home certain types of guys and ignoring the nice guys at the bar.
Researchers from St. Andrews and Stirling Universities have found that women on the pill tend to choose more macho, masculine men with distinct physical characteristics and disregard sensitive, more feminine men with softer features. Sensitive men tend to be good communicators and also able to express their feelings, traits that make good boyfriends, husbands, partners, and fathers. Probably not a good group to marginalize in the dating pool if you are looking for a long-term relationship. And who wants to enter the dating pool with “pill goggles” on?
Other medical experts such as Dr. Laura Berman have questioned the psychologists’ conclusions explaining that there was not enough data about the women’s physical preferences. The jury is out.
12. The pill could impede your ability to find your best match.
There may be more than just personality compatibility to the adage that “opposites attract.” In Woman Code, Alisa Vitti writes that “the more genetically dissimilar two partners are, the lower their rates of miscarriage and the greater their chances are of having a healthy baby as well as happier relationships, more satisfying sex, and a greater likelihood of female orgasm. However, women on the Pill tend to unconsciously seek out men with more similar genes…” Ok, that’s scary. I wonder if any of the 4-year-itch can be attributed to birth control pills? Women meet a partner while on the pill, when they get ready to have children, they stop using birth control and then they become less attracted to their mate, which strains the relationship even more.
13. It’s a Band-Aid for menstrual cramps, pain, and migraines.
Up to 60% of women experience some sort of menstrual cramping and get some symptom relief through birth control pills, which have been shown to eliminate ovulation, and the hormonal fluctuations linked to cramps and pain. Are there long-term effects of using birth control to treat these symptoms? The jury's out.
14. It can delay your fertility.
The monthly cycle is the best text message from your body that your hormones are in-sync. Progesterone and estrogen in-balance? Check. Other hormones in-sync? Check. Hypothalamus sending the right signals? Check. Since you don’t experience a “real” period on the pill, you are missing the signs that everything is – or isn’t working correctly. With women coming off the Pill later in life, Vitti writes that “now, having gone off the Pill, not only do you have to direct your energy toward healing the issue, but it may take longer to do so than had you addressed the real problem originally.” With less time available to “fix” the issue, many women may opt for more drugs to help get their bodies back in sync. And so the “cycle” continues….
Knowing what I know now: would I take the pill again?
No, it wasn’t for me.
Am I telling other women to ditch the pill? Not necessarily. I'm telling you to realize that it’s a big decision, and—as with all major life decisions—make an informed choice and get the right people on your team to help.
Invest the time in finding a great doctor and building a relationship with that doctor. Ditch the transactional mindset of “I’ll-take-this-Pap-and-answer-some questions-if-you-give-me-a-prescription” and learn how to better build a relationship with your doctor so that she can truly be your trusted co-pilot.
On the road to recovery from my pulmonary embolism, I found it helpful to learn more about the connections between birth control, hormones, and fertility. Reading books by women’s health pioneers such as Dr. Claudia Welch, Dr. Christiane Northrup, Dr. Sara Gottfried, and Alisa Vitti HHC, helped me understand what the heck was going on in my body for the decade that I was on the Pill. I recommend those books for anyone hoping to take charge of her health.