The landscape of contraception for women has seen minimal change over the past 50 years, with successive generations often relying on the same methods. The conventional pill for pregnancy prevention includes brands such as Microgynon or Rigevidon. Alternative options include the hormonal or copper intrauterine device (IUD), injectable contraceptives, the implant, or the vaginal ring.
The most prevalent contraceptive pills contain synthetic hormones that emulate the body’s natural hormones. These may be predominantly testosterone-based or estrogen-based, each with distinct, nuanced effects. For instance, a pill such as Levonorgestrel tends to have a more testosterone-like effect, including potential side effects such as acne. Meanwhile, the Yasmin pill is more estrogenic, potentially giving clearer skin but increasing the risk of blood clots. Unfortunately, women often receive insufficient information regarding these varied side effects, which are commonly generalised across all pills as headaches, nausea, weight gain, mood swings, tender breasts, or acne.
These synthetic hormones function in several ways. Progestin, a mimic of the natural hormone progesterone, thickens cervical mucus to obstruct sperm. The combination pill, which includes both progestin and synthetic estrogen, not only thickens the mucus but also disrupts ovulation. These components are present in oral contraceptives, implants, and hormonal IUDs. The copper IUD operates differently, as copper is toxic to sperm, but it may lead to increased menstrual bleeding.
The problem with synthetic hormones
Synthetic hormones can suppress natural hormones and do not always interact identically with the body’s receptors. For example, natural progesterone has a calming effect and promotes sleep, whereas the synthetic version, progestin, may bind to incorrect receptors, disrupting the body’s balance rather than providing the calming influence of natural progesterone.
Moreover, synthetic hormones can influence mental health. Estrogen and serotonin are closely linked, with low estrogen levels correlating with reduced serotonin, leading to emotional blunting. This effect is observed during menopause when estrogen levels decline, resulting in decreased mood and heightened anxiety. Synthetic estrogen, similar to progestin, may not always target the appropriate receptors, causing young women or individuals with female reproductive systems who take the pill to experience emotional effects akin to those of menopause as their bodies produce less natural estrogen in response to the synthetic hormones.
In the documentary Pill Revolution, Channel 4 surveyed 4,000 women in the UK and discovered that 64% began using the pill during their school years. Alarmingly, there is a significant research gap on how this might affect brain development in adolescents. The pill is often prescribed with scant information on the potential impact of various synthetic hormones on the body and mind. Of the surveyed women, 77% reported side effects such as weight gain, headaches, decreased mood, and libido. A 2016 Danish study involving over a million women revealed that those using a pill with synthetic progestin were 34% more likely to be prescribed antidepressants within the following year, with users of the hormonal IUD facing a 40% increase.
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By GlobalDataDifficulties in research
Historical research on birth control was marred by unethical practices. For example, in the 1950s, an asylum in Massachusetts served as a testing ground. Inmates were given high doses of the pill with permission from their families but without their own consent. Three women died from the excessive dosage, and a quarter withdrew from the trial due to headaches and dizziness – symptoms indicative of potential blood clots and strokes. Ideally, the effects of the pill would be studied through randomised control trials with a placebo. However, this approach faces volunteer recruitment challenges, as those seeking contraception wish to ensure pregnancy prevention. Consequently, reliance on surveys of personal experiences with the pill may leave women feeling like experimental subjects in the examination of their bodies.
What does the future hold?
Emerging alternatives include new apps that measure basal body temperature daily. Since ovulation raises body temperature, the app advises the use of a condom during this period. However, factors such as illness or alcohol consumption can affect temperature readings, making these apps just 93% effective.
Nonetheless, the onus should not rest solely on women. Ongoing trials are exploring various male contraceptive methods. The NES/T trial in Edinburgh, spanning over a decade, involves a shoulder gel containing progestin and natural testosterone, which significantly reduces sperm count after three months of consistent use. Plan A is another approach, injecting a temporary vasectomy gel into the vas deferens to block sperm, with a subsequent injection available to dissolve the gel. YCT529, still in the experimental phase, targets a receptor involved in sperm function.
Whatever the future involves, greater research is needed into birth control. With methods remaining fundamentally unchanged for the past few decades, it is an area of healthcare that has been largely neglected, and the effects of birth control on a person’s health and well-being are vastly overlooked.
