The pill has granted freedom to generations of women, but the normalisation of pain and the risk of depression as side-effects demand a rethink.
I remember the moment with mortifying clarity: it was a sunny Saturday in November, the day before my eleventh birthday. I was playing inter-school tennis and I was up 5-2 in the deciding set. I approached the baseline, prepared to serve and as I looked down to bounce the ball, I saw it: the dripping of blood between my legs. I wasn’t confused. I may have only been a day shy of eleven but I’d read enough Judy Blume books to know exactly what was going on: I’d gotten my period. I frantically tried to scuff the ground to hide the blood as more trickled down my thigh. I knew I had to get out of there. I double-faulted on purpose, threw the game and raced to find my Dad, who was surprised but played it cool. He told the other parents I wasn’t feeling well and took me home via the pharmacy. My blood-stained skirt and I stayed in the car while poor, clueless Dad went inside for supplies, coming back with Panadol, a hot water bottle and incontinence pads.
Two outta three ain’t bad.
I spent my eleventh b’day doubled over on the couch, clutching my belly and crying in agony while my little brother held my hand and stroked my head and wondered if the same horrors lay in store for him when he turned eleven.
Things never really improved after that inauspicious beginning. Each progressive month my periods seemed worse until finally, at the age of 12, Mum hauled me off to the GP who put me on the pill “to manage my symptoms.” (I was still years away from needing it for contraceptive purposes). Throughout my teens, my periods sent me to bed with a heat pack and a box of painkillers for days at a time. I’d go through a packet of tampons in 24 hours. Sometimes the bleeding would last a week, sometimes longer. When I was seventeen I bled for thirty-eight straight days, passing out and missing an HSC trial exam. Sometimes my doctor would give me an injection to numb the pain, sometimes I’d take sleeping tablets and just knock myself out for a few days. In my 20’s, sex was painful and I bled frequently. One night I ended up in hospital with a burst ovarian cyst and still the doctors (by then I’d seen six in ten years) told me I was just unlucky, that periods were an unfortunate by-product of being female. Each time the answer was the same: try the pill and if that one doesn’t work, try another one. I reckon I’ve tried at least five different pills and whilst they’ve been 100% effective in not getting me up the duff, and some made me feel much better than others, not one of them made me feel particularly fantastic.
So, when a new study came out linking the pill with depression, it wasn’t surprising to me – nor to any woman who has ever popped that little Tic Tac before bedtime and weighed the pros with the cons. We’ve known for years the pill has side effects – any quick scan of a packet will warn of things like weight changes, breast tenderness and mood swings – but we’ve always accepted those as the trade off for having control over our sex lives. What we’ve now learnt, thanks to a groundbreaking study of more than 1 million Danish women over 13 years, is that the effects are more serious than first thought. Women taking the combined oral contraceptive were 23% more likely to be diagnosed with depression whilst women using the mini pill (aka the progestin-only pill) were 34% more likely. For other hormone-based contraception, the effects are even worse, with methods like the patch, the injection and the ring shown to increase depression at a higher rate still. For teenagers the chances of suffering depression increase by 80%.
The pill, when introduced, was a revelation. But it should have been the start, not the end. If women are at an alarmingly increased risk of depression – if the pill is allowing doctors to ignore the true effects of chronic gynaecological conditions – it’s not working.
This study came out last week without a lot of fanfare. A couple of outlets ran with it, with medical talking heads insisting that whilst proper precautions must be taken, the pill was perfectly safe for most people and remained the most effective form of contraception.
There’s no doubt it’s an effective form of contraception. But perfectly safe? I’m not so sure. I’m not a medical expert, nor am I a scientist. But I am a woman who has been on the pill for twenty years and I have many female friends. Anecdotally, I don’t know any women who enjoy being on it, who feel better on the pill or feel that it’s anything other than a necessary compromise. Furthermore, thinking back to my school friends, I wonder now how much of our “normal” adolescent angst was amplified by our contraception.
It took me twenty years – and all those pills – to finally get a diagnosis: endometriosis, where the lining of the womb grows outside the uterus, often attaching itself to other organs like the bladder, bowel and fallopian tubes. One in ten women suffer from it – it’s more common than asthma – but there’s no cure and it’s criminally under-diagnosed because it doesn’t show up on a blood test or an ultrasound. You can’t know for sure you have it without being cut open to find out, as I was last year. It can be removed but it always grows back – mine has already – and my gyno told me (very gently) that there’s really only two options: more surgery or have a baby as the change of hormones during pregnancy can suppress some of the effects of endometriosis. Neither option is ideal right now and the scary reality is that endometriosis greatly affects fertility. I have no idea what twenty years of the condition might have done to my reproductive system and frankly, I’m not quite ready to face that just yet. But I do often wonder if I’d been taken seriously at the age of 12 (or 16 or 25) rather than just being told to pop the pill because my pain was normal…would I have been saved years of the emotional (and financial) burden of my condition?
I’m not alone. The sad fact is that because of this normalisation of pain, endometriosis (and other female health issues like polycystic ovarian syndrome) takes a long time to be diagnosed. Once they are diagnosed, there’s not much to do. Over 176 million women across the world are living with endometriosis, yet there are no cure or permanent treatment. According to a government report, the disease costs Australian society $7.7 billion dollars a year – two-thirds of that in lost productivity from women who are suffering. The rest is taken up on healthcare costs, like surgery and the pill, which are band-aid solutions.
That’s not mentioned what living with a chronic condition does to a someone emotionally and financially. And whilst there are no long-term Australian studies when it comes to the pill and its affect on mental health, the research from Denmark is conclusive enough to assume the same effect is being felt by women across the world. And mental health, as we know, has a huge impact on productivity.
It took me twenty years – and all those pills – to finally get a diagnosis: endometriosis. I often wonder if I’d been taken seriously rather than just being told to pop the pill because my pain was normal, would I have been saved years of the emotional (and financial) burden of my condition?
This adds to the perception, along with the fact that we still pay women less and expect them to stay home and raise a family, that male productivity and well-being is more important than female. It’s why research into male contraception isn’t properly funded and isn’t considered a priority. A male friend said to me recently, “if men were given a middle-of-the-road option, something that wasn’t condoms or a vasectomy, men would happily take a pill.” I’m not so sure they would, because I think there’s a psychological barrier there, but even so, no-one is really trying to make this happen. There has been vague talk of a male contraceptive gel but it has not yet begun a human clinical trial.
There are no more plans for a male pill after the last study, overseen by the World Health Organisation, found that whilst it was seemingly effective in preventing pregnancy, there were concerns about the “negative” emotional side effects that the male pill might have on the participants…as opposed to the truly positive side effects of the pill for women which we’ve already mentioned – not even including the serious side effects like blood clots, cancer and stroke. This is all when women are actually only fertile for six days of the month. Six. Yet contraception remains largely our responsibility, not that of men who are fertile 100% of the time.
The pill, when it was introduced, was a revelation. It sparked the sexual revolution. It was the great liberator, it gave women control over their sex lives, it let them choose if and when they started a family. I’m not knocking it entirely – it’s a bloody amazing invention which suits some women fine and it should always be an option. But it should have been the start, not the end point. It’s been fifty years and now we’re stuck with an “if it ain’t broke, don’t fix it” attitude to birth control.
Well, I reckon it is broke. If women are at such an alarmingly increased risk of depression, then it’s not working. If the pill is allowing doctors to ignore the true effects of chronic gynaecological conditions, allowing them to fester for years, then it’s not working.
It’s ridiculous in 2016 we’re still punishing women for having periods (hello, Donald Trump) and it’s ridiculous that women’s concerns regarding their reproductive health are still not being taken seriously. What’s even more insane is that women are still being held solely responsible for both procreation and the prevention of it. This must change. There can no longer be a “suck it up and bear it” attitude to women’s health. It’s not just a women’s issue. It’s time we all took responsibility.