Why is avoiding pregnancy such a hard pill to swallow?

Vue recounts society's complicated history of making love without making babies

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From 17th century French methods of brandy-soaked sponges, to early 20th century olive-oil-soaked sponges and cocoa butter/boric acid recipes for which women paid $50, to the giant breakthrough pill of the 1960s, to the modern mini pill and the possibility of a male pill, we’ve come a long way. One thing is clear—women have been trying to control conception for a very long time, and have overcome more than a little resistance along the way.

Birth control clinics in the 1930s distributed foams, diaphragms and condoms only to women who were married with a minimum of two children, and drug store owners in 1960 could still be fined for distributing condoms. And though the pill became available in the early ’60s, contraception wasn’t legalized until 1969. Doctors, however, had by then been prescribing it for close to a decade, though ostensibly only for menstrual irregularities and severe cramping.
The first pill, Enovid, with its built-in overdose, caused thousands of blood clots and strokes before we figured out we only needed a fraction of the dose it delivered for effective contraception. Modern pills, which deliver about a tenth the level of hormones, are considered safe by most, though not by all.

One thing almost everyone agrees on is that the pill and its cousins are an effective form of contraception—anywhere from 92 to 99 per cent effective. But whether we’re talking about the combo pill or the mini pill, the Patch, Depo Provera shots, the Nuvoring or the newly-approved Seasonale, we’re talking about tampering with a woman’s natural hormonal state, which comes with some risk. And we’re also still talking about opposition, though the loudest opposition now comes from new quarters, from people anything but anti-sexual freedom or anti-feminist.

Most opposition to birth control has historically been based primarily on philosophy, the argument being that effective birth control promotes immoral and liberal attitudes toward sex. But the idea of hormonal contraception, now both widely accepted and even pushed by mainstream medicine and pharmaceutical companies, is now being opposed by women themselves—women tired of being expected to artificially override their natural hormone states, and women sick of both the immediate effects and the long-term risks associated with doing so.
“Women are so ready for options in birth control,” said Megan Lalonde, a holistic reproductive health practitioner with Justisse Healthworks here in Edmonton.

“We work with a physician who supports choice for women, and see women of all ages, women in their late teens to those in perimenopause,” she explained. “Some have never been on the pill and prefer not to take oral contraceptives, others can’t be on it because of familial health histories, and many just don’t like how being on the pill makes them feel.”
For many years women have routinely been told by their doctors that the pill is the only truly reliable option for birth control. And though things are changing, Megan pointed out that “women are still too often being shamed by their doctors for going off oral contraception because of its side-effects.”
Most doctors and pharmacists insist the chemicals found in the pill are very similar to the hormones produced by our own bodies and are very safe, though the pharmacist at my local drug store couldn’t explain to me why we so readily consider the pill safe when the hormone levels delivered by even low-dose pills are actually higher than those delivered by standard hormone replacement therapy—the risks of which have received much attention in recent years.
But not all health professionals are comfortable with the idea of synthetic hormones. “Their chemical structure is different from the hormones produced by our bodies, and so is their action in our bodies,” said local alternative health practitioner Cathy Weigle. “What they do is override our own sensitively balanced endocrine systems, which can have far-reaching effects.”
Pharmacists who provide bio-identical hormones for menopausal women agree that in order for a hormone to fully replicate the function of our own, the chemical structure must match exactly—and synthetics don’t.
Combination pills work by suppressing our bodies’ own hormone production and feedback cycle, and by artificially controlling hormones at levels high enough to suppress ovulation. Estrogen/progestin combination methods include varying doses of daily pills, the Orthoevra patch, the Nuvoring and Seasonale. The well-marketed Orthoevra patch delivers the convenience of once-a-week changes over daily pill-popping but delivers more estrogen than low-dose combo pills. The Nuvoring delivers estrogen internally over a period of three weeks, and the controversial new kid on the block, Seasonale, which does require daily pill-popping, comes with the promise of only four periods a year.
The advantages of estrogen/progestin combinations generally cited are alleviation of severe menstrual symptoms or acne and regular cycles. (And with Seasonale, only four per year; with the 365-day pill Lybrel now on the horizon, none at all). Combo pills can also help prevent bone loss and come with a slight decrease in risk of ovarian and uterine cancer. But they also come with a daunting list of disadvantages.

Protracted periods of elevated hormone levels bring an increased risk of cervical abnormalities and, according to the Canadian Cancer Society, an increased risk of breast, cervical and liver cancer, though Planned Parenthood says a link to cancer has not been shown.
Combination pills also come with an increased risk of blood clots, heart attack and stroke, especially in those who smoke, though Planned Parenthood says this risk is limited to smokers only and primarily to higher-dose estrogen formulas such as the patch. Combo pills also come with the fairly common side effects of depression, nausea, headaches and reduced libido, and with the fairly rare (though I’ve seen it in a friend) effect of darkened skin on the upper lip and under the eyes, which can be permanent.

Hormonal birth control has also been shown to cause a number of key nutritional deficiencies, which can have far-reaching health effects. And there is little disagreement that synthetic estrogen in the pill is less easily metabolized than other hormones, which puts significant stress on our livers.

Research published in the Journal of Sexual Medicine last year showed reduced bio-available testosterone in women while on the pill, and persisting well after stopping the pill—which just may explain the not-so-little irony of decreased sexual desire many women experience with oral contraception.

Progestin-only options include the mini pill, Depo-Provera and Norplant, which work mainly by making things difficult for sperm rather than by preventing ovulation. The mini pill is tolerated well by some who don’t tolerate combination pills, but both the quarterly injection Depo-Provera, which has already been embroiled in a class-action lawsuit, and Norplant, a set of capsules surgically implanted under the skin of the upper arm and replaced every five years, seem to come with more trouble than benefit.

The mini pill comes with a slightly higher failure rate than combo pills, mostly due to its time sensitivity—a pill missed by three hours can cancel protection, which is a problem for travellers and partying types with irregular schedules. And all progestin-only options come with the very real risk of osteoporosis, as well as the short-term side effects of intermittent and unpredictable bleeding, headaches, acne, weight gain and irritability. (Men have been known to quip that the main reason progestin-only options work lies in their ability to make women irritable.)
Despite its list of problems, the pill is still popular with many women, but especially with the doctors who encourage its use—and with men. One young man, in summing up the attitude of his peers, said, “There are two kinds of women, those on the pill and those not.” It’s not hard to guess what they prefer; based on what I hear from the young women I know, the pressure to be on it is significant.

The pill’s popularity with doctors lies in its reliability, though there is yet another energy driving it. Not all options in birth control are patentable, and those who profit from hormonal contraception have more than a little influence. When sales of hormone replacement drugs for menopausal women dropped because women began turning to pharmacists willing to compound bio-identical hormones for them, the drug company Wyeth filed complaints against the compounding pharmacies.

I asked Weigle if she’d recommend the pill for her daughter. Her answer was a pretty quick and definite no.
“There are other safe and effective options out there,” she said, “and fertility awareness education will empower women much more than the pill has.”

The tension between pharmaceutically oriented doctors and women becoming aware of the consequences of disturbing their very finely tuned hormonal systems may well just be beginning. But more and more women are paying attention to their intuition and insisting on information and choice, even digging in their heels in the face of pressure. One thing is sure: as women have fought for choices in how they give birth, they are now also fighting for non-invasive and non-chemical options in birth control. V

Why is avoiding pregnancy such a hard pill to swallow?

Vue recounts society's complicated history of making love without making babies

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