Why It's Time For Women To Question The Pill

by Rachel Krantz

I didn't get my first period until I was 16-and-a-half years old. I was the last girl I knew who hadn’t gotten it, and I was downright ecstatic when I finally saw my stained underwear. Here, finally, was the proof that I was a fully functional woman.

I don't remember when I got my second period, but it was probably at least five months later. The next period came four or five months after that. I never saw any problem with it — until I went to see my doctor for a checkup.

She said she was concerned about what she called "my irregularity." Are you thinking about having sex? I remember her asking me, almost offhand. I answered that I had a regular boyfriend, but was still a virgin ... for now. I had just turned 18. Her swift prescription for the birth control pill killed two reproductive birds with one stone: I would be protected against pregnancy, and I would get a regular period.

Though I was already thinking about having sex soon (and as much as it feels like a progressive taboo to admit it), the pill did feel like a mandate to expedite the process. Though I absolutely would have lost my virginity that summer anyway, I decided to have sex the next night.

The only problem was that my doctor didn't warn me that the pill took a week to become effective — and I was too naive to consider otherwise. It wasn't until I read the prescription liner notes the morning after (hey, I was a teenager) that I realized I had to call my doctor. I needed a prescription for Plan B. I spent the next 48 hours feeling more nauseous than I had in my entire life. This is so unfair, I remember moaning over the toilet, cursing my boyfriend.

In the end, though, I did well on the pill. I experienced minimal side effects — perhaps some decreased libido, a little bloating. My skin was radiant, and to my own delight, my breasts went from modest b-cups to the c-cups I’d always wanted. Perhaps best of all, I finally felt like I was getting a "normal" period. Every month, right on time.

But I never quite took to the idea of being on artificial hormones for my entire reproductive life. Perhaps because I could count the number of natural periods I’d had on one hand, I was still eager for my body to learn how to do things the old-fashioned way. So every year and a half or so (usually when I was in between relationships) I’d decide to stop taking the pill for a while.

When I’d go off birth control, I tended to get one “real” period about a month after my withdrawal bleed, right on time. Then, it was pretty much reproductive radio silence from there. After about five months of no bleeding, I usually got concerned and went to the gynecologist.

That doctor would always tell me the same thing: that it sounded like I have something called PCOS, or Polycystic Ovary Syndrome. PCOS affects one in 15 women, and according to the Mayo Clinic, it is a hormonal disorder common among women of reproductive age, and marked by “Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity.” The biggest clue as to whether or not a woman has PCOS? “In adolescents, infrequent or absent menstruation may signal the condition.”

I never suffered from acne, excess hair, or weight gain. Doctors never suggested an ultrasound of my ovaries to confirm that there were, in fact, cysts on them. Tests of my hormone levels always came back normal. And yet I was told time and again by numerous different doctors in different cities that I "probably had PCOS," and it was always recommended that I resume taking the pill. Which I always did, for the better part of eight years, despite my feeling that something wasn't right.

A small but growing number of doctors and health advocates are beginning to question the widespread prescription of hormonal birth control. They are raising what may be one of the most taboo questions a feminist can ask these days: What if the pill isn’t really all that good for women?

When I questioned doctors, repeatedly, what the long-term effects of being on hormonal birth control might be, they usually answered in a manner that seemed designed to placate me. "In your case, the benefits outweigh the risks," more than one told me. Only one doctor told me it might be good to "take a break every few years, just to give your body a break from the hormones."

When I asked whether the fact that I'd had so few natural cycles might affect my ability to have children one day, I got answers ranging from "You won't know until you try" to "It may very well take you longer, or IVF treatments" to "Don't think about that now. Enjoy your life, and worry about it when you get there."

I never felt reassured, and the more I learned about the pill, menstruation, and big pharma, the more I questioned whether I was making the reproductive health choice that was right for me. So I decided to do what any journalist would: I would use reporting as an excuse to figure out whether I should stay on the pill.

“I totally agree that the pill changed power and changed the way women control reproduction. But we’re beyond that now,” Dr. Jerilynn Prior, Scientific Director at The Centre for Menstruation and Ovulation Research, told me. “We now not only have the power to control our own reproduction — but also to affirm our own natural physiology. Once you realize the menstrual cycle serves not just a reproductive purpose, but also an extremely important physiologic purpose, then you start to look at controlling reproduction in a less cavalier way.”

What I found is that a small but growing number of doctors and health advocates like Prior are beginning to question the widespread prescription of hormonal birth control. They are raising what may be one of the most taboo questions a feminist can ask these days: What if the pill isn’t really all that good for all women? Especially when it comes to long-term use of the pill?

My teenage induction into the birth control pill club — before I was even having sex or getting a regular period — is reflective of a much larger trend.

Prior, who is also a Professor of Endocrinology and Metabolism at the University of British Columbia in Vancouver, is troubled by the ubiquitous use of oral contraceptives to treat menstrual disorders like PMDD, amenorrhea, and heavy bleeding. “Oral contraception does not fix menstrual problems. It just imposes a fake cycle on a disordered cycle. Not ovulating for years and years is probably not in women’s best interest.”

But it is extremely popular. According to a 2011 study on oral contraceptive pills (OCPs) conducted by The Guttmacher Institute, 88 percent of women taking the pill who are not yet sexually active — presumably mostly teenagers — report taking OCPs for non-contraceptive reasons like menstrual regulation (46 percent) and menstrual pain (40 percent). Among women who are indeed sexually active, 58 percent report that they also rely on the pill for non-contraceptive reasons.

And if recent numbers are any indication, my teenage induction into the birth control pill club — before I was even having sex or getting a regular period — is reflective of a much larger trend. According to a 2013 Child Trends Data Bank poll, more teen girls in the U.S. are using hormonal birth control than ever. Nineteen percent of girls aged 13 to 18 are filling prescriptions for the pill, a 50 percent rise in use since 2002. The Centers for Disease Control’s recent comprehensive study of contraceptive use in the United States found that an estimated 53 percent of women age 15 to 19 who use contraception are now choosing the pill as their primary form of birth control.

I was unable to track down any studies about what the effects of putting still-developing teenagers — specifically, those like me who had not yet gotten more than a handful of periods — might be. Still, most OBGYNs I spoke to for this piece didn't seem too concerned about the implications of putting a still-developing teenager on the pill.

"The pill is an invaluable medical intervention. In my practice, caring for adolescents and young adult women, I use it in ways that saves lives, improves quality of life, and prevents future disease," Dr. Melissa Gilliam, Professor of Obstetrics/Gynecology at the University of Chicago told me. "It's a critically important medication with lots of available data that should and can be mined to answer outstanding questions — in particular, our scientific understanding of puberty and the environmental impact of hormones continues to evolve. [Of course], clinicians cannot be complacent in prescribing any medication, including the pill."

Dr. Prior, however, is more worried. She is especially concerned about the false sense of security taking a "low-dose" pill might give women.

“The industry has done an excellent job of labeling the current pill as ‘low-dose.’ Sure they are — compared to the pill I tried in 1967 — but that implies that it’s low-dose in comparison to a woman’s natural hormone levels," Dr. Prior says. "A 20-microgram pill still has four times the natural amount of estrogen in a normal menstrual cycle, [and] estrogen is powerful. If you put cells in culture, they will grow exponentially if you squirt in a bit of estrogen. That can lead to mutations and cancer.”

In actuality, those of us on hormonal birth control aren’t getting a "real" menstrual cycle at all.

Indeed, according to the National Cancer Institute itself, "A number of studies suggest that current use of oral contraceptives (birth control pills) appears to slightly increase the risk of breast cancer, especially among younger women. However, the risk level goes back to normal 10 years or more after discontinuing oral contraceptive use."

But for many, the benefits of the pill continue to outweigh the risks. Though the risk of breast cancer slightly increases with use of the pill, the risk of ovarian and endometrial cancer is actually reduced. Popular brands like Ortho-Tricylin-Lo (the pill I was on) promise “more predictable” periods, while LoEstrin, one of the lowest estrogen-dose pill on the market, invites us women to “say hello to shorter, lighter periods,” all “lasting less than three days” and “with less bleeding.”

In actuality, however, those of us on hormonal birth control aren’t getting a "real" menstrual cycle at all.

"The true meaning of menstruation is the shedding of the lining of the uterus after estradiol and progesterone levels decrease in a normal ovarian cyclic pattern," Dr. Prior explains. "So what we get when we stop taking the Pill after 21 days is more properly called 'withdrawal flow' rather than 'menstruation.'"

So why do most pills even induce a withdrawal flow with at all? As Bustle’s own sexual health columnist Emma Kaywin explains,

Back when the pill was first put on the market in 1960, the creators thought that preserving the appearance of a menstrual cycle would make the product more marketable to women, who wouldn’t necessarily have to disclose that they were on it to their partners (or Church, which was and still is very worried about birth control).

Of course, just because you're not actually menstruating on the pill doesn't mean it's a bad birth control option. Several of my friends love the pill for giving them manageable, lighter "periods" — and it is very possible that in my case, being on the pill prevented accidental pregnancy before I might have been ready to reliably use condoms every time.

Look: I am truly grateful that I and so many other women have avoided the turmoil of unwanted pregnancy thanks to the pill. I am so glad that the pill exists, and I will fight till I'm blue in the face for every woman's right to reproductive freedom — in all its forms. Plenty of women take the pill for their entire reproductive lives and experience no health or reproductive side effects whatsoever, and that is wonderful.

But do I believe I was put on the pill too early, before my cycle had even had two years to regulate itself? Absolutely. In my case, I don't think the pill "solved" my irregularity — it simply put a Band-Aid on it.

Everything I was more or less muting before — the sexual and emotional boost of feeling fertile, the particular skepticism that comes with PMS, the period of reflection and release encouraged by my period — all feels somehow essential, like the changing of the seasons.

I decided that I didn't want to wait until I was trying to get pregnant to find out if I could ovulate. Doing this reporting had convinced me — or rather, it had echoed my skepticism. A little before my 26th birthday, I decided to try to go off the pill for good.

At first, the same pattern held: I had only one period in five months. But then, slowly but surely, my body began to find its rhythm. I started getting a period every 35 days. Now, over a year later, I am more regular than I ever thought I would be, and get a period every 30 days. As it turns out, my reproductive system didn’t need the pill to function — it needed proper time to acclimate to being off it.

It took me 10 years, but I’m finally getting a regular period. Granted, I do not get severe cramps or PMDD, and I'm sure that if I did, I would probably be less excited about it. But as granola as it might make me sound, now that I'm finally getting a natural cycle, things finally feel somehow ... right.

“There are hundreds of things shown to vary throughout the menstrual cycle that we’re suppressing artificially when we [anyone] takes high-dose continuous hormones," Dr. Prior told me. "Awareness of color, creativity, emotional impact of interactions with other people — they are all accentuated at times during a normal cycle, and on the pill, they are likely suppressed.”

For me, I can say that it feels important to finally experience my natural cycle. Everything I was more or less muting before — the sexual and emotional boost of feeling fertile, the particular skepticism that comes with PMS, the reflection and release encouraged by my period — all feels somehow essential, like the changing of the seasons.

It may just be the experience I've had with my body, but it is an experience I deserved to have. And it is an experience I worry that too many women are being discouraged from connecting with for the wrong reasons, much like we have seen with the medical industrialization of childbirth.

It's time for doctors and feminists to open up the conversation about hormonal birth control.

It is troubling to me that despite visiting dozens of different traditional and holistic western doctors over the last decade, not one seemed open to the idea that my body might just need more than five months to figure out how to menstruate on its own. Everyone seemed in a rush to prescribe, and to treat only the immediate "problem" of my irregularity and "diagnose" my PCOS.

My experience worries me, especially when I try to fathom all the other women in my situation who might not be natural investigative reporters or self-advocates. It troubles me that hormonal birth control has become the leading form of contraception for women in the United States, especially when we have so many other options and when there are so many known side effects to the pill. When IUDs are the most effective form of contraception out there, it becomes pretty clear that our prohibitive healthcare system is the main reason so many young women are being put on a higher-dose hormonal option instead.

I'm not trying to say that every teenager or woman should go off the pill, or that you'll also love having a natural cycle. Using condoms or a non-hormonal IUD certainly isn't the right birth control option for everyone, and if I've learned anything from this experience, it's that no one truly knows or deserves to make decisions about your body but YOU.

It wasn't easy to stand up for what I suspected was right for my body — even though I always believed, on a certain level, that I had the right to. I sensed that I knew something that doctors didn’t all along, but I didn’t believe I could know myself better than they could. I was in a rush to let others define what “normal” looked like for me — and to take a pill when they told me I needed fixing. I also wanted to keep my c-cups and my clear skin. Because that's what reproductive health is all about ... right?

It's time for doctors and feminists to open up the conversation about hormonal birth control. Because no woman — whether she's trying to get pregnant or not — deserves to be treated like she's a cow waiting to be milked. All of our bodies are not the same, and we need to be aware that there is a tendency in medicine to diagnose and solve problems in the immediate, while sometimes ignoring the long-term implications of that approach to health.

Feminism is about the freedom to make choices, and those choices have to include the right to question whether the pill is really our best option.

Images: Planned Parenthood/Instagram; Giphy; Rachel Krantz