To pill or not to pill: Is that even the question?

By Emily Sheene of the Menstrual Health Hub (MH Hub).

Image: BSIP / Getty Images

The pill. Even if you aren’t active in the female health space, you would likely know which pill “the pill” refers to.

Oral contraceptives or birth control pills have been considered a quick-acting, reversible and ‘modern’ method of contraception (just like condoms or injectables). They can be composed of either a combination of estrogen and progestin or progestin only. The pill is only one option in a wide range of contraceptives such as implants, intrauterine devices, injections, vaginal rings, patches, condoms, fertility awareness methods, abstinence and sterilization, among others. With each option come different levels of maintenance, costs, effectiveness and side effects. The birth control pill with typical use is 91% effective (99% with perfect use) and can average in price between $0 and $50.

While a wide variety of contraceptive options are available none have proven as empowering or divisive as the pill. Whether you are for or against it, the pill has undoubtedly altered the way women manage their sexual and reproductive health worldwide.

Ortho-Novum advertisement for the birth control pill, 1963. Source: https://www.theglobeandmail.com/life/health-and-fitness/health/conditions/the-pill-turns-50/article572652/

Since its first introduction in the United States in the 1960s, it has increased women’s bodily autonomy and informed their ability to decide if, when and how often they get pregnant. Some pill advocates claim that the pill gave birth to an economic revolution as it enabled unprecedented professional progress for women entering traditionally male-dominated fields, and simultaneously boosted earnings with women no longer held back by unwanted pregnancies.

Considering these benefits, it is no surprise that today a large number of women around the world rely on the pill as their primary form of contraception.

According to the UN, it is the most widely used form of contraception across Europe and Oceania, and the third most widely used globally among married or in-union women aged 15–49 following female sterilization and the IUD.

Yet despite all of this, new trends show a significant shift away from hormonal contraceptives and an increased uptake of other methods.

Over the course of the next year, it is projected that 10 percent of contraceptive users in low- and middle-income countries will stop using this method because of side effects and health concerns. A UN research survey found a general shift toward more long-term methods such as IUDs and injectables especially in African countries. This is mainly due to the popularity and availability of injectable contraception coupled with the growing numbers of contraceptive users in many African countries. In high-income countries, a growing number of women are opting-out of hormonal contraceptives as greater emphasis is placed on lifestyles of natural health and sustainability and women seek longer-acting and more convenient options.

Parallel to this shift towards more sustainable or natural products, women are becoming more body literate or knowledgeable about how to better understand and read their bodies. This expanding self-education brings greater confidence and trust in alternative contraceptive methods, evidenced by the rise in fertility tracking. In response, an expanding body of innovations, literature and events that guide users toward natural alternatives is emerging.

Image: Natural Cycles from https://www.vox.com/2018/8/14/17684392/natural-cycles-birth-control-app-fda

One such innovation example recently making headlines is Natural Cycles. Coined as a form of digital contraception, Natural Cycles is the first FDA-approved birth control application. The app that is also certified for use in Europe involves a complex algorithm that uses basal temperature readings to predict fertile and non-fertile days of a user’s cycle.

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There are also workshops assisting women looking to quit the pill, such as the ones offered by Holly Griff-Spall, author of Sweetening the Pill: How We Got Hooked On Hormonal Birth Control. Alongside the book and the workshops, a related documentary, Sweetening the Pill, is currently in post production.

Image: Flo Living from https://www.floliving.com/about/

Another popular literature source, Woman Code by Alisa Vitti, has led to an entire online hormone center called Flo Living Virtual Hormone Center which includes broader information on realigning hormones and menstrual cycles with natural methods. The site has many posts about transitioning off the birth control pill.

A final example is the work of Jolene Brighton. Brighton’s recently published Beyond the Pill offers readers advice on how to balance their hormones and reclaim and support their bodies while on or off the pill.

These are only a few of the more recent examples that highlight the brewing curiosity in society to shift away from hormonal contraceptives or towards a better understanding of how they truly affect overall female health.

With widespread ambiguity regarding its usefulness and the range of negative side effects and risks, it is clear the one-size-fits all approach of the pill that has existed since the 1960’s does not, in fact, fit all.

However, even women who experience negative side effects may choose to stay on the pill for the freedom and security it brings.

Therefore, maybe the question of whether or not the pill is good or bad is redundant.

The fact that women can take their own decisions regarding contraception will always be seen as positive. However, what if women could be better informed and guided before making these choices? Instead, maybe the question to focus on is how we can better enable women to make the best decisions they can for their sexual and reproductive health.

Whose decision is it anyway?

One such way to improve women’s health-decision making regarding suitable contraceptive choice is through

informed, insightful, and intelligent health discussions between women and their healthcare providers.

What does that mean exactly? Drastic changes are needed in the way medical professionals present a basket of choice to women regarding the available options to them, including the risks and benefits of different methods.

With regards to hormonal birth control, precision medicine offers a great opportunity for more informed choices, as it is based on the individual’s specific biological and hormonal profiles. This increase in informed choice could ultimately lead to a better relationship between women and oral contraceptives, and sexual health at large. Precision medicine represents an opportunity to provide tailored contraceptive choice based on an individual’s specific biological and hormonal profiles (check out Sura for more information on this approach.) A future with “precise” oral contraception may include a change in dosage based on weight or age, as is already seen with other prescribed medications.

Ultimately, more options for women will always be a positive thing.

The pill, despite its drawbacks, has allowed women the world over to conveniently manage their own sexual and reproductive lives. This is a liberty that cannot be price-tagged. Yet, we remain far from the utopia where women feel confident and completely happy with their contraceptive options. As we work our way towards a future with improved women’s health-decision making, it is vital that informed and tailored choice becomes a part of the process. When women and healthcare providers come together towards this common goal of finding individualized contraceptive options that truly work well for each woman, we will be on the way towards a future where there will be no metaphorical contraceptive pill that is “too hard to swallow”.

Feel free to comment below and tell us about your experiences!

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Madami is a purpose-driven advisory & innovation agency specializing in femtech, sextech and gender lens investing