Hormonal Contraception and Its Discontents

When I was sixteen I went to the gynecologist and told her I had severe menstrual cramps. I had actually never experienced menstrual cramps. Other than debilitating worry that I might bleed through my clothes in public, my periods were easy. But I was a rebelious soul born into a conservative Catholic family, and even though I did not have a boyfriend and had never had sex, I wanted to take “the pill.”

I wanted to do nearly everything my mother and the priests told me not to, and this one seemed easy to cross off the list. I had read countless magazines aimed at teenage girls and young women (the same sources which had instructed me on how to have an eating disorder a few years back), and I knew what to say to the doctor to get a prescription for the drugs I wanted to try.

I knew from the magazines that I would be subjected to a pelvic exam, so I had insisted to my parents that I see the only female gynecologist in my little sexist town. She was nice enough. I told her I had menstrual cramps. She gave me a pelvic exam and a prescription for synthetic hormones that would over-ride my own menstrual cycle and induce temporary infertility, otherwise known as the pill.

One month later I had weird and disappointing sex at a church youth retreat with a boy I had just met and would never see again. The experience was not exploitive or painful or abusive; I had initiated the encouter because I wanted to see what the fuss was about. Nevertheless, it left me feeling terrible. On the bus ride home the next day I did a lot of thinking. I was shocked by the overwhelming emotions I was feeling. I was completely unimpressed by the act of intercourse.

I decided that the hours-long makeout sessions I had enjoyed before with male friends had been far more satisfying than that brief and strange encounter. Making out was super fun and sexually satisfying (for me; the boys often complained of “blue balls” but that really was not my concern). Making out had never led to me feeling so emotionally confused. I knew that I would have just made out with this boy instead of having sex if I hadn’t been on the pill.

I took hormonal contraception on and off for about four years and it almost certaily prevented me from getting pregnant during that time. Luckily, I learned that sex could be fun and satisfying. But I also learned that once boys and men knew you were taking the pill they seemed to expect sex and their make-out/foreplay skills severely declined. The effects of the artificial hormones combined with what I was perceiving about the male-centered expectations of intercourse, left me feeling, again, kind of weird. I was ambivalent, but was bombarded with messaging that responsible young women took birth control. At twenty I developed a love of ecology and had the epiphany that I would never pour chemicals into a healthy river system to prevent possible future invasive species. So why was I pouring chemicals into my own body to prevent unwanted conception?

Around that same time I discovered the radical self-help women’s health movement. These women had strong criticisms of industrial medicine and advocated for women’s health in women’s hands. I read the old, still highly controversial Our Bodies, Ourselves (the editions that had not yet been captured by Big Pharma-linked grant funding.) I became infuriated when I learned the deeply racist and sexist history of gynecology, including the fact that hormonal contraceptives were first tested on women in Puerto Rico because the researchers deemed the risks too high for testing on women in the mainland US. I got angry when I read that Depo-Provera and other progestin-only contraceptives are actually very effective forms of male birth control but research was discontinued when the men conplained of side effects. This information combined with the fact that the pill made me feel disconnected and out of sorts led to me decide that I was never going to take hormonal contraception again.

It’s not my place to tell other women what to do, and I am staunchly pro-choice on all aspects of health care. But my bias remains that hormonal contraception has at least as many downsides as benefits. I have made it part of my life’s work to educate women on the risks and political problems associated with hormonal birth control. Given the fact that I am a self-described radical feminist, I’ve been surprised to see a propaganda trend painting all who criticize hormonal birth control as right-wing conservatives.

Like so many issues of our times, support for or opposition to hormonal birth control does not break down easily into a left/right political divide. In fact, it never has. One thing that has always been true is the ruling class loves to divide and conquer. The easiest way to consolidate power is to get the people below you fighting amongst themselves. Our Big Pharma overlords don’t want the masses uniting to curb a predatory industry intent on turning every human on Earth into a life-long daily pharmaceutical customer. So they purchase the media not only to relentlessly sell their drugs, but to seed a narrative that anyone who questions whether giving women drugs that suppress their libidos and make them constantly accessible to male-centered, consequence-free ejaculatory intercourse is obviously an anti-feminist Trump-loving fascist.

Women’s bodies are battle grounds where social and political wars are fought. Ever since men figured out they played a role in human reproduction and stopped worshipping women as life creators, they have invested enormous amounts of time and energy pursuing control of female bodies. Women are the original means of production, and since the dawn of patriarchy we have not owned ourselves.

Patriarchy in this case means any social structure where lineage, power and property are controlled by males and passed through male heirs. Legal surnames are one small example. This system can create anxiety around paternity in males and lead to varying degrees of coercive control of females. I happen to dislike this system of social organization. Other women (some of whom I love and respect) are really into it.

Overuse of the word patriarchy aside, we still live in a time where many men believe they have some degree of ownership over women, especially women they have or have had sex with. These men believe they have a right to force women to continue pregnancies, and in twenty four US states pregnancy has become a nine-month suspension of civil liberties. Family law treats children as property and considers ejaculation to be the same contribution to parenthood as gestation, birth and breastfeeding. A woman unfortunate enough to have a baby with a man who is now her adversary risks being tortured through the family court system for eighteen years. From this perspective, higly effective hormonal contraception gives women freedom from both pregnancy and male control.

In my ideal world, heterosexual women would not be in adversarial relationships with the men we have sex with. We would only be having sex when we desire to have sex with men who love and respect us as fully autonomous human beings. Sex education would center on respecting our innate fertility and being very discerning with whom we decide to share our life force. Boys would learn that they are fertile every day and with this fertility comes great responsibility. Girls would receive instruction on tracking their fertility cycles from puberty onward, because knowing ourselves makes us powerful. I know this sounds totally crazy, but I want to live in a world where sex is sacred. In this world there is very little need for medications that cause infertility.

While some women find themselves partnered with nice responsible men, the reality now and for most of human history is not so kind for women. All over the world, women are stuck trading sex for shelter, money, and protection from other men. Too many people have never witnessed a mutually respectful heterosexual relationship, and are therefore incapable of creating this with a partner. Pornsickness is a public health disaster. Even in caring relationships, both women and men are woefully ignorant of their own bodies and their fertility. All of these factors can lead to unwanted pregnancies. All of these factors contribute to the need for reliable contraception.

Women of all cultures have figured out ways to both prevent and promote pregnancy. Simultaneously, men in power have always been invested in controlling the population. Controlling the population necessitates controlling women.

Sometimes the ruling class wants to make more people, sometimes it wants fewer people. In her excellent book Caliban and the Witch, social scientist Silvia Federici details how the population crash after the Black Death in the 1300s led to strict governmental controls over women and midwifery and the criminalization of medieval forms of birth control in an effort to increase the population. Historical texts also tell us of times the ruling class have encouraged infanticide to decrease the population. We continue to have a ruling class and it’s not a conspiracy theory to point out that these people are interested in population control.

For over a century and a half, there has been an interesting dynamic between women’s desire for reproductive autonomy and ruling class forces desiring to control women’s fertility.

In the late 1800s American women began to organize for expanded freedoms. First wave feminists worked to secure the right to vote for women. These activists also fought for women to have more control over reproduction. Unsurprisingly, first wave feminists did not all agree with each other on matters of reproductive rights.

Many women’s suffrage activists fought for the right of women NOT to have sex, a concept which makes sense when you realize that marriage was an economic necessity for women and marital rape was legal and widespread. Abortion was also common, and many first wave feminists believed contraception and abortion primarily benefitted men who could then force more sex on women while avoiding all consequences. (This concern remains valid, as evidenced by ISIS fighters feeding captive women birth control pills so they could rape them without causing pregnancy.)

By the early 1900s, feminists like Emma Goldman, Rose Pastor Stokes, and Margaret Sanger began advocating for the right of women to have sex for pleasure, which necessitated contraception. Goldman, an anarchist, opposed state and ruling class involvement in women’s lives. She took her message to the masses and directly taught women how to control their fertility. (Goldman was arrested and deported to Russia in 1916 for the crime of distributing information on contraception to women.) Rose Pastor Stokes was a socialist-turned-communist unironically married to a multi-millionaire. She was instrumental in mainstreaming the cause of contraception using her connections to wealthy men to further the work of her colleague Margaret Sanger. A public health nurse distressed by the miserable living conditions of poor immigrant women in New York City, Sanger coined the term birth control and founded the first clinic dedicated to contraception in 1916.

Margaret Sanger was a progressive willing to join forces with the powers that be in order to shape history. Elite men promoting the philosophy of eugenics saw Sanger’s work as a way to put their theory into practice. John D. Rockefeller, founder of industrial medicine as we know it today, donated large sums of money to Sanger. In the 1950s, Margaret Sanger took some of Rockefeller’s money to Gregory Pincus, the first scientist to creat an embryo outside of a female body (in this case a rabbit), and asked him to create a pharmaceutical contraceptive. Sanger specified her order as “a magic pill” that a woman could “swallow with her morning orange juice.” Pincus delivered with a high dose synthetic progesterone medication which, when swallowed daily, suppressed female fertility.

In a process which mirrored my teenage quest to get the use of the pill approved, Pincus applied for FDA approval of this medication for the treatment of menstrual disorders. Just like the dynamics of the home I was raised in, the political and religious authorities were willing to sanction the use of a drug that suppreseed female fertility under the guise of treating menstrual cramps, but not as a way for women to have sex without getting pregnant. Under the original 1956 FDA approval, contraception was a side effect, not the intended use of the product.

This ruse did not last long. In 1960 the hormonal contraceptive pill gained full FDA approval. The birth control pill was unleashed on the public. Patriarchal forces on the right (like the Vatican) condemned the new technology. Patriarchal forces on the left (like Hugh Heffner and the porn industry) celebrated it.

The split in support for contraception among men in power continues to this day. Consider the fact that high ranking male officials in the Philippines openly oppose contraception because the main export of the Philippines is people. Compare this to Thailand where prostitution and sex tourism comprise over 10% of the nation’s GDP leading to strong governmental support of both contraception and abortion.

Feminist reviews of hormonal birth control were and remain mixed. Liberal feminist organizations like Planned Parenthood have always expressed unequivical support for hormonal birth control. Grassroots women’s liberation activists have been more critical. In the 1970s radical feminists expressed concerns about the risks of this new medical technology. Second wave feminist Dr. Barbara Seaman wrote a book entitled A Doctor’s Case Against the Pill in 1970 which spurred congressional hearings about the safety of hormonal contraception. Women’s health activists stormed into the all-male Senate hearing, shouting “Why have 10 million women been used as guinea pigs?”

Most women didn’t think too deeply about it. The entertainment industry, broadcast news, and other cultural forces promoted oral contraceptive use. By 1980 fifty-six percent of American women had used or were using hormonal contraception. Today, 90% of American women ages 18-64 have used hormonal contrception at some point in their lives. Temporarily neutering ourselves so men can ejaculate in us without risking pregnancy is normal now.

And I think we need to talk about that.

As a health care provider in in 2023, critiquing “the pill” seems almost passe. Who even prescribes or takes oral contraceptives anymore? Long-acting reversible contraceptives (LARCs) are in. The pill has gone the way of condoms and diaphragms, with similar manufactured justifications. Taking a pill every day is inconvenient, too much work, there is too large of a risk of user failure, women are not responsible enough to remember to take a pill every day: these are all statements I have heard medical authorities make as they push IUDs, implants, and inectible hormones.

If we return to the old feminist rallying cry of women’s health in women’s hands, LARCs are concerning. A woman can easily stop taking a daily pill if she does not like the side effects. It is significantly more difficult to pull an IUD out of your uterus or surgically remove an embedded plastic rod from your arm. I have fielded many tearful phone calls from women who recently had an IUD or Nexplanon insterted, then quickly decided they wanted it removed. Over and over again I hear women tell me that providers at Planned Parenthood and other clinics refuse to remove the birth control devices because the women have not “given it enough time.” LARCs are sold under the promise of giving women autonomy over their bodies, but these methods actually leave women more dependent than ever on the medical system.

The pressure to prescribe LARCs to girls and women of reproductive age is enormous. In graduate school my professors would not-quite-joke about wanting to put an IUD or implant in every girl over twelve. Federally funded school based health centers exist primarily to distribute birth control to teenagers, and increasingly this means LARCs.

History and politics aside, I am opposed to the mass drugging of healthy girls and women with hormonal contraception. Below is a brief list of my concerns.

1. Loss of libido

The most common side effect experienced by women taking hormonal contraception is decreased sex drive. In many women this manifests as a complete loss of libido. There is something so sinister, so Stepford-esque about giving women a drug designed to make them sexually accessible to men which eradicates the female sex drive. When I think of teenage girls growing up in a pornified culture taking drugs that disconnect them from their own desires and prevent them from fully experiencing sexual pleasure, I want to weep.

2. Decreased response to pheromones

I know it sounds all kinds of problematic, but the whole reason humans evolved to have sex was to make babies. We are animals doing our animal thing. Our sex drives and attractions evolved over millenia to maximize the chance of successful reproduction. For women who still want to make babies the old fashioned way someday, taking hormonal birth control can mess up your ability to choose a compatible mate.

Humans, like all animals, excrete chemicals called pheromones which affect the behavior and emotions of other humans. Some of these pheromones serve to attract a sex partner. Each person’s unique scent gives information about our immune system, or major histocompatibility complex (MHC) genes. When not taking hormonal contraception, females are attracted to males with MHC genes different from their own, an evolved preference thought to increase the likelihood of healthy offspring. Studies show that when women take hormonal birth control, they sexually prefer males with MHC genes more similar to their own. Other studies show that a significant percentage of women who discontinue hormonal birth control experience a decrease in attraction to their current partner.

3. Depression and suicide

When I talk to women about contraception, I often hear them say “I can’t take anything with hormones because it makes me crazy.” The women are not wrong. Hormonal contraception can cause severe disruption in women’s moods. Taking the pill or LARCs doubles the risk of suicide in adolesent girls and women. Twenty five to 30% of women taking hormonal contraception develop new onset depression. But we keep giving these drugs to girls and women.

In 2012, a very promising study on male birth control was halted because 2.8% of the men involved developed depression and some others got acne. Any questions?

4. Blood clots

Hormonal contraception directly causes the death of 300-400 American women from blood clots every year. A woman taking hormonal birth control has a 1% risk of developing a blood clot over the course of ten years. This risk is increased in women who smoke or are over the age of 35.

Those who promote hormonal contraception like to argue that even though the drugs do kill some women, pregnancy is more likely to lead to fatal blood clots than the pill or LARCs. This may be true, but as Holly Grigg-Spall states in her excellent book Sweetening the Pill, being pregnant and taking hormonal drugs are not the only two states available to girls and women. It is possible for women to be sexually active, avoid pregnancy and not take these drugs.

5. Increase risk of cardiac disease

Heart disease is the single biggest cause of death for American women and hormonal contraceptives increase a woman’s risk of developing heart disease. A 2015 Cochrane Review found that women taking the pill were significantly more likely to die of heart attacks or strokes than women not taking hormonal contraceptives. Estrogen-containing birth controls control drugs increase serum triglycerides, while synthetic progestins increase LDL, or “bad cholesterol.” Elevated triglycerides and LDL cholesterol are a major risk factor for heart attack.

6. Endocrine disruption

Homonal birth control induces endocrine disruption. Disrupting the female endocrine system is the whole point of these drugs. The endocrine system is comprised of more than just our reproductive organs, and these drugs affect the thyroid, pancreas, and adrenal glands.

Long term use of hormonal birth control greatly increases the risk of thyroid disease, insulin resistance, weight gain, and obesity. Hormonal birth control directly affects the function of the adrenal glands, leading to elevated levels of the stress hormone cortisol. Increased cortisol has been linked to obesity, poor wound healing, lowered immune response to infections, and increased risk of autoimmune illness.

These medications are designed to create infertility in healthy women. We like to pretend we can turn our fertility on and off like a faucet, but the reality is more complicated. Suppressing fertility with drugs when we are young by nature increases the risk we will have difficutly conceiving when we discontinue these drugs later in life. Human female fertility peaks in the mid-twenties. The older we get, the harder it is to make a baby. Additionally, suppressing our fertility with drugs unsurprisingly can create problems returning to a normal fertility cycle. When women stop taking these drugs it can take years for a healthy menstrual cycle to return. Some women report that their cycles have never been normal since coming off hormonal contraception.

The US contraceptive market was valued at 8.3 billion dollars in 2022. Birth control is a growth industry, expected to expand by at least 5% a year for the foreseeable future. One market analysis states, “Increase in the use of modern contraceptives and rise in awareness among adolescents and the young population about sexual health and family planning are key factors that driving the U.S. market growth. Moreover, government programs have led to an increase in access to contraceptives in teenagers.”

The global industry treating infertility is also booming. Big Fertility was valued at $1.5 billion in 2021 and is projected to be worth $3.5 billion within the next decade. From this perspective, hormonal birth control and delayed childbearing are a long con on women. The powers that be are making billions off the bodies of women by suppressing our fertility, then making even more billions treating the resulting infertility that they have helped create.

Examining the current and historical forces driving markets and critiquing the harm being done to consumers used to be a left-wing endeavor. But today we are being told only right-wingers criticize Big Pharma and the pill. In my opinion critical thinking about hormonal contraception transcends politics. This is a woman’s issue, and women exist across the political spectrum.

I certainly do not want to see the use of hormonal birth control banned or restricted. I do want women to be fully informed that Big Pharma does not love us. These medications come with a biological and social cost and lower-risk options of controlling our fertility exist and are available.