More than half a century since its first release, the impacts of the pill are remarkable. It’s hard to think of an invention that has impacted women’s position in society more. The pill freed women of the social boxes and biology that had previously constrained them. No longer did women have to fear unwanted pregnancies, they also had full autonomy over childbearing, and could have risk-free sex, just like men. Contained within a small pill, taken daily, was women’s improved access to education, financial independence, and open sexuality.
The first oral contraceptive pill was approved by the US FDA in 1960, following years of clinical trials by biologists Gregory Pincus and gynaecologist John Rock. It was released a year later in Australia.
Decades on, we’re slowly learning more about the ramification of the pill. As it turns out, its potential side effects aren’t insignificant. In a recent episode of The Philosophy of Sex podcast, I spoke with Dr Sarah Hill. Dr Hill is an Evolutionary Psychologist and Professor at a leading university in Texas. She is also the author of “How the Pill Changes Everything: Your Brain on Birth Control”, a book exploring the newest research into the contraceptive pill.
Dr Hill explained to me the pill has been found to impact the mood, stress response, and sexual appetite of many women who take it. The pill can change everything from how women cope with stress to who they want to have sex with. It’s even been associated with an increased risk of anxiety and depression, particularly in young women.
“Because the pill changes a women’s hormones, it changes her brain, this impacts everything.” Dr Hill says.
Hormonal contraception in Australia
Gaining a clear picture of the contraceptive habits of Australian women is difficult, however, studies suggest around 80% of women use some form of birth control. While the use of the pill remained steady for many decades, the last 10 to 15 years has seen a decrease in the prevalence of pill taking. Some peg this decline to a rejection of the pill’s side effects, however, when we account for the significant uptake in Long Acting Reversible Contraception (LARC), like IUDs, implants, and injections, Australian women are overwhelmingly still choosing hormonal birth control to prevent pregnancy, alongside condoms.
Dr Hill pointed out, “It’s important to remember many LARCs are still hormonal, and we still have very little understanding of how these different forms of birth control can impact women. The effects of hormones on the body are pervasive and all-encompassing, irrespective of whether you take the pill or have an implant.”
In our modern world, access to the pill is readily available. You can even receive it in the mail via subscription. Despite its ubiquity, dialogue about how the pill works and how it can impact those who take it is rare.
So, how does the pill work?
The contraceptive pill uses artificial hormones to mimic the second half of a woman’s monthly ovulatory cycle, when the hormone progesterone is dominant. Using artificial progesterone, also known as progestin, the pill turns off the brain signal that prompts egg development and release. LARCs use hormones in a similar way.
Hormones are a core signalling system in our bodies, they’re part of what gives us the experience of being who we are. “When you release a sex hormone, it will affect every single cell in your body that has receptors for that particular hormone. This means it could affect your skin, your hair, and it’s going to affect what goes on in your brain. And this means it is going to influence how you feel and respond to the world, including your sexuality,” Dr Hill says.
The case of the missing libido
While alleviating the risk of getting pregnant creates more opportunities for stress-free sex, it is hugely ironic that the pill can cause women to lose interest in sex altogether.
Dr Hill tells me, “Taking hormonal contraceptives means the ovaries aren’t producing oestrogen, which is the most prevalent hormone during the first half of a woman’s natural cycle. Oestrogen release is associated with increased sexual desire, making us social and feeling more energetic. While some pills include synthetic oestrogen, this is usually to curb the side effects of the additional progestins.”
“Oestrogen plays a vital role in a woman’s feelings of sexiness, desire, attraction, and sexual function,” Dr Hill says. “When you take hormonal birth control, the constant hormonal message to the brain of high progestin, and low oestrogen and testosterone, is associated with low libido.” There is also evidence this can cause reduced sexual function, not just lowering desire but also diminishing natural lubrication.
Although you may have heard the pill can make women less interested in sex, research also suggests the impact of the pill on sexual desire might cut both ways, potentially making men less interested in sex with you. Heterosexual men find women’s faces, voices and body scents most alluring during the time of high fertility, which has obvious reproductive benefits. Some research has also found that hormonal contraceptives suppress the oxytocin-induced brain reward a man feels when looking at their female partner’s face.
The pill and stress response
Being on the pill is also associated with an increased risk of being diagnosed with anxiety and depression, though there are some women who report the pill stabilises their moods. “The association between the pill and depression was particularly high in women aged 15-19, and their suicide risk is also more than twice that of non-pill takers of the same age,” Dr Hill says. In a study that followed more than half a million women over eight years, hormonal contraception was positively associated with subsequent suicide attempts and suicide, with adolescent women experiencing the highest relative risk.
“This is partly because the pill dysregulates stress response by inhibiting the production of cortisol, the hormone that, among other things, helps regulate stress.” Dr Hill explains.
For women starting to take the pill, or changing their pill, Dr Hill advised keeping a mood journal or asking a friend to keep an eye on you, especially if you have a personal or family history of mood-related symptoms. “For young women, the pill may not be worth the trade-off if it is being used for reasons other than to prevent pregnancy – for example, to clear acne or regulate periods,” she says.
To pill or not to pill?
Reading all of this, it’s hard not to feel negative about the contraceptive pill. It’s important to remember “some women are going to experience big changes while others are going to have absolutely none”, according to Dr Hill. “Each woman should know about the research that’s out there so they can monitor themselves and troubleshoot,” she adds.
At a time when many women lament a lack of libido, motivation and ability to manage stress, questioning the pill’s possible role in these outcomes seems important. “Our hormones, especially our sex hormones, are a key part of what creates the experience of feeling like ourselves,” Dr Hill says. “And talking critically about the pill doesn’t mean that the benefits aren’t going to outweigh the cost. It’s not antithetical to women’s rights to talk about this stuff.”
To question the role of hormonal contraceptives might seem unfeminist, or potentially harmful, but as Dr Hill points out “In recent years, we’ve become a lot more tolerant of grey area conversations, where we can recognise the important role pregnancy prevention plays in women’s upward mobility, while being able to have critical conversations about the trade-offs we’re making in controlling reproduction hormonally.”
There is a broad spectrum of feelings about the pill. In my work, I’m constantly having conversations with women who feel disheartened by the trade-offs they’re forced to make. I know women whose lives were put at risk due to hormonal contraceptives, and I know women who rejoice the feeling of freedom it allows them.
However, irrespective of where a person sits on this spectrum, most are disappointed by the lack of transparency and frankness in education about contraception. Most are also frustrated that there don’t seem to be any consequence-free options. Perhaps this is because there is no foolproof way to trick nature.
While we may not have a side-effect-free silver bullet, there are certainly ways we can reduce the confusion and burden of birth control that women carry. In the case of heterosexual couples, it’s important more onus is put on men to see birth control as a shared responsibility. If you’re paired up, consider splitting the cost of the contraceptive pill and try to have honest conversations with your partner about how the pill makes you feel. When you go to the doctor, don’t be afraid to ask lots of questions about why they’re making certain birth control recommendations, and ensure they have a clear picture of your health history.
Our hormones are as unique as we are, “otherwise we’d all be the same”, Dr Hill says. In our society, we put a high price on our individuality and personal preferences. If our hormones play a role in making us who we are, then any interference should be tailored to us, as individuals. To achieve this, “We need the minds of great researchers on this issue, and we need to push for better information. Otherwise, we won’t see improved outcomes for women.”
If you’d like to know more about the science and research behind the pill, consider reading Dr Hill’s book, available on Becuming. If you’re struggling with diminished lubrication due to the pill, I recommend Melbourne-based Figr, which has been formulated for vulva owners experiencing dryness due to medication.
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