Contraception Inception
This week I’m starting new birth control. Anyone who’s switched pills before knows how intimidating that can be.
Choosing new contraception is like choosing new pants from the lost and found. Nothing fits quite right, everything smells a little weird, and you're only there because something dreadful happened to your actual pants. Would you rather have acne, night sweats, or pure emotional chaos? How noticeable will it be walking home in ill-fitting sweatpants?
With birth control, we’re chasing perfection that (frankly) doesn't exist when it comes to altering fertility. Instead, we're resolved to whatever option is the least damaging. How joyous.
For some, an IUD is worth the one-time dose of horrible pain for five years of protection. Others pay out of pocket for the only pill that gives them equilibrium. Some can't afford any option besides tracking their cycles on paper.
Even when the going is good, hormone shifts keep you on your toes. I had a pill that only gave me positive side effects for 7 years until it suddenly stopped working the same way. It felt like something inside me had turned evil - hot flashes, mood swings, acne. My body had spontaneously revolted.
Ready for a disgusting parallel?
There's a parasite called a hairworm that grows inside grasshoppers. More specifically, it devours them from the inside out. The hairworms have learnt to attack the nervous systems of grasshoppers, eventually taking control of their lifeless bodies and flinging them into pools of water. There, it bursts free from its host.
These parasites are particularly scary because of their selective manipulation. They can control the grasshoppers by producing molecules that mimic their natural proteins, thus keeping the frame of the insect just functional enough to manipulate it.
It's like the world's grossest puppetry.
New pills can often feel like they're controlling your body - mostly because they are. It's hard to remember where the hormones stop and you begin, and it can mess with your sense of self. I know many women who have taken a break from the pill to "reset". There are instances of women going off of birth control only to realize they aren’t actually attracted to their partner. The hormones just confused their sense of smell.
I am still relinquishing my hormonal autonomy for the greater good of regulating pregnancy. Honestly, I’d be nervous to see what I’m like without it - and my husband definitely is.
Jagged Little Pill
Looking at my new prescription, I can’t help imagining what kind of parasite is about to enter my body. Will it clear up my skin? Change my boob size? Alter my emotions?
Or maybe it will make me sick.
My new pill boasts a concerning list of side effects that include:
Blood clots in the legs, lungs, heart, eyes, and brain
Breast cancer
Liver tumors
Gallbladder disease
Crushing chest pain
Sudden loss of vision
Jaundice
Persistent sad moods
Vomiting
Numbness in the face
How enticing...
Fun fact: there hasn’t been a major update in contraception tech since IUDs came on the scene in the 90s. Looking at that list of risks and considering the first pill was FDA-approved in 1960, it’s weird that we’ve stopped trying to perfect the method. How are these side effects accepted as par for the course?
It’s also surprising that pills still have to be prescribed by a doctor. Imagine, for instance, that you had to pay for those appointments. Or, hypothetically, that you lived in a small town where everyone knew your doctor personally. These are barriers which prevent women (especially young women) from taking control of their reproductive health.
Increasingly there's a push to make over-the-counter options available. COVID has seen a boom in telemedicine, and many of us have adapted to dealing with doctors over the phone. Some companies, like Felix, have extended prescription services online for 40$ a visit - which is great if you can pay to play.
Unfortunately, not everyone can. In Ontario, the pill is only free up until the age of 25. In many places, it’s not covered by insurance. I’ve personally spent as much as 90$ to test out a new prescription. Even more fun? It didn’t work for me. That’s a tough pill (and bill) to swallow.
The expense, like the side effects, is a female burden. One calculation supposes that, if a woman were on the pill from age 16 to 65 without insurance, she could spend up to $28,200.00 USD over her lifetime. Contrastingly, a man who uses a condom EVERY DAY from the age of 18 to 65 would only spend $17,155.00.
The math ain’t mathing.
If you don't have access or can't afford to take the pill, the alternative is to take your chances. Although, sometimes that seems like a better option anyway. I don’t know many people who want to pay thousands of dollars to potentially get blood clots or “crushing chest pain.”
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Daddy Issues
You know the saying: sharing is caring. Annoyingly, male birth control has been researched and abandoned time and time again. It’s the elusive unicorn of contraception - a system I don’t have to use.
In 2019 a pill for men passed the first round of clinical testing, but the side effects were too much for many of the trial participants. Laughably, many of those symptoms are the exact same that women are expected to endure. Even funnier, men who were on the placebo pill also reported side effects. The term 'cry baby' comes to mind...
The major symptoms from the trial are as follows:
Acne
Headaches
Mild erectile dysfunction
Reduced sex drive
Tiredness
Weight gain of 5 lbs. or less
No duh. That's what happens when you mess with hormones. I'd take that over breast cancer and liver tumours any day.
It's possible that we will see a commercial pill for men in the next decade, and it's promising that these studies even exist. That said, I can't imagine it's a high priority in the medical space.
Besides condoms, the other male option is a vasectomy. Compared to IUDs, vasectomies aren't horribly invasive. Planned Parenthood refers to them as “get-it-and-forget-it birth control,” indicating that the side effects are minor, and the effectiveness is unparalleled. Though vasectomies are meant to be permanent, they can be reversed if need be. This begs the question, why aren't these more widely used as contraception?
While women can have 1-3 babies at a time, a man can impregnate hundreds of women in the span of a few weeks. Depending obviously on his popularity and stamina. If we want more bang for our birth control, we’d focus on turning the male faucets off.
Alas, vasectomy reversals aren't common practice. The success rate of a reversal decreases if you wait more than 15 years after the procedure. Generally, the thought is 'don’t do it unless you’re sure.'
My thought is 'let’s make this a better option.' And why not push to perfect these procedures? Fewer side effects, fewer babies, less cost over time - these are calculations I can get behind!
The biggest barrier is the most obvious one: pregnancy isn’t a man’s problem. Carrying children is a uniquely female burden. Why would a man subject himself to the rollercoaster of hormonal birth control when he doesn’t have to live through the consequences? It’s hard enough to sort out as someone who needs it.
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The End of My Cycle
Birth control is tough. Simple as that. I have spent time, money, and emotional energy trying to get the right contraception, and I’m not that much closer to a solution.
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To the men reading, a little empathy goes a long way.
For women, the important part is to never settle. We have to continue demanding improvements and solutions that will keep us baby-free and fully functional. A mile-long list of side effects isn’t good enough.
What we need is more women doing research, weighing in on healthcare, and treating patients. We need progress, new ideas, and fully reversible vasectomies.
Also, while we're at it, Period Days on top of sick days would be nice. Just saying.
