‘The pill picked at me a little bit every day. I lost something.’ Those are the words of Kirsty Keating, from Tring, Hertfordshire, who went on the combined pill aged 14, and only discovered when she came off it at 30 that it had been slowly turning her into a different person.
Like many girls, Kirsty went on the pill at school for her skin: ‘I had terrible acne on my back, chest and face. I tried all the topical treatments and they didn’t work.’ She was prescribed a pill which can reduce female testosterone levels and help with acne.
Kirsty’s combined pill Dianette contained synthetic versions of oestrogen and progesterone – ethinylestradiol and a progestin called cyproterone acetate, which is anti-androgenic. Kirsty’s skin improved, but there was a long-term price to be paid. ‘I’d been a very sparky, in-your-face Gemini, and suddenly I just couldn’t go to school. I couldn’t do my GCSEs. No-one ever asked why. They thought it was just teenage mood stuff.’ There were other changes: Kirsty put on weight and suffered an eating disorder. She also lost her sex drive with the lower levels of testosterone in her body. ‘There was literally nothing,’ she said.
Like most women, she never read the pill leaflet, yet her brand Dianette did note the possibility of ‘severe depression’ as a side-effect for a few women. By the time Keating was 21, she said, she was ‘very, very unwell, agoraphobic and housebound. I got lots of psychotherapy, but no-one ever asked about hormones.’
It was only when she decided to get pregnant, she said, that things changed: she had energy again and even set up her own cleaning business. After two children, Kirsty went back on the synthetic progestin-only mini-pill or POP. ‘It spun my world upside down. I felt physically terrible and mentally clouded.’ She was offered anti-depressants. This time, however, her husband had noticed the patterns and Kirsty came off the pill. ‘It was a eureka moment! He gave me a massive hug and said he’d get a vasectomy.’ After that, Kirsty had ten happy years off hormonal contraception and is now in perimenopause – and keeping an eye on her hormones.
But why didn’t a single medical professional think about the effects of synthetic hormones on Kirsty over all those years? We now have research which shows synthetic hormones can lower mood-boosting serotonin and dopamine in the brain – no wonder women get depressed. Women and their doctors need better, more up-to-date knowledge. It makes sense that ‘Think Hormones!’ is the slogan for the new Mumsnet awareness campaign.
I interviewed Keating for my book Everything You Need to Know About the Pill, and I also made a Channel 4 documentary, Davina McCall’s Pill Revolution, which included a survey of 4,000 UK women aged 16-49 who were on contraception. We were astonished that of 1,800 pill-users, 77 per cent experienced side effects. The most-reported effect was weight gain at 37 per cent, then 36 per cent with low mood, anxiety or depression, 26 per cent with headaches, and 21 per cent with lowered sex drive. And 29 per cent of those surveyed couldn’t even name the pill they were on.
Prescriptions are hit and miss. When there are side effects, GPs who usually suggest women stick with a pill or contraceptive implant for three months before trying to swap, which can be miserable. Women’s truth is often dismissed. If you look up ‘side-effects’ on the combined pill listing on the NHS website it says: ‘Some people report headaches, feeling sick or dizzy, and sore breasts. But there is not enough evidence to say whether this is caused by taking the pill…There is no evidence that taking the pill makes you put on weight or changes your sex drive.’
Read next: Not being taken seriously by your GP? Here's what to do
That’s not what I found after two years of research into contraceptive science, as well as listening to women’s stories. Actually, we have solid evidence that shows the combined pill’s synthetic oestrogen - a chemical called ethinylestradiol - increases Sex Hormone Binding Globulin levels which lowers your free testosterone and your sex drive. Isn’t it annoying that you go on the pill to have sex, and you might end up wanting it less?
As for weight gain on the pill, it varies between women depending on their different metabolisms, but it is a factor. For women who have insulin resistance or pre-diabetes, hormonal contraception can make managing blood sugar levels harder, and they are the unlucky ones who tend to put on weight. Genetics have an effect too, particularly for women using the contraceptive implant, and we know that the Depo Provera or Sayana Press injection has proven record of weight gain, as well as causing low libido. The injection is also worth avoiding as more research comes in on its raised risk of meningiomas, benign brain tumours. Given the evidence, I’m astonished that the injection is still being offered given to women.
Some doctors are keen to raise awareness and find better contraceptive options. In her book The Power of Hormones Dr Louise Newson explains that ‘hormonal contraceptives do not actually contain hormones’. Instead, they contain synthetic chemicals: ‘This means they work differently to hormones, and these synthetic hormones actually block the action of your natural hormones on your brain and body.’
But the body-identical, natural hormones – oestrogen and progesterone - which are prescribed for most women in the newer Hormone Replacement Therapy, are much safer and better tolerated than the synthetic versions. Dr Newson states that younger women should be able to access body-identical hormones to help with conditions like PMS, PMDD, menstrual migraines and heavy bleeding as well as PMOS (polyendocrine metabolic ovarian syndrome, formerly known as PCOS). ‘The underlying cause of these conditions is often low hormones. Topping up low hormone levels with progesterone, estradiol [oestrogen] and sometimes testosterone is likely to be far more effective and is much safer than prescribing contraceptives for these conditions.’
There are also a few new contraceptive pills on the market which contain body-identical oestrogen: Zoely, Qlaira and Drovelis, but it can be hard to get them on the NHS because they’re more expensive than the old-fashioned products. They all still contain synthetic progestins, but the oestrogen is natural. Zoely has performed well in helping women with PMS; Drovelis can help with acne; and Qlaira is recommended by the NHS for heavy periods.
Of course, there are non-hormonal options: the copper coil (which can increase menstrual bleeding in some women) and the good old condom, as well as more tech-based versions of the rhythm method in apps like Natural Cycles, but there’s still a small risk of pregnancy with that too. Some women consider sterilisation too.
We deserve better. Or as Dr Newson says, ‘We desperately need more research and investment into new and different forms of contraception, but in the meantime, we need to make sure that women are well informed about the contraceptive choices that are on offer.’
About the author