Contraception is in chaos in the UK. Women are coming off the pill in droves, and turning to high-risk cycle-tracking apps for birth control – with mixed results. Meanwhile, waiting lists for the coil are a crazed postcode lottery, as women queue for appointments for over a year in parts of Northern Ireland and Devon, and six months in some rural areas. Pills are free from doctors, plus the progesterone-only pill is available over the counter in pharmacies, but that is clearly not providing women with the contraception they really want. Unplanned pregnancies are rocketing, and the abortion rate is at its highest ever in England since the 1967 act came in. What’s going wrong?
I started investigating contraception after my student daughter became depressed for months on the combined progestin and estrogen pill, Microgynon. That and Rigevidon are the bog-standard, older, cheaper pills often used by the NHS. We all thought lockdown was making my daughter depressed – and then she came off the pill and her mood improved within weeks. A month later, her world had gone from black and white into colour again.
I was annoyed with myself for not linking mood to hormones – after all, I’d researched two films and a book on menopause. It took me a while to remember I, too, had been on Microgynon as a student for a few years, and it made me feel a bit flat. I also realised after I stopped Microgynon that it had lowered my libido. Yet here we were, over thirty years later, still using the same old pills made from synthetic hormones. Why hadn’t they improved? Why weren’t women being given contraceptive pills with better body-identical hormones like the ones for HRT in menopause? Why was no-one taking the side-effects seriously?
We commissioned a UK survey of 4,000 diverse women for the Davina McCall The Pill Revolution documentary, and discovered that women felt they had been gaslighted for years about the pill – 77% said they had suffered side effects, and a third had come off the pill because of anxiety or depression. And 21% had lowered libido. Overall, 57% said they were worried about the possible effects of hormonal contraception on their mental health. And half of those who had considered the coil were scared to get it because they feared pain on fitting.
There was one more problem: younger women were getting fed stories on TikTok that sometimes exaggerated the risks of hormonal contraception. Meanwhile, the Natural Cycles app – which gives ‘green’ and ‘red’ days for having sex, depending on dates and temperature - was endorsed by Love Islanders and influencers, but has a 7% failure rate in typical use.
It’s clear we all need to take action. Years of cuts to local authority sexual health and reproduction clinics have meant longer waiting lists, and we know doctor’s appointments can be as rare as hen’s teeth. GPs no longer seem to have time or incentives to do coil fittings, which take longer than a ten-minute appointment, and the training to fit coils needs to be regularly updated at their own expense. The government says the new plans for Women’s Health Hubs will help – but the £25 million works out at less than a pound per fertile woman.
So what needs to be done?
Access: cut waiting lists for coils. Hormonal coils are 99% effective, last for over five years, lessen periods and the new smaller ones like the Kyleena and Jaydess can more easily be fitted in women who haven’t had children. The copper coil is also a good choice for women who want to avoid hormones. GPs have to pay for training in coil fitting
Choice: allow better choices of contraceptive pills. Women should be encouraged to change their pill and not soldier on for months with side effects. Each progestin has different effects, and some are more expensive, so NHS regulations make it hard to prescribe the new, better-tolerated combined pills with body-identical estrogen like Zoely, Qlaira and Drovelis, because they cost up to £8 a month compared to £1 for the bog-standard synthetic pills. Women should also be taught which pills are estrogenic or androgenic in their effect. It’s not one pill fits all.
Education: schools need to deepen contraceptive knowledge. Schools need to teach contraception in depth, and make sure every teenager knows to double fact-check anything they read on Tiktok.
Safety: read the small print on cycle-tracking apps. Women are keen to avoid putting synthetic hormones into their bodies, and the Natural Cycles app is 98% effective with ‘perfect’ use, but has a 7% failure rate with ‘typical’ use.
Fast-track research: there’s a male testosterone-progestin contraceptive gel being trialled in the UK now, with good initial results. There’s a melt-away gel vasectomy being tested in Australia, and a new non-hormonal sperm-barrier cervical gel is going to human trials in the USA next year. Governments and pharmaceutical companies need to fast-track this research – after all, women have had the pill for 60 years, and men have had nothing but condoms and vasectomies. It’s time they shared the birth control burden.
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Watch Davina McCall's Pill Revolution here.
Twitter: @muirkate