The moment you inch into the realm of adulthood, you enter, in some way, the conversation about birth control. You may be one of the lucky ones who only has to consider birth control if the condom breaks, or you may be someone for whom worrying and thinking about birth control is as regular as brushing your teeth. Even if hearing the phrase, “the pill,” doesn’t stop your heart for the moment it takes you to recall if you took it that day, hormonal contraceptives touch all of our lives. Data from the Centers for Disease Control and Prevention’s 2015–2017 National Survey of Family Growth indicated that nearly 65 percent of the United States’ population of women aged 15 to 49 use contraception, with 12.6 percent using the oral contraceptive pill.
After some reflection on the pill’s many marketed talents, it’s not hard to understand why millions of women have welcomed it into their lives. Aside from the obvious benefit of staving off pregnancy, oral contraceptives can be used to relieve menstrual cramping and even clear up acne. More than half of oral contraceptive users, a 2011 study sponsored by the Guttmacher Institute finds, use it for birth control purposes as well as menstrual pain, menstrual regulation or endometriosis. While the pharmaceutical companies choose to sell those pleasant, easily quantifiable effects of birth control, they neglect to mention the profound influence it can have, for better or for worse, on the user’s mental state. I’m not too troubled by this. After all, I’m an American, born and bred — misleading drug advertisements and profit-hungry pharmaceutical companies are as much as part of my heritage as apple pie and the Super Bowl. What we should be disturbed by is the meager amounts of research published on the relationship between the pill and our brains. Somehow, both the medical community and the government that provides most of its funding don’t feel as though the hormonal contraceptives used by several millions of women, that produce wildly individual and sometimes severe side effects, warrants any further scientific inquiry. If I can be permitted to indulge in some meta-analysis, the study from the Guttmacher Institute that I cited above is months away from being one decade old. It was the only reasonably recent study I was able to find relating to the various uses of birth control. It doesn’t discuss some sophisticated science experiment or some complex theories, it simply lays out the results of one survey. For the millions of women on hormonal contraceptives, we must do better than that.
Sarah E. Hill, professor of psychology at Texas Christian University, explains it best in her book, “How the Pill Changes Everything: Your Brain on Birth Control.” “You quite literally are your hormones,” she writes, “And when you change your hormones — which is what hormonal contraceptives do — you change the version of yourself that your brain creates.” Her mission, as she describes it in her book’s introduction, is to equip her audience with a full understanding of the implications of oral contraceptive pills so that they can make the best choice for their reproductive health. A former birth control user herself, Hill understands that the pill often has an effect on the brain’s amorphous functions, like personal identity and general disposition, which is ignored by the warnings on the label. With the oral contraceptive pill, or any hormonal contraceptive treatment for that matter, these issues go far beyond reproductive health.
Despite the enigmatic reputation that inadequate clinical research has permitted hormonal functions to cultivate, hormones dominate our bodies and our minds — especially those bodies and those minds that have yet to cross the puberty finish line. Adolescents are bona fide cocktails of hormones until their biological and psychological development begins to plateau around their early to mid-twenties, after the body and the brain have adjusted to these new changes. For particular difficulties regulating stress responses, demanding libidos and whiplashing mood swings, teenagers can look no further than their internal chemical whirlwind. Adrenal stress hormones like cortisol, sex hormones like testosterone for males and estrogen for females and growth hormones swirl around and mix, triggering everything from hair growth in unexpected spots to brain maturation. I’m sure this isn’t news. The turbulent hormonal journey experienced by adolescents is well-documented in popular culture. Everyone is familiar with the trope of the moody teenager, prone to outbursts so abrupt and irrational that they verge on comical. But for young women, facing the consequences of throwing birth control into the hormonal tempest already raging in their brains isn’t so funny.
When combined with the hormonal instability characteristic of adolescence, birth control’s variable psychological implications can have extreme effects. The unfortunate reality that we have little more than an inkling of how those effects will manifest in the birth control user adds an additional layer of anxiety for them. For women suffering from premenstrual dysphoric disorder (PMDD), which is the nastier, seriously troubled sister of premenstrual syndrome, oral combined hormonal contraceptives have been found to alleviate some symptoms. Although inconclusive, scientific evidence suggests that other forms of hormonal contraceptive treatments, including birth controls with different progestogens that could take the form of IUDs, patches and implants, could also be effective in the treatment of PMDD and the depressive episodes, physical exhaustion and wild mood swings associated with the condition. Birth control could be the saving grace of women struggling with PMDD, replacing selective serotonin reuptake inhibitors, which can have unpleasant side effects, as a first line of defense.
For other women, though, birth control could tamper with brain functioning by skewing stress responses. One of the most recent forays into birth control research is an August 2020 study funded by the University of Ottawa Brain and Mind Research Institute on the relationship between birth control use and brain function. This study finds that oral contraceptive pills are linked to significant structural changes in brain regions involved with memory and emotional processing, noting that those using oral contraceptive pills experience more brain activity when confronted with negative stimuli (pictures of busted cars, beaten dogs, etc.). In adolescents specifically, it briefly mentions how the blunted stress response experienced by younger users can be a risk factor for depression. The conclusion is less than satisfying, but to be expected — the study acknowledges the desperate need for more scientific inquiry in such an “under-researched field riddled with inconsistent findings.” “Even less is known about the impact of [oral contraceptives] during puberty/adolescence,” it continues, “a sensitive period of neurodevelopment with a high emergence of psychiatric disorders.”
The first of several events that prompted Hill to inspect birth control effects more closely was when she stopped taking the pill after almost ten years of consistent use. Her experience was nothing short of revelatory. She writes about how her confidence, her motivation, even her general life outlook changed for the better after subtracting the pill from her daily routine. She’s certainly not the only woman for whom the pill has unexpectedly given a “personality transplant.” The subreddit r/AskWomen is the home to countless threads on birth control experiences, advice and recommendations, where women share their often emotional stories about hormonal contraceptives. Users gush over the pill, hailing it as the best answer to acne and unpleasant periods, while others warn of depression, stifled sex drive and weight gain. These threads are splashed with stories of triumph, bitter reflections and cries for help by new and potential birth control users. As much as I’m thrilled to see that women have carved out their own virtual space where they can support and uplift each other, it’s shameful that the best recourse for women with birth control concerns is an informal online forum. It speaks to the mistrust of the medical industry that many women share. How could anyone expect otherwise, when women’s health problems are routinely spurned in favor of other concerns? As a woman, it would be irresponsible to not be wary of the drug companies, research institutions and governments that clearly place women’s health needs beneath everything else. For young women especially, more research — and therefore, more funding — into the relationship between hormonal contraceptive treatments and mental health could prevent those in an already unstable hormonal condition from getting seriously worse. Women’s health concerns are societal health concerns, despite the impression made by inadequate research into birth control, and we all will suffer if they aren’t finally given the attention and care they so rightly deserve.
Madelaine Hastings is a sophomore majoring in cross-cultural communications.