Does the Pill Shrink Vulvar Tissues? Examining the Clitoral Shrinkage Study (Episode 604)

Episode 604

Lisa Hendrickson-Jack:

This is the Fertility Friday podcast episode number 604.

In today’s episode, we are diving right into the controversy. We are going to go over what I consider one of the most controversial studies. And if there was one time that I’ve ever gone viral, this was many years ago, it was because of the study. It was because I posted on social media about the study and the findings and I was fully like attacked and it went like crazy because, you know, the sample size is too small and you can’t use this and you’re going to scare women off of the pill and all that stuff. So, we’re going to go into why. So, the title of the study is super long, but the gist of it is that they’re looking at clitoral vascularization and sexual behavior in women who are using the pill. And they’re comparing a small group of women who are using the pill to a small group of women who are using the vaginal ring. There’s a couple things I want to point out about the study right off the bat that I will get to later on. And I think the most important thing to keep in mind even before we go into it is that this study while it was done many years ago, it has never been repeated. So I’m just going to leave that right there and come back to it.

All right. So the reason that this study is so controversial, of course, is because of what it found. The title of today’s episode is, “Does the pill shrink vulvar tissues?” because I didn’t think that I should write the word clitoris all over everything. But ultimately what makes this study different is that not only did it study the vulvar tissues, but it specifically measured the size of the clitoris. Well, let me clarify what I mean by that. It measured the size of the clitoris before the administration of any hormonal contraceptive and after 6 months of it, and it compared the users of the pill, the combined oral contraceptive pill as well as users of the vaginal ring. And so that is what makes it one of the most controversial studies. And I would anticipate that is why I wasn’t able to find a duplicate of the study. So there’s quite a few studies that look at vulvar tissues and how the pill and other contraceptives impact the vulvar tissues and there’s a pretty consistent finding that these hormonal contraceptive options are shrinking vulvar tissues and we’ll talk a little bit about why that is and all of those things. So without further ado, let’s go ahead and get into today’s study.

So, a little bit of preamble to why studies like this are done and why this is important. It kind of goes back to one of the big topics that I highlighted in my first book, The Fifth Vital Sign, which is the impact that the pill has on sexual function. So, there’s a pretty significant body of research that does indicate that the pill and other contraceptives can have a negative impact on sexual function. And so a lot of studies have been done looking at a lot of different factors, whether it’s self-reported satisfaction, whether it’s frequency of intercourse, whether it’s frequency of orgasm, whether it’s sensation, whether it’s pain with sex. And some studies actually measure physical attributes related to the reproductive organs. So that’s one of the things that makes this study unique because not only did it measure some of those other factors which we’ll talk a little bit about, but it also specifically measured the clitoral volume before and after use as well as the vulvar tissues. And it did find that there was shrinkage. And again, the study was never really replicated. And when you bring it up, there’s often a lot of kind of like push back about, yeah, really make any conclusions based on this data. The sample size is too small. But what I’ve said for many, many years is, well, where’s the follow-up, right? Like, why hasn’t this been done?

And obviously, the implications are there. If there’s a study showing that the pill shrinks the clitoris, then who’s doing that follow-up? The drug companies are paying for these studies to be done because they want people to use their products. So if this type of result is being found, I mean that would be all over the internet, social media, and potentially could have a negative impact on their bottom line. So I suspect that’s one of the reasons why we haven’t seen follow-up to the study.

Okay. So what did they do? So the sample size in the study is small. So unlike last week’s study, if you remember last week, we looked at a study of over 800 women and it’s a totally different topic, but it was looking at how ovulation may affect how attractive a woman feels and her interest in sexual behavior. But in that study, one of the things that the researchers did is they purposely aimed to get a large sample size because there had been previous research in the past with smaller sample sizes, smaller groups. So they really wanted to kind of see if there’s some legitimacy to this hypothesis by having a larger group. And obviously that is one of the best ways to show if there’s anything there, right? Like is this going to reach statistical significance? Is this going to be consistent? You do the smaller test study initially that’s like a proof of concept. But then when you continue to see these trends, eventually you move on to a larger scale study so that you can have more solid data and information to really support if this hypothesis is correct. So I’ll preface this by saying that yes, the sample size is small, but I will tell you why we should still pay attention to the data even with a smaller sample size. So in this study, they actually had 40 women and they were randomized into two groups. So, one group received the oral contraceptive and the other group received the vaginal ring. And the intention of the study, the researchers, when you kind of look at why they chose to do this study is because they acknowledge right in their introduction, they’re talking about the mechanics of sex and they’re talking about this kind of history of contraceptives being linked to changes in sexual behavior, dissatisfaction, lower libido. And this is a common thing. I mean, one of the running jokes about hormonal contraceptives is that one of the reasons it works is because you don’t feel like having sex anymore. Now, that is not everyone’s experience. So, before anyone wants to jump on me and say, “Okay, I was on the pill and I want to have sex all the time.” So, obviously, everyone’s experience on contraceptives isn’t the same. But when you look at the research in terms of how the pill works, one of the ways it works is to shut down ovulation. And when you shut down ovulation, you have a significant impact on the natural hormone output. So we produce significantly less of our natural estradiol progesterone. So our natural estrogens, we produce significantly less of that. But in addition to that, when we’re on hormonal contraceptives, we also produce significantly less testosterone. So our testosterone production drops by 50%.

But that’s not all. In addition to that, a hormone SHBG sex hormone binding globulin significantly increases as well. And when that increases, it actually absorbs even more of the free testosterone. So the analogy I give in The Fifth Vital Sign is that SHBG is kind of like when you see those images of the iron filings and like a magnet and you see the magnet kind of like pulling up the filings. So they’re being drawn to it. So that’s essentially what this SHBG does. So not only does it reduce the overall testosterone, but it actually also reduces free testosterone by increasing the SHBG. So the bottom line is that regardless of how you experience this individually, so you could take 3,000 women on the pill and you could have all kinds of surveys about their energy levels and their libido and all of these different things. Like you could look at all that and of course there would be a lot of differences between how these women are actually experiencing this but if we look at the blood work we’re going to see a significant reduction in testosterone free testosterone because of the production and also because of this increase in SHBG. So what I always say is that we have the kind of physiological things that we know happen and then the story of how this plays out for an individual woman can be different. So some women may not really notice that they have a change in their sexual function. One of the things that I often argue is that women who are put on contraceptives at a very young age may not have a lot of history about knowing themselves and knowing how they are sexually. So, they may not even have anything to compare it to. But then you’ll have other women who do notice a drop in their libido. Or some women who maybe they weren’t even sexually active before the pill. They don’t really have like a background of what their sexual activity was, but maybe they just think that they don’t have much of a libido. And certainly many women come off of contraceptives and find that they do have more of a libido than they did before. And then the other factor is that some women find that sex is painful. They find that insertion is painful. And a lot of studies show that a certain percentage of women will experience thinning of the vulvar tissues, particularly around the opening, which can then make sex painful. So this can play out in different ways.

So I just want to kind of preface with that. If this is new information for you, if this is not something you’ve heard talked about before, but when you get into the research, like I said, it’s really interesting and we see a lot of different pieces to this. And so my argument is that well, we know what’s happening hormonally. We know that there’s going to be a significant drop in testosterone for women who are using especially these estrogen containing contraceptives because you can read enough research papers to see that as an effect. And then the question becomes, well, how is this going to affect? So these researchers are kind of acknowledging that this is an issue. And one of the reasons they did this particular study is because they wanted to kind of test if there’s an effect not only just how women are experiencing it, but if there’s a physical effect. Right?

So, one of the quotes from the study, it’s a little technical, but it says, “Sex involves a successful integration between an intact neurovascular and muscular circuitry, complex interactions between multiple neurotransmitter systems and critical modulating influences from the endocrine system.” So, they’re kind of saying in order for sex to happen normally, there’s all of these different aspects of it, some which are physiological. And so they also kind of described that one of the earliest signs of changes in the female sexual response is an increase in the vulvar, clitoral, and vaginal blood flow. So they’re kind of looking at the specifics of sexual function and the specifics of how that plays out in our sexual organs. And they’re saying that we see blood flow, we see all of these different aspects of it. So not only did they measure the size of the clitoris, but they also measured blood flow to see if when women are using contraceptives independent of sexual activity, if there’s any difference in their actual physical sexual function. So hopefully that gives you a sense of what they were doing here and why this is different to other research because other research I’ve seen often just looks at the vulvar tissues in a certain way but isn’t necessarily this specific in terms of measuring blood flow and measuring the actual clitoral volume.

Okay, so we’ve got 40 women. They’re between the ages of 18 to 35. Now, they had women specifically that they chose for the study that were not on contraceptives previously. So, naturally cycling women in stable relationships. They said non-smokers. So they had all these different criteria, but they were specifically looking at non-users of contraceptives and then giving them contraceptives and measuring before and after. And this took place over a six-month period. And so it says the core measurements were focused on clitoral anatomy and blood flow. So they were doing ultrasound measurements of clitoral volume and they were using a Doppler to measure blood flow essentially. And they also did different blood tests to measure hormone levels. And they evaluated sexual function with questionnaires. And then they also tracked specific behaviors. So independent of their feelings in terms of how they were answering these questions, they were also looking at frequency of intercourse, orgasm, intensity, and pain. So they were looking at a broad variety of factors. And this is one of the reasons why this study is something that while people are quick to dismiss it because it had a small sample size, I think that the design of it and the intention behind it is so specific and like I said quite unique. And to me, I still am waiting for the follow-up to this study with a larger sample size. I don’t think it’s going to happen honestly, but who’s hoping, right? But like I said, I do think and one thing interesting as well, like they were serious about trying to understand how hormonal contraceptives could impact sexual function outside of sexual activity. So they had strict protocols to avoid things that could change the volume of the clitoris. So specifically, participants were asked to refrain from sexual intercourse or masturbation 12 hours before when they were being examined and also to even avoid wearing tight clothing or crossing their legs. Like they were trying to get kind of like that objective is this affecting it and not having the interference because what they’re saying is during times of sexual activity you’re going to have more blood flow and some swelling and things like that. So you don’t want that to be interfering with the data.

So then the main question becomes what did they find right? So when you kind of read through what their expectations were because I always find it interesting to see like what they thought was going to happen versus what happened. So they did expect that both types of contraceptives were going to suppress the ovarian hormones as we know as we talked about. So they do suppress estradiol, testosterone, progesterone, we’re not producing significant progesterone when we’re not ovulating. And they did expect that the hormonal suppression, and that’s how they termed it, but essentially when we’re using hormonal contraceptives, it is a form of hormonal suppression because you’re suppressing your natural hormones. So they expected that would lead to changes in sexual response including desire, orgasm and lubrication. And of course if you read through the study it’s because they have this body of research that shows that this is a common response. You know up to 50% of women who are put on oral contraceptives either switch or come off of it within the first year. So we know something’s going on there. They also expected some possible differences in what they call genital vascularization. So they expected some differences in the blood flow because of the differences in hormones in terms of the profile of hormones with these contraception. So they did anticipate the results that they found maybe not necessarily to the degree but they did anticipate that.

So what did they find? What did this study reveal? Why is it so controversial and why am I focusing on it today? So the biggest I think and most controversial and quote scary finding was that both types of contraceptives did result in a significant decrease in clitoral volume over the six-month period. So for pill users that reduction was just under about 20% and then with the vaginal ring users it was about 12 to 13% smaller. And so ultimately the line of the study, the title of the study could have been pill shrinks clitoris by nearly 20%. That could have been the title of the study. So a significant reduction of clitoral volume was observed in both groups after 6 months of treatment. So they’re telling us that we’re getting the average. So with studies they don’t always give you every single data point. Of course that would be so fantastic to get every single data point. And I’m always kind of wondering well what was the range? Like the woman who had the most significant shrinkage like what was that percentage versus the women who had the lowest but an average of almost 20% is quite significant. And over the years when I share the study I’ll often say if there was something that was shrinking men’s penis or testicles by up to 20% right we would be hearing a whole lot more about that you know so something to be thinking about. And I guess one thing I can mention is that we do know that men who use steroids similarly may experience the reduction in the size of their testicles. That’s a pretty common knowledge thing. And so it’s interesting because then we have that kind of mirror effect of adding artificial hormones. So doing kind of hormone suppression. You’re suppressing your natural hormones when you’re taking these artificial hormones and therefore it is having an impact.

Okay. So interestingly there were some differences that they found between the pill and the ring and they theorized that the differences were because of the mode of delivery. But they did find that the pill in this case impaired clitoral blood flow where they did not have that finding with the vaginal ring. And so that did show that there was actually changes to blood flow. And so if we’re finding that women who are using contraceptives are reporting changes in their sexual function, then this study kind of gives even more credence to that in the sense that it’s not in your head. We’re actually seeing changes in how blood flow is delivered to the clitoris which is an important part of sexual function. And so when they measured hormonal shifts they found that the estradiol so the estrogen levels dropped more sharply in pill users compared to ring users. So they did find some changes hormonally there. And they did find that both groups had significantly suppressed testosterone and increased SHBG which lowers free testosterone. So that was what I was talking about before. So often some of these sexual side effects are linked to the significant decrease in testosterone. So as women, we make 90% less testosterone than our male counterparts, but even though we make a lot less of it, it is essential for sexual function. And so when we’re significantly decreasing testosterone, that is one of the factors that correlates to this change that we see in sexual function.

So in addition to those findings, they found that sexual desire and orgasm frequency decreased in both groups more in pill users. So pill users had significant drops in the frequency of intercourse, orgasm frequency, orgasm intensity and sexual satisfaction. And again, just to kind of reiterate this, so this was a group of previously they were not on contraceptives and then they were put on contraceptives. So again, this study is really interesting because it’s specifically trying to say, okay, so when we put women on the pill who weren’t previously on it or have women use a vaginal ring who previously were just cycling naturally, what is the difference that we’re seeing here? Also, pain during intercourse increased, but only in the pill group. So they reported more pain with sex after the six-month period. Lubrication reduced significantly in the pill group while ring users did not have that negative effect. So the women who were on the pill reported that they had less natural lubrication.

Then one of the questions is kind of like well so because they were looking at the difference between pill users and the ring users what was going on there. So just to kind of go through how they interpreted this change. So both of these modes of contraceptives, there were similar effects. Both groups had lower testosterone levels. Both groups had clitoral shrinkage, although the ring users to a lesser degree. So there was a lot of overlap and a lot of similarity, but the pill seemed to have a more pronounced negative effect on sexual function. So why is it? So one of the reasons that they suggested is because of the way that it’s delivered. So the researchers argued that the pill caused more sexual side effects and impaired clitoral blood flow because the oral estrogen spikes SHBG and suppresses free testosterone more dramatically. So they were arguing that because the ring gives this kind of steady hormone delivery that that’s one of the reasons it has more stable delivery. So maybe that’s one of the reasons why it had fewer of those negative effects or the negative effects to a lesser degree. But keep in mind both of the types of contraceptive methods did reduce the clitoral size and both of them did have an impact but interestingly the ring fared better.

So what do we do with this information? What does this all mean? And why is it so controversial and why has a follow-up study not been done? So I mean if I summarize the information in the study into a little package for you, we do know that both the pill and the ring were associated with pretty significant clitoral shrinkage. So that’s the big takeaway of that. And the pill also significantly decreased clitoral blood flow. The pill disrupted hormones more dramatically than the vaginal ring did, especially in terms of its effect on free testosterone and estrogen. Sexual function declined in both groups. So both groups did report a drop in sexual desire and having sex less frequently, fewer orgasms, etc. But of course, the pill did have a more pronounced effect. And there was kind of a question around the deliverability of the ring versus the pill showing that maybe that reduced some of these effects to some point. So then the ring had a better sexual side effect profile. So it’s like both of them are kind of negative, but the ring was less negative, right?

And I think ultimately I have several takeaways from the study. I think the big one is that it really helps to validate the lived experience of women who have taken contraceptives and have noticed a shift in their libido. Or maybe, like I said, if they weren’t sexually active prior to using the pill and they still had some of these effects, maybe not knowing that it’s not normal to have pain with sex or it’s not normal to not lubricate or it’s not normal to kind of not have as strong of a sex drive. I feel like it really helps to normalize and put that information out there. When women are going on the pill, we’re not really counseled and told that it can have a negative effect on sexual function and libido. The line that is repeated over and over and over again is that the pill is a reversible contraceptive. It’s perfectly safe. It’s widely used. And of course, that’s marketing. And if you want to find out more of the side effect profile, you would have to go online and search for the prescribing information, which isn’t hard to do. If you currently are taking contraceptives or someone who is, you just type in the brand name and then you would put in the prescribing information and you should be able to find literally like the PDF online. They’re typically available, but unless someone tells you that or unless someone goes through it with you, especially if you’re like 13 or 14 or 15 when you start taking it. I mean, I’ve had many conversations with adults who are in their 20s, 30s, 40s who are taking medications and it’s me that’s suggesting that they search for that or go to their pharmacist and ask for that because it never even occurred to them. So, we certainly live in a time where we are kind of used to taking medications and we’re not necessarily used to looking deeper into what those side effects are, but the information is available. But I would say most women who I’ve ever spoken to who’ve been put on contraceptives, it’s not necessarily discussed. And maybe some of the side effects are discussed at some point, but the low libido sexual side effects aren’t necessarily front of the line, I guess you could say.

So, I would say that what this study did do is it points to the fact that it’s not just in someone’s head. It’s not just emotional. It’s not just like hormones or just this kind of concept that is in the air or something. And it’s not really a tangible thing. You know, when people say, “Oh, it’s your hormones,” we kind of think that it’s like this force or something. This study shows that there are specific measurable physiological effects that hormones have on our sexual organs specifically. And so if you’re experiencing changes in sexual function when you’re using these products, it is not just in your head. We can actually measure changes in hormone levels. We can measure the thickness of your vulvar tissues. We can measure the volume of your clitoris. We can measure the degree to which these medications are changing the blood flow to said sexual organs. And these researchers did and the results are very striking.

So some of the criticisms obviously then especially the blowback that I’ve had at times when I’m sharing about this is that the sample size is so small you can’t draw conclusions based on a sample size of 40 women. And so there’s a couple things that I just want to say to that. So obviously when we have data like this it’s not as strong as it would be if we had data on a thousand or 2,000 women obviously. But when you have a study that’s showing such specific results that the researchers expected because previous research has shown that this is a common effect of said medication. And when you have a situation where all of the participants experienced shrinkage with an average of just under 20% for those who were the pill users, then I don’t think we can just ignore it. So, I find it just so interesting like there’s this touch of like hysteria when studies like this are so damning for birth control for various reasons. Of course, pharmaceutical companies don’t want to dissuade women from using it because that’s going to affect their bottom line. We often have women who are concerned about the availability of contraceptives. They don’t want people to bash contraceptives, so to speak. I don’t think it’s bashing. I honestly think it’s reading the paper and like sharing the research. I feel like it’s important for us to have informed consent. I always have. So, I don’t think that actually just telling women what studies have shown is bashing. I think that’s just providing information. But to each their own, right? But there are of course women who don’t like when we highlight these types of issues because it’s like, well, then you’re going to make all these women not want to use it and potentially it could mean that they’re going to pull it. Well, no, they’re not going to pull contraceptives. It’s a 30 plus billion dollar industry. So I don’t think we’re ever going to lose our access to contraceptives. And maybe I’m naive by saying that but honestly $30 billion industry there’s a lot invested in making sure that contraceptives never go away. So if they’re not going away we need to be able to talk about — not that I’m asking, I don’t want them to go away. I’m not saying that’s what I want either. I’m just saying that as a response to that common critique. But I guess what I’m saying is we have them. They’re available. So then the next step would be well what can we do to reduce the side effects? The first thing we have to do is actually study them.

So again, going back to what I said at the very beginning when I started recording, this study initially came out in 2014. So that’s 11 years ago. And that’s a long time in research land. There are so many studies of contraceptives. If you’ve never looked at studies on contraceptives, have a look. The pill first came out in 1960. That was 65 years ago. So, we have a lot of research about the pill, which is so fortunate. We live in an amazing time where we can actually look at it. And so, what’s incredible to me is that this study had such damning and specific negative results and it has not been touched since then. And part of that, I think, is that it allows the marketing to kind of say, well, the sample size was small. We can’t really draw conclusions about that. We just don’t have enough data. So, it allows them to kind of continue to say like, we just don’t have enough data. We just don’t have enough data. Whereas, really and truly, this should have been an alarm, right? To say, oh my goodness, this is shrinking the clitoris. It’s dramatically changing sexual function. It’s changing the blood flow that is being distributed to the clitoris, right? And there’s plenty of other research studies that show that shrinkage of the vulvar tissues, that thinning of the vulvar tissues and the association with contraceptives with painful sex because again when we dramatically drop testosterone, it can have this kind of atrophy effect on the reproductive tissues. And we also have studies on how the pill impacts ovarian reserve parameters. And we know that women who are on contraceptives see ovarian shrinkage, which is the other scary stat from The Fifth Vital Sign. Like there’s like two stats that like have people stopped in their tracks. And one of them is the it could shrink your clitoris by up to an average of 20%. And then the other stat is it shrinks the ovaries by about 50%. Right? So ultimately this artificial hormone replacement suppresses our natural hormone production and then that has a tangible physiologic effect on the body. And you know my question is like A, why can’t we talk about this more B, where’s the follow-up research right? Like where’s the research follow-up to this study?

So I will leave those thoughts with you. I just wanted to share this and before I wrap up though I don’t want to just leave it there because the one thing I think the one issue about bringing up this information is that it terrifies people because again the pill is one of the most widely used medications on earth. Over a 100 million women are estimated to have used it including myself. I was a pill user when I was a teenager so I would have experienced some of these effects as well. And so what we know about the pill is that the research does not suggest that these effects are permanent. But with that said, we don’t really have the research then after the women come off to see how long it takes the size of the clitoris to return back to normal. Of course, that study isn’t done, right? Because we have barely gotten this study to begin with. So we don’t really have actual research to say how long does it take for those tissues to return back to normal. But with that said, the research that we do have on ovarian function and sexual function, it does suggest that over time the SHBG levels do return to normal. Although it can take many years for the SHBG levels to normalize. We do see that the estrogen, progesterone, testosterone do normalize at some point. We have our post pill studies that show that typically cycles return to normal within about 6 to 12 months I think for most contraceptive methods. Though the caveat about the shot is that it does have a more pronounced negative effect and the time to pregnancy and the time for the cycles to return to normal for women who’ve used the shot in particular is longer. So more like 18 months to two years before we’re seeing full normalization of hormones and cycles off the shot. But what we do know is the research shows us that there is a post-pill transition period and it lasts a minimum of 6 to 12 months but it can be longer depending on the situation. So we don’t have any research to suggest that this is a permanent thing — that this is a kind of a temporary effect from the exposure to the artificial hormones for the duration that we’re using it. And the research would also indicate that when women are using these effects for long term, which in most studies is kind of like two years or more, so long-term use, this tends to be associated then with a bit of a longer delay. So again, in that 6 to 12 month timeframe. So that’s what we know. And so I don’t share this information as a scare tactic to say no one should ever use the pill, but this research, like I said, is really important because many women do experience changes in sexual function. Many women have concerns about how the pill could be impacting their sex drive, their libido. And many women who come off the pill find that after a few months, after their body has started to normalize and their cycles are normalizing, many women find that they do have more of a desire and that libido does come back and they are finding that they’re more lubricated. And whatever the case is, some women do find that maybe it takes a bit of time or maybe that painful sex persists. And so there’s an episode that I shared a few years ago with a client who had this experience and she ended up having to use testosterone replacement cream. That was the thing that finally helped to relieve the pain that was associated with insertion and again likely due to pill use in her case.

And of course one other thing I’ll say is that every woman doesn’t have the same experience. So, not everybody who uses a pill is going to have painful sex, just like not everybody who uses a pill is going to report the same side effects. There’s quite a wide side effect profile. And obviously, everybody doesn’t experience the same thing. But as with anything, in order for us to have informed consent, we need to know. We need to understand. And if you happen to experience one of these side effects, I think the most important empowering thing about this conversation is that it’s better to at least know what the side effects are because the number of women who experience negative side effects, it’s not like 1%. There is a decent percentage of women who are experiencing side effects of hormonal birth control. And so if you happen to experience a side effect that is particularly negative, it’s way better that you actually know that is a side effect of birth control because the number of women that I’ve spoken to over the years who were having to kind of do a midnight googling situation to try to figure out what was going on with them, that’s just unacceptable, right? We need to be aware when we’re being put on these medications what some of those side effects are. So if you do experience like a drop in your libido or if sex becomes painful or you notice a change in your sexual function, if you do notice that you are starting to have anxiety, panic attacks, mood changes, these are things that have been linked in research to the pill. If you notice symptoms of depression, that’s also a very common response to birth control and that can be a result of a combination of the way the pill changes how we process our nutrients, particularly B6, vitamin B6, B12, and also the drop in testosterone. There’s a lot of research that we have, but if we are not provided with that information, it’s harder for us to make an informed decision.

And I’ll conclude with this for anyone who has not heard what I say about birth control. So for anyone who’s wondering about my personal opinion about birth control, my opinion is that we should just be aware of the side effects. And I think that when we educate and empower women, just giving them the information about it, then they get to make a decision. And I think that many women fall into one of three categories. So category one, it’s like, okay, so I’m happy that I know this information. You’ve told me what the side effects are. So I’m going to use it now, but then it gives me the option if something does come up, at least I know about it, and then I can decide what I’m going to do about it then, whether it’s switch to a different brand or maybe try something else. There’s a second group of women who when they learn about the side effects, they may say, “Okay, you know what? I’m glad that I know about the side effects and so while I need to use this now, maybe instead of being on it for 20 years, maybe I would shorten how long I use it.” And I think there’s a third category of women who are going to hear about those side effects and they’re going to say, you know what, this isn’t for me. But I don’t think every single woman who learns about the side effects is going to say, “This isn’t for me.” Or we wouldn’t have 100 million women worldwide using it and we wouldn’t have a $30 billion industry. So, I don’t actually think that educating women about the side effects is going to destroy the industry and make everyone just not take it anymore. But I think we would have a more informed population and we would have women who would be using it more mindfully. And some women don’t have a lot of negative experiences on it. Over the years, I’ve worked with countless women who used contraceptives and they didn’t have the negative side effects. And I’ve also worked with countless women who they went on it and they felt completely crazy and they had to come off immediately or they felt fine for the first few years and then all of a sudden they started to have all these side effects and they had to come off and the things that they were experiencing stopped when they came off.

So ideas for future research. I mean I have a gazillion but what I would love is I would love for the industry to care enough about women to not only do research in general but get to the point where we’re doing such specific research where we can actually try to identify: okay, we have some women who are just like they go on it and they’re just like roller coaster crying, laughing and immediately have to come off. We have some women who are going on it and the side effects kind of just increase over time or just start to happen more and more after they’ve used it longer. And we have other women who say they’re totally happy with it and don’t really report negative side effects. What if we figure out why that is and who’s more prone to side effects so that we can maybe gear the women who are more likely to have the negative side effects to other methods that might not. Right? I feel like if we actually cared about the women who are using these products, then we could get somewhere. But I think we’re currently in a time or at least historically we’ve been in a time where when women bring up side effects, we’re just dismissed. We’re gaslighted. We’re told it’s in our head and we can’t get anywhere if we’re doing that. If we’re not listening to the people using the products and we’re not hearing what they’re saying, we’re not researching more deeply, then we’re not going to make any progress.

So those are some thoughts I wanted to leave with you today. Like I said, this study I always find really interesting and I always like to share about it whenever I have an opportunity and I always want to leave with that question of like it’s been 11 years — like why is it that this is the only study about this topic that I’ve seen publicly? And if it has been done, tag me on Instagram at Fertility Friday because I would love to do an episode on the follow-up study to this.

If you found today’s episode particularly interesting and you can think of somebody who absolutely needs to hear about it, make sure to share. You’ll find the show notes page at fertilityfriday.com/604 and that is the same link you can use to share this episode. So with that said, I hope you have a wonderful week, weekend, whenever you’re tuning in to the show. And of course, as always, until next time, be well and happy charting.