Uh oh, Women Are Talking About Birth Control on Instagram Again (Episode 651)

Full Transcript: Episode 651

Lisa Hendrickson-Jack: This is the Fertility Friday Podcast, episode number 651.

Uh-oh, women are talking about birth control on Instagram again. You know how much I love a good study that researches the women who are talking about the things that affect them and make them seem like they’re the bad guys.

A recent study just came out in the European Journal of Contraception and Reproductive Health Care that looked at Instagram posts in Germany that specifically mentioned birth control. Now, of course, we’re going to want to hear more about what they have to say. So without further ado, let’s go ahead and jump into today’s episode.

If this is your first time tuning in, I’m Lisa Hendrickson-Jack, Certified Fertility Awareness Educator. I’ve been teaching women to chart their menstrual cycles for over 20 years. I’m the author of The Fifth Vital Sign, co-author of Real Food for Fertility, and I’m also the founder of the Fertility Awareness Institute. And of course, this is where we teach women’s health professionals to use the menstrual cycle as a true vital sign in practice.

I’ve been at this for a long time, but my message for over 20 years has been the same, that women really should be using the menstrual cycle as a vital sign because there is so much more that we can learn about our bodies, about our hormones, about our cycles when we pay attention and track accurately. So let’s go ahead and jump into today’s topic.

I’ve already mentioned the study that I wanted to talk about today. Super interesting. The researchers in this study looked at over 30,000 German Instagram posts about birth control and they assessed them. They looked at what these women were talking about. They categorized the different birth control methods that they were looking at. And of course, came up with some really interesting perspectives on hormonal birth control as well as fertility awareness methods. And in this study, they referred to fertility awareness methods as NFP, natural family planning.

One of the first points that I wanted to talk about is how the researchers framed the results. When they were looking at the results of their analysis of these over 30,000 posts, they found it to be very imbalanced. What they mean by that is that the majority of posts about hormonal methods are about side effects, negative experiences, all of that kind of stuff. And the majority of posts about natural methods, fertility awareness-based methods, NFP methods are positive. And so they’re saying that this is imbalanced and that this is, of course, a problem.

If you think about that, though, it makes perfect sense. When women take birth control, the research tells us that as many as 50% of women who start the pill in any given year will come off of that pill and at least switch to either another type of birth control or completely abandon it just within that first year.

What that means is that while there are plenty of women that are happy with their contraception, there is a pretty significant majority of women who are not. And at best, they may be neutral or outright unimpressed by the side effects that they experience. So it doesn’t really surprise me that the majority of comments about hormonal birth control are negative because these are the things that women say. If you actually listen to what women say when they talk about birth control, they are often talking about the negative side effects of it.

And then on the flip side, when women are talking about natural family planning or fertility awareness-based methods, well, why are women turning to these methods, right? They’re turning to these methods because many of the women who choose these methods had a uniquely or specifically negative experience on hormonal birth control.

That’s at least what I found in my programs. When I would run group coaching programs for women who were learning to use fertility awareness for contraceptive purposes, many of them were there because they had tried not just one option of hormonal birth control, but often many. Many of the women in my programs had tried multiple different pill formulations. They had tried a hormonal IUD. Some of them had tried the implant. Some of them had tried the ring or the patch or even the shot.

And regardless of how many different types they try, there are certain women, there’s a percentage of women who just have really negative side effects. And when they discover that there’s a way to prevent pregnancy naturally, that has no side effects whatsoever, many of them are overjoyed.

And so there are a lot of benefits about charting your cycles. One, of course, is the birth control aspect, the side effect free birth control aspect. And then there’s a bigger part of that conversation, which is that this method allows you to connect more to your body, to learn more about how your body actually functions, to learn how to support your fertility and to support your hormones, because you can’t chart your cycles for very long without noticing how your cycles respond to whatever is happening in your life, whether it be stress, whether it be over exercise, under nutrition. Your cycle is always telling you and reflecting back to you what’s happening in your body.

So unsurprisingly, what the researchers found in the study was that there was this imbalance of results. More positive comments about fertility awareness type methods and more negative comments about hormonal birth control.

Now, another interesting part about this observation was that the actual side effects that women were discussing on social media reflected the side effects outlined in the research. So it wasn’t that they could say that these women were exaggerating or making up things that weren’t actually happening. The side effects that the women were complaining about the most were the same as the side effects reported in the literature.

There were a variety of themes, including blood clots, skin problems, mood swings, depression, nutrient deficiencies, hair loss, weight gain, that kind of thing. And when we look at the research, that aligns with what we know about how hormonal contraceptives affect women.

At the end of the day, I find these studies to be fascinating. And every time I find them, I will bring them to the podcast because it’s so interesting. These researchers are so perplexed. Like, why are they talking about this in this way? Why are these women complaining about birth control? Why is there this imbalance between the negative comments around hormonal birth control compared to the positive comments on fertility awareness methods?

It’s like, well, maybe just read what they’re saying and actually listen to them. Shock of shockers, if you just read what they’re saying and listen to them, then you’ll know why. Okay. Ask me how I really feel, right?

And so, of course, there were some downsides listed about fertility awareness methods. What the researchers identified were the three themes of the downsides that were discussed on social media: having to figure out the rules, the occasional confusion around potentially the different aspects of charting, as well as the requirement that you be consistent.

Obviously, in order for fertility awareness-based methods to work, you have to maintain that consistency of actually charting. You have to have some level of self-discipline to be able to be consistent with that. And so that’s interesting because that, again, reflects the real genuine experiences of women with these methods.

What I always say about fertility awareness-based methods is that no one is forcing anybody to use them. So any woman who is choosing it is often choosing it for a very compelling reason, whether it be that she’s looking for an alternative to hormonal birth control or that she is simply excited and jazzed to learn more about her body and how it works and all of that. Maybe she’s trying to conceive, which obviously is a huge motivational factor.

And so the perceived downsides, whether it be the rules or the confusing nature, are often an acceptable trade-off to side effects or to some of the other experiences that these women have had on hormonal birth control.

Again, I just love how reading pieces like this, the researchers look at this as kind of like a disaster. Like this is a huge problem. We’ve got all these positive comments about family planning methods, natural family planning, like I said, is how they refer to it in the paper, and all these negative effects about hormonal birth control.

Here is a quote from the researchers in that paper, quote, “The polarizing presentation of the pill and NFP should be considered in public health initiatives by prioritizing balanced evidence-based education about all contraceptive options, ensuring that both benefits and barriers are communicated in a nuanced manner,” end quote.

So they’re looking at this as a problem, and the solution to the problem is to make sure to present all the positive sides of hormonal birth control and all the negatives about fertility awareness type methods so that it’s more clear. And I feel like there’s nothing wrong with that on its face to just have an equal presentation.

But the issue that I have is listen to the women. Perhaps the negative side effects of hormonal birth control for many women do outweigh the positives. And perhaps it doesn’t matter how well you market those positives. There’s always going to be a group of women who say, you know what? No, it’s not for me. And is that not okay? Because there are plenty of women who do use hormonal methods.

One thing I like to point out when I look at these studies that are critical of women’s actual commentary, particularly in social media, is that let’s just not forget that 100 million women worldwide are estimated to be using hormonal methods. They’re still making money. It’s okay.

It’s still a small percentage of women who are not choosing these methods and who are choosing alternative methods. And yes, that number is growing, but it still represents a very small percentage. So I find it so interesting, the mass overreaction to the fact that there’s a percentage of women that are actually quite happy off contraceptives and really enjoy the benefits of non-hormonal methods.

Okay, so I did touch on this point, but I do want to go into it a little bit more. Another big finding from the researchers is that the pill side effects that women post about are actually real. These are the ones that are well documented.

Based on what their findings were, about 97% of the posts that mentioned blood clots also mentioned the pill, 93% of the posts about skin problems, 96% of the posts about nutrient deficiencies. So when women were posting about contraceptives, they were frequently talking about these side effects, specifically blood clots and skin problems and nutrient deficiencies. Many of the posts that mentioned blood clots also mentioned the risk of stroke.

There were a significant percentage of posts about mood swings. And as I often talk about, and as I wrote about in The Fifth Vital Sign, it’s interesting how the side effects can be presented. Like, oh, there’s a percentage of women who take hormonal contraceptives that experience mood changes. But when we actually look at what that looks like for many women, it’s anxiety and depression, pretty serious emotional shifts that they’re experiencing that are often just not talked about in real terms and kind of skirted over with polite language.

Also, low libido is quite common, and many of the women were talking about that. Nutrient depletion, many women were talking about that. And again, in case I didn’t mention this, this study was looking specifically at German language posts. So this study was outside of the United States, North America, Canada.

The point is that the researchers were not only looking at how many posts there were and what they were talking about, but they were also looking at the validity of the claims, naturally, to try to identify if they were legit, I guess you could say.

And what the researchers couldn’t say was that the women were talking about things that were false or that there was no actual research and backing for. What the women were talking about were quite consistent with what the research actually says.

A quote from the researchers on this point, quote, “The predominance of pill-related content and its negative framing is consistent with prior research, which has identified side effects concerns as the dominant theme in online contraceptive discourse,” end quote.

Like I said, it’s interesting looking at this from the standpoint of research because now with the advent of social media, I think the only difference between now and, let’s say, 30 to 40 years ago is that when women would complain about these side effects before, they didn’t really have a platform to complain about them such that millions and millions of people could actually witness and participate and read it and share those experiences in a public forum.

When women would complain about this before the advent of social media, maybe they told a girlfriend, maybe they tried to talk to their doctor, but there was no real social platform for that as there is now. And so it’s kind of interesting. The only difference now is that when women complain about this, we have an audience of other women who also have had similar experiences. And so we can be validated, we can share in these experiences. And we now know that no, they are not in our head. No, they are not rare. Actually, they’re quite common.

And so it is interesting to watch the falling out from this reality, which is typically this idea of damage control. Well, we have to control the narrative now. We don’t want to necessarily listen to the women who are complaining and try to fix the problem.

We don’t necessarily want to try to reevaluate the formulations and determine if maybe we can make them better and actually take into consideration the fact that all of these millions of women online are just saying the same exact thing that’s also shown in the research. It’s all consistent. We typically want to look at the women who are complaining and then try to control the narrative.

Okay, so this point I thought was really interesting from the study. The researchers found that fertility awareness is actually the second most talked about birth control on German Instagram. So the pill was first and then fertility awareness was second. So there’s a huge conversation happening on German Instagram about birth control, which I find to be really, really interesting.

What the researchers did is that they sorted out the posts that they were looking at into seven different categories of birth control. And then they counted how many times that those types of birth control were mentioned. And natural methods were mentioned more than barrier methods, more than emergency contraception, more than the copper IUD.

And so while the pill did make up the majority of the conversation, fertility awareness methods were second. And then other types of hormonal birth control, like the IUD or the ring or the patch or the implant or the shot made up smaller percentages. And in German Instagram, NFP is the name that women are using, and that made up almost 70% of natural method mentions.

Another interesting piece of information, I feel like this study just has lots of different nuggets, but what the researchers mentioned was that the first post about hormonal contraception showed up in 2016 and have been growing since then.

I also find that to be interesting. And again, it tracks. It tracks with when the public discourse of fertility awareness methods started to blow up on social media. And I still remember when I first started this podcast back in the fall of 2014, there were very few voices, just even just online, like blogs and things like that talking about fertility awareness. And of course, the Fertility Friday Podcast was the very first podcast specifically around fertility awareness-based methods around that time.

So it is interesting to see what has happened since then in that span of time. And of course, online, these conversations have blown up. And there’s so many different reasons for that.

I would say one of the main reasons for that is when women learn about their bodies and how their cycle works and ovulation and cervical mucus and all of the different things that we talk about on the podcast, they are genuinely excited and also typically really pissed off at the same time. And they’re upset because no one taught them this.

And so part of the reason that I would say women are going online and taking to all the different social media channels is because where else are we learning about this stuff? No matter how many women complain online, I have not seen any systematic changes into our education system that would ensure that all young women and girls are learning about their bodies.

I always say it’s up to us to make a ruckus and just to do it in our own lives. Why wait for the so-called powers that be to decide that this is important when clearly they haven’t? So again, I feel like this is the play-by-play of the unfolding of the process by which women are learning about their bodies and their cycles. And a huge part of that is what’s happening online.

The last point that I wanted to end on today is a theme that has been running throughout this entire episode, which is, of course, one of the biggest reasons why women turn to fertility awareness-based methods.

As women, we value fertility awareness, not just for its ability to help us to prevent pregnancy naturally without having to worry about side effects or its ability to help us to time sex correctly so that when we’re ready to conceive, we can do that. But I would say, especially because of what it teaches us about our bodies.

As women, we live in our bodies. And we experience these cyclical changes. But if we’re not provided with any information and education about how it works, we’re often left in the dark about these things.

And so what a breath of fresh air when you can learn to chart your cycles and you can learn, oh my goodness, there’s a whole explanation for why I feel this way, why I feel energetic at some points in my cycle, whereas in other points of my cycle, I feel less energetic. Why sometimes I might have that spotting leading up to my menstruation and why other times I don’t have it. Why sometimes my cycle is a little bit longer, a little bit shorter. And instead of it just being a total mystery, I can actually track it and identify and determine when my period is going to come. So it doesn’t always have to be a surprise.

There is so much benefit that comes from tracking your cycle. And so again, it’s no surprise that this is blowing up on social media. It’s no surprise that women are talking about this.

Again, I find it really interesting that the researchers are just so confounded by why all these women are complaining about side effects. If anyone would listen to us, then we wouldn’t have had to take to social media. If you actually look at what women are saying in social media, if you actually look at it and you analyze the comments, many women have tried to talk to their health professionals only to be dismissed or to be gaslighted or to be told that it’s not that big of an issue, whatever the case.

So I think that it’s good that we have these avenues. I think it’s amazing that we have the ability now to connect with the world through these channels and to be able to share our stories. No matter how much they may try to invalidate them, the more that we talk about our stories, the more that we share our stories, the more it prompts studies like this to come up.

Researchers are now studying this. This is now a topic of discussion. Women talking about their side effects of birth control online is now a legit research topic. The researchers are studying us under a microscope to figure out why we’re complaining about birth control and what they can do to damage control the situation. I feel like this is progress. I’m excited to see it. I’m happy to see it.

So keep sharing your experiences online. Do not keep them to yourself. Not only does it apparently strike nerves with researchers, but of course, it also helps our fellow women to know that we are not alone. We are not the only ones to have these types of experiences.

And the more we can share, the more that we prompt additional research to be done, maybe, just maybe, at some point, they might look for alternatives to the current hormonal birth control formulations aimed to minimize side effects if possible. Maybe, just maybe, after all these years of criticizing and trying to share that maybe many of us are not happy with the alternatives provided to us, maybe just maybe it’ll encourage some of these drug producers to come up with better options for us. So I’m not holding my breath or anything, but I’ll just put it out there.

Okay. And so there was one more point that I found really, really interesting about this paper. And it was about the efficacy.

I’m actually quite used to seeing papers that are looking at what women are saying online or looking at the social discourse and specifically talking about fertility awareness-based methods. There’s so many studies and so many commentaries that have come out around fertility awareness-based methods. And in the past, they would jump straight to these methods are not effective. These women are choosing these ineffective methods over hormonal methods that have a higher established efficacy.

And so I’m quite used to seeing fertility awareness-based methods portrayed in a certain light in these kinds of studies. But interestingly, in this study, it was not actually portrayed that way.

I feel like we’ve come to a point now where it is getting more difficult for researchers and medical professionals to continue to dismiss fertility awareness-based methods. And I think that, again, that’s really interesting to see. It’s really interesting to see the shift.

I would argue that the data itself hasn’t necessarily changed. It’s just that the community of women out there who use this method have been so consistent and so loud and the information itself hasn’t changed so that they know that if they want to be scientifically accurate when they talk about these methods, they cannot just lump them all into one category, say it’s a rhythm method and say that it’s like 70% effective.

So interestingly, in the study, they actually did have to acknowledge the symptothermal method. So the double-check symptothermal method has been shown to be up to 99.6% effective. 99.6%, 99.4%. In the study commonly cited, one of those figures is for women who completely abstain from sex in the window and another 99.4% is the stat for women who use barrier methods during that.

So ultimately, a perfect use efficacy at 99.4% would indicate that the method is not ineffective. And a typical use effectiveness rate for the double-check symptothermal method of 98% would indicate that the method is not ineffective.

And so while all fertility awareness-based methods do not have the same efficacy, there are different efficacy numbers for mucus only methods or symptohormonal methods or other types of fertility awareness-based methods. What I did find interesting in this particular study is that the researchers were not able to just throw it all under the bus and say that it just doesn’t work. They actually did have to acknowledge that the methods themselves, particularly the double-check symptothermal method used correctly, is a legitimate option.

And so I see this, of course, as progress, because in that way, they can’t just dismiss what they’re seeing. So they’re seeing this trend on social media, they’re seeing all these women talk about fertility awareness methods. They’re seeing all these women not only just talk about it, but they’re talking positively about it. And when they’re even looking at the potential downsides or critiques or complaints, there are legitimate complaints and concerns with these methods, but they are fewer and far between than the complaints out there about hormonal methods.

So, like I said, I’m here for it. I’ll just continue to sit back and pop my popcorn as I watch this all unfold. But I do find studies like this to be super interesting. And I feel like we’re making progress, especially when researchers can no longer say these methods just don’t work and pretend like they don’t know that there are different efficacy numbers for different fertility awareness-based methods.

Now, if they want to be accurate, and if they want to publish material that is in line with what the literature actually says, they actually have to give fertility awareness-based methods a fair reading and stop pretending that they just can’t work for anybody.

I’ll share a quote from the paper on this point. The researchers said, quote, “Additionally, given that the reliability of methods such as the symptothermal method depends substantially on standardized training, public health communication should explicitly emphasize the importance of proper instruction,” end quote.

This quote is actually fascinating to me. Instead of saying that all these women are choosing these improper methods and all of these crazy online influencers are advocating for these ineffective methods over the more effective methods or whatever, because that’s the kind of stuff that I’ve been seeing over the past couple of years, the researchers are actually saying, well, look, these methods are actually shown to be highly effective. And what we really need to make sure is that if women are using these, they have proper instruction.

That is actually a legit response. I completely agree. In order for women to be successful using fertility awareness-based methods, they do need proper instruction because it is an entirely user dependent method. And if you don’t understand the rules, if you don’t understand how the method actually works, you don’t understand the difference between the double-check symptothermal method with the highest efficacy versus just using a charting app, of course, you’re not going to be set up for success.

So again, I love it. I love the fact that we are making progress. Maybe it’s different in Germany. Maybe it’s because it’s a German study. Maybe there’s a different standard in terms of how they’re talking about these types of methods. Maybe there’s a higher level of general acceptance for these types of methods in Germany. Any Germans out there who have a comment on this, let me know. I’d love to hear more.

But either way, I’m still pleased by what I’m seeing here. And I do hope that this means that there is a bit of a shift and a turning point in terms of the way that fertility awareness-based methods are discussed overall.

And of course, this has significant implications for our women’s health professionals, as we always talk about at the Fertility Awareness Institute. If you are working with women and you are not teaching them how to chart their cycles and you are not able to confidently not only teach them how to chart their cycles, but help to interpret them, even if their cycles are very complex, then you are missing the boat.

As more women learn about charting, as more women start paying attention to their cycles, they need more and more support. They need to have support from their health professionals. And fertility awareness is not something that is commonly taught. Whether it be for medical professionals, whether it be for women’s health and hormone experts, it is just not a part of the regular curriculum. So it is something that most professionals need to seek additional training subsequent to what they received if they’re really wanting to support their clients to the highest degree.

So whether you are a longtime listener of the show or if you’ve newly found us, one of the best ways that you can show your appreciation if you are enjoying what you’re hearing, of course, is to leave a rating and review on Apple Podcasts. I do my best to read every single review that you leave. I think we have over 700. And of course, this is the way that people find new podcasts and also determine if this is something that they’re wanting to listen to.

If you haven’t left a rating and review on Apple Podcasts, I would really appreciate that. Like I said, this podcast has grown over the years mostly through word of mouth. So from our listeners sharing the show with friends, with clients, with their practitioners, this has really been a grassroots movement.

So I just want to thank all of you for being part of the Fertility Friday community. And as always, until next time, be well and happy charting.