Women’s Concerns About Hormonal Birth Control (Episode 550)

Full Transcript: Episode 550

Lisa Hendrickson-Jack:

Today I’m sharing another brand new episode in the FAMM Research Series, and I’m sharing a paper that is delving into an interesting question: how do women really feel about hormonal birth control? This study is largely a qualitative study in that they had these women complete a questionnaire about how they felt about contraceptives, and so we’re going to get into that in a whole lot of detail in today’s episode.

The title of the study that we’re going to be getting into today is called Contraception Use and Attitudes: Women’s Concerns Regarding Hormonal Contraception and Copper Intrauterine Devices. So the researchers were specifically looking at how women are feeling about contraception as well as the copper IUD in particular.

One of the most interesting things I find when reading research is trying to understand the researcher’s perspective — the reasons why they wanted to conduct the study. We’ll talk about that as we go through the paper. But essentially, overall, it seems as though the researchers wanted to have a better understanding of the women in particular who have concerns about contraception. So they are wanting to identify how prevalent it is — how many women have concerns about contraception — and they also want to find out a little bit more about those women in particular.

For any of you who have read The Fifth Vital Sign or who have listened to one of the past research series episodes — I will make sure to link it to today’s show — where we went into a similar study, a study where the researchers specifically wanted to find out what percentage of women had side effects. The reason they wanted to do it is because they wanted to understand the characteristics of the women who were complaining about the pill. I always find this kind of research area very interesting, because of course the researchers are looking at: okay, so who are the women that are complaining about the pill, or concerned about the pill in this case?

This is a little bit different, because they’re asking women more so their concerns about it. But then they’re also wanting to know the characteristics. And it’s not so that it can help them better understand the side effects of the pill and look into potentially improving the formulations or anything like that. That’s not the goal here. The goal here is to identify the characteristics of the women who are either concerned or complaining about contraception, so they can better understand them and find ways to better market to them. That’s one of the things that I always find interesting about these types of studies, because really they’re doing these studies to help doctors better understand the issues that women might have with contraception so that they can better overcome their objections. So the question of whether their concerns are valid, or whether they have had negative impacts from these contraceptive methods, is not necessarily a consideration at all. It’s kind of just like, who’s complaining, and what does that tell us about them, and how can that affect the way that we present the same stuff to them?

I always find that to be really interesting because it’s definitely not in our heads as women when we feel as though our concerns are being minimized or that we’re not being listened to. It’s really not in our head, because it’s quite clear, even when you read research, how prevalent it is that even though these women aren’t telling the researchers, “Hey, I have these concerns, these are the issues that I have with contraception, or these are some of my hesitations” — they’re not being taken as legitimate issues. They’re kind of being taken as like, “Well, this is just preventing them from using the most effective methods of birth control.”

So that was a bit of a preamble, but it does set the stage for what we’re going to talk about.

Back to the study. This study was actually done in Sweden, and so the population they surveyed is a population of Swedish women. There were a couple of interesting things that the researchers shared just to set the stage. They were saying that in Sweden, contraceptives are subsidized and contraceptive counseling is free of charge to all women 25 or younger. So they’re letting readers know that women who are under 25 have kind of free access to contraception and to this information. And they also said that the majority of contraceptive counseling in Sweden is done by midwives — approximately 80% of contraceptive counseling is done by midwives. So these were essentially women who were seeking information about contraceptives or other related health issues, and they were attending various clinics that had been selected. When they were attending these clinics, they would have these women complete the surveys, and based on that information, they were able to derive the data for this study.

The women who completed the study — there were 212 in total. They were between ages 17 and 50 with an average age of about 30 years old. Most of them were in a stable relationship and about 25% had children. That kind of gives you the background.

There were three main objectives that the researchers put forward. One was to estimate how prevalent contraceptive use is among women. They wanted to specifically look at the concerns that women were expressing around hormonal contraceptives and the copper IUD. And then they wanted to determine the characteristics of the women who had concerns.

In terms of the prevalence of contraceptive use, broken down by type — there was nothing really surprising about how it played out. The highest percentage of women used combined oral contraceptive pills, which is the most common type — about 25% of women were using a pill. About 22% were using the hormonal IUD. Only about 6% were using the copper IUD. About 18% used condoms. 16% reported not using any contraceptives, and about 11% reported using withdrawal. There were other methods listed, including sterilization, reported by 1%, and a fertility monitor device, which had a very small percentage, as well as what they called safe periods. So essentially, anybody who fell into that umbrella of no contraception, withdrawal, or any type of fertility awareness cycle-based tracking were thrown into a category. And the comment by the researcher on this was, “In this sample, as many as one-fourth of women reported no use or use of what they termed ‘ineffective methods’ at the most recent intercourse.” And they went on to talk about how essentially these women have an unmet need for contraception. So the researchers are kind of looking at this as a problem — anyone who’s not on a hormonal birth control method is essentially like a candidate for a hormonal method. At least that’s the general kind of perspective you get when reading the study.

Now the researchers spent a lot of time talking about how the women responded to the question of whether or not they had concerns about using contraception. Overall, about 41% of the women surveyed expressed that they did have some concerns about using hormonal contraception. And then they went on to break down the reasons. The most common concern was side effects — the category was “side effects not specified,” so basically anything related to side effects would be put into that category — 42% of the women who had concerns about contraception had concerns about side effects. The second largest category was “fear of hormones,” as they termed it. The third was mood changes — concerns around contraception interfering with mood. The fourth was depressed mood — concerns about the pill could be bringing on feelings of depression. Followed by blood clots, and then others: weight gain, decreased fertility, decreased libido, etc.

And I’m just struck as I went through this paper at how these concerns were just talked about in general, and how little the researchers seemed to be concerned about the fact that these women were having these concerns. When you look at other research — research I’ve covered in my books or on the podcast — when women start taking oral contraception, about 50% of the same women who started taking it will stop within the same year due to side effects. And the most common side effects are mood changes, depression, and low libido. Sexual side effects represent a big percentage of the side effects women experience.

I’m reading this from a different perspective. I’m looking at this as: these women are fairly educated about what’s going on with birth control if 41% are aware that there are these side effects. And the side effects that they’re listing are some of the most common ones, being the mood changes and depression and potentially effects related to the artificial hormone exposure.

I’m guessing that you, as a listener, are not surprised by these results. But when you read the study, it seems like the researchers are kind of surprised — maybe — by how many women are expressing their concern. If I read a short excerpt from the study: “Another interesting finding was the high number of women expressing concerns towards contraceptive methods. Four out of ten had unspecific concerns about side effects regarding HC, and half had concerns about using the copper IUD.” So they go on to talk about why they think this is, and they’re talking about how even 10 years ago, far fewer women had concerns about contraceptives. They’re saying 10 years ago, similar research showed only about three out of 10 women expressed concerns, whereas now they’re showing four out of 10 — an increase of 10%. Pretty significant.

And so they go on to theorize why this might be, and they state that social media and media in general are exposing women to more of these ideas around contraceptives. They say specifically: “In Sweden, social influencers often recommend natural family planning, such as fertility-based methods, over hormonal contraceptives, and digital fertility applications are positively advertised as hormone-free alternatives that enhance reproductive anatomy among users.”

I feel like there is this kind of dismissive quality — all these women are just talking about their issues and it’s having an impact on how these methods are perceived. Coming from the scientific, conventional medicine side, they’re looking at these as the only alternative — these are the effective standard that women should be taking. And if they’re not taking them, that’s a problem. Anything that could be making it more difficult for medical professionals to get women on these things is going to be a problem.

The system itself is coming from this perspective: this is the standard, this is what we do, and anything that you suggest or want to do outside of that standard is often met with pushback — all the way up until outright rudeness and doctors laughing at you for wanting to use fertility awareness, or really heavily discouraging you because anything outside of these accepted hormonal methods is really considered to be ineffective. And of course, nowhere in that discourse is it even acknowledged that maybe now that we have access to various social media channels, women actually have a voice and actually have the ability to publicly share our experiences on these contraceptives — that women are now actually sharing what’s happening behind the scenes, and having concerns about it as they should.

We should be concerned about the side effects related to contraception. It doesn’t mean no one should ever use contraception, but it means we should all be aware of all of the side effects that women experience on these methods. We should be privy to the experiences that women have had, even if it’s through social media. We should be allowed to hear what other people have experienced, to see what the research is showing, so that we can make an informed choice.

They give some examples — just a very short excerpt of some of the statements that women made. Although the study doesn’t go into a ton of qualitative examples, they did have open-ended questions and did share a couple of examples of what women were saying. For example, to the question “Do you have concerns about using hormonal contraceptives? If yes, why?” — what they shared as a general example of responses was: “I’ve tried but I don’t feel well using them. It doesn’t feel good to add more hormones. Depression. Mental illness. And I’m scared of mood changes and blood clots.”

Specifically related to the copper IUD, the reasons women cited for the most part were related to increased bleeding and menstrual pain. The general response compiled from open-ended answers was: “Bleeding and cramps. I’m mostly worried about the insertion. My sister had a bad experience. I’ve heard that it gives you sleep disturbances and mood changes because of magnesium deficiency.” And then the last response was something like “I don’t know how it works.”

What’s interesting is that if you read the research data on hormonal birth control, depression is one of the most common side effects, as are mood changes, and these are related to the addition of the hormones. The concerns that these women are expressing are actually extremely valid and based on real-world as well as scientific data. I find it really interesting that the researchers aren’t acknowledging, “Hey, look — it looks like the population is getting a lot more educated about some of these side effects.”

Now it might seem like I’m being extremely one-sided, which — there’s some validity to that. I’m not going to pretend like I’m not coming into the research with my own perspective. But I do want to read you just this little excerpt to show you what I mean. My impression when reading this study was that the researchers were kind of largely downplaying the very real concerns of the women they surveyed.

So, quote: “After unspecified side effects, adverse mood symptoms was the most commonly mentioned reason for concerns about hormonal contraception, which is being supported by previous research. Adverse mood symptoms as a main reason for cessation have become more prevalent over time, possibly due to increased stress and anxiety in society in general. Another explanation could be that acceptance of side effects, including adverse mood symptoms, has decreased and that higher awareness has led to increasing concerns and a lowered threshold for cessation.”

Basically what they’re saying is that they’re seeing this trend, and that’s why they’re doing these studies — because more women are expressing their concerns, doctors are having a harder time getting women to take this stuff, and they’re having to contend with complaints. Women are saying: “I don’t like the mood stuff. It’s making me feel depressed. It’s making me feel anxious. I’m having panic attacks and I never had them before I started taking this medication.” But what’s interesting is the researcher says, “You know, maybe this is happening because of increased stress and anxiety in society in general.” Like, maybe the world is just more stressed. He’s not saying, “Maybe the drug is actually causing these side effects.” What’s said is maybe there’s just an increase in stress and anxiety in general overall in the world.

It just blows my mind that all these women are complaining and no one’s listening. Instead of thinking, “Well, maybe these women are complaining because there’s a real problem” — instead of that, it’s like, “Oh, well, maybe there’s a problem with society in general.” Or, “Maybe women are actually less open to accepting side effects than they used to be.” And actually that last comment is a good one — we shouldn’t be. We should be a lot less willing to tolerate side effects.

Back in the day, when women weren’t talking to each other, when we didn’t have social media, when you couldn’t just search online and find 3,000 women who’ve taken the same drug as you to see what they’re saying in a support group — you probably had the same side effects, but you were less likely to do anything about it. You were less likely to kind of put up a stink and ask your doctor for another option. If you had an issue, you were much more likely to be dismissed by your healthcare professional — partly because of stereotypical gender stuff — but also you were less likely to have the confidence to say, “Wait a minute. No. This is not in my head.” The average woman would just think she was alone. You assume that everyone else is completely fine and you’re the crazy one having these depressive symptoms and panic attacks and anxiety and low libido. But now it’s not like that.

I think we should feel comfortable and confident pushing back and expressing concerns about contraception and switching to a different formulation if the one we’re using isn’t working. And we should have the right to learn about what the researchers would term “ineffective methods.” Obviously I wouldn’t term fertility awareness-based methods as ineffective, but we should have the right to learn about them and know that they are options.

If you were to read the study, you might be under the impression that choosing a non-hormonal route is a dumb choice — that it’s not an intelligent decision, that only uninformed women are scared of hormones because they’ve been influenced by social media. Of course, my language is a little hyperbolic here — I’m being a bit sarcastic. But ultimately, I always find it interesting when I read papers like this, because it gives you really good insight into how our system is designed and why it’s so difficult for women to get support.

The number of times I hear stories about women who have sometimes quite obvious signs of a particular menstrual issue, who have to go to five, six, seven doctors to be listened to, who have struggled with issues for 10 or 15 years before someone took them seriously — women who are outright laughed at or dismissed or told it’s in their head, or told that their side effects couldn’t be related to their contraceptives. We should be sensitive to the research and how these questions are looked at, because that helps us to understand why we get those types of reactions.

This paper really does validate how we experience medical care as women. It’s just looked at as an obstacle to get over. Nowhere in this paper are the concerns taken seriously whatsoever. And if you can really wrap your head around that, then it can help you as a woman trying to get care — it can help you to better choose the healthcare professionals on your team, and clarify that maybe you need to have your regular primary care doctor but also someone else on your team who’s more of an advocate, coming from a more holistic or functional medicine perspective — someone who isn’t simply looking at this as an opportunity to put you on the pill.

And if you are a women’s health care provider, this should also interest you because maybe it calls into question how you yourself have interacted with clients — maybe, maybe not. But also, it really shows what our clients are up against and where the opportunity is for us to support and empower them.

I think they’re looking at the wrong problem. They’re looking at the problem as women complaining. That’s the problem. No — the problem is that the medications cause side effects. That’s the problem. And if we could just get our heads around that and actually address the fact that contraceptives have side effects that are concerning, that are valid, that are real, and these women are not complaining because they’re crazy people — they’re complaining because there’s a legitimate complaint to be had — then we could start getting somewhere. We should be looking at improving the methods that are there. I will keep hoping for that, but in the meantime, I will continue to pursue non-hormonal alternatives as a legitimate option for women who don’t do well on contraceptives.

If you enjoyed today’s episode, please share it with a friend. You’ll find the show notes for today’s episode over at fertilityfriday.com/550. If you’re loving our research series episodes, you’ll find more of them over at fertilityfriday.com/research. If you’re newer to the podcast and you haven’t heard our “Pill Reality” series, then I highly recommend heading over to fertilityfriday.com/pillreality. In that series, I’ve interviewed a variety of clients and other members of the Fertility Friday community over the years who share in their own words their experiences with hormonal birth control. There’s nothing more powerful than women sharing their own experiences in their own words about what happened to them when they took hormonal contraceptives. So with that said, I hope you have a wonderful week. Until next time, be well and happy charting.