The Problems with the Pill

A cautionary exploration

By Sylvia Rani

Since gaining FDA approval in the 1960s, hormonal contraceptives have been lauded as magic pills that would liberate women from the oppressive structures of enforced motherhood. By giving women control over their fertility, hormonal contraceptives (also referred to as the pill) would allow them the choice to decide precisely when or if they would bear children. Fast forward to 2020, and hormonal contraceptives are the most common form of birth control in the United States. To reach this point of such widespread adoption, much of the conversation about the pill has focused on the benefits: for the individual woman, for her family unit, and for society at large. Unfortunately, this emphasis on the positive has largely obscured the discourse about the very real risks that exist alongside these benefits.

Hormonal contraceptives are unique as prescription medications because they do not treat a condition nor enhance the normal function of the body. Rather, they serve to impair the normal function of a body system: the reproductive system. The hormones in the pill prevent ovulation by mimicking pregnancy. Chronic usage of the pill is essentially a long-term disruption of the endocrine system. Consequently, this disruption has other varied effects on the user—some of which do not appear until years of continued use, and most of which are linked to inflammation. There is a large body of emerging research on the health risks of the pill, and I would encourage anyone taking this medication to look into it, but in short: The pill is not completely harmless. There are risks associated with its use, and the burden of these falls on the person who decides to take it.

Unfortunately, medical providers often fail to draw women’s attention to these risks. The contrast between the medically approved literature on the pill versus the actual experiences of women who use it is frankly disturbing. On the Planned Parenthood website’s information page for the birth control pill, it reads: “Most people on the pill won’t have any problems at all.” This is a blatant lie. If you are a woman who talks to other women, you know that while some have few issues, many more have had a terrible time on the birth control pill. Denying, minimizing, and ignoring concerns about side effects and long term outcomes is medical gaslighting, and it poses a real threat to health decision-making autonomy. Women are increasingly turning to online forums such as r/birthcontrol to discuss their lived experiences with this medication, likely because the medical field has refused to acknowledge their realities.

The suppression of information about the issues with the pill is not new. In the 1970s, women’s health advocate Barbara Seaman brought the health risks of the pill to a national stage. After a decade of uncomfortable side effects and increased mortality rates, Seaman and other feminists organized congressional hearings in which they questioned the safety of the pill and demanded full disclosure of its health risks. Up until this point, the hormone dosage was extremely high and there were no warning labels or mandatory information inserts included with the medication. The pill hearings exposed the ugly reality of a medical-pharmaceutical establishment that had continually evaded transparency and responsibility for its harms.

I know what you may be thinking: Why does this matter so much? Sure, the birth control pill may not be perfect, but it performs an important—even essential—service: controlling birth rates. When I discuss this topic with logical, science-minded people, the response I receive most frequently is, “But think of the alternative… would you rather be pregnant?” And this bravely presented yet false dichotomy is the most infuriating part of the discussion.

The alternative to hormonal contraception is not pregnancy. The alternative to hormonal contraception is condoms, cervical caps, diaphragms, spermicide, the sponge, fertility awareness, sterilization, and other hormone-free methods that approach similar levels of efficacy. If we are to move towards a world where women are truly liberated, it is essential that we provide them with all the information they need to make decisions about their health. This means informing them of the risks of hormonal birth control as well as providing them with ample alternatives. It means questioning the male-dominated pharmaceutical industry that has used women as unsuspecting lab rats for decades. And it means thinking critically about how hormonal contraceptives have become the default for birth control despite their well-documented risks, persistent side effects, and viable alternatives.