Still Pill – Grace
‘The [oral contraceptive] pill’, rolled out to the public in the 1960s, is a popular answer to that burning pub-chat question, ‘what has been mankind’s greatest invention?’ Motivations for this answer generally come from one of two positions: for some, the pill is terrific because it liberated women from obligatory pregnancy and radicalised both their working and private lives; for others, the pill is terrific because it curtailed population growth, or rather curtailed family size, in the oh-so-civilised West. Adherents to option two have a marked tendency to be fans of Richard Dawkins and / or fantasy Thatcherism. But hey, it takes all sorts.
Without doubt, the popularization of the pill, available either as combined oestrogen and progestin or progestin-only, and legally on sale in Ireland since 1978 (with conditions, initially), has transformed social and family life. What is more important, however, is the physical and psychological impact it has had, and continues to have, on the bodies of girls and women. ‘Going on the pill’ is culturally considered to be a minor, often inevitable thing, and anxieties regarding adolescents on the pill usually centre on parents’ fears of losing a little girl and gaining a woman rather than concerns about health and wellbeing. Then, of course, there’s the Mickey Harte thing, but the less said about that the better.
To open a discussion about the potential gains and pitfalls of synthetic hormones is also dangerous; there exists a sinister strand of argument which vilifies women for taking control of their reproductive life. The last thing I want to do here is endorse the dodgy logic of a certain RSE luminary at my old school, who likened taking the pill to filling one’s body with ‘rubbish’ in the sanctimonious tones of Gwyneth Paltrow encountering a Pot Noodle, but actual, workable, knowledge of how oral contraceptives operate and what they can do is perilously lacking in the public sphere, and the pill is perhaps one of the most misunderstood and gossiped about phenomena in female experience. Now, I’m no doctor, but my own experiences with oral (and otherwise) contraceptives have been nothing if not interesting, and, in the interest of debate, I’d like to share some of these with you.
I first went on the pill at seventeen, not because I was sexually active, but because I suffer from a disorder known as dysmenorrhea; a common hormonal problem that causes excessive period pain, frequently in the form of contractions that are not unlike labour cramps. As you can imagine, this was disruptive to everyday life, causing me to miss school once a month, and generally meeting with hostility from adults and teachers who did not believe that I could possibly be in that much pain because they had never experienced it. One option for treating dysmenorrhea is the oral contraceptive, which can be incredibly helpful; after ensuring the doctor that ‘my mother knows’ (!), then, I got my first prescription for Mercilon. I’ve since been told that Mercilon is considered a somewhat old-fashioned pill, and not prescribed very often, if at all, anymore. Of course, I’ve garnered this from hearsay; good look spotting a comprehensive and non-sensational article about oral contraceptives in your Sunday paper.
Apart from Mercilon, I’ve also tried out Dianette, Microlite (too ‘lite’ for me), and Ovranette. Four kinds of pill over the course of eight years, with two interventions (pill-free and inter-uterine device): this movement between brands and strengths is actually normal. Doctors tend to ‘advise’ (read: choose) which pills you go on, but this is actually about you, not them, and you do not have to settle for a pill that is giving you a bad reaction. And yes, pills have side effects and no, you are not imagining them.
Side effects from the pill tend to be either exaggerated or made up (you’re get fat! You’ll get cancer!) or played down (why would you care about lost sex drive? You’re a girl!) Some alleged side effects are also more complicated than they seem. If and when you decide to go on the pill, at least one person will swear blind that it causes weight gain: in truth, the pill can cause water retention in the first few weeks, and this can be mistaken for weight gain (it passes). So, the pill does not actually cause weight gain directly. But, one of the unspoken and less-flagged side effects of the pill is hormone-induced emotional issues, from mood swings to depression, and these can, among other things, cause weight gain and weight loss through comfort eating and / or loss of appetite. It’s complicated.
In my opinion, it is important to be on your guard against the possible emotional side-effects of the pill, not least because doctors and peers will very rarely point these out; they are less easy to identify, and our culture tends to discount people’s experiences of low mood. It also tends to dismiss, or completely fail to acknowledge, another common side effect of oral contraceptives – loss or diminishment of sex drive.
Glancing at popular culture and sex ed, one would be forgiven for thinking that (1) women’s libido exists solely in relation to the requirements of a culturally sanctioned vision of masculine desire, or (2) women don’t have libidos, just strategic pregnancies. The ‘mysteries’ surrounding female desire are largely a by-product of cultural neglect and institutional discomfort with the notion that women might desire other bodies, or indeed anything, at all; in spite of this, however, we do have sex drives, and they can be inhibited by oral contraceptives, because an imbalance of hormones impacts upon fertility and libido.
When I went on Dianette (a decision based on whimsy and supported witlessly by my doctor), I not only lost my libido, but also became quite depressed. I blamed these symptoms on other things for several months until coming off the pill for a three-month break; without wishing to make this article X-rated, let’s just way I woke up feeling like a new woman – a woman who wanted to climb the walls and talk to lots, and lots, of boys. When my hormones balanced out and I felt normal again, I began to register just how severe the reaction to Dianette had been, and a cursory glance at internet chat-rooms confirmed that I was far from the first woman to have had this experience. I went back on Mercilon, but my trust in oral contraceptives had been severely dented, and I resented having to take it; I also began to have break-through bleeds which were misdiagnosed as ‘chlamydia’ by an especially po-faced locum doctor. The type who judges first and performs actual internal examinations later – or, y’know, never.
Shortly after this episode, I moved to London and took advantage of the open-minded attitude of the NHS (free contraceptives for all, free sexual testing for all, bowls of condoms that runeth over in every waiting-room, etc. etc.) to come off the pill altogether, and try out the IUD coil (copper, no hormones). The principal rumour about the copper coil is that it is painful to have fitted, and my own experience of it can confirm that…yes, it is very bloody painful to have fitted. The procedure involves having a speculum inserted and a local anaesthetic to the cervical area; the coil (about the size of a thumbtack) is placed inside, and, for me, this involved a struggle as I am small-organed, and had never had any children – not the most elastic cavity, in other words. The real pain, however, came afterwards, when the anaesthetic wore off as I shopped on Oxford Street: I crawled home and spent two days off in bed with whiskey and ibuprofen. There’s really no gentle way of putting this: it hurt.
Moreover, it continued to hurt. With the coil, I had normal hormone levels and felt fine, but the device never stopped, well, scratching. I began to have god-awful period, and inter-period, pain. More tests confirmed that, while the coil was sitting where it should be and doing what it should do (killing sperm with copper somehow; essentially, generating a ton of discharge), I have endometriosis. Which was causing the dysmenorrhea. Which had never been spotted, diagnosed, or raised with me. Which threatens my fertility significantly and runs in my family. I suppose I should be glad that, at twenty-five, I finally know about it, eh? Three cheers for society’s open-hearted willingness to educate women about their bodies in a timely and level-headed manner. *Sarcasm off.
I had the coil removed six months after it went in; this procedure is infinitely easier, essentially having a nurse tug it out by hand (‘the first coil I removed was my own!’ she informed me cheerfully mid-tug. ‘But that was a bad idea!’) I also went back on the pill, and remain on it, but the brand is different: Ovranette. I have decided to stay in the pill until I want to get pregnant, because the oral contraceptive helps to preserve fertility somewhat in cases of endometriosis (preventing loss of eggs to ovulation), as well as alleviating pain.
And how do I feel? Well, actually, I feel ok: Ovranette, for some reason pertaining to my particular physical makeup (I’m not giving any greedy pharmaceutical company a plug here, mind), suits me relatively well. It doesn’t impact on mood or sex drive, and I have break-through bleeds quickly if I forget to take it – this, for me, is a good thing, as it indicates that the dosage of hormones is low. My experience tells me that low dosage means less of a chance of mood swings or diminished libido; again, this is simply my experience, and it differs from woman to woman, but I have only arrived at this conclusion because I have tried different brands and attempted, bravely if unsuccessfully, to get off the pill altogether. I would still prefer to be pill-free and, in an ideal world, would be; for me, it is always a compromise.
I don’t think that the pill is a perfect solution to the issue of unwanted pregnancy, but it is a seriously helpful and effective means of securing peace of mind; better debate, more education, and a healthier attitude towards contraception will help to make this phenomenon work for women rather than (a) those sweaty bloggers who describe reproduction as ‘selfish’ and ‘bad for the planet’, or (b) the scandalized Mummies and Daddies of Middle Ireland, who shudder at the thought of their darling girl getting pregnant and letting the family down. It is, perhaps, a question of priorities; people ought to accept the fact that the body and the mind are not separate entities, and that peace of mind must match up with physical wellbeing if life on the pill is going to work. Remember, you are deciding to take the pill; it does not dictate to you – and who knows, maybe if the male contraceptive pill ever goes on sale, we can share the burden of experience with men too. Something tells me the Sunday papers might have something to say about it then.