A bitter pill to swallow: The risks & side effects of hormonal birth control

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“The pill is an endocrine disruptor by design—it has to override the endocrine system to prevent ovulation from happening.”

An interview with Holly Grigg-Spall on her experience with hormonal contraceptives

Hormonal contraceptives are so ubiquitous in modern society that few question whether or not they are safe to use. Holly Grigg-Spall, the 34-year-old author of the book Sweetening the Pill, has made it her mission to lift the veil on this potentially dangerous contraceptive after her own pill-induced health crisis.

In 2017, the term “birth control” was nearly synonymous with hormonal contraceptives, including the pill, the ring, injectables, and some forms of IUD. The benefits of hormonal birth control are marketed aplenty: women can regulate their cycle, prevent menstrual cramps, or avoid getting pregnant. 

But as the use of such contraceptives has risen, so have the reported side effects—everything from mood swings and anxiety to weight gain and longer-term changes in one’s cycle.

Holly became a passionate advocate for women’s health after experiencing a health crisis that she traced back to the pill. Her book caught the attention of Oprah’s protégé Ricky Lake and Abby Epstein, who decided to turn it into a documentary.

This is the same team who created the surprise documentary hit The Business of Being Born, about the American healthcare system’s approach to childbirth. Against all recommendations of doctors and current conventions, Holly followed her instincts—she bravely sought answers on her own, wrote a book, and got the attention of major filmmakers to create a hotly anticipated documentary for women. 

Holly went on the pill around sixteen. She doesn’t remember the consultation she had with her doctor before taking it, but she does remember feeling as though she was entering some kind of special club. As a teen, she had heavy, painful periods, but her mother’s main reason for getting her to go on the pill was a fear of pregnancy—an understandably well-intentioned plan for a woman who came of age in the sixties, when the pill was considered a critical part of women’s liberation. 

Following in the footsteps of her two much older sisters, who were also on the pill, Holly felt as though she was completing a right of passage that was practically the same as having sex (even though she went to an all-girls school and didn’t start dating until college). 

Nearly a decade later, when her health began to unravel, Holly was horrified to discover that all of her symptoms traced back to one (seemingly) harmless, ubiquitous little pill she had been taking every single day for the past ten years.

What happened that made you start to question whether you should be taking birth control pills?

I was taking a pill called Yasmin, which was very popular at the time (in 2006)—my best friend took it, a lot of people I knew took it—and it was marketed as the pill that wasn’t supposed to have any negative birth control side effects. But it was also marketed to have positive effects like making your skin really clear, helping you to actually lose weight, and making your breasts larger. 

I was on it for quite some time and I started to get what seemed like really bad PMS every month. And then my PMS developed into a combination of depressive symptoms like anxiety, paranoia, self-consciousness, lack of self-esteem, and social anxiety. 

The physical side effects included urinary tract infections, colds, feeling really tired, or just not feeling very well all the time. But the psychological side effects were the worst. I wasn’t able to cope with anything. I would get very depressed and then would get very angry and not really be able to calm myself down, not really be able to control how I felt or take an objective viewpoint.

After you started researching the pill, what were you most shocked by?

What shocked me is that it had so many side effects—and that they were whole-body side effects. I think a lot of women often imagine that the pill prevents pregnancy and doesn’t really affect anything except your reproductive organs. But what I didn’t realize was that any effect on your hormones happens in your brain. Like, “Oh, well it’s changed my brain chemistry,” because literally, that’s how it works. 

The pill is an endocrine disruptor by design—it has to override the endocrine system to prevent ovulation from happening. So the pill was fundamentally changing my core being—my personality, my moods, my emotions, how I reacted to things, how I processed information, how I responded to other people. It was actually tampering with who I was and how I felt.

Once you came off the pill, what was the biggest difference that you noticed?

I did try another pill before I decided to come off completely, because it’s really hard to decide to stop doing something you’ve been doing for ten years, whatever it is. I’ve been off for seven years or so now and I’ve never had those psychological symptoms again. 

And physically, the only thing that lingered was some issues with my skin. But I don’t have UTIs all the time anymore, I maybe get sick once a year, I have more energy and more clarity of thought. It’s really the best decision I ever made for my health.

What do you recommend to women who want to avoid getting pregnant without hormonal contraceptives?

I’m a big advocate of condoms, but I don’t think that we need to necessarily rely on them when we’re in a committed relationship, which is why I always talk about the fertility awareness method. Fertility awareness—as a skill—is important. Knowing how to track your fertility is an education that’s necessary for making decisions about contraceptive choices and reproductive health. 

But I think you can actually use the fertility awareness method effectively to avoid pregnancy. And there’s so much new technology out there to do that now. The device I use is the Daysy fertility monitor, which takes seconds a day and it gives me my fertility state with a colored light: green means you’re not fertile and red means you’re fertile. 

It’s an easy transition to go from the pill to fertility awareness—to have the same effectiveness without it having to be terribly time-consuming or difficult or too big of a commitment. Getting back to body literacy, getting back to our bodies as a society, is really important for loads of reasons, not just for avoiding pregnancy—but it’s also a totally legitimate way of avoiding pregnancy.

How would you define “body literacy?” 

Laura Wershler coined the phrase “body literacy” and defined it as understanding your female fertility cycle as a life skill, like being able to read or ride a bike or cook. She felt that all women should have this. 

That it’s very powerful to know about your menstrual cycle, how it changes through the four phases and what the fertility signs are – like basal body temperature, cervical fluid, and cervix position. And to really know how to listen to your body and take that feedback—like you do if you’re hungry or thirsty—and read those signs, interpret and use them, whether to monitor your health, to prevent pregnancy, or even to achieve pregnancy.

How can one get involved in women’s health activism?

I like to support the independent women’s health clinics that have feminist principles and structuring and are better at centering informed consent and female empowerment. And there are quite a few of them in the United States—there’s a group called Women’s Health in Women’s Hands in California, which I really like. I also love The Fifth Vital Sign, which offers free reproductive health classes, focusing on body literacy, across the US.

The big takeaway

The birth control pill is only one way to prevent pregnancy—and it may not be the safest way when it comes to your overall health. Take control of your health by becoming educated about birth control side effects and your body, so you can be empowered in making choices about your own health and fertility.