A bitter pill to swallow


In October, The Irish Times published an article about an almost 100 % successful male contraceptive injection. This is a huge step forward for many reasons; mostly because it shifts part of the burden from the woman, but like all breakthroughs, there are inevitable pitfalls.

According to The Irish Times, in a clinical trial of 350 men, over the period of one year, the injection had a success rate of 96%. In the course of the trial 20 men dropped out due to side-effects, and researchers admitted that there was still a lot of work to be done.

The side effects were mood swings, depression, acne, muscle pains and changes in libido.

There will always be side-effects with any medication, particularly in the development stages, and if those listed above are not something you’re used to, they can be daunting.

The pill has been around for the greater part of 60 years, and has been growing in popularity ever since. The idea is inspired, and as long as you feel safe from the risk of infection, it’s probably one of the better options out there. Most women I know are on the pill, as are most women they know. And most of them feel ok on it. Mostly.

The side effects listed for the trial above, for which general release has been suspended, and due to which men find it unsuitable, are the same side effects women have experienced on the pill for a long time.

The pill is  a symbol of a social revolution, of the swinging sixties and women’s liberation; it has given women and men so much relief and freedom. Because of the pill and its siblings, women no longer had to have children early and stay home to raise them; they had options.

Fast forward to the present day and the zeitgeist of ‘Repeal the 8th,’ it means we don’t have as much to fear when it comes to unwanted pregnancies.

Is it a beacon of hope, or a poison chalice? It can be both.  For as long as the pill has been around, so too have its side-effects. Many women never experience them, and continue to lead their normal lives with an extra kind of liberation, but many others find their lives change dramatically.

I have been on 8 different combined pills, with side-effects ranging from weight gain, uncontrollable appetite, 5 Kg water retention every month, depression, acne, migraine, mood swings, muscle pains, and others besides.

In every case where a nurse or doctor was consulted, the attitude was the same; that you won’t know what will happen until you try it.

Every pill reacts differently with every body, and you must risk side effects for a minimum of three months, just to make sure they are there to stay. Another friend had episodes of vomiting every morning she was on a certain pill, and of course, that makes it redundant.

For the first three months of any new pill, we must be our own guinea pigs. This means that exam periods, holidays, new jobs, and anything where a modicum of stability is required, must be avoided. We may experience these side-effects within the first two weeks, or even 6 months later.

In the case of depression, we may not even realise it’s the pill causing it. We turn our bodies into chemistry labs and roulette tables, where we take a chance and wait to see what happens – hoping we win big and come out still feeling ourselves.

This can bring months of depression, apathy, weight gain, first-time or worse acne, migraine, nausea, potentially blood-clots and pulmonary embolism, and the kind of things many are embarrassed to talk about. These other lesser known side-effects of certain pills include candida, pain during intercourse and prolonged bleeding between cycles.

These symptoms are something we are taught we need to deal with, because the onus is on women to ensure they don’t get pregnant. These can be grueling, painful months, both emotionally and physically, and can take a significant toll on interpersonal relationships and mental health.

At the same time, contraceptive solutions for men will not be released because of the same side-effects being deemed too severe to proceed. This is not a diatribe, nor is it a complaint – it is merely an observation. This is our reality.

A male friend in his 20s says ‘there isn’t any education about it at all in schools for men. We need to be educated about it.’ Adding, ‘I always thought there was just one pill.’

Lack of education is a huge contributing factor to the problem – in girls as well as boys at school. Girls and women are not told enough about their bodies, particularly in single-sex Catholic schools.

As a result, we feel unsure, ashamed, and fearful when things start to go wrong. Young men are perhaps not given enough of a depth of education when it comes to hormonal contraception, which may lead to their underestimating the side-effects.

The worst part of all of this was what I found when I did a little digging. Look hard enough and the answers are there. What began as an attempt to understand the problems I was having ended in the realisation that a lot of them are due to lack of interest in student clinics. Not all, but some.

‘Finding the Right Option – Side Effects of the Pill’ ICGP, 2010

In 2010, the Irish College of General Practitioners released an article on the potential side effects of several popular contraceptive pills called, ‘Finding the Right Option – side-effects of the pill.’ The stand-first as follows, ‘With many contraceptive choices available, deciding on the right one can be a case of trial and error, but having some guidelines is helpful.’

It is understandable that your doctor cannot tell you exactly what they think might happen, or even what will probably happen. They need to cover themselves in the case of an unforeseen outcome. Nonetheless, to have released a set of guidelines for something deemed so mysterious, and to not provide them seems irresponsible.

For me, this chart was like a blueprint of my experiences. Yes they are guidelines, but their accuracy was extremely impressive, considering how often they are handled with kid gloves. On one hand this is positive – it demonstrates the possibility of knowing the body well enough to cause it the least harm.

On the other hand, it adds to the frustration of having putting your reproductive fate in the hands of a physician who may not necessarily feel your apprehension. It took until pill number 8 for a doctor – a new doctor – to suggest the combined pill may not be for me.

Many women have tried more, and will continue to suffer because these pills are picked from a list, instead of by a process of understanding an individual patient’s needs.

There are of course many other possibilities for women; the mini-pill, the IUD (copper and hormonal), the implant, the patch, the injection, the diaphragm, the coil, the ring, and family planning. Of these nine, seven are hormonal, and if you are sensitive to hormonal changes they may be similarly damaging.

Equally, if you experienced heavy and painful periods before you began using contraception, they will more than likely become worse with the IUD and coil. Little needs to be said about the effectiveness of family planning.

Female contraception: image from thinkcontraception.ie

So yes, we have many choices, but they are not as benevolent as they first appear. There is a very real and urgent need to educate young men and women about effective contraception. A lot of emphasis is placed on its ability to protect you from pregnancy and STDs, but there is very little said about the risks.

As women, we are taught that the side effects of contraceptives are part of the process, and that the benefits outweigh the risks. We are given the burden of finding our own way through this jungle, and of working it out somehow so that we can have freedom in our careers, our relationships, and our life choices.

This is the price we paid for the freedom we received when it became un-sinful to commandeer our own bodies. The information largely available to us is misleading and damaging, as is the culture that surrounds it.

There are vast strides being made for gender equality, but for every step forward we take two steps back. The initial freedom and sexual revolution delivered by the pill has become a binding stalemate. In a time when yearly pregnancies were the norm, and marital rape was impossible in this country, it was simpler to see the dividing lines between a woman and her body.

Contraception was illegal, and abortions still are – what could be done? Women could become slaves to their bodies by fulfilling their natural and national purpose. When contraception and particularly the pill became legal, it brought a new liberty, and new choices. Women could own their bodies to a greater degree, and make their own decisions. The problem is, this has been the case for so long, that the reverse has begun to happen.

Giving women the power to make their own reproductive choices – to a degree – also takes away their right to contest that power. If you have been given something which benefits you, how can you complain? The responsibility has been ours for so long, that there is no need for reform. What we received was so different from what came before that it was revolutionary; now, it’s standard.

There is no denying the cut and dried positives of hormonal contraception, and the pill particularly. It is difficult to argue against its popularity. Nevertheless, it is gut-wrenchingly frustrating to watch as science backs the needs of men above women.

It is heart-breaking to know that, if you’re a woman, and you haven’t yet found a method that works for you, and maybe none of them will, you will continue to shoulder this burden.

If you are a man, and you have a wife, a girlfriend, a mother, daughter, niece, or female friend; this affects you. If we want equality, we must want it together. Too often do we see women being neatly packaged so that they offend neither men nor other women. When things become visceral, they grow uncomfortable.

Doctor’s need to stop seeing women’s bodies as medical textbooks, and schools need to realise that young people need positive sources for learning about their bodies. This is not an issue that affects women alone, because as long as we have imperfect contraception, men and women will suffer differently but equally. Changes must be made for everyone to get the best from them.

Women will find that the power lies in our hands. If we take an active interest in our own machinations, we give ourselves a different kind of power and agency – one which is not granted by an institution. Do your research and your reading, and if something doesn’t feel right, go get it checked out. Keep a diary, note any changes – there are enough options out there for all of us.



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