Ditching the pill for good

New health concerns have women looking for different choices

Teresa Lambert was 15 years old when she first went on the pill. Her family doctor, she says, talked up its benefits: “She said my skin would be clear, and I’d know when my periods were coming.” At the time, it sounded “great,” she says, but 10 years later, she’s feeling differently: the 26-year-old recently went off the pill, and says a lot of her friends are doing the same. “I didn’t want to be taking something that altered my body any more,” says the Calgary native, who now uses condoms instead.

Lambert isn’t alone. While the pill remains one of the most widely used methods of birth control in Canada—only the condom is more popular—a growing number of women are feeling ambivalent about it, or ditching it altogether. In fact, oral contraceptive prescriptions in Canada levelled off in 2008, reports pharmaceutical industry analyst IMS Health Canada. Health care workers are seeing a growing demand for non-hormonal methods. Spurred by concerns about their health, the environment, or even frustration with family doctors, who sometimes seem to push the pill as a modern-day cure-all, Canadian women are looking for other options.

In this age of organic produce and yoga studios on every block, it’s no surprise that a growing number of women don’t want to take hormones every day. Yet a spate of recent studies left some, Lambert included, doubly concerned. In April, U.S. researchers announced that birth control pills seem to impair muscle growth: in 73 healthy women aged 18 to 31, those who weren’t taking oral contraceptives gained 60 per cent more muscle mass than those on the pill. Birth control pills typically contain a mix of estrogen and progesterone, the “pregnancy hormone,” says Steven Riechman of Texas A&M University, one of the study’s authors; the results could be due to the fact that, “when you’re pregnant, you’re not building muscle, because you need to reserve resources for the fetus.”

To prevent pregnancy, the pill suppresses ovulation, which is why Emma Lind, 28, avoids it. “I consider ovulation to be my most powerful time,” says the Ottawa resident, who uses condoms. “My skin clears up, I’ve got lots of energy, and I’m physically present.” Before this fertile phase, a woman’s estrogen and testosterone levels peak, causing a spike in libido, says the University of British Columbia’s Dr. Jerilynn Prior, scientific director of the Centre for Menstrual Cycle and Ovulation Research. In women who take the pill, hormone levels stay relatively flat.

It isn’t just a woman’s sex drive that might be affected by the pill; experts speculate it could even impact their taste in men. In a recent paper, University of Sheffield researchers concluded that women on the pill don’t show the same preference for more “masculine” features—like dominant behaviour, or competitiveness—that ovulating women do. What’s more, they’re less likely to choose partners who are genetically dissimilar from themselves. (When genetically similar couples have children, it can cause health problems for the baby.) Though the reasons aren’t fully understood, it seems that men respond to a woman’s cycles, too. Prior cites a surprising study in lap dancers which found that, right before ovulating, they got the most tips.

For Lind, the environment was also a factor in her choice of birth control. Synthetic estrogens from the pill, as well as those naturally produced by our bodies, are passed through human urine, ending up “in the sewage treatment plant,” says Vance Trudeau, a biologist at the University of Ottawa. Trudeau’s work has shown that, when these estrogens find their way into the ecosystem, they can turn male frogs into female, a result that Lind declares “scary.”

How to explain the pill’s lasting popularity? For one thing, it’s effective: about 98 per cent, if used correctly. In spite of the wide range of birth control options available to Canadian women, from the contraceptive ring to the patch, women stick to the condom and the pill, notes a recent report from the Society of Obstetricians and Gynaecologists of Canada.

That’s partly due to a lack of familiarity with other methods: health care workers are often “more comfortable talking about the pill,” says Dr. Amanda Black, an assistant professor at the University of Ottawa and lead author of the study, and lack the time to walk a patient through several other options. Even so, many women increasingly lack patience with this. “I’m amazed how many contraceptive devices there are out there that you just don’t hear about,” says Toronto resident Emily van der Meulen, 32. Meanwhile, “you go into a university washroom, and every second ad is for the birth control pill.”

As women look for other options, the intrauterine device is making a comeback: the Mirena IUD, for one, releases small amounts of hormones directly into the uterus, levels that Black says are almost undetectable in the bloodstream. But several women told Maclean’s that, when they approached their family doctor about being fitted for one, they had to be referred to another doctor. “Not all doctors are comfortable putting them in,” Black agrees. “Sometimes there’s an extra step that isn’t there with the pill.”

Of course, that’s not the only reason the pill is prescribed. It offers benefits beyond pregnancy prevention, she adds, lowering the risk of endometrial and ovarian cancer. (Some studies have suggested an increased risk of breast or cervical cancer, she notes, but more research is needed.) It’s often prescribed to treat everything from menstrual cramps and acne to hirsutism (excessive hairiness).

Not all women, though, are happy to take hormones to treat what they see as perfectly natural conditions. Stephanie Bialik, a 25-year-old Calgary-based writer, was prescribed the pill at the age of 13 to help her heavy periods; looking back, she wonders if it was necessary. “I wasn’t really used to my cycle, or how it felt,” she says. She’s not taking the pill anymore.

The pill does have some side effects, Black notes, but most of them—like headaches, nausea and bloating—are simply a “nuisance,” and will soon go away. Indeed, millions of women take the pill today with good results. Prior agrees that most doctors would advise women to “take the pill and not worry about it,” but she takes a slightly different view. “There’s an emotional identity attached to achieving your own menstrual cycle, and being able to read your body,” she says. “When you’re on the pill, it’s the doctor who’s controlling your cycle. You don’t own it.”
Since going off the pill, Lambert’s been watching her own body change: “I always had really clear skin, and now my skin’s breaking out,” she says. “It’s not awesome being 26 and having acne, and trying to figure out your periods.” Even so, she says, “I’m glad I’m doing it.”

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