it's twice as hard to swallow when you know precisely what the pill is
November 2, 2016 9:28 AM   Subscribe

Broadly takes a deep dive into the racist and sexist history of keeping birth control side effects secret. The Atlantic follows up with an examination of the different stakes of male and female birth control: "...it makes perfect sense that women would be willing to endure all kinds of side effects in exchange for, essentially, freedom. Being able to control whether and when they become pregnant has opened up so many opportunities for women, opportunities that men already had greater access to by virtue of being men. Men's careers, men's bodies, men's control over their own lives, have never been at stake in the same way."
posted by amnesia and magnets (49 comments total) 58 users marked this as a favorite
 
From the article in The Atlantic:

“It was believed women would tolerate side effects better than men, who demanded a better quality of life,” Squires writes.

One-third of women’s wage gains since the 1960s can be attributed to the availability of oral contraceptives, according to a report by Planned Parenthood. College enrollment has historically been higher among women who have access to the pill, and “birth control has been estimated to account for more than 30 percent of the increase in the proportion of women in skilled careers from 1970 to 1990,” the report reads.

Wow. We may be better at tolerating the side effects of birth control, but only because we sure as hell won't tolerate the side effects of patriarchy.
posted by quiet coyote at 10:01 AM on November 2, 2016 [49 favorites]


Related, I think, is how majority of testing on drug effectiveness is on a homogenous population (hint: white men) so dosages are rarely calibrated to your sex or size or know whether your ethnicity might alter effectiveness of a treatment. You get studies on one population and then anecdotal field reportage for the rest of us. Here's an article from The Well @ NYTimes on how this plays out with a number of drugs. I was glad to read this as I had been cutting sleeping pills in half for awhile. Years ago I was prescribed Ambien for my hormonally-related insomnia* (2-3 nights of every month at the start of my cycle) and started cutting the low dose in half because I found that the full dose didn't sit well and the smaller amount was fine.

Now the healthcare field has decided that Ambien is bad and so I have to lobby each time I want to get a new prescription. The last time, they only allowed me a single scrip for 12 pills. I asked what the deal was and they said that there were other more-effective remedies and people had experienced side effects. Did they tell me that I could or should take a lower dose? Nope. 12 pills, cut in half and taken when I need it lasts me at least a year but still. I have a feeling I won't be allowed this in the future.**

*Various doctors have said they have never heard of this.
**Also, the generic is soooo cheap. I can't help but wonder if the relative lowered effectiveness of Ambien relates to it's lower profit center.
posted by amanda at 10:04 AM on November 2, 2016 [10 favorites]


I've had doctors trying to push birth control on me for years. Yes, I'm sexually active. No, I'm not willing to take a pill that makes me want to kill myself. The doctors response is always, we can prescribe an antidepressant for that. seriously, what?
posted by [tk] at 10:11 AM on November 2, 2016 [38 favorites]


All of the guys (who can have children and are in relationships with women who can have children - this is one of the few bonuses I know for trans friends who don't want kids) I know (all of us in our late 20s to mid 30s) are similarly pissed about this. We would like to help shoulder the responsibility for birth control and assist with peace of mind. The percentage of side effects seems low, lower than many of the other things we see showing up behind the pharmacy counter anyway. Even if they hadn't halted the study, we know it's years from market, but this is something that all of use have been wanting for ages.

I do wonder if this would mean an increase in non-HIV STI cases though. HIV is better controlled with PreP alone than with a condom alone, but things like Gonorrhea and Chlamydia are already having a field day with new antibiotic resistant strains. I may just be looking for a silver lining here, but I do wonder about a resurgence of STIs if this does get approved.
posted by Hactar at 10:11 AM on November 2, 2016 [4 favorites]


This episode of Fresh Air on the history of birth control which includes the story of the Puerto Rico experiments is really great.
posted by amanda at 10:18 AM on November 2, 2016


Damnit.

My wife has been refusing birth control for years because of her bad experience with the side effects, which, OK, there are alternatives.

And yet.

...and yet still a part of me kept thinking that she was just being finicky.

I have the feeling that I'm either particularly stupid or particularly entrenched in privilege, because I just can't seem to learn that when people tell you something, especially people who experience societal discrimination, listen to them.
posted by leotrotsky at 10:19 AM on November 2, 2016 [29 favorites]


I do wonder if this would mean an increase in non-HIV STI cases though.

The real-life effects of PrEP availability in the gay community shows all signs point to "yes".
posted by hippybear at 10:20 AM on November 2, 2016 [2 favorites]


I had no idea that the initial studies were conducted in such a horrifying and unethical manner. Jesus! They gave people birth control pills without knowing ANYTHING about their lives and it didn't even occur to them, initially, to give women some fucking information about this? It'd sure be nice if the default assumption were that women should be given the power to make decisions about our own bodies and lives.
posted by Mrs. Pterodactyl at 10:23 AM on November 2, 2016 [4 favorites]


Something related to this showed up on my Facebook feed with a "hardy-har men can't handle the side effects that women have put up with for decades" framing.

But honestly -- even without getting into the economic arguments of it -- the known primary medical effects of pregnancy followed by childbirth, miscarriage, or abortion seem worse than most of the theoretical side effects of hormonal birth control. Even assuming a "healthy" pregnancy.

And when you look at the economic, or even just social effects of an unwanted pregnancy, even the really bad potential side effects (like treatable depression from a known medical cause) seem like a trade I would make any day.

It's a reasonable goal in medicine to make sure that the cure isn't worse than the disease. I can easily see the argument that given that unwanted pregnancy isn't a disease that male bodies have to fear, the "cure" better be pretty damn benign.

That being said, keeping the side effects secret is some bullshit, (but also unsurprising, given a.) paternal/sexist attitudes and b.) a general reticence to talk about how hard having children really is, leading to the paternal assumption that women would make the "wrong" decision if given the truth about the pill).
posted by sparklemotion at 10:23 AM on November 2, 2016 [5 favorites]


...particularly with anything to do with medicine, because goddamn have I heard some horror stories here.

And because I know from experience that having a natural birth was made a horrible PITA at two different hospitals halfway across the country from each other ...even though we had midwives on our side ...even though we had a birth plan. They are just so goddamn eager with the mag and the drugs to medicalize the process into a c section. We got out with a natural birth both times, but fucking hell it was a grinder. Like fighting a strong current to swim upstream.
posted by leotrotsky at 10:24 AM on November 2, 2016 [2 favorites]


What am I supposed to say to any of this? I'm enraged. So much of it hits too close to home. The history of birth control is a long list of men offloading responsibility and flat-out exploiting the disadvantaged positions of poor, fat, brown, or mentally ill women. just because they can. It's disgusting.

“the risks to the (male) study participants outweighed the potential benefits.”

This makes me want to scream. They're not saying "the risks outweigh the benefit of mitigating unwanted pregnancy", they're saying "the risks outweigh the benefit of mitigating unwanted pregnancy for someone else" i.e. the woman involved. Men have never taken responsibility for pregnancy, and it's just because they don't have to, they can get away with it. Same with an abortion if it's needed. It's a gross exploitation of women and it makes me furious.
posted by FirstMateKate at 10:27 AM on November 2, 2016 [47 favorites]


In this patriarchy in which we live, it feels to me like most of existence is a gross exploitation of women. I wish that would change.
posted by hippybear at 10:30 AM on November 2, 2016 [7 favorites]


So I guess my devoutly Catholic friends were right all along?
posted by timdiggerm at 10:33 AM on November 2, 2016


the known primary medical effects of pregnancy followed by childbirth, miscarriage, or abortion seem worse than most of the theoretical side effects of hormonal birth control. Even assuming a "healthy" pregnancy.

this isn't a value scale any woman can decide for another so I am not saying you're wrong, but I am kind of shocked at the idea that simple condom use, with its very small risk of malfunction/failure, with emergency contraception as primary backup and abortion as secondary backup, could seem worse than all the many common effects of hormonal birth control, never mind the uncommon ones. I don't want to be pregnant for even a few weeks, but I don't want to be feeling the physical and mental effects of extra hormones every day even more. The way the effects normalize themselves over time so that you forget ever feeling differently before, after enough years, is the worst part.

I speak as someone who lives where abortion is legal and someone for whom it will be affordable, and also as someone who has not had to distrust male partners' cooperation in the recent past, so I of course see why some people will always want the pill even if it never gets better than it is now. but I'm never not going to be angry that I took it for 10 years or so and thought it was the responsible thing to do.
posted by queenofbithynia at 10:35 AM on November 2, 2016 [7 favorites]


I had to drop my OB when she refused to believe that constant yeast infections plus rage + PMS symptoms at all times were not, in fact, in my head or due to my suddenly becoming some sort of filth-beast who didn't clean her bits properly. I had not had those problems before the pill, and when I dropped it, they went away. But I tried longer than I should have because I kept wondering if maybe she was right and I was just suddenly moody and inept at managing myself.

Haha no.

Diaphragms worked out great for me, but they get a little harder to find each time I replace them, are never covered by my insurance, and I always get side-eye when I have to ask for a prescription to replace mine (which is dumb, why do you even need one for something that is not a medication).

If I can't find one next time, the husband will have to get snipped because I'm not putting pill hormones in my body again.

Birth control in general is still in the dark ages. It needs to be effective for all bodies and it needs to be safe for all bodies. We're a long way from that.
posted by emjaybee at 10:35 AM on November 2, 2016 [4 favorites]


So I guess my devoutly Catholic friends were right all along?

I mean, I guess that depends? Were your devoutly Catholic friends saying "people should be given appropriate information and resources to exert control over their own bodies, including their reproductive systems, and that includes providing patients with information about potential side effects and complications of the medicines they take" or were your devoutly Catholic friends saying "the pill has negative side effects but we bring this up to try to scare uterus-havers away from taking it rather than providing them with the guidance and support they need to make the best choices for themselves"?

I mean, either way might be technically CORRECT but I don't know that I think that the second option is particularly "right".
posted by Mrs. Pterodactyl at 10:40 AM on November 2, 2016 [20 favorites]


I'm going to urge the men in this thread to strongly consider whether or not what you're about to say actually adds any value into the discussion on how women have faced decades of mistreatment and downright abuse at the hands of a misogynistic medical system.

Unless, of course, what you want to talk about is how to encourage the attitudes of men so that they, too, feel responsible for pregnancies and the well-being of women.
posted by FirstMateKate at 10:44 AM on November 2, 2016 [13 favorites]


The male birth control study everyone is talking about is available here. Interesting is that the vast majority of men in the study were happy with the method, which is not how it's being framed in Buzzfeed and other pop science outlets. Also the framing it as "men are wussies and can't handle what women can" is pretty insensitive to the men who suffered in this study, including one who committed suicide, though who really knows if it was related to the study.

I'm also disappointed that Holly Grigg-Spall (author of Sweetening the Pill) is getting so much press from this because that book is a disaster of bad science almost at the level of anti vaxxer nonsense. A lot of OBGYNs are bad and give awful advice on the pill (which made me biased towards the thesis of the book for sure, considering my personal experience with bad doctors) and other things, but that doesn't make bad science fear mongering true.
posted by melissam at 10:50 AM on November 2, 2016 [10 favorites]


We still don't have male birth control — but no, it's not because men are wimps
:
The study was halted, but it wasn't because the men who participated in it were wimpy. It was halted because two independent committees that were monitoring the trial's safety data were concerned about the staggeringly high number of adverse events the men reported. And, yes, the rate of side effects in this study was higher than what women typically experience using hormonal birth control.


posted by melissam at 10:55 AM on November 2, 2016 [14 favorites]


And, yes, the rate of side effects in this study was higher than what women typically experience using hormonal birth control.

Quantitatively or qualitatively higher?
posted by amanda at 11:02 AM on November 2, 2016 [9 favorites]


Generally speaking, the lopsided injustice of biology aside, straight men are, as far as I have ever seen or heard, literally never socially encouraged to neglect (or straight-up forfeit) their own health in order to maximize their sexual availability to women, let alone to the degree women are regularly expected to do so for men.

Which reminds me of how much hell the average heterosexual dude ISO permanent contraception will kick up when confronted with the possibility of getting a vasectomy, though the same man is depressingly likely to suggest tubal ligation (a significantly more invasive and prone-to-post-operative-complications procedure) as a solution to his female partner with nothing more than a shrug.
posted by amnesia and magnets at 11:02 AM on November 2, 2016 [21 favorites]


I am kind of shocked at the idea that simple condom use, with its very small risk of malfunction/failure, with emergency contraception as primary backup and abortion as secondary backup, could seem worse than all the many common effects of hormonal birth control, never mind the uncommon ones.

This came up the last time we discussed menstral cups, but it always seems like the women who experience bad side effects from things assume that their experiences are more universal than they actually are. Hormonal birth control, for me, means no monthly migraines, a lighter (to non-existent) period, no cramps, and fewer wild mood swings. These symptoms all came roaring back when I dropped off the pill for a year, and went away when I smartened back up again.

I know that my experience is not universal, and I know that I'm downplaying some side effects (I'm pretty sure I'm fatter than I would be if I were fertile), but net-net, HBC is a godsend. To the point that even though Mr. Motion has offered to take the one birth control option available to him, I see no point in spending the money*.

Condoms are fine and good for what they are, but at the very least, paying money to have sex with a long-term partner seems foolish. For women who need condoms for STI protection anyways, I can totally see the HBC tradeoff calculus coming out a different way.

The tradeoff for dudes, looked at from a purely medical view, will always be wary of side effects because pregnancy literally can not harm their bodies. Looked at from pretty much any other point of view, men need better options to control their fertility, and maybe we should let adult men make the decision about what side effects they consider to be "intolerable" but I can't fault doctors for looking out for their patients before other people.

*I also think that all forms of birth control should be free: not just "covered by insurance" but literally "this clinic will provide the appropriate services to anyone who walks in off of the street anonymously"
posted by sparklemotion at 11:05 AM on November 2, 2016 [15 favorites]


I speak as someone who lives where abortion is legal and someone for whom it will be affordable, and also as someone who has not had to distrust male partners' cooperation in the recent past, so I of course see why some people will always want the pill even if it never gets better than it is now.

As a caveat, the second part of your post speaks loudest to me. Condoms are not a solution when it relies on your partner to be a responsible, caring individual. Coersive sex is highly normalized in our culture. Women have to have the means to control their reproduction. And I think that the options for women have increased over time and I do think that the understanding of reproductive health and individuality has continued to get better. We don't have to be fatalistic even when we have legitimate gripes about how women have been treated historically on this issue and how vestiges of our cultural blindspot toward women and children continue to this day.
posted by amanda at 11:06 AM on November 2, 2016 [7 favorites]


"And, yes, the rate of side effects in this study was higher than what women typically experience using hormonal birth control"

I would love to know how side effect frequency in women was studied (I mean, what specific studies the article is alluding to), and how recently. (I would put this as a question in case you know offhand, but I can google it up with enough time and probably will.) I am only one person and I don't know if my physical reactions to taking the pill were typical or not. All in all, they were mild, meaning that I did not have a stroke or become suicidal. Plenty of women will say the same, having a high tolerance for suffering and a reluctance to complain.

But I do have reason to think my psychological reactions to the effects were extremely typical; namely, that I never mentioned them to any doctor.

effects included: that the pill flattened my libido into a dull average of what was formerly a fun monthly cycle of peaks and valleys (i.e. normal); that it did the same to my moods. It functioned, in fact, exactly the way people describe antidepressants as working when they don't work well. One reason I didn't mention this horrific set of effects was because you could easily frame it as "fixing" PMS, which is more or less accurate, and I had been informed that this was one known and positive effect of the pill. So apart from conditioned reticence to discuss such things, why would a doctor care? They certainly never inquired.

Another thing I didn't mention was weight gain, because again, it's a known effect - why tell a doctor what they already know? And how could I prove it's the pill doing it? I couldn't.

And of course, I first took hormonal birth control when I went off to college, so my late teens. This is pretty normal for girls to do, and it makes it next to impossible for them to know if a libido wrapped in cotton wool is a side effect of something or just how they are. There is a lot of messaging from the world that this is just how women are in general until later in life, and that expecting to have orgasms in the ordinary course of good sex is unusual, unrealistic, high-maintenance, or just naive. So who will report these effects? Who will know to? I would think in an organized study, more people would speak up. but do they?
posted by queenofbithynia at 11:10 AM on November 2, 2016 [17 favorites]


Quantitatively or qualitatively higher?

From the article:

The 320 men who participated in the research reported a whopping 1,491 adverse events, and the researchers running the trial determined than 900 of these events were caused by the injectable contraceptive.

Nearly a quarter of participants experienced pain at the injection site, nearly half got acne, more than 20 percent had a mood disorder, 38 percent experienced an increased sexual drive, and 15 percent reported muscle pain. Other, rarer side effects included testicular pain, night sweats, and confusion. One study participant died by suicide, though the researchers determined it wasn’t related to the birth control. Twenty men dropped out of the study because of the side effects.


But those guys are just wimps, right?

In fact, 75 percent of the men wanted to continue using the shot, according to a press release from the study. "Despite the higher than expected number of adverse events, many participants expressed their satisfaction with the method and indicated that their partners were relieved that they did not have to bear the burden of contraception themselves."
posted by fifthrider at 11:13 AM on November 2, 2016 [3 favorites]


Oops; missed the paragraph making the comparison explicit:

"These side effect rate is pretty high with this new study of men when compared with contraception studies for women," OB-GYN and blogger Jen Gunter wrote. "For example and perspective, a study comparing the birth control patch with the pill found a serious adverse event rate of 2%. The pill reduces acne for 70% of women and in studies with the Mirena IUD the rate of acne is 6.8%." Remember that in the study, nearly half of the men got acne.
posted by fifthrider at 11:14 AM on November 2, 2016 [1 favorite]


But those guys are just wimps, right?

Can we not with this straw man, please?
posted by FirstMateKate at 11:15 AM on November 2, 2016 [19 favorites]


Quantitatively or qualitatively higher?

It's implied to be quantitatively higher. Of course what queenofbithynia says about the quality of quantitative measurements is a real point.

It's linked in melissam's article but here's a direct link to study results.

(I'm not gonna say a whole lot about this but I am certain there is a solid market for male hormonal/reversible fertility control out there, and I think the study does in fact back that up.)
posted by atoxyl at 11:18 AM on November 2, 2016 [3 favorites]


But so many drug studies are done almost exclusively on males, and women are trained from childhood to minimize and hide their own discomforts, where males are not. I believe it's completely possible when men are told by study doctors to report all possible side-effects, they do so. Women probably second guess themselves and report fewer side-effects, whether or not that's actually true.

After all, look at the examples in this (short so far) thread of women doubting their own lived experiences with birth control side-effects, even though they know their own body better than some doctor. I can totally see a woman in the birth control patch study going "Oh, I always have a few pimples, what's a few more?" or "Man, I've been feeling a bit down lately, maybe I need to get outside more and see if my BFF wants to hang out"

All pure speculation at this point; but I'd love to see some actual studies on the difference in study reporting by men and women.
posted by sharp pointy objects at 11:30 AM on November 2, 2016 [22 favorites]


But those guys are just wimps, right?

With the exception of the participant who died by suicide, my response to that is...shrug? Yeah, I guess? Those side effects are pretty much everyday life around here in Ovarytown, and on a semi-regular basis you can toss blood, clots, cramping, diarrhea and other GI excitement, and headaches into the mix.

I don't like the construction of the wimps statement, and I don't think it's necessary. But if you want to have a contest about who's suffering more, you're going to lose if all you bring is "night sweats" and "pain at injection site."
posted by witchen at 11:41 AM on November 2, 2016 [8 favorites]


even though they know their own body better than some doctor

well, I wouldn't go that far. Doctors know my body better in several respects, but the trick is getting them to care.

e.g. I had high blood pressure, (now recently determined to be only high in doctor's offices -- but they didn't know that), was significantly overweight at the time I was taking the pill, had a history of migraines and had a grandmother who had had a whole bunch of strokes. What this has to do with the wisdom of taking the pill, I have only a vague idea of from reading drug package inserts. Presumably doctors know more, but they never said a word to me about it, even to reassure me that these are not serious risk factors. I did ask a time or two but never got more than a surprised vagueness out of anybody.

regarding mood and libido, you're of course right.
posted by queenofbithynia at 11:45 AM on November 2, 2016 [4 favorites]


And, yes, the rate of side effects in this study was higher than what women typically experience using hormonal birth control.

I too wonder what studies they're comparing this to. Sooooo many side effects for women from birth control either aren't recognized for being side effects or aren't reported on or BELIEVED by the doctors.

Ah yes, the fun gaslighting about the side effects of hormonal birth control. The first pill I was prescribed made me sick to my stomach for several months and the doctors kept testing me for EVERYTHING ELSE (Including pregnancy! And in the end THEY PRESCRIBED ME AN ALLERGY NOSE SPRAY!!! thinking it was post-nasal drip for allergies I do not even have) without even considering it was the birth control pill. That damned first pill wreaked havoc with my life for months before I changed for another one for a different reason and poof, the sickness was gone. Was that counted as a birth control side effect? NOPE.

And then the second one was fine for a couple of years until I started crying uncontrollably every month around 10 days after my cycle for a year, then went straight down into a suicidal depression. I stopped the pill because I had run out and didn't want to go to the doctor and poof, the clouds parted and I was mostly fine. Also not counted as a birth control side effect.

To say nothing of the complete and utter lack of libido. Never again hormonal birth control.

And of course my employer's (very generous) health care plan covers only hormonal birth control and nothing else (not even IUDs).
posted by urbanlenny at 11:50 AM on November 2, 2016 [5 favorites]


simple condom use, with its very small risk of malfunction/failure

Just to note that condoms only have a low rate of failure if used perfectly, which is to say that they have a low theoretical failure rate.

In actual use, as people really use them, 18\% of women using condoms for birth control become pregnant in the first year (CDC data). For a point of comparison, withdrawal has an as-actually-used failure rate of 22\%, and birth control pills have a 9\% failure rate as actually used. The only actually-very-low rates of failures, under 1\%, are for implanted devices and sterilization.
posted by ROU_Xenophobe at 11:54 AM on November 2, 2016 [6 favorites]


Sterilization is awesome. I was fairly champing at the bit to get snipped. The only reason I held off as long as I did was because the answer to "do we want any children?" kept being "maybe one, eventually." Once the Scatterkitten was out and, near as anyone could tell us, looking likely to survive, I went straight to the urologist. Now my spouse can do whatever works best for them, health-wise, and I'm not being a weight on anyone. It's the best.

Every time I see a sitcom scenario about how terrifying vasectomies are, my eyes roll straight out of my skull. There's this bizarre hangup about it that I'm assuming has its roots in the patriarchy and the need for "manliness," but seriously, it's like, "Do you have kids? Yes? Do you want more? No? Then GO GET THE SNIP-SNIP, YOU DRIP."
posted by Scattercat at 11:59 AM on November 2, 2016 [9 favorites]


Also I think this ties in with some broader issues in pharma. A lot of successful drugs approved in the past probably wouldn't be now, but you only have to look at the Broadly article to see why the pendulum has swung the other way. And I'm guessing regulators and industry people are very cautious about mental health side effects right now because of what happened with SSRIs etc.

(Also even though I've defended the men in the study I don't get the sense that there's a huge external movement behind this. Can we at least do for it what they did for Flibanserin?)
posted by atoxyl at 11:59 AM on November 2, 2016


Just to note that condoms only have a low rate of failure if used perfectly, which is to say that they have a low theoretical failure rate.

Oh, I know, and have myself had to resort to emergency contraception due to indelicate details. but that's why I feel bound to stress that my method presumes a cooperative male partner, since risk of failure due to improper use is generally going to be in his hands, as it were. I didn't say competent but should have.

I do always raise an eyebrow at the (completely normal, I know) phrasing of "perfect" use since all that means is consistent and correct, right? Perfection seems like such a high and unlikely standard, but in this case it is not, if both partners are willing. nobody's perfect but with condom use you really can be.
posted by queenofbithynia at 12:01 PM on November 2, 2016


I remember reading a few years back about a male birth control that took the form of a polymer that shredded sperm, placed in the vasoduct by injection. Did this ever make it off the drawing board?
posted by dr_dank at 12:14 PM on November 2, 2016 [1 favorite]


For some epidemiological-toxicological context, this study discontinuation's been discussed at public health conferences for a while. At those conferences, the discussion has been mostly "woah, why are serious adverse effects for this treatment--like suicidal ideation and suicide--so geographically lopsided," while the conversation here is leaning toward "men versus women." The Atlantic pieces doesn't even mention the former.

The lay press is not science press. There's more to this issue than dashed out thinkpieces from Vice. The APHA annual meeting just ended today, but tune into almost any professional conference for better information (including on real, verifiable, problematic areas of sexism in medicine and health than this).
posted by late afternoon dreaming hotel at 12:15 PM on November 2, 2016 [19 favorites]


Perfection seems like such a high and unlikely standard, but in this case it is not, if both partners are willing.

Meaning no disrespect, but if that were true the actually-used failure rate for condoms would be close to their theoretical failure rate instead of being close to the failure rate for withdrawal. Just as an empirical matter, consistent and correct use must be difficult to achieve, or the failure rate would be lower.
posted by ROU_Xenophobe at 1:02 PM on November 2, 2016 [3 favorites]


Things change. Been looking at a hysto again. Talking with my contemporaries about mortecelleration and cervix removal ... and trying to find a doctor who won't remove my ovaries because "he knows best" and "might need to make a decision in the moment while he is in there".

I've got a couple of kids broaching the cusp of puberty. Because of my issues with clots I hope to avoid the pill for them ... and encourage them if they choose reproductive science to find us something better.

Too many of my age group lost babies to placental malformation--likely due to long term effects of hormonal birth control. These medicines need to get better.
posted by tilde at 2:00 PM on November 2, 2016 [1 favorite]


I think one key thing is that so many of us women have been on HBC for so long we don't realize the side effects we were experiencing until we're off it - so in my case I was on it for something like 12 years continuously. When I went off it in order to have our daughter, I noticed a ton of differences, some good, some bad. But because I went on when my body was still going through the end of puberty, it's easy to ascribe a lot of stuff - weight gain, libido changes, migraines, acne, etc - to the rest of your body sorting itself out. So it's pretty easy for me to believe that women under-report side effects like crazy, whereas adult men used to their hormones in a natural state will notice changes and side effects with greater clarity.

It's also really interesting to me how I'd been prescribed the combination pill for 8 years by my doctors even though I had a history of migraines with aura, and that was never pointed out to me as a contraindication (I just got the standard "there are some risks to the pill but no one cares" talk). When I moved to the UK my GP was literally horrified to find out what I'd been on, and she switched me to the minipill, which has less of a risk of stroke for migraine sufferers. Unfortunately that pill had a whole host of other side effects I wasn't okay with, so I had a talk with my next doctor after I had my daughter and made an informed decision to go back on the combination pill - though I'm about to stop it again because I've had more migraines in the last three months than I'd previously had in a few years combined and I figure that's not a great sign. But yeah. It was literally never mentioned to me before I was 28 that I had a major contraindication for the pill I'd been prescribed for a decade.

That said: I am ridiculously obscenely hugely ("bigly!") grateful for reliable birth control and the freedom it's given me. I think the fact that so many women feel the same way despite the range and severity of side effects says a whole damn lot about how we feel about the alternative. Thanks, science!
posted by olinerd at 3:43 PM on November 2, 2016 [12 favorites]


*I also think that all forms of birth control should be free: not just "covered by insurance" but literally "this clinic will provide the appropriate services to anyone who walks in off of the street anonymously"

Can I favorite this so hard it knocks a hole in the page??

I've said this many, many times. Frankly, I think that they should put fishbowls full of condoms at the exit to ever high school and college in the country. Put them near the exits of grocery stores. Have free vending machines on every street corner. Hell, why don't we give them out at Halloween?
posted by BlueHorse at 7:16 PM on November 2, 2016 [8 favorites]


My experience with the pill was that it had no effect on my mood, no effect on my libido, and gave me perfectly clear skin for the first time in my life post puberty.


Plus total control over when I'd have my fake withdrawal bleeding "period". I'd honestly be willing to take it for that alone, never mind the all important prevention of pregnancy-- being able to skip periods was glorious and heavenly, and knowing exactly when they were coming (instead of having a wildly irregular cycle, fun fun) was also great.

I missed it when we decided to try for a kid.
posted by Cozybee at 9:03 PM on November 2, 2016 [1 favorite]


One such lead that needs further investigation: why comparatively low-hormone birth control like IUD's and vaginal rings correlated with more depression than higher-hormoned pill takers.

I wonder if this could be related to a higher incidence of chronic vaginal infection with these methods of birth control? Seems like every woman I talk to about this has either had or knows someone who's had ongoing issues with recurrent yeast infections, BV, UTIs, or some mystery "discomfort" that their doctors don't bother to properly diagnose. Let me tell you, that shit is depressing.

(Not to mention, there seem to be few realized efforts to develop more effective drugs/treatment protocols for these VERY COMMON problems. Can we take care of the leading women's health complaint before we develop another drug for erectile dysfunction?)
posted by materialgirl at 10:22 PM on November 2, 2016 [2 favorites]




ROU_Xenophobe: In actual use, as people really use them, 18\% of women using condoms for birth control become pregnant in the first year (CDC data). For a point of comparison, withdrawal has an as-actually-used failure rate of 22\%, and birth control pills have a 9\% failure rate as actually used. The only actually-very-low rates of failures, under 1\%, are for implanted devices and sterilization.

On the gripping hand, if you actually *use* the things, condoms have a 2% failure rate in the field & the pill is 99% effective. (Source: http://www.nhs.uk/Conditions/contraception-guide/Pages/how-effective-contraception.aspx )

The CDC figures come from going to people and asking them "What method of contraception do you use?" and them replying "Oh, condoms" (but they don’t actually use them every time, for a variety of reasons) or "The Pill!" (but they tend to skip days here and there). If you have a lifestyle (co-operative partner, regular daily routine etc etc) that makes using these methods consistent and straightforward for you then they are very effective. If not, well, not.
posted by pharm at 5:03 AM on November 3, 2016 [1 favorite]


(I made that comment not to criticise those who find themselves unable to use these forms of contraception effectively, but just to counter the scary headline numbers. The Christian right in particular is very fond of using the CDC numbers to 'scare straight' their teenage flock, because obviously condoms are pointless & terrible amiright & therefore no sex ever ever ever is clearly the only way forward.)
posted by pharm at 5:06 AM on November 3, 2016 [4 favorites]


(For anyone that can’t be bothered to cut + paste that NHS link, that’s a 2% failure rate per *year* obviously. A 2% failure rate on a single use would be pretty terrible!)

That concludes your parenthetical remarks from me today. Hopefully.
posted by pharm at 5:38 AM on November 3, 2016 [1 favorite]


I had endometriosis and got stuck trying several different pills for about a year and a half, probably five or six of them. I had absolutely terrible side effects from all of them, my gynecologist didn't believe me about some of the more severe ones ("That's not a listed side effect, it must be psychosomatic"), I have frequent sinus infections so when I was prescribed antibiotics I still ovulated, which was hideously painful, and the whole time all I wanted was a hysterectomy. I asked repeatedly for something that would actually treat the endometriosis and was told there wasn't anything, and since I was 28 at the beginning of this they wouldn't let me have a hysterectomy. Just for extra comedy, I'm a lesbian and can't have a biological child with a partner anyway, but heteropatriarchal norms must always be enforced.

For extra extra comedy, this was around the time that pharmacists across the US were refusing to fill birth control prescriptions because of their personal religious beliefs. Not where I was in the city, thankfully, but just a little extra strain on the situation.

Flash forward several years, my (new) gynecologist tried to put me on the mirena after I had an adverse reaction to tramadol. I'd already had a bad reaction to the drugs in the mirena and refused, and asked again for a hysterectomy, and she thankfully said yes. It's been the best thing I ever bought myself (alas, I am American). The first time I ever got any real pain relief for what had been devastating menstrual issues was post-operatively - before that I had repeatedly been called a liar and an attention-seeker, as though at twelve I wanted any sort of attention for bleeding out my junk.

All around, the experience was incredibly frustrating not only because my pain and discomfort were never taken seriously but also because my sexual orientation and sense of self weren't taken seriously either - I was lying about the side effects, and also could be expected to recover from all these terrible homosexual impulses at any time. I know other women and people of various genders who have used the pill have had really positive experiences, but for me it was a nightmare.

To take this back to the article, I have sympathy for men with severe reactions, but this is again a situation where women's discomfort is taken for granted and normalized while men are entitled to complain about every little thing ever and also put the entire onus for birth control onto women with an added expectation that women will use a method that is invisible to them and causes them no inconvenience. This needs to stop.
posted by bile and syntax at 7:01 AM on November 3, 2016 [16 favorites]


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