Wednesday, November 25, 2009

Follow the money

I just came across this film that hasn't had a cinema release yet, called Orgasm Inc, directed by Liz Canner - she took a job as an editor for a pharmaceutical company, editing erotic movies for test trials of versions of 'female Viagra' - like the drug I talked about in the last post. She investigated from the inside the billion dollar industry built around finding a cure for what is labelled 'female sexual dysfunction.' She discovered there has been a race on for a long time to come up with a marketable drug of this kind.

I've been thinking a lot lately about the pharmaceutical industry. I found out last week that Bayer Schering Pharma want to contact me, well the company's 'local drug compliance officer' wants to contact me. To me, that title sounds like something out of Minority Report. Is the suggestion that I need investigating because I am not complying with their drug? Or that they want to improve compliance by talking to me? How can a person be compliant to a drug? It's a bit like 'loyalty' cards for supermarkets - can a person be loyal to a company? Compliance seems to mean that you take the drug, and keep taking it no matter what, and like it.

Anyway, so, yes, thinking about the pharmaceutical industry lately - that 45% of the female-orientated side of the industry springs from oral contraceptives is quite amazing. The mood side effects of the pill I am discussing here - the anxiety, the depression, the fatigue, the panic attacks, the fearfulness that many women experience - could actually be seen as bolstering other areas too - such as the sales of anti depressants and mood stabilizers, and the invention of a 'female Viagra.' In a sense, it is useful for women to have 'female sexual dysfunction' - which basically means low libido and depression - and to not link that to the pill. I know I am going over old ground. Keeping women feeling sickly must be a booster for all sorts of other areas of money-making. I watched Sicko again the other day, and Tony Benn said something similar about how a sick, anxious public is an easily controlled, easily influenced, passive public.

I wonder if there are any statistics out there on the number of women on anti-depressants and on the pill. I know they hand them out to everyone these days, but that would be interesting. There's a doctor, Irwin Goldstein, who believes the pill has much to do with this 'sexual dysfunction' idea. It's not enough to convince healthy people they are sick - with social anxiety disorder and all that - it must be even better to make sure that half of them are sick, and sick because of a drug they don't even notice they're taking.

I had a a bit of an altercation on the comments section of my guest blog for the Society of Menstrual Cycle Research - someone, I thought perhaps this drug compliance officer - took issue with my lack of 'rational' research. I have contacted most of the research scientists who have looked into the impact of the pill on mood and well being. There isn't an awful lot of research on this to read. But whilst I was addressing the criticism I thought how most of my discussion of late has come from the very factual, rational understanding that the pill suppresses and stops the natural ovulation cycle.

Laura Werschler, executive director of Sexual Health Access in Alberta, contributed to the comments section also. She insightfully pointed out that there is research available into the benefits of the natural ovulation cycle for women's bodies - for their immune system, hearts, bones and general wellness. In a letter to Ms magazine she commented that we should not just be asking what the pill is doing to our bodies, but what natural cycles can do for us.

I have tried to point this out here, but it bears clarification. Side effects of the pill are experienced by many women, but not all in the same way, and not all at the same point. However, all women taking the pill are suppressing their natural cycle, and this does have an effect on general health. If we don't have scientific back-up for the side effects we are discussing - not that this undermines their existence in any way, or means they should not be taken very seriously - but we do have scientific back-up for the function of the ovulation cycle. Although, as Laura pointed out, many doctors, and much of the medical profession, still thinks the natural cycle is useless until a woman wants to get pregnant.

There was an article on the Macleans website yesterday entitled Ditching The Pill For Good which said that due on young women in their twenties reconsidering the pill, prescriptions for oral contraceptives have not risen in the last year. That's women like me, and perhaps you, then. The 26 year-old Teresa Lambert is the main subject of the piece. She took the pill for ten years and just came off it. She is 'watching her body change' and says, 'I always had really clear skin, and now my skin’s breaking out. It’s not awesome being 26 and having acne, and trying to figure out your periods. But I’m glad I’m doing it.' Sounds familiar. A friend pointed out to me that coming off the pill is like having a second adolescence, or even a first adolescence, if the first - and the acne, the periods - was controlled by the pill from the start. So, like a teenager, you get bad skin and bad hair and you feel very volatile, super emotional and sensitive. Your emotions are overwhelming, and kind of frightening. It's like the pill creates arrested development.

The scientific director of the Center For Menstrual Cycle and Ovulation Research - someone I interviewed back when writing the Easy Living piece - Dr Jerilynn Prior is quoted as saying, 'There’s an emotional identity attached to achieving your own menstrual cycle, and being able to read your body. When you’re on the pill, it’s the doctor who’s controlling your cycle. You don’t own it.' She talks about the importance of ovulation, about how at that time the hormones peak and this has all sorts of positive effects.

As is the way with the internet, the comments underneath the article are just as interesting as the article itself. Many people wrote to advocate the fertility awareness method of contraception, which I was talking about last time. One man even went as far as to say that his wife being connected to her cycle, and his understanding of it, made for better sex, apparently 'sex on the pill was a mere shadow of the real thing.' So, I guess that's a good answer to people who criticise condoms too.

I don't think I've mentioned before that I ordered and read that book, The Optimized Woman. It's all about how women can make the most of their natural cycle - in a life-coach, self improving, achieving more, feeling better way. Oddly, Miranda Gray sort of says that the book should be good for women on what she calls 'medically managed' cycles, although she doesn't say how or why. I suppose that's marketing for you, needing to appeal to everyone and all that. Doesn't make any sense though.

She has some very interesting points to make that overturn conventional attitudes towards menstruation which were, and are, crucial in promoting and pushing the pill on women. I have said before that I think the pill was enthusiastically received as a necessity for women wanting to get into the workplace, and work alongside men - they could choose when to have children with other methods, but menstruation, and the changes of the natural cycle were seen as making women weak, frail and irrational (and therefore not able to work alongside men) and menstruation in particular was thought to be a threat to productivity and work output. The natural cycle was understood as a handicap that held women back and could not be tolerated by the economy, the world of business, or just by men in the office.

Gray argues from within the system as we know it, using business-y language and turning the assumptions around. She says that the economy ignores the 'truth' about women. The cyclical nature of women's lives could be an asset. We have overriden our cycles to fit into a world that perceives us as inconsistent and unreliable - when the changing states women go through are actually anything but, and can be utilised by us, and by the economy, for success and achievement.

We accept the way the business world wants us to be - static, unchanging, regimented, passive - as the 'way it should be' and struggle to fit this structure rather than accepting and understanding how we are. Gray argues that the social focus on menstruation suggests to women they are 'abnormal' once a month, and 'normal' the rest of the month, which lets us lose sight of the cycle completely. If women were free to be female, and not have to fight themselves - with the pill, as I would see it - then they would be better off all round. Not only that, society would be better off too.

She splits the cycle into four sections - pre-ovulation, ovulation, pre-menstrual, menstrual - and gives them labels like 'dynamic' and 'creative.' I've posted a link to Gray's site before. It's funny to see Cosmopolitan magazine has picked up on her work with a piece on the four kinds of sex drive, of course. But it's actually pretty intriguing, and she doesn't even try to impose her own system as a replacement - admitting instead it is flexible and adaptable in itself. Shame she doesn't quite get it about 'medically managed' cycles, though.

Sunday, November 22, 2009

In other words

I thought it might be about time for another personal pill experience, and some writing from someone other than me on the subject. A fair few women have given their stories in the comments section also, so do take a look at those.

El is in her mid-twenties and lives in the UK:

"I was 18 and at university when I went on the pill. I had really irregular periods – sometimes 12 weeks apart – and my GP said it’d help to regulate them. Obviously my first pill (like most people’s) was Microgynon. After a few weeks I noticed how hungry it’d made me. I’d started to eat way more food than usual, and all I could think about was where my next snack was coming from! It sounds stupid, but I couldn’t concentrate properly on anything because I kept thinking about food.

I went back to my GP who prescribed me Cileste. I took this for a while but soon noticed I had really tender breasts and a bloated feeling, all the time. I changed pill again to Yasmin, but soon got thrush (ew – sorry!) I’d never had it before so I was really surprised. I did all the right things – used the medication, made sure I wore cotton, etc. But it kept coming back. I was 19 at this point.

I went to my GP again and she prescribed Dianette. I got the packet home, took out the leaflet, and read all the instructions... which said the pill should be prescribed for adult acne, and though it was also a contraceptive pill, it shouldn’t be prescribed primarily for contraception. This seemed weird, but I trusted my GP and took it anyway.

A little while after, I began to feel really miserable, and went to my GP for advice. I started crying at the doctor’s but she put it down to a recent bereavement, handed me some tissues, and I went on my way. Over the next few months I got worse and worse; I’d cry all the time and couldn’t bring myself to talk to anyone because I felt disconnected. Physically, I couldn’t sleep and night and also lost my appetite. I’d cook myself food and then feel like I was going to be sick at the first mouthful and end up throwing everything away. This went on for a long time, and really affected my personal relationships and my university grades. The only things that kept me going were my mum, my best friend and my boyfriend.

The worst time was when I went home for Christmas. My parents noticed how bad it was and my mum suggested I consider taking anti-depressants to see if that would help. I’d been determined not to take anything, but I made an appointment with my home doctor who prescribed me some very mild anti-anxiety pills to take if I needed them. I got the box of pills but decided not to take any. I wanted everything out of me system so I could decide if my feelings were part of ‘me’ or part of the pills – by this time I’d started to wonder if they were having an effect.

I came off Dianette and noticed an improvement within a matter of weeks. I felt able to cope again, I stopped crying, I was able to talk about how horrible I’d found my experiences. And I decided not to go back on the pill. Searching the internet, I found others who’d had negative experiences with Dianette. And I found out you’re only supposed to take it temporarily until the acne clears up (what acne?!)

This happened to me in 2004/5, and in 2006 the BBC published the story that Dianette was being investigated due to a link with depression: It's a shocking read but makes a lot of sense to me, especially this quote: "A spokeswoman for Schering Health Care, which manufactures Dianette, said: "Severe depression is listed in the patient information leaflet as a reason for stopping Dianette immediately. Depressive moods are also listed as a possible side effect.""

While the pill might not have been /entirely/ responsible for the depression I felt, I feel convinced it played a big part and will never take it again. In my experience, GPs (especially those working with people of university age) are too cavalier about prescribing the pill, and don’t take time to discuss other options or potential side effects. While on the pill, I also leapt from being a size 32A to a 32D. This could have been a consequence of taking the pill. If not, it’s at least a sign my body hadn’t finished developing yet, and so probably could have done without extra hormones confusing it!

There are pros to taking the pill that I miss: for example, it feels nice to have sex without a condom, and it’s nice to run packs together and miss periods if they’re inconvenient. When I first started taking the pill, it also made me feel ‘grown up’. But for me, the benefits are outweighed by the negative side effects. If I’m having period pains or mood swings, at least I know it’s just my natural cycle and I can deal with it. I also have a very supportive partner who would also prefer sex without condoms but not at the expense of my happiness.

At the end of the day, I feel angry about the way the pill’s sold to women, and don’t think there’s enough information for people to make informed decisions about contraception. I would have thought twice about going on the pill (which is marketed as such a ‘normal’ thing) if I’d known then what I know now."

Friday, November 20, 2009

Who am I when I'm not on the Pill?

Bayer Schering Pharma, once again the company behind Yasmin/Yaz, made an announcement this week that the Asia-Pacific market is opening up for sales of the birth control pill. Oral contraceptives are not popular in China, India, Vietnam and Japan. I have kept meaning to write here about Japan, as the pill was only legalised there at the end of the 1990s. Apparently women in this area of the world are suspicious of the pill and its long term side effects. In Japan 80% of women use condoms as their main method of contraception. This attitude has been put down to conservatism - mostly that women are not considered responsible for contraception, concerns that it might cause on-going infertility, and a dislike of the regime of daily pill taking. Even since its legalisation, and we can imagine much campaigning from frustrated pharmaceutical companies, women remain uninterested.

There's a book by Japanese writer Ayako Matsumoto titled Why The Pill Is Not Welcomed in which she argues the lack of interest in the birth control pill is partly due on the availability and acceptability of abortions. When the pill was released in 1960, abortion was still illegal in Western countries, but legal in Japan. Women at the time protested that the pill gave them the burden of contraception, plus the side effects of the drug, and allowed men to deny all responsibility. They saw that the pill was not treating a disorder, but changing the natural patterns of a healthy body.

Of course, in the news stories and discussions you can read about the pill and Japan on the web, there is the argument that Japanese women are restricted in their freedoms and the Japanese government wants to keep it that way. I think it would be fascinating to look further into this, and compare women's lives in Europe and the US. I have been talking here about how bound up the birth control pill is with the progress of women, their relationships to their bodies, and society's attitude towards them so it was be interesting to look more in depth at a country in which women work, choose relationships, have similar lifestyles, but do not take, or like the idea of, the pill.

I have read a little about how Japanese women are more interested in charting their own cycles, and working out when they are fertile and when they are not. As I mentioned in my last post, I had a talk with fertility awareness method expert Jane Bennett the other day. She argues that it is better business to keep women mystified about their hormone cycles as prescribing the pill creates a lot of money, and although educating women about their natural patterns would take time, once they had that knowledge no money could be made from it. Although I think capitalism always finds a way, I understand her point.

Phil Smits, head of the Women's Healthcare Global Business Unit for Bayer Schering, informed reporters this week that the women's healthcare market was valued at $16.4 billion worldwide in 2007, with oral contraceptives accounting for around 45 percent.

Aligning their company with women's liberation, and promoting the idea that Japanese women are oppressed is sure to help their cause. In his statement, made in Singapore, Smits also emphasised that use of "reliable" contraception was low, and as such suggested the methods chosen by Asian women, including condoms, are unreliable. By drawing Japan's attitude towards abortion into the matter, however significant this point likely is, has the effect of making the providers of birth control pills saviours of the unborn, moral crusaders fighting to stop the brutality of abortion. Of course, abortion shouldn't be used in place of contraception, but I doubt it actually is to such an extent as is claimed.

The statement was rounded off with the announcement that Bayer is working on drugs for women with menopause and "gynaecological disorders."I find the vagueness of that term worrying. What will women find they have wrong with them now? I came across an article last week that talked about 'restless vagina syndrome.' The 'female answer to Viagra' is all over the news today - Flibanserin is a failed anti-depressant now being marketed as a drug to increase women's sexual desire and what they like to call 'satisfaction.' It is also said to reduce the 'stress' caused by lack of desire, rather oddly - sounds like spin to me, suggesting that they are really concerned about women's desire and satisfaction, rather than exploiting their situation. Creepily it is explained in some articles as acting by 'decreasing inhibitions.'

The pill was supposed to help women enjoy sex more as they wouldn't have to worry about pregnancy. It used to be thought that fear of pregnancy prevented women from having the same level of libido as men. The pill, however, reduces libido in a large number of women, as it stamps out the important hormone testosterone, has depressive effects and stops ovulation. Women's libido peaks around ovulation for obvious reasons, and when you take the pill you don't ovulate. If the pill makes you feel low or anxious then you are less likely to be interested in sex. Despite the pill's popularity, and the resulting liklihood that many women with low libidos feel this way because of the pill, at least in part, we are supposed to get excited about the prospect of taking another pill to deal with the side effects of the first.

This development has already been greeted with the usual talk over how complicated women's sexuality is, and how it includes the complexities of their relationship, their self-image, their feelings of stress. Now, this is all true, but it's irritating how such discussion ignores the biological side, when that too exists and is important. Women are effected by testosterone levels like men, their libido is linked to their hormone levels. Pretending they aren't just allows further justification for any and all messing around with these hormones. Also, one of the most irritating assumptions to be used by both sides is that frequency of sex signifies interest and desire for sex, which is completely wrong. Just because women are having it more, does not mean they want it more. Unfortunately.

I imagine they are hoping it might get to the stage where the mere availability of this drug will force women to take it - if women can want sex more just by popping a tablet, why would they not want to? If they don't want to, what is wrong with them? And so on, and so on.

Some, well many, other interesting points came up in my conversation with Jane - she talked about the "slow creep" of the symptoms of suppressing your cycle with the pill for years. Even if you are super healthy, the pill blocks nutritional uptake, so any conditions you have or may be prone to can be provoked or worsened. She suggests that women coming off the pill should make sure they are taking good vitamin supplements and eating very healthily so your liver has the chance to clean out and clear. The healthier you are the better you will feel throughout your natural cycle.

I have been feeling far clearer this week, around two and a half months after stopping the pill. I am energetic, motivated and more, well, reasonable in my outlook and responses. I met a woman last night who related her own coming-off-the-pill story to me - she said she felt like she was 'human' again, and that the range of emotions suddenly available to her to feel and experience was shocking after years of numbness and nothingness. We talked about how if you take the pill through your teens and twenties and then stop, it's hard not to feel like you may have missed out some pretty important elements of living by being so mentally and emotionally cut off.

A study involving 900 women over a ten year period in Germany found the fertility awareness method to be a very effective form of contraception. As I have said before, it's not the same as the rhythm method - involving instead charting your temperature level and the consistency of the discharge you produce through the month. I found the study a very interesting read, particularly considering that this method is rarely openly discussed. I am intrigued, mostly at this point because I think it would be helpful to be aware of my body's changes and feel connected - I figure it will make coming off the pill less worrying. Jane is going to be sending me a home kit to try out for myself - so I'll let you know how I get along. I will be sticking with the condoms and spermicide for now, but as Jane says, it's good to find out about your body regardless and take back a sense of control and confidence.

Friday, November 13, 2009

Not so fast

I've written before about how the release of the birth control pill was, in my view, as much an economic and social necessity existing to push forward the status quo as it was a radical shift in support of women's progress. Now, after reading The Beauty Myth - and I'm aware I am very late coming to this one - I am starting to wonder if the mood side effects of the pill that I'm discussing here are actually just as useful and necessary for the continuation of life as we know it too, and that this might be part of the reason why the whole word seems so nonchalant about doling such a drug out.

Perhaps I'm beginning to sound a little paranoid, but I think that's actually natural considering the complete lack of criticism out there, and rather aggressive supportiveness of the medicating of millions of women on very faulty logic. Naomi Wolf does mention the pill in her book, she says that when society needed sexually available women for the economy to grow and expand - as I talked about with Susan Faludi's Backlash - the pill was marketed as a drug to keep women young, beautiful and sexy. Young, because they were in biological stasis I suppose, beautiful because they were no longer doing that messy, unattractive menstruating and sexy because they were always available with none of the worries of pregnancy.

She also says, in discussing the ideals of attractiveness and the hamster wheel of keeping up your appearance, that "passivity, anxiety and emotionality" are needed for the economy and the culture that supports it to thrive. Women need to be both "sexually available and sexually insecure" to be good consumers. The more worried, self doubting, unconfident and fearful you feel - the more you will buy - as buying stuff is comforting, soothing with all its promises of making you, and your life, better. Funny then, that the pill makes women sexually available, in that they are assumed always ready for sex, and it makes many women feel insecure. If they can leave the house without having a panic attack, then, yes, they are probably buying clothes, make up, anything to feel a little better for a moment. I know that's what I felt like doing when I was low, so I doubt I am the only one.

Wolf doesn't talk about the pill further than stating the original marketing techniques - which are, of course, exactly the same as those used for the latest birth control pill, Yasmin. But, much of what she discusses, particularly about the plastic surgery industry is applicable and enlightening. She argues that society does not care about women's health or appearance, however much it might appear too, the only concern is that women keep being happy to be told what they can and can not do. Women's ovaries had long been battled over by the medical world before the pill came about, but once it did, women's whole reproductive system was made collective property. Women might 'choose' to take the pill, although as you know I think the popularity of the pill is destructive to that choice, but essentially they have handed over their reproductive organs to the control of the doctors, the pharmaceutical companies.

There's much said about how the pill 'protects' a woman's fertility by basically stopping the site of fertility functioning, thus preventing any problems arising - in the way that if you never drove a car it wouldn't need new brakes, new tires. The pill can actually mask many problems a woman might have, which then would only reveal themselves when in her thirties she decides to try to have a baby. Also, it can take a long time for a woman's natural state of fertility to return, holding the woman ransom to her bodies ability to process the chemicals it's been taking in for years. But, the falsity of that assumption aside, the idea of 'protecting' a woman's fertility is in itself controlling. It used to be that doctors thought women were intrinsically mentally ill and morally weak and that the repurcussions of this would effect her ability to have children, which led to doctors dictating what women could and could not do with their lives.

The pill perpetuates the fear and mystery surrounding women's reproduction ability and sexuality. The existence of the pill does not suggest society has come to accept women's bodies, or just plain women, nor does it suggest that society understands women's bodies. The pill is a rejection of women. It is a rejection of femaleness. The pill helped bring women into the man's world, and make them acceptable to work alongside men, but it did so at its high price. Women had to make a sacrifice to have some power. Society would not change for them by changing its structure to include child care, parental leave, felixible hours or even change its culture to be more compassionate, caring, human. Instead women had to change and fast.

John Galbraith is quoted in Wolf's book: "Behaviour that is essential for economic reasons is transformed into social virtue." Women who don't want to take the pill are treated as odd, abnormal, by doctors who often see the pill as the only choice for contraception. Women are thought ungrateful if they do not want the pill - here's this wonderous, liberating drug that was fought so hard for, how can we turn it down? The idea of the pill is still saturated with that radical spirit, even though it is now taken so casually. Wolf points out that women are indeed, at least in the western world, able to live much healthier lives - there are less threats from sex and pregnancy than there were before, but because the progress of medicine and hygiene has allowed us to be free of this vulnerability, it has been made certain that we are unable to experience our wellness. She was talking about the oppression of the beauty myth, but the statement could equally apply to the pushing of the pill.

I found a book in the library, Elizabeth Draper's Birth Control In The Modern World, published in the mid-1960s. In it, she argues that the pill should not be considered the pinnacle of contraceptive reseach achievement, that science should keep searching for a better method. She discusses previous attempts at creating oral contraceptives that would not intervene with the physicality of sex - drinking water used to wash dead people, eating honeycomb containing dead bees. One statement stuck out for me:

"It is one thing to use on a short term basis and in urgent therepeutic need drugs whose long term effects maybe in doubt, and quite another to use a drug for a purpose still imbued with an aura of questionable self-indulgence and for which alternatives exist. The oral contraceptive is a drug, a drug on the poison list, and one only available under medical prescription."

This related to something I found interesting in The Beauty Myth's chapters on plastic surgery. The Hippocratic Oath forbids experimentation without therepeutic purpose. Barbara Seaman, women's health agitator, was fond of calling the birth control pill a massive experiment on women.

Two and a half months into coming off the pill and I'm feeling brighter, but still disorientated. It's like having to relearn how to react, and feel, naturally. Natural feelings in their depth and intensity can be overwhelming. The flatness, if not the episodes of feeling insane, provided by the pill is a real contrast to the fullness of feeling that's slowing coming through the haze of chemicals. Talking to Jane Bennett earlier this week I discovered the liver processes all the pill's chemicals and so when you stop taking it, the liver is still working hard to clear the chemicals and get back to working normally and healthily. If your liver is clogged up then that can make you feel tired, down and quick to anger. A lack of patience or tolerance is often associated with a sluggish liver. It's like a pill-taking hangover.

Monday, November 9, 2009

Silent bodies

My guest blog for the Society for Menstrual Cycle Research was published this morning. The editor saw fit to give the piece the title, 'Are we addicted to the pill?'- drawing my attention to a line of thought through my writing here that I hadn't previously paid that much attention too - the thought that we, as individuals and collectively, are addicted to the pill, and that the pill has become so fundamental to the workings of the world, or at least the western world, that the issue of women taking it or not taking is now amazingly complex.

It would be fair to think that taking the pill was solely about avoiding pregnancy. After all, that's what it was invented for right? But we know that it is also prescribed for poly cystic ovaries syndrome, heavy bleeding, and acne - to name really only a few of the reasons I've heard doctors give. The papers this week have been full of the news that the pill might help women suffering with asthma. Most of these articles mentioned somewhere, in some way, that the pill is 'the most researched and safest medication' around.

Now, from what I know about the pill's impact on the body there's a good chance it increases the likelihood of developing allergies, or worsening allergies, due on its suppression of the immune system - however, I am happy to accept that it has been found that some forms of asthma can be helped by the pill. I'm not so happy that it is thought acceptable to treat this problem with a drug that shuts down the hormonal cycle and has such wide ranging effects on all bodily functions. Once you know something about how the pill works, prescribing it for anything - even its presumed main reason for being - seems very drastic. Like cutting someone's arm off because they have arthritis in their wrist.

The pill is often cited as giving protection against ovarian and endometrial cancers. This protection comes about because these organs are not functioning when a woman is taking the pill, and if they are not functioning they aren't alive to developing cancerous cells. I have also heard it said that the pill protects a woman's fertility. Again this is because her reproductive system is dormant and as such not open to certain problems. I won't deny the veracity of the first statement, although I would the second, but both come from an understanding of women's bodies which is worryingly negative. It is assumed women's reproductive system is intrinsically hazardous, dangerous, not to be trusted and only useful, or good, when creating a baby. This to me seems a little like saying living is dangerous, because it can result in death.

Alexandra Pope, co-author of The Pill: Are You Sure It's For You? calls the side effects of the pill "quality of life threatening." Many women take the pill, and ratio-wise, not that many of them die of pill-related blood clots. But, I believe many women suffer a poorer quality of life when taking the pill, and that the effect of this daily wear and tear on their well being, and their basic, necessary bodily functions such as metabolism and immunity, is serious. I have not died from taking the pill, but I have spent months feeling very unwell and unable to enjoy life, and many years feeling less than healthy. The twin ideas that women are naturally, as women, always sick and that women are inescapably emotionally erratic are ingrained in our minds with the same casual ease as our knowing how to eat a banana or use a knife. We think the way the pill can make us feel is normal, and that essentially, we don't deserve anything else.

Speaking of normal, my guest blog was proceeded by an interesting post from Moira Howes of Trent University. She discusses a statement made by Timothy Rowe, Head of Reproductive Endocrinology and Infertility at the University of British Columbia: "The pill keeps a woman's reproductive organ's quiet and healthy." Rowe argues that this 'quiet' term is unscientific and as such laden with social values and assumptions. It suggests that an active uterus is unhealthy, if a dormant one is healthy. She brings up an idea from the medical field that apparently has only come about recently - 'incessant ovulation' - a term which implies uninterrupted ovulation, as in not suppressed by the pill, is unhealthy. When the uterus does not contain a foetus it is seen as doing nothing at all.

Let's take another look at that edited list I've posted before of all the bodily systems effected vitally by the monthly hormone cycle:

Body temperature
Blood glucose regulation
Energy levels and sleep patterns
Thyroid and adrenal hormone production
Skin colour, texture
Memory and concentration
Brain wave patterns
Balance, fine motor coordination
Metabolism rate
Levels of adrenalin
Visual, auditory and olfactory acuity
Pain threshold
Concentrations of vitamins

Two women commented on my guest blog, both remarking that in either not wanting to take the pill, or in finding the pill made them unwell, they were considered by doctors, and friends, to be 'abnormal' or 'unusual.' I have spoken to doctors previously for interviews who have complained that much of the research done into the menstrual cycle uses the cycle of a pill-taking women as its basis, as though that were more normal than the cycle of a woman not taking the pill. When the pill is called 'the most researched medication in history' it has to be noted that the medical profession has a tendency to come from the point of view that modern women's cycles are not normal - they have too many periods, too few pregnancies - and it is far better to have a 'quiet' uterus.

I don't want to demonise doctors, and I don't actually blame them for all the times women try to talk about the pill's side effects or find out about alternatives and they don't help - they probably truly only know what they're told in medical school and they probably don't have time to do the sort of reading required to understand. It's important women take responsibility for themselves, in the most meaningful way, and for each other.

I've often heard people worry over the drugs given to those with mental disorders, and how they will have to take them forever, and have heard many stories of people who have tried to stop, reluctant to take a drug for their whole life. These drugs hold their own problems for sure, and stopping them is inadvisable for some and can have terrible consequences. Yet we are it seems entirely unconcerned that millions of women take the birth control pill until menopause. And we are, as a society, entirely opposed to having them stop taking it, even though the worst that can happen for most women is withdrawal symptoms, which if you are aware that's what they are, although nasty are bearable. It's a state-sponsored addiction...

- the basis of which is, as I have just read Naomi Wolf describe in The Beauty Myth, "the dread of lost control" - control over our own bodies, and control over us.

Thursday, November 5, 2009

The change

I picked up a copy of Bust magazine for the first time yesterday and it contained two birth control related articles - one about a new female condom, and the other about the fertility awareness method. I'm beginning to wonder if there's a whole lot of women coming off the pill at the moment, either in direct response to the negative news around Yasmin or because of a more general growing consciousness of the lack of choice, individual and social, in taking the pill.

I came across an article on ABC news about withdrawal problems experienced by women coming off the contraceptive injection Depo Provera. Women had written in to them complaining that even if they had been fine whilst on this medication, once stopping they experienced bad mood effects, nausea and headaches. The final quote of the piece from Dr Louis Weinstein typically waves away these issues, saying that it wasn't "fair" to blame the injection when it could be any manner of other problems in the women's lives.

This of course is true, and pretty difficult to argue against, particularly if you are one woman in Dr Weinstein's office. But I'm right now trying to think of any other drug a person could take that would be so easily dismissed as the cause of physical and emotional changes. Even if the answer is to give a person another drug to combat the side effects of the first, it is rare that the drug is so willfully pushed out of the equation. The doctor's attitude is given support with talk of the benefits of the injection in terms of preventing unwanted pregnancy in unreliable teenagers not trusted with the pill and, worryingly, young women with learning difficulties.

That's all very well and good, although of course it isn't, but it is not a good enough reason to dismiss the possibility of side effects entirely in some sort of utilitarian ruling of the greatest good for the greatest number. It sounds a bit like the argument used to support vaccinating children, except women won't die or cause others to die if they don't have the contraceptive injection, and there are other choices available to them that do just as good a job of stopping pregnancy.

I've been concerned to see that a couple of articles on the side effects of the pill in magazines lately have suggested the injection, the patch, the ring and the implant as alternatives. I worry that negativity surrounding the pill will focus on the lack of offered alternatives rather than the reasons for its side effects and therefore usher women towards other hormone-based methods rather than other non-hormone based methods. The injection, ring etc might well be fine for some women, but they still act to suppress the natural hormone cycle just like the pill. And a woman is less in control because she can't just decide to stop if she feels unwell.

This population control issue has been gaining ground recently with environmentalists. Luckily, those same environmentalists tend to think women shouldn't be peeing a lot of chemicals into the sea too so they aren't backing the pushing of the pill. As I have said before if criticising the pill causes unwanted pregnancies this only goes to highlight how important it is that we all get over our myopic view of contraception and talk about alternatives so women know how to use them if they want to.

Anyway, so withdrawal symptoms - as I have been saying, the pill can have withdrawal effects. If I think back to how I would be on the week I would stop the pill every three months - tired, achey, feverish, like I had the flu - it makes sense that I would feel bad when I stopped entirely. I have had a couple of meltdowns this week of the kind I haven't seen since my Yasmin experience. It's not that I wouldn't expect to be feeling somewhat low and worried in my life right now, it is more that I am much less able to cope with feeling that way. Rather than having a grasp of the feelings and an overarching rationality when I start getting stressed it's like quicksand. The connections in my brain and body that are meant to kick in and calm me down, and the wider perspective that should be revealed, are lost, and I just look deeper into the big black hole.

It gets very dull to keep repeating the obvious - women who don't take the pill feel bad sometimes too - but I think if a lot of women are coming off the pill right now then it is partly due to wanting to feel better than they have been, but also partly because - as Hannah remarked in the last post - they want to know if they would be experiencing life in a brighter, happier, more relaxed and joyful way if they weren't on the pill. Women are curious to know if after five, seven, ten years their true perspective and nature is different. Of course, as Hannah said, it might not be.

That upon stopping you might suddenly feel particularly bad probably causes many women to go running back to the pill. Also the fear of pregnancy, and the effect that might have on your sex life and relationship must test some women's resolve. Both these issues have certainly tested mine.

As you might be able to tell from my posts I'm feeling rather foggy-headed this week and less motivated than before. There's always that nagging worry that this won't pass, even though I've heard from tons of women who say it does. On the other side there's the knowledge that with the pill all out your system you can't rely on it as an explanation for your moods, even if like me you struggled a long enough time to realise the pill could be the cause.

It's like some weird abusive relationship of co-dependency - once you know the pill's effect, the lack of control and self-understanding fostered through taking it then makes you reluctant to take responsibility for your moods. If you are left wondering who you really are and then feel pleased to have some power from your knowledge of the pill, it can be sort of scary to carry on without it. I'm pretty sure next time I'm stressed out, in a couple of months or so say, I will be able to cope, but I feel so detached from my self at the moment it's difficult to be sure. Of course it's this blurriness of lines when talking about mood and emotions that has held back acknowledgement of the potential impact of the pill.

The FDA has approved a new female condom named FC2 and made by the Female Health Company. I liked this statement from a WHO study about the motivation behind the creation of FC2:

"Globally, health and human rights advocates have been demanding that scientists develop fertility regulation methods that are safe and reversible, under the control of the user, not systemic in action, which protect the user against STIs and HIV, and do not need to be provided by a health service. The female condom comes closer to these requirements than any other family planning method."

I also found this instructional video sort of fascinating. Like I said before, a lot of these alternative methods seem so hokey and silly precisely because many of us are lifetime followers of the pill and have had little to no experience with anything else other than male condoms. The pill's cultural dominance has made female condoms seem bizarre, when actually they look easy to use and quite sensible.

I'll talk about the Fertility Awareness Method next time. It's not like the Rhythm Method at all, and although I doubt I'll ever be brave enough to use this way alone as contraception it is actually very useful in terms of helping women gain confidence in their bodies and to feel in control and secure once they come off the pill. Not only does it allow you a better understanding of your body's cycle but can also give the support needed to make the leap from the pill to condoms and spermicide or something else.

Monday, November 2, 2009

It's Not Me

I thought it might be a good time to let some of the women who have been in contact with me have their say. As I explained in my last post I have been feeling some nasty post-pill comedown anxiety lately which I only attributed to the chemicals leaving my system after about a week of wondering what was so wrong when nothing in my life seemed to have changed. This started me thinking of all the women who likely experience similar problems, on the pill and in the first few weeks of coming off the pill, and how most of them probably don't even consider it might be side effects. I also mentioned in my last post that I understand life has it's good and bad moments and not all times of depression can be attributed to the pill. Women who don't take the pill feel bad too. However, I also believe in letting women know the pill can be a direct cause and that its emotional impact can come about two months into taking the pill, two years or ten years. I hope these following messages will go some way to support my intentions here.

The first is from Hannah, who is in her late twenties and lives in England:

"I was initially prescribed the Pill as a teenager because of painful periods, which it didn't really help with. I think the main reason I stayed on it was because it was nice not having to use condoms, though actually in retrospect I was probably lucky not to get any icky STDs with that kind of attitude. (This is another aspect of the indiscriminate Pill usage that I often wonder about -- in my experience of one night stands the only thing that anyone ever worries about is pregnancy, not STDs, so being on the Pill is often carte blanche to have as much unprotected sex as you like.)I tried Cileste, Dianette and Microgynon, which were prescribed by a succession of GPs in response to skin problems and mood swings -- every doctor I saw was familiar with this kind of response to the Pill, and the solution was always to prescribe a different kind of Pill.

I was on and off various kinds of Pill for about six years, with long breaks. I tended to change Pill regimens at times in my life when things were changing anyway -- a new relationship or the end of a relationship, a new schedule, travelling, etc -- so I was never 100% sure if my mood swings were because of the Pill or because I was a naturally moody person. I have suffered from depression and stuff, so I'm not entirely blaming the Pill, but it definitely didn't help.

The first time it occurred to me that my anti-Pill suspicions were correct was when I visited a country I'd really wanted to go to for a long time. I was going to be doing a lot of travelling and didn't want to have a period, so I went back on the Pill just before I left. I found myself incredibly depressed within days of arriving. I came off the Pill, and within a couple of days my mood lifted again.

I had one more go at the Pill about 18 months later. I had just gotten together with my first really serious boyfriend, and we'd been apart for a couple of weeks. I went to the doctor, got a Pill prescription, and flew back to my boyfriend. I was really happy to see him. Within a few days, I was incredibly irritable, getting annoyed about everything, feeling really down. This time I couldn't find a non-Pill-related explanation -- everything else was pretty good! -- so I came off it once and for all. Even the idea of going back on it now makes me feel instantly anxious.

I sometimes wonder if my experience of my late teens and early 20s would have been different if I hadn't been sold the idea that artificial hormones were the best possible form of contraception/skin treatment/period regulation. I might have been less moody and irritable, more in tune with my body. On the other hand, maybe this is bollocks and I would have been like that anyway. What's sad is not to know.

I have always had a lot of interest and perhaps perverse pleasure in my periods -- I think it's amazing to be connected to lunar cycles and to your own fertility and your body in this way. I even like how sometimes I have period pains and am forced to just lie in bed for a few hours, suffering and thinking. So I hate the Pill not just because it made me spotty and unhappy, but because it temporarily robbed me of this really incredible aspect of being female (and no I'm not even slightly a hippy in any other way)."

And here is Lia, also in her late twenties, she lives in Germany:

"I never thought about “the pill” really: I wasn’t in a relationship, wasn't having sex, have good skin and I was afraid of gaining weight, as I’m a big girl by nature. It just wasn’t part of my life. Until I talked to some friends about problems I had been having with my period, cramps and terrible moods that just made several days per month miserable. They urged me to finally go and see a gynecologist, something I just didn’t do, out of fear of doctors - all doctors. But I tried to be an adult and went to my friend’s gynecologist.

After the check up she told me my ovaries were enlarged and if I wanted to be fertile and have children, we’d have to ‘make’ them shrink. I wondered if I should tell her that I don’t really care about my fertility, as I don’t want to have children, but just let it go. Her methods for shrinking them were: either lose a lot of weight in a short time (yeah right!) or take the pill. I took the pill.

She advised me to take it without interruption and I followed her instructions, taking “Valetta.” That was one and a half years ago. After 6 months my ovaries had shrunk a bit, so I thought it worked. Now last winter things started to change, I became much more sensitive to my environment, to people and how they behaved towards me - that pretty much resulted in crying-fits. I’d start crying for the tiniest reasons and then I wouldn’t be able to stop. I’d have a couple of crying-days per month; they had substituted my cranky period-days.

I’ve always had migraine attacks, but I’ve also always been able to sleep them off. This changed as well, I’d wake up with a terrible headache 3 or 4 days in a row, nothing helped, no painkillers, no sleep. I gained about 10 kg, which was bad, but the crying-fits were my biggest concern.

I went to see a therapist and he was the first who said that my body was maybe reacting to the pill and to not having a period anymore. My mother said the same, that it wasn’t ‘natural’ to repress your period. When I asked my doctor, she told me that it was necessary for my ovaries. Whenever she’d ask me if I got along with the pill, I’d ask her how I’d know if I didn’t get along with it. She’d answer: “Oh, trust me, you’d know.”

I didn’t connect the dots until three months ago when I did some research on “Valetta,” because I wanted to know whether I would get it when I moved to the US. I came across several blogs and chatrooms discussing side effects. Three things struck me immediately: weight gain, headaches, moods/slight depression. That was exactly what I’d been suffering from.

On my last visit to my gyno, she said my ovaries hadn’t shrunk for six months, and now, after about one and a half years with the pill and without my period I stopped taking it, without consulting her really. My ovaries aren’t shrinking anyway it seems, so I want to use my 7-month stay in the US to see if things will get better without taking it. I haven’t taken “Valetta” for two months now and my headaches are better, the rest might take some more time."