Wednesday, September 30, 2009

Staying fresh

My research has veered a little lately - I've been reading Karen Houppert's 'The Curse: Confronting The Last Unmentionable Taboo: Menstruation' - well, I say veered, but actually it seems like discussing how women, and society as a whole, responds to menstruation is kind of crucial in explaining the trajectory of the birth control pill.

A few posts back I was wondering about my own feelings towards taking the pill and how they were wrapped up in what I felt about my body and being a woman. Houppert discusses this very intelligently in relation to how women feel about having periods. I remember feeling annoyed, angry and upset about getting my first period. I imagine that's a pretty common experience. Houppert argues that these negative feelings about menstruation stem from long upheld myths, but are also constantly stirred up and confirmed by the 'feminine hygiene' industry - the people who make tampons and pads and want you to buy them.

Obviously tampons and pads are very useful and convenient - although there are alternatives out there now, moon cups etc - so we think we buy them out of complete necessity. But for the market to be propelled, for new products to be accepted, and for lots of money to be made a certain level of compliance has been ensured through advertising that basically repeats over and over that periods are bad, disgusting, gross and having periods is shameful, unbearable, depressing. Their products are then not only used on the days of a woman's period, but even on just-in-case days and other days to ensure constant cleanliness - this is true, there's tons of women doing this.

How does this link in to the pill? Well, there are now pills available which allow you to have just four breaks a year, pills you can take continuously for years and years and never experience a period (or the not-really period you have on the pill). Women are often encouraged to run pill packets together three at a time, anyway. Seasonique is one of the continuous pills, I discovered it's been advertised heavily on the men's channel Spike TV and in the men's magazine Maxim. Why? Men don't like periods, women don't like periods, they talk and no one likes periods and so you take Seasonique.

Not all women take the pill for contraception, many take it to regulate their periods - make them lighter, more regular, less painful - especially teenage girls. I've been off the pill for around two weeks now and already started noticing bodily stuff that hasn't been going on in the last decade - stuff that makes me think - oh yeah, human body functioning. From when women are young they are taught that bodily secretions of any kind - snot, urine, sweat, period blood - are not ladylike or nice. Our bodies feel alien enough to us anyway, growing and changing at a faster rate than we can keep up with, and then we are told we must stay in control if we want to be attractive. A prescription for the pill can shortcut this requirement, making your body immediately more manageable.

And of course, menstruation is all bound up in our minds with developing sexuality, so when we suppress periods, socially we are also suppressing sexuality. Part of the pill's success has been convincing women they need to be on it always, even if they're not having sex, to control their cycle, and getting women on the pill from their early teens so they're so used to the non-periods created by the pill that real periods are even more disgusting to them than the 'feminine hygiene' industry would have them believe, they're completely alien. If women don't ever get to know what having a mature woman's body really feels like then they will never know how it shouldn't feel, or how it feels when something is wrong or unhealthy.

"If it isn't broke, fix it anyway."
Sign on the reception wall of the Tambrands (Tampax) factory in Rutland, Vermont

Next, the invention of PMS.

Monday, September 28, 2009

Noncompliance

The Yasmin manufacturing company Bayer's troubles have multiplied rather quickly in the last few days. Now the Swiss medical authority Swissmedic is investigating the death of a woman who died from a blood clot ten months after being prescribed Yaz (the lower dose version of Yasmin). This story was all over the news, providing further fuel to the seventy plus law suits underway in the US.

The blood thickening effect of the birth control pill, and the consequential risk of blood clots, has been linked to the estrogen content since the first health scares of the 1960s. But Yasmin, and more so Yaz, contain low levels of estrogen and so the blood clots suffered by a number of women taking these pills have been blamed on the unique, and under researched, progestogen component, drospirenone.

Then today research was released stating that a blood clotting disorder that affects younger women - Antiphospholipid Syndrome - increases the risk 200 fold of blood clots developing in arteries and lungs if the woman is taking the pill. Women can be tested for this disorder, but until now it has only been discovered after a stroke or other medical problem has occured. All the women in the study with this syndrome who suffered a stroke or heart attack were taking the pill.

It is understood generally that the risk of blood clots from taking the pill is relatively small - that there's more to fear in crossing the road - but as the pill is prescribed so casually certain predispositions to blood clots go unconsidered. For example, we are as a race, in the rich countries anyhow, getting fatter and if a woman's BMI is over 35 she has an increased likelihood of developing a clot. Not yet widely publicised, there's an idea going around those in the research business that the pill might also be much less effective as a contraceptive in larger women. A BMI of 35 only suggests you are somewhat overweight.

Just to back up that remark about the pill being prescribed casually - I read on Marie Clair website that there's a pill about called Femcon Fe that's chewable and minty. They're handed out like sweets and now they are sweets. Because, well, all that swallowing is such a hassle, you actually have to pause and think for a second doing it.

http://www.femconfe.com/index.jsp

We've only known of the existence of hormones for the last 100 years, and here we are in 2009 chewing them.

I very much enjoy how whenever a reporter goes to a representative at Bayer to get a statement they always give the same answer, which amounts to: "What about pregnancy? That's way more dangerous, that'll kill you." Nothing much has changed since the 1920s when campaigners for contraception had to get the state of pregnancy labelled as a disease, so that they could 'treat' it with contraceptive devices and educate people about avoiding it.

Of course, if we can all be terrified of pregnancy we'll stay on the pill for longer, take it more studiously and not question our doctors. Even though the pill has never been thoroughly tested for it's longterm impact on women taking it for the ten plus years they do now as a rule. Back at the pill's beginning women would only take it when they had a boyfriend, and usually for only three years total. It wasn't taken continuously from early teens to 30 something. In fact, most of the research on the pill was undertaken on the older, first generation set.

There's something creepily called 'compliance' by the pharmaceutical companies which is of great concern to them. In terms of the pill, compliance is when women are given a pill, take it, and shut up. No, really, it's when women don't stop taking the pill, or their brand of pill, for any silly reasons like nausea, headaches or suicidal thoughts. Pharmaceutical companies are always on the search for ways to increase compliance. Hence why they come up with new 'natural' pills as we discussed earlier, and chewable pills.

They've got all het up recently because as we are in a recession and everyone has less money, or no job, women have reportedly started to take their pill every other day to spread out their $50 supply for longer than the month. Many women's insurance policies in the US, if they even have insurance, do not cover the birth control pill. They do, however seem to cover the contraceptive injection, patch and implant, or so I have heard - because I would assume it works out cheaper for them. So who knows if women are really spreading out their pills to save money, or whether that's just a way of herding us all towards these alternatives. A diaphragm, or a non-hormonal IUD, or even condoms and spermicide are cheaper - but these don't make near as much money for the pharmaceutical industry.

"Never in history have so many individuals taken such potent drugs with so little information available as to actual and potential hazards. We are embarking on a massive endocrinologic experiment with millions of healthy women."
Senator Gaylord Nelson, 1970

Saturday, September 26, 2009

In the news

Today the New York Times contained an article entitled 'Health Concerns Over Popular Contraceptives' which suggests the pharmaceutical company Bayer is heading for some serious trouble over its pills Yasmin and Yaz. Alongside the mounting law suits claiming these pills have caused blood clots and strokes in a large number of women, researchers are now speaking out on a matter that's been rumbling for a while - that all third generation pills containing new progestogens might hold a higher risk of causing such health problems.

On top of that, the Food And Drug Administration in the US had to intervene when Bayer was found to not be following correct quality control procedures at its pill manufacturing factories. The piece starts by highlighting the promotion of Yasmin and Yaz as 'quality of life treatments' and ends suggesting women would be right to switch to a pill containing levonorgestrel, an older progestogen. Microgynon is one, but you can consult the ladder graph linked to in an earlier post where I also remarked that pills containing this progestogen are always the recommended first choice. As a result of the marketing of Yasmin and Yaz, they have become what the New York Times describes as 'go-to drug brands' for young women, overriding this advice.

Here's a link to the article - I have a feeling this marks an important step in changing attitudes towards the birth control pill.

http://www.nytimes.com/2009/09/26/health/26contracept.html

I've been reading Bernard Asbell's 'The Pill: A Biography Of The Drug That Changed The World.' The first few chapters are full of first person accounts from women who were helped during the preliminary years of family planning clinics - women made sick by pregnancy after pregnancy after pregnancy - who physically and mentally couldn't bear any more children. Seeing what a world the birth control pill rose up out of, why it was so desperately wanted and why as a consequence it became so popular has helped me to understand more clearly why this is such a tangled issue.

In the first part of the 20th century little was known about the female reproductive system, relations between men and women were imbalanced to say the least, and procreation was enthusiastically encouraged. I realise that my writing here could seem ungrateful in the face of the suffering endured by women then, but I hope I have been clear that I feel the situation is very different now and believe the pill has run its course as the 'go to drug' for women. I know I live luxuriously - I can discuss possibilities for birth control, read about the options and discuss them with my partner. Which brings me to my next, as yet undiscussed point.

That is, the matter of birth control in developing countries. There are women who live right now in situations very similar to those of early 20th century America. Places where dying during childbirth is a very real risk, where having another child could mean you'll go hungry. There has been little coverage on the way birth control is managed in these countries, but the contraceptive injection Depo Provera and the implant Norplant are widely administered. The effects of these hormone-based options last for months. The pill is not as popular, the authorities distributing birth control likely believe women will not take it as prescribed or keep coming back to collect packets.

A recent study showed 88% of women in the US forget one to three pills a month. The manufacturers of Depo Provera have said that if 7.7% of women had the injection rather than taking the pill the number of unplanned pregnancies would be reduced by 70,000 a year. There are around 400,000 in total annually.

Depo Provera isn't just popular in developing countries - in the US one in five black teenagers have the injection every three months. This is a far higher number than in the white population.
In response to concerns over the injection's side effects - particularly loss of bone mass, increase in risk of cancer development and the long term impact on fertility - the pharmaceutical company Pfizer have recently developed a different, updated version of the drug.

Depo Provera has long been used in Sweden, Denmark, Canada and eight US states for the chemical castration of paedophiles and sex offenders. Basically, it handily wipes out testosterone. The injection used in developing countries and on one in five black teenagers is the same as that used on sexually disturbed prisoners.

The development of the pill was sped up by a calculated change in the debate - rather than pushing for women's sexual liberation those behind the drug presented it as a cure for the overpopulation problem - a far more acceptable argument to audiences then. And, it seems, now.

"The issue was whether any woman would take a pill every day to prevent the chance that she might get pregnant. They believed nobody's going to do that, not when they're not sick, and they're not sick!" James Balog, science trained financial analyst.

Wednesday, September 23, 2009

Testing, testing

As we are on the subject of alternatives to the pill I thought we'd now take a look at the IUD. When I think about the IUD it makes me feel a little squeamish - the idea of a plastic device being put inside your body and staying there year in year out. I was talking about this to a friend, she said she worried that she'd need a doctor to take it out, and that what if, what if there was some kind of apocalyptic situation in which you couldn't find a doctor to do that, or what if all the doctors throughout the world suddenly forgot how.

An ironic reaction, I know. We've been happily putting the pill into our bodies for a good time now, and that can't ever be taken out. I think testing our reactions to the IUD gives insight, the assumptions and fears that arise help highlight how comfortably entrenched the pill is in our culture and how little we have questioned its place.

Kate Klonick wrote a piece for Slate on the IUD last month. She points to the contraceptive's checkered history for an explanation as to why just 2% of women in the US use them now. In the 1970s a type of IUD named Dalkon Shield was heavily marketed but soon linked to illnesses that lead to hysterectomies, deaths even. The side effect of pelvic inflammatory disease put American IUD manufacturers on the line, and they ended up dropping all research into the device until a decade later. But in the 1990s a study opposed the research and statistics that had sunk the IUD, finding the problems were down to a design fault in the Dalkon Shield that could be remedied. The pill has also been the subject of many health scares, none of which have punctured its popularity in this way for longer than a few months.

There are now two kinds of IUD available - Mirena and ParaGard. Mirena includes a hormone release element. Paragard combines copper with the plastic, and contains no hormones. Mirena is the second most complained about drug, after Yasmin, on most online patient forums. Klonick says the hormone release can be likened to taking one to three pills a week. If I was to have an IUD, I'd go for Paragard, as I don't see why you'd want to get a device inserted and then still have to deal with similar side effects to those you'd get from the pill.

The pill may cost up to $60 a month in the US, but if you want to you can just stop taking them, whereas Mirena costs a $300 one-off payment which I bet stops women going back to the doctor to have it removed, even if they're experiencing mood swings, until they feel they've got their money's worth. It's a double whammy for advertising - still containing hormones, which women still trust to be most effective, but containing less hormones than the pill and so encouraging to the women who have had unpleasant experiences.

The hormone used is levonorgestrel, a synthetic progestogen also found in the emergency contraceptive pill. Mirena is produced by the same pharmaceutical company that manufactures Yasmin, and can be seen advertised in just as many women's magazines. Although the Slate writer does not emphasise the hormonal element of Mirena, she states earlier in her piece that she had used many different brands of the pill and was looking for a better, hormone-free alternative.

According to the piece, there's another reason many of us know very little about IUDs and probably barely consider them as an option, a recent study in the medical journal Contraception found that 96% of education for pre-medical students on contraception centred entirely on the pill.

The doctors I've spoken to, who receive the marketing, the promotional mugs and pens and the sponsored lectures well before we all get to know about a new drug, have said that in the coming year alternatives to the pill will be more enthusiastically offered, but they will all be hormone-based - Mirena, the NuvaRing vaginal insert and the injection Depo Provera. Maybe my friend has a good reason to worry about all the doctors suddenly forgetting how after all.

Monday, September 21, 2009

Thinking over

This week hormone replacement therapy was back in the news with research suggesting a link to higher mortality rates in lung cancer. The comment made by the expert in the Guardian report seemed to me equally appropriate for a discussion on the birth control pill:

Kishor Ganti, from the University of Nebraska Medical Centre, states: "These results, along with the findings showing no protection against coronary heart disease, seriously question whether HRT has any role in medicine today. It is difficult to presume that the benefits of routine use of such therapy for menopausal symptoms outweigh the risks of mortality, especially in the absence of improvement in the quality of life."

Does the birth control pill have a role in modern medicine? Does its routine use as a contraception, above all other forms of contraception, still make sense? The menopause was medicalised by HRT, just as menstruation was medicalised by the pill. In both cases, it's time to take a more progressive approach. And that progressive approach might involve a return to and reevalution of a very basic form of pregnancy prevention. Condoms.

There seems to be this universal belief that condoms are messy, intrusive, unromantic and an all-round hindrance to having decent sex. This opinion is expressed in women's magazines, in books written by doctors, in most conversations between women, between men and women, and probably between men. It's a thought so widespread that I was initially reluctant to write anything that would oppose the idea. I second-guessed myself, figuring that maybe I was missing the point, maybe I just didn't understand. But then I remembered this line said by Woody Allen in 'Manhattan.' At a party a woman tells the group that all her life she hasn't been able to have an orgasm, then when she finally did have one, her doctor told her it was the wrong kind. To this, Woody replies:

"You had the wrong kind? I've never had the wrong kind. Ever. My worst one was right on the money."

From what I can work out, condoms are universally disliked because it is thought they give you the wrong kind of orgasm, that is, not such a good one as you could be having if there wasn't a condom involved. I would like to take a look at this idea, and well, dispute it, in the most delicate way possible. From what I understand, sex of any kind, involving whatever contraceptive apparatus, tends to end up at the same point. After which what we are discussing is a matter of subjectivity in degrees.

Who really has the problem with condoms? It looks to me like there's some miscommunication going on. I don' t believe there are many women who could honestly say that their experience of sex is hindered by a condom. In fact, if a man is using a condom it might increase his longevity (see, told you I'd be delicate) and that can increase the enjoyment for women, right?

So, perhaps women think they are being nice and sympathetic and helpful to men by disliking condoms. I wonder if men actually don't like condoms, or whether we just think they don't. I reckon there's lot of men out there, and I've spoken to some of them, who dislike more so their girlfriend/wife going nuts on the pill.

I think women's enjoyment of sex is a bit more complicated than whether there's a condom involved or not, and I think men's enjoyment likely is too - in that, if you're in a good, friendly relationship, your boyfriend/husband is going to be able to handle using a condom. Also, if you're in a good, friendly relationship having the right kind of orgasm probably won't depend on a condom. If you're not in a good, friendly relationship then I would say using a condom is a great idea anyway, due on the STDs.

I can hear the other argument now: it's not about rubbish orgasms, it's about intimacy. Again, if your intimacy hinges on a small piece of rubber, I think there might be bigger problems at play.

If we are going to glorify condom-less sex, if it truly is that important to us all, then what if we made condom-less sex something to work towards, look forward to even? Like how sex in general is for the Silver Ring Thing abstinency gang. We could save condom-less sex for when we're at a point in our lives when having a baby wouldn't be so bad. Then maybe, if it is that good, all these longterm relationships will get a new lease of life upon giving up condoms.

If there are women who feel using condoms for contraception takes the power out of their hands then there's also the diaphragm and the IUD. More on that soon. But, I would argue for a reevaluation of this idea also. Why shouldn't we be able to ask men to use condoms? The insistance on keeping our 'power' in this way suggests a very dim view of relations between men and women. What's so powerless about this set-up? I don't mean to be a prude, but if you can't ask, perhaps he's not the kind of man you want to have sex with.

As I wondered in the last post, did the pill liberate men more so than women? And now, considering where the pill has got us, maybe we should take some of that liberation back in the traditional way of third wave feminism - by flipping our view of condoms, and reclaiming them for ourselves.

Saturday, September 19, 2009

What's this?

Here's a weird one - I just now came across a blog about Yasmin, which looks as though it is being written by a woman in her twenties relating her experiences. But the entries have marketing-type photos of the Yasmin logo and pill packets, and each piece ends with a link to a website where you can put in an order.

http://yasmin-pill.blogspot.com/

The writing style isn't obviously advertorial, it's actually quite amateurish, yet repeated over and over is the assertion that the writer believes "The Contraception Yasmin is a very effective form of contraception." Stranger still, the postings are linked to 'Benjamin Barroga' but 'Benjamin' makes statements like, " i had an extremely high sex drive before going on this pill, your talking 4-5 times a day type of couple which has gone down to 4-5 times a week if that, some days i am so tired i cant even be bothered to kiss my boyfriend never mind anything else! So the dramatic change was a shock for both of us."

The writer emphasises how much weight she has lost, how good her skin looks, and tempers her casual complaints about low libido and breakthrough bleeding with suggestions that these problems lie in an irregular pill-taking schedule, or the length of time she's been on Yasmin - "teething troubles" apparently. She picks out other pills - Cileste, Dianette - from which she claims to have experienced bad side effects - including suicidal thoughts. Each post rambles around only to end in a version of "I think you should absolutely try out the Yasmin Contraceptive Pill."

Creepy, go see for yourself. Looks like some kind of odd marketing project. Interesting to note it's only been up for the last month.

According to a piece at ezinearticles.com the blog is being written by Jackie Barroga (Benjamin's wife perhaps?) and there's even a photo of her:

http://ezinearticles.com/?Can-You-Really-Trust-the--Yasmin-Contraceptive-Pill?&id=2741348

This piece can be found all over the web if you start searching for recent additions relating to Yasmin.

Jackie Barroga's bio states, "Jackie Toto is an expert in the field of health and nutrition. After a major health scare at the age of 20, she began her conquest to search for the best natural health information available." A Benjamin Barroga is all over the internet as a doctor working in Georgia.

Curiouser and curiouser. I'm 'following' this blog now, so let's see if Benjamin gets in touch.

Thursday, September 17, 2009

Choices

The pharmaceutical company Bayer Schering has apparently been getting increasingly concerned about the impact of building lawsuits on sales of Yasmin. So much so that they are seeking approval to start selling a new brand of birth control pill called Qlaira (where do they come up with these hippy-sounding names?).

Already circulating is a press release calling Qlaira the first 'natural' oral contraceptive. They claim that the oestrogen component of this pill is bio-identical to the oestrogen found in women's bodies, that is it has a similar molecular structure. The oestrogen component is called estradiol valerate. When the body takes this in and metabolises it, separating the estradiol from the valerate then the estradiol part will act much like the body's oestrogen. But, really, the only truly unmanipulated, natural oestrogen is that found naturally in the body. Introducing the estradiol valerate into a woman's body will produce the same results as any other pill - replacing the natural hormone cycle with a pill produced cycle - and thus all the same side effects.

The synthetic progestogen part of Qlaira is dienogest, which is entirely man-made. Dienogest is anti-androgenic and has anti-mineralocorticoid effects the same as the progestogen in Yasmin, and will therefore have that negative impact discussed previously. A strange choice for Bayer Schering, considering it is the progestogen in Yasmin, drospirenone, that is at the centre of the lawsuits concerning women who have suffered from blood clots, strokes and heart attacks.

The Qlaira pills are marked as to the day of the month you should take them, with 28 in total. They range in colour to show the different doses of hormones contained - with four types of tablets and a placebo. The two dark yellow tablets contain 3mg estradiol, the five medium red tablets contain 2mg estradiol and 2mg dienogest, the 17 light yellow tablets contain 2mg estradiol and 3mg dienogest, and the two dark red tablets contain 1mg estradiol.

Bayer Schering's press release suggests that the synthetic oestrogen used in all other pills is inferior to this new, unique, 'natural' estradiol. It's a bit like when a laundry soap or shampoo is advertised as 'new and improved' - as though the one you've been spending your money on, putting your faith in for years is suddenly revealed as a ruse, a sham. Hopefully, the company's promotional wording might make people question what's wrong with the old synthetic oestrogen we've been taking for decades.

Be aware that in the next six months you will likely start seeing promotional pieces in women's magazines about this 'natural' birth control pill and hear doctors suggesting we give it a try, seeing as the other kinds haven't quite worked out. The Qlaira progestogen also aids weight loss and gives you glowing skin, just like Yasmin's drospirenone. A 'natural' pill that makes you skinny and beautiful, how can we refuse?

That Bayer Schering have noted a sea change of sorts and felt compelled to develop and release a 'natural' pill at this time is intriguing. Such a move suggests they are afraid of the tide turning against the pill. Before the billions could even start dwindling they were ready with a better sell.
Here's a link to the press release, you can see it says 75% of women prefer a 'natural' pill. Well, if you put it that way...

http://www.schering.co.uk/html/news_documents/080609_QLAIRA_consumer_release.pdf

"I am constantly concerned about the number of women who do not use effective contraception because of fears of risks, or side-effects they have experienced. Each completely new addition to the range of contraception must be welcomed as it gives extra choice to more women." Indeed so, Dr Annie Evans.

Tuesday, September 15, 2009

Book reading

I am re-reading a book called 'The Pill And Other Forms Of Hormonal Contraception' by John Guillebaud, subtitled 'The Facts: All The Information You'll Need - Straight From The Experts.' I have spoken to Dr Guillebaud, he's a nice man, and his intent with this book is to give women 'all the information' as the subtitle says so that they can exercise their own judgement about how they choose to control their fertility.

The facts he presents are mostly to do with the physical side effects of the pill - arguing from a standpoint that you are less likely to die from taking the pill than from smoking, crossing the road, or indeed being pregnant. Some of it is an effort in calming the media flare ups around pill related scares.

I had never before, however, read the foreword by his wife, Gwyneth Guillebaud. In this she asks several questions: Do we still feel the same about the pill now as we did on its release? Does taking the pill mean taking control or being controlled? Did the pill liberate men more than women?

Dr Guillebaud states in his book that he believes suppressing a woman's menstrual cycle is not unnatural, explaining that for centuries women spent much of their lives pregnant and therefore did not have the number of periods women do today. He asserts that the artificial hormones used in the pill are as close to the natural hormones' make-up as possible. He argues that statistics showing the physical problems caused by the pill are skewed - women take the pill for years and as illness is a part of life, that illnesses occur when a woman is on the pill could be merely coincidental, rather than related.

When listing the negative effects of the pill Dr Guillebaud places 'depression' and 'loss of libido' in definite brackets - setting them very much aside from common physical problems such as migraines and urinary tract infections and the more serious increases in the risk of breast or cervical cancer development. Under the assessment of this much used book, such changes are definitely secondary and of less concern. Now, I'm not saying that loss of libido should be considered of the same 'seriousness' as breast cancer, but I do think that the emotional effects of the pill are overlooked. Despite their insiduous, far reaching impact on women's lives they are too often considered negligable, unimportant.

The pill's emotional effects can be debilitating. Some women feel desperate, like life is not worth living. To dismiss these issues as likely unconnected to the pill, as mere coincidences, only goes to prove how difficult it is for women to get their thoughts heard by those in the medical profession. Depression is a complex matter, and of course the pill is not the only known cause, but it can be a factor, and for the sake of the depressed this ought to be made clear.

Even in this otherwise modern, up-to-date book there is reiterated the idea that women get depressed because they are sad that they can not conceive. This statement is frustratingly Victorian in its assumptions.

In the Victorian age it was believed that if women had access to education or worked on the same pursuits as men they ran the risk of becoming infertile. The Victorian doctors felt that if women thought too much, or were over-stimulated they could lose the capacity to menstruate entirely. Some Victorian doctors went so far as to say that allowing women to learn and work would bring an end to the human race. As Lisa Appignanesi states in 'Mad, Bad and Sad: A History Of Women And The Mind Doctors' these attitudes have not disappeared . We now see the same ideas in newspaper headlines that claim working mothers are ruining their children, career women will miss out on having babies or will suffer with their inability to cope with the stress.

Back then, when pregnancy and child birth carried a higher risk of resulting in illness or death, the promotion of ideas connecting menstruation to mental breakdown exaggerated women's fear of their own bodies. They were required to be suspicious of themselves, watch their periods for signs of change and keep themselves physically and emotionally in check at all times - lest they be chucked in an asylum.

It was believed at this time that women were more disposed to mental illness than men. Much psychological understanding was based on the workings of the nervous system and it was thought that women's uterus and ovaries had a particular effect on their nerves. Women were considered frail and prone as such to many disorders. The behaviour of some GPs towards their female patients coupled with the lack of acknowledgement of the pill's emotional effects suggests to me this mindset has lived on to the present day.


http://books.google.com/books?id=BvoKKb_DfwwC&pg=RA11-PA38-IA6&lpg=RA11-PA38-IA6&dq=guillebaud+pill+ladder&source=bl&ots=KnSDbklNJH&sig=amJiSbbxd_tEEdBMHkIeKFOHcp4&hl=en&ei=KYewSpjGCILOsQOExszMCw&sa=X&oi=book_result&ct=result&resnum=10#v=onepage&q=guillebaud%20pill%20ladder&f=false


I've added here a link to a page reproduced from Dr Guillebaud's book which I have previously found useful. It is a ladder graph showing the different brands of pill arranged by the amount of oestrogen and the kind of progestogen they contain. If you do indeed want to stay on the pill, or want to try another brand, this information is good to know.

As a rule, the less oestrogen involved the better, or at least the less bad, the pill is for your body.
The progestogens norethisterone (contained in Norimin, Binovum, Trinovum, Synphase, Brevinor and Ovysmen - which are tri and biphasic pills)and levonorgestrel (contained in the popular Microgynon, Ovranette and Eugynon) are considered the safest, and should be a first choice. The pills seen at the very bottom of the ladders are progestogen-only pills (or POPs), the details of which I will address later.

Referring to this table can help you manouever your way through the pills and work out why certain brands might cause problems. But, remember, each woman's body is different in its natural hormone levels through a month, and its ability to absorb and receive hormones, so this can only provide a rough guide.

Sunday, September 13, 2009

Quitting it

When relating my research into the pill to men the same analogy is often brought up, I think it's a good one - that taking the pill can be a bit like smoking cigarettes. That easily irritated, emotional, foggy, out-of-it feeling that the pill can cause is somewhat similar to how smokers feel with nicotine withdrawal. Once you've been smoking for a long time, you don't even notice these changes in your day to day personality, you only can recognise the need for another cigarette. My husband has given up smoking, but just a whiff of it now and he'll be miserable the next day. He believes that smoking has far-reaching effects on your well being, your personality, that smokers just can't see happening until they stop.

A friend related how when you smoke for long enough, you become 'a smoker' and as such 'a biological extension of a medicinal parasite.' The effect of the smoking hijacks your personality, your self in that it's always there, a routine you must stick to and in that the chemicals are meddling with your emotions and experiences of the world.

When you take the pill you might not see yourself as a pill-taker (in a sense it would be better if we did) but you are doing something every day in a routine fashion that can have a major effect on you, on who you are. You keep taking it even when you have doubts, because you feel you need it and, as I have felt, it's become an unthinking habit. Taking the pill and smoking detaches you from your self, with the pill you are masking your natural cycle, and with smoking you're doing something harmful to your body. This feeling of detachment makes it easier to keep taking it, keep smoking. Through taking the pill even when it wasn't about stopping pregnancy, even when it was a secondary method of contraception, even when I knew I was experiencing unwanted side effects, I only now realise how bound up this action has been in how I felt about myself, about my life, about being a woman. There were lots of pretty complicated reasons for me taking the pill that need unpacking.

As with smoking, it effects different people differently and it's hard to study emotional side effects when we all live in the world and have experiences and not a safe, secure vacuum. But, it is helpful to know that the pill can make you feel bad so that you aren't left thinking you're flipping out.

Of course, there are women who feel good on the pill, and we can speculate that if you have a lot of trouble in your natural monthly cycle with PMS symptoms and emotional changes then having this all flattened out and smoothed down by the pill could help, at least for a while. An online survey conducted by the website Aphrodite showed over half of women on the pill experienced all the side effects we have discussed before - depression, anxiety, lethargy, low libido, but then some women complained of more specific problems no doubt related to these as sub-symptoms - loss of creativity, irrational thinking, jealousy, a constant sense of fear.

My husband will say that he wonders if the Beatles would have ever broken up if they weren't all smokers and getting irritated at the slightest thing. If so many women have been taking the pill for so many decades for such huge chunks of their lives and over half of these women have suffered from depression and anxiety then perhaps we should start wondering how the pill has impacted socially and culturally on our progress, our development. If the pill holds back individuals all the time, making them scared, fragile, unable to cope, then what has the pill done to us as a whole, as women?

The pill arrived and effectively medicalised fertility. As someone commented on my first post, this was an important event which changed views of women, sexuality, relationships. But, perhaps it's time to move on. Perhaps the pill had it's moment and it's not relevant any more. The changes provoked by its release are now concrete. Taking the pill is no longer about freedom. For many women it makes them feel the opposite of free - it makes them feel controlled. They don't feel liberated, they feel oppressed. In a very real way.

Saturday, September 12, 2009

Reinforcements

Of all the brands of pill out there, Yasmin is the one that really gets women talking. Some time down the line, we might see the release of Yasmin as a positive thing - it's certainly got people talking about the effects of the pill more openly.

I've heard a number of Yasmin stories in the last couple of weeks, so I thought it might be useful to look at its potential impact on your body in some more detail. The particularly nasty emotional side effects of this brand can build very sneakily and slowly, which I have found means some women go for years before they realise why they feel so wrong. Considering the massive amounts of anecdotal evidence filtering through to those in the medical profession - I've heard complaints have got so common that doctors are actually joking about it these days - I think we can assume research is being done on this pill and the negative results are not getting published.

That Yasmin immediately makes you lose weight (water weight, remember) and very quickly gets your skin glowing (wipes out testosterone, if you recall) means it's extremely effective in persuading women to take it for as long as they can stand. Those sort of instant side effects are reinforcing, and make you feel like this pill can only be doing good, healthy things to your body. That then makes you less likely to question later on whether it is Yasmin that's stopping you leaving the house or making you cry all the time.

So, what is this pill up to? Yasmin has anti-androgen and anti-mineralocorticoid properties. Mineralocorticoids are hormones, the main one is called aldosterone, which is produced by the adrenal gland and acts on the kidneys to control sodium and potassium levels in your blood. Androgens are also hormones, the main one of which is testosterone. The higher level of potassium in the body produced by Yasmin, and since the FDA warning openly advertised as a side effect, elevates blood pressure which can in turn cause heart failure. Many of the class act lawsuits against Bayer Schering are to do with Yasmin's connection to heart attacks and strokes. The progestogen drospirenone, unique to Yasmin, has been connected with an increase in the risk of blood clots.

As I've mentioned earlier, Yasmin suppresses the adrenal gland which controls hormone production as one of the ways it ensures you don't get pregnant. This suppression kicks off a lowering of serum cortisol levels, a hormone produced by the adrenal gland which guides the body's responses to stress. When your adrenal gland is put under this kind of pressure over a long period of time, it can lead to Adrenal Fatigue. Adrenal Fatigue symptoms will ring bells for women with Yasmin stories - fatigue, weakness, nervousness, anxiety, depression, brain fog, muscle pain. This illness can also show up in allergies and irritable bowel syndrome.

If you take a look at the side effects listed in a Yasmin packet, there's mention of Flu Syndrome, which as you can guess, has similar symptoms of weakness, fatigue and low immunity. In recent studies on trans-gender people taking anti-androgen medication containing similar components to drospirenone, it was found that the effect produced cognitive overload and cognitive dysfunction - that is, confusion, short term memory problems and inability to concentrate.

All of the lawsuits against Yasmin's producers are based on physical side effects, which I will go into at a later point. Clearly, emotional side effects would be harder to prove in a court, but it will be interesting to see if they become the focus down the line.

Thursday, September 10, 2009

The painters are in

A year ago research was released that suggested taking the pill could effect women's taste in men and lead them to choose genetically incompatible partners. Women on the pill experience a change in the type of male scent they find attractive. They are drawn to men who smell similarly to them. To produce strong, healthy children we need to be making them with men who smell differently to us - an indicator that they have complementary genes and immune systems, different to our own.

A couple with dissimilar gene make-ups is less likely to have problems conceiving, or have a child with health problems. At the time the researchers speculated that starting the pill or coming off the pill during a relationship could change your perception of your partner, make them seem less attractive. If you consider how many women take the pill and how this number has risen over the last half century and the social changes over that time you could start jumping to some wild conclusions. Like perhaps the pill is a factor behind the rising divorce rates, the rising number of single people staying single, the increase in food allergies, the increase in infertility.

Of course, smell is likely only one of many indicators of genetic compatibility. Plus I'm not keen on the nothing-but philosophy that reduces attraction, love, and relationships to biology. Perversely, considering how I am criticising the pill, I like to think we are more than slaves to the urges and desires that only exist to perpetuate survival of the human race. I've always been doubtful even of that overwhelming desire to have a child that is promised to appear at 30 and have long thought of it more as a social conditioning. But, then, perhaps that's the pill talking. My body has sort-of believed I've been pregnant for a decade now, which could go some way to explaining my lack of interest in small children.

That disinterest in biology and nature or at least, the striving to be free of what we see as our biology's restraints and what others, men, see as its restraints has been a force behind women's enthusiasm for the pill since 1960. Being rid of our woman-ness has been promoted, until very recently, as a necessity for career success. I think it goes way back to Victorian ideas of hysteria, but we'll come back to that later. I'm just starting 'Mad, Bad and Sad: A History Of Women And Their Mind Doctors From 1800' by Lisa Appignanesi.

When you're on the pill you're not ovulating, so where your natural mid-cycle would be, and you'd ovulate, and produce a rush of oestrogen, there's nothing. So, normally, you're body would have a gearing up stage, a ovulating stage, a gearing down stage and then up again. I've never been off the pill for long enough to know what this feels like, or, more accurately, when I wasn't on the pill I didn't take note of how my feelings changed across the month. I'm not an earth-mother, hippy type. Moon cups scare me. But there's successful business women out there lecturing on ways to use your natural cycle to benefit your career.

Here's a website about "using your menstrual cycle to achieve success and fulfilment" - I'm well aware of how, well, American, this stuff seems - but it's refreshing to be see a positive and active viewpoint, and it makes you realise what a lot of negativity we have been fed over the years.

http://www.optimizedwoman.com/the-optimized-woman-success.html

"The menstrual cycle is one of the most impactful influences on a woman’s motivation, energies, skillsets and perception, and it's time for the menstrual cycle to take its rightful place as a powerhouse of resources for women to use in practical everyday ways to create the best work / life balance, their full potential, goals and dreams and the life they deserve."

However cheesy, this is such a radically different perspective to what we are used to hearing. We have been taught to see periods as a nuisance, a burden and an affliction, and therefore, to view the whole cycle as something to be rid of as soon as possible. I was pleased to see Grazia had a feature a couple of weeks back on the new Australian book about the pill I mentioned before. The emphasis was on the lack of information given by GPs, with one woman claiming her doctor refused to fit a diaphragm on 'moral' grounds because it wasn't as effective as the pill.

Now, I know that they get their lectures and research funded by the pharmaceutical companies, and all those free mugs and pens of course, but that's a bit much. Maybe he was a lazy doctor, I think we forget that doctors despite the Hippocratic Oath, are human beings and thus can be lazy, greedy, careless and bored. I'm in the US right now, and it's harder to forget that here as you have to pay them directly, like you would an electrician, or a waiter. It's a consumer service, with all the suspicions and demands that go with that.

The pill is very under-researched, but it occured to me that it would surely be in the pharmaceutical companies interest to look into the pill extensively, to work out ways to make it even more appealing to women (hence how Yasmin came about), to work on decreasing side effects so women would keep taking it. The pill is the top selling medication for most pharmaceutical manufacturers, there's plenty of money to plug back into studies. There's therefore probably a lot of research in existence, funded by them, that never gets published because the conclusions aren't positive.

I've decided to come off the pill. I was feeling like the opposite of a celibate person looking through medical encyclopedias at sexually transmitted diseases (I've seen that scene in at least two movies, one was Rules Of Attraction). It's been three days.

Monday, September 7, 2009

Adding up

The few studies that have been done into the Pill show a significant percentage of women suffer from depression as a side effect. These numbers can't take into account the millions of women who start taking the pill, immediately experience its negative impact and stop taking it - as many as one in ten, the majority within the first six months. But for more women the pill's side effects are insidious. Feelings of anxiety, lethargy and emotional unbalence can creep up so slowly they are blamed on a relationship, a job, a house move, a bad week, a bad year, anything but the pill.

I've been reading a book that only came out this month, 'The Pill: Are you sure it's for you?' which has distilled some of what I had previously understood about the pill's effects into a simple statement. The two main causes of the side effects experienced on the pill are the unnaturally high quantity of synthetic hormones being introduced into your system, and its impact on your metabolism producing nutritional disturbances.

Women on the pill are invariably deficient in many necessary nutrients. The depletion caused by the pill in just vitamin B12 can have negative consequences as far reaching as low tolerance to stress, weakness, insomnia and paranoia. Lowered levels of Vitamin B1 can lead to a lack of initiative, irritability and fatigue. The pill's effect on nutrient balences builds over time, which accounts for the slow development of problems, and the appearance of such problems years into a woman's pill use.

It is a good idea to adjust your diet, and take supplements - but as the effect is on your actual metabolism your body will still not be able to take in and utilise as much as it needs. If you decide to come off the pill however, eating foods high in B vitamins, zinc, calcium, vitamin C along with taking supplements can help your body return to its natural balence more quickly.

As we could guess, many women are prescribed anti-depressants to alleviate the mood changes brought on by the pill. In the past medical journals speculated that women's feelings of hopelessness and sadness could be attributed to their understanding that they were no longer able to get pregnant, a sort of mourning if you will. Still now, I have discovered, through interviews with practicing doctors, there are many who believe the emotional side effects of the pill should not be discussed openly incase the idea 'is put into women's heads' thus causing them to experience problems psychosomatically. From my experience in the doctor's chair, it's only when you initiate the conversation that they feel safe enough to agree the pill might be the issue.

But it is often the case that women will not connect the medication they take every day with the onset of disturbing changes. As I mentioned before, in the US, it's legal to advertise prescription medicines. I once saw the campaign for Yasmin over ten times during one 40 minute long TV show. Advertising like that can be particular powerful if you're feeling nervous, lacking confidence or falling out with your family and friends - powerful enough to have you keep popping the pills.

If you've never been in the US, these adverts can seem a little odd, so here's a couple of examples:

http://www.youtube.com/watch?v=uCg1q0h1PP0

http://www.youtube.com/watch?v=NoKSL8eBrW0

After that first advert came out, although it took something like a year, the Food And Drug Administration ordered that Bayer Schering put out a retraction campaign stating that Yasmin was not proven to help with 'irritability' and 'anxiety' and to make clear that any weight loss was down to dangerously high increases in potassium levels. Here that is:

http://www.youtube.com/watch?v=EO-G8O0lHq0

And here are some of the posts by women on medications.com, askapatient.com and the Yasmin Survivors Forum regarding the side effects of Yasmin. I guess googling is easy than going to the doctor, especially if you have no health insurance.

Sarah, the founder of the Yasmin Survivors group, details her side effects as 'electric shocks shooting through my body, a smothering feeling, depression, numbness in my face, hands and feet, headaches. I became agoraphobic and suffered constant panic attacks.' A woman with the username '2young4this' describes suffering with 'Brain fogginess, mood swings, panic attacks to the point I'd get stuck in a state of paranoia that would last for hours and hours, constant anxiety, nausea, lack of coordination, depression, severe stomach pain, suicidal thoughts, severe fatigue, muscle weakness. I had to drop a semester of school because I was too tired and uninterested. I lost contact with nearly everyone. My sex drive went out the window. I became paranoid and suspicious.'

Lee describes her experience, 'I have turned into someone I no longer recognize. I am angry, depressed, and emotional and I cry all the time for no reason. I snap at my boyfriend or deliberately lead him into a fight. I know what I'm doing when I do it, but I can't stop.' Wodesorel lists her side effects, 'panic attacks up to four times a day, complete meltdowns twice a week (screaming, crying, throwing things, punching, rocking, banging head), self injury and attempted suicide.' Jasmine, one of Yasmin Survivors most active contributors, describes the chronic fatigue she believes Yasmin provoked, 'I'd take a walk and be overwhelmed by exhaustion. I've been physically active my whole life and strong. I lost a lot of muscle mass and found it incredibly difficult to even work-out. All my energy was gone. I was like a zombie.'

It would have made interesting reading if I had been blogging back when I was on Yasmin and had just started finding these testimonies. But of course to be doing that, I would have needed some motivation, energy and initiative.

Saturday, September 5, 2009

Coming clean

I have a confession to make - I am still taking the pill. I am on Femodette. Despite writing about the horrors of the pill, talking friends out of taking it and spending many an hour pouring over the research, the case studies, the statistics, I'm still taking the pill. This, I guess, is a good illustration of the power of the idea of the pill, and the stronghold that is women's faith in it for contraception. I know all the problems the pill can cause - we've barely scratched the surface so far here -but still I carry on. Why?

I really, especially, truly do not want to get pregnant. I'm not one of those who don't want to get pregnant, but if it happened would be secretly pleased or one of those who has no plans for a baby any time soon but would be alright if it just happened to come about. I am one of those women who use the pill and condoms and still feel the need to buy pregnancy tests every other month, just to keep check. I don't know how many of us are out there, I suspect a fair few.

I think some of this anxiety has to do with the length of time I have taken the pill - since 17. I have no idea how my body feels naturally, what it would do naturally over the course of a month or how it might change were I to get pregnant. I am completely cut off from any sense of my body's physicality, its femininity. I've kind of come to fear it. My fertility is something to be fought constantly, to be suspicious of, to contain at all costs.

I have been on the pill for my entire adult life. I don't know anything else. I had two years of painful periods and then my mum, with the history of two older daughters on her mind, marched me to the doctor and they put me on the pill for fear that I would accidently get pregnant. But the pill didn't get to do its proper job, stopping me getting pregnant, for another five years. I had five years of pointless pill-taking - sure it helped with the painful periods, but there were no potential babies that whole time. I now know it is very common for a teenage girls' periods to be painful for a few years and that usually their cycles settle down and regulate. Also, I really could have put up with the pain - I have fond memories of getting out of gym class.

Soon I will have been on the pill for a decade. At the time of its release onto the market, doctors had no expectation that the pill would be taken for more than a few years. Back then, you got married young and you had babies young, and then you kept have babies. You didn't so much start having sex at 14 or wait until you were 35 to consider getting pregnant. The impact of the pill has never been properly researched over such a length of time. Side effects, as I have discovered, can turn up right away, or seven years down the line. As your body changes the way the pill effects you will change. Plus, there's the build-up effect, those hormones are filtered through your liver, and they won't just disappear when you stop.

I suppose my thoughts go along the lines of - being on the pill sucks, but getting pregnant and having to have a baby right now would suck much worse. But the thing is, I know I don't take the pill perfectly, in fact to get the same effectiveness results as advertised would be impossible as these are obtained only in labatory conditions and in real life, all sorts of stuff gets in the way, and not just being busy, or being ill. I recently found out if you're taking a lot of vitamin C in and then that stops, it can change the effectiveness of the pill. As I said before, it is known that generally women are much more careful, and much less likely to get pregnant when using condoms, or a diaphragm - the barrier methods, basically. And I'm using both. So I don't trust the pill, clearly, I don't trust it to do what it is meant to do, to do the thing that makes me take it every day and yet...If I only used the pill I know I'd be buying the pregnancy tests up in bulk.

This feels something like an addiction, or perhaps, more accurately, I could describe it as a form of Stockholm Syndrome - you know, when someone is abducted and they show signs of being loyal, or loving to their kidnapper? I am who I am on the pill, I'm not sure what I'd be like not on the pill - I would hope nicer, happier, more relaxed. I think about that and I can't believe I have spent a decade taking a medication each day without a very good reason.

I've never been at a point in my life when I can say the pill helped me as it should. No sensible person wouldn't use condoms, with STDs and all. Then when I met someone I wanted to be with properly the thought of becoming pregnant with their baby was more frightening than becoming pregnant with the baby of someone I had no feelings for, didn't know, didn't love - because I know I would find it impossible to have an abortion. I'm in no way against anyone having an abortion, and if I got pregnant from a one-night affair I wouldn't think twice. I'd find it much harder to make that choice in a long-term, committed relationship.

I've taken the emergency contraceptive pill, and experienced nothing too untoward. No side effects that is, the actualy procuring of the pill experience has left me quite beaten. Both times I was made to feel like a bad person, a bad person with the mental faculties of a five year old. I didn't get the chance to tell them I was already on the pill, but didn't trust it, so I thought I'd take another pill just in case. Then buy ten pregnancy tests and drink a bottle of wine.

I have another confession. In the last decade I have come off the pill once for longer than the standard week. Six months ago I came off Femodette for about three months. I had just finished writing the Easy Living piece. I had switched from Yasmin to Femodette four months previously and I felt much better, but the extreme emotional side effects had left me wondering. I'd started realising that some of my physical problems - endless urinary tract infections, sore and bleeding gums - were very likely down to hormonal and vitamin imbalances caused by long-term pill use. All in all, I knew the pill was a bad idea, and I was telling everyone who would listen just that, but I'd not taken my own advice.

In those three months when I was not taking the pill I felt light, stable, rational. I felt like I could cope with anything. I stopped thinking over and over and over petty worries. I stopped feeling insecure and started feeling stronger, confident. The fearfulness went away, I remembered I was young, that I should enjoy change, disruption, lack of routine and not break down over the minor struggles of every day life. I stopped feeling helpless, child-like. I felt connected with the world, and my experiences of it.

I remember one weekend in Brighton everything felt wonderful, the sunshine, the egg on toast, the gin and tonic, the futon mattress, the TV show, the conversations, the busy pub. It all felt so good it was like I was on some mood enhancing drugs. That was my only reference point, my only way of describing what was going on in my head. Back in London, I started carrying a notebook and writing down ideas, ideas with no purpose or place, just ideas - and I started having the kind of conversations where dots connect up, thoughts crackle and come to life, there's energy in what you are saying and excitement at what the other person is saying and it all feels organic, spontaneous, new, alive. The kind of conversations where you're inventing phrases, the kind you talk about for weeks after, that feed into everything else. It was like all the lights had got switched back on, all the pipes were unplugged. I had clarity.

On the pill, I had come to feel very stagnant, very still. I felt like if life didn't carry on forever in exactly the same way, even though that way didn't make me happy - I would just curl up and die. When I wasn't fraught with anxiety or overwhelmed with rage, nothing moved me. As I said in my first post, I just felt blah - an annoying phrase, but accurate. All my synapses were dampened down with wet cotton wool.

The pill wipes out all the natural ups and downs, tos and fros, grey areas and subtleties that natural hormone cycles produce. We do, literally, stagnate in the same state all the time. Our life experience is flattened. Well, apart from when we stop for a few days and the massive increase in oestrogen whacks us into withdrawal.

Three months ago I started taking the pill again. I was feeling much better, but my life was changing quickly, and the pill seemed like a reassurance, a comfort almost. I thought not being on the pill was causing problems in my relationship. I convinced myself it wasn't the right time to be 'experimenting.' Not taking the pill felt irresponsible. I was worried about taking the blame. Looking back, it appears very Stockholm Syndrome-like to me - I can't say exactly what the made me pop that Femodette back in my mouth one morning. But I know when I did, it felt right, not because I knew it was, but because it was all I had known for so long not doing it felt wrong.

Thursday, September 3, 2009

Julie Burchill was right

Here's some mind-twisting research for you:

Strippers on the pill make a lot less money. Strippers generally make around $70 an hour in tips when they are at peak fertility in their hormone cycle - in other words, when they are ovulating. The rest of the time they make an average of $50 an hour, except when they're menstruating - then it's $35 an hour. Strippers on the pill average $37 in tips an hour across the month, compared to the $57 average of a stripper not on the pill.

When the pill was launched in 1960 feminists believed it would liberate women, allowing them to enjoy hassle-free sex without the worry of getting pregnant. Many feminists still believe that today. Through the rise in STDs, through HIV, through lowering libidos, they've kept on believing.

I think many of us would agree that behind the pill's popularity there are a lot of women giving in to the idea, whether for themselves or their boyfriends/husbands that using a condom makes the whole experience significantly less enjoyable. I'm not sure this is true, or just one of those myths perpetuated by women's magazines. I think we should air that out, reexamine that thought.

The mind-twisting research not only illustrates the pill's insiduous, pervasive effect on your body, it's also useful as a small reminder of the necessity for reevaluation.

We can say, from this research, that the pill makes you potentially less attractive to men. Now, I'm not saying a side effect of unattractiveness should be considered anywhere near as urgent as panic attacks, paranoia or, dare I say it, blood clots. But there are all sorts of subtle, varied reasons each woman on the pill keeps taking it, and I think this research could help us reconsider our rationilisation.

I took Yasmin because I was told it would help me lose weight and get beautiful skin.

Wednesday, September 2, 2009

How it works

It seems sensible to next answer the question of what the pill actually does to your body. That way you'll know, and be able to make an informed decision as to whether that's fine by you or not. If we have how it works straight, we can start looking at the effects in more detail. Rather than be hard-line and say no one should be on the pill - there's a very vocal doctor, Dr Irwin Goldstein, who supports this argument and if you keep reading you might decide that for yourself - I want women to have all the information.

Now, I have no science background to speak of - I scraped through the mid-level science GCSE, but I have managed to get my head round this stuff. I once interviewed Dr Peter Bowen-Simpkins, a gynaecologist and spokesperson for the organisation Wellbeing for Women and asked him why GPs didn't fully explain the pill's workings to their patients and tended to give nonsensical platitudes. He said, 'Why wouldn't you be satisfied with just knowing it stops you producing eggs?'

The pill changes almost every bodily system. In a normal cycle huge hormonal fluctuations occur that have an impact on the whole body, right down to sense of taste and smell. The pill prevents ovulation so all the changes your monthly cycle provokes are altered. Regular hormone production is replaced by a daily dose of synthetic oestrogen and progesterone. This prevents pregnancy by shutting down the ovaries, depleting hormone production from the adrenal gland, and changing the condition of the uterus and cervix. Women are often told the pill mimics pregnancy, but the opposite is true – rather than increasing your hormone levels and fluctutations, the pill reduces and flattens them. Hence, that 'flat' feeling I spoke of earlier.

There are many brands of pill on the market, and each will have varying effects on different women. The pill that works well for your best friend, won't necessarily be right for you. And a pill that worked well for you at twenty-five might cause problems at thirty-five. Although research is dramatically lacking in this area, there are certain facts that it can help to know.

The most commonly prescribed pills are called combined, as they contain both a synthetic oestrogen and progesterone. The level of ethinylestradiol (the synthetic oestrogen) can range from 20mcg to 35mcg. A number of different progestogens (the synthetic progesterone) are used across the brands. Although your doctor will usually recommend pills that are monophasic there are also biphasic and triphasic pills which vary the levels of hormones across the monthly cycle. Also available are progesterone-only pills which have no oestrogen content.

Generally, the lower the dose of hormones, the safer the pill is for your body. Although the difference between doses in modern pills is slight, it is still recommended that the lowest dose be your first choice. Some women will experience unwanted side effects even on an ultra low dose pill, and when this occurs they can switch either to a higher dose pill or a pill containing a different progestogen.

There are two groups of progestogens – the first contains levonorgestrel and norethisterone. These progestogens act on the ethinylestradiol in the pill, and as such counter its impact on the risk of thrombosis development. These progestogens also combat problems caused by the hormone testosterone such as acne and excess hair. The pills containing these elements are progesterone-dominant.

The second group includes desogestrel, gestodene, norgestimate and drospirenone, progestogens used in oestrogen-dominant pills, so-called because the ethinylestradiol is not acted on by the progestogen. These are usually prescribed as a second choice if side effects occur with a pill containing one of the progestogens in the first group.

The progestogen-like element of the brand Dianette is an anti-androgen called cyproterone acetate specifically used for it's suppression of the androgen testosterone. This is an oestrogen-dominant pill.

Of the most popular pill brands Femodette has the lowest level of synthetic oestrogen, Femodene, Microgynon, Ovranette and Yasmin have the next highest dose, and Cilest and Dianette have the highest. Microgynon and Ovranette contain the progestogens in the first group mentioned, and as such are amongst the recommended first choice pills. All the others are in the second group as they contain the other types of progestogen.

Biphasic and triphasic pills mimic women's natural hormone cycle more closely than monophasic pills but there is no evidence this is safer or better for you. They do however produce more natural-like periods and can control more effectively bleeding patterns. Progesterone only pills are most often offered to breast feeding mothers, and women who find they are in a higher risk category for some of the pill's potential serious side effects such as thrombosis due to personal or family history, or as they grow older, or gain weight. These pills don't fully stop ovulation but act more prominently on the lining of the cervix.

Research has shown that the pill's main objective - that is stopping you getting pregnant - is actually more accurately upheld by using a condom and spermicide. Apparently, statistically, women are far better at this than taking the pill every day. Supposedly its 2 in every 100 users with perfect usage that get pregnant, and 8 in every 100 users with typical usage. Perfect usage is taking it bang on time, the same time, each day.

Back to Yasmin - I have looked more thoroughly into the science behind this one pill - it contains a particular, unique kind of progestogen which is what has caused it to produce such severe and specific side effects.

Yasmin is made up of ethinyl estradiol (that's the oestrogen part) and drospirenone (the progesterone). The drospirenone makes this pill what is called a potassium-sparing diuretic. A lot of women will have noticed needing the loo a hell of a lot more than normal when taking Yasmin. As a diuretic Yasmin causes dehydration and dehydration affects the body at a cellular level, interfering with mineral and electrolyte balances. Potassium levels to rise in the blood.

Yasmin suppresses the adrenal gland, as do all pills. The adrenal gland controls hormone production. Its suppression provokes a lowering of serum cortisol levels, which is a hormone produced to guide the body's responses to stress. Changed levels in serum cortisol are connected to depression and psychological stress. When the body experiences stress it provokes heightened adrenalin production. The long term effect of high adrenalin levels is exhaustion. Yasmin, and the pill in general, in its suppression of ovulation and the adrenal gland causes testosterone levels to drop dramatically. Testosterone plays a key role in controlling libido and mental and physical energy.

It is Yasmin's diuretic effect that accounts for the promoted weight loss, which is effectively the loss of water weight. The quashing of testosterone accounts for its clear skin benefits as it is this hormone that controls sebum (the oil in your skin) production.

So, the pill has a whole body effect, every day, for years you are taking a pill that has a extensive, insiduous effect on every bodily function.

There was an article in More magazine earlier this year that showed what days of the month you should do certain things - go to the gym, meet friends, write an essay, have a business meeting - dependent on what your hormone levels were doing at that time. This acknowledged how powerful hormones are in our lives, but I've been wondering if the article was based on the natural cycle of a woman, or on the cycle 80% of women are experiencing at any one time, that is the unnatural pill cycle.