Sunday, March 11, 2012

Coming off the Pill - a guide

Could furor over contraception spark a birth control rebellion?

In the past week I have collaborated with Laura Wershler to come up with a response to the currently raging birth control furor. We wanted to produce a considered, practical guide for women fed up with being dismissed and talked over. A plan for action. We're looking for other homes for it too, to get the information out there as widely as possible. But I wanted to post it here as I often get asked by women that are coming off the Pill what they should expect, what the alternatives are, how to access them and although I like to think my blog is riven with that information, it seems like it'd be useful to have it all in one place.

So, here it is:

As politicians, pundits and priests whip the nation into a frenzy over access to birth control, it’s understandable that women of every political affiliation may have had just about enough.
If women are fed up with this furor over contraception, this daily demonstration that their rights to sexual and reproductive self-determination are vulnerable, then maybe now is the time to do something about it: Throw out your pills, rip off your patch, pull out your ring and take back control. There is more to birth control than prescription medications.

One way to take back power from those who would deny, bully or browbeat you is to not need what they are fighting over. This act of rebellion won’t be easy, and it won’t be for everyone. But if you’re mad as hell and not willing to take it anymore, here’s a primer on how it can be done.

Coming off the Pill:

Many of you may have been using hormonal contraceptives for years, perhaps a decade or more -
for most it will be the birth control pill. By coming off the pill, or other hormonal methods, you will be joining an underground revolution. Over the last few years women have been ditching the pill in droves due to unwanted side effects and environmental concerns, or as a result of reassessing, in their late 20s, a choice they may have made back in their mid-teens. These women have taken to the Internet to unearth information, share experiences and gain advice.

Coming off these contraceptives can be a rocky ride – reports of withdrawal symptoms such as acne outbreaks, mood swings and insomnia abound, lasting anywhere between a few weeks to a few months depending on the individual, the type and the length of time that they’ve been taking the drug. Some women find their menstrual cycles do not return or become regular for up to a year, and may feel like they are experiencing a “second adolescence.” Starting the pill in your teens pushed the pause button on your body’s maturation process; coming off synthetic hormones presses the play button, and your body has to pick up where it left off.

But hold your resolve! It is worth the wait.

Look to resources like The Pill: Are You Sure It’s For You? or Coming Off the Pill, the Patch, the Shot and Other Hormonal Contraceptives for information and support on how to manage the transition. You’ll find nutritional advice, practical insight and comforting case studies to help you through what some call a “life-changing” experience. Miranda Grey’s The Optimized Woman gives you an idea of what you have to look forward to when your menstrual cycle returns.

Rebranding the Alternatives:

Condoms hold an undeserved bad reputation for being unreliable and icky. Yet, when used consistently and in conjunction with spermicidal jelly or foam, they are just as effective at preventing pregnancy as hormonal contraceptives. And there are better condoms, advanced in technology and design, than the brands you normally see on drugstore shelves. In Japan, where the pill was only legalized in 1999 and condoms are the primary contraceptive choice, innovation and creativity has led to condom brands such as the top-rated Beyond Seven and Crown, which claim to provide a far more natural, comfortable feel and fit. The added benefit? Condoms are still the only way to protect yourself against STIs – and many of you will have been using them in addition to hormonal methods. Spermicidal gels and foams – Conceptrol, Gynol, Encare – are readily available in stores and online. For those who find that these brands cause irritation and infection, or you just don’t like the chemicals, try the green, clean alternative made by Contragel.

Or, like Carrie Bradshaw in Sex and the City, get yourself a diaphragm. Once you have been fitted for the correct size at your doctor’s office or Planned Parenthood clinic you can get a prescription to pick one up at a pharmacy or you can buy one online without a prescription. Increased demand from women for this currently little-used, but effective alternative will produce better options and access. Research is underway for a one-size-fits-all diaphragm.

For a full run-down on alternatives to hormonal contraception, read Laura Eldridge’s In Our Control: The Complete Guide To Contraceptive Choices for Women. For many years she worked closely with women’s health activist Barbara Seaman, whose motto rings so true today: “Let’s not start and stop what we have to say about contraception with the Pill.” Eldridge tells the story of how she came off the pill and chose the diaphragm.

You can increase the effectiveness of these methods even more so by becoming aware of your ovulatory cycle and studying the Fertility Awareness Method – more about that later.

Managing Menstrual Cycle Disorders Without the Pill:

If you were taking hormonal contraception to manage serious menstrual problems, you’re no doubt concerned they will return if you stop taking your pills. Yes, the standard medical treatment for such problems has been to prescribe the pill, but there are other treatments that work.

Dr. Jerilynn Prior, a Canadian endocrinologist with over 40 years of clinical practice, has effectively treated a range of menstrual cycle problems without using hormonal birth control. At the website of the Center for Menstrual Cycle and Ovulation Research founded by Prior, you can find information on how to treat heavy bleeding, painful periods, PCOS, ovarian cysts, endometriosis, and amenorrhea. The bonus to this approach is that it can also restore or protect your fertility, meaning if or when you want to get pregnant, you’ll be able to. Prior includes articles on the website for health-care providers that you can print and take to your doctor.

Naturopathic doctors and nutritionists can offer support to ease menstrual symptoms. Alternative therapies for disorders such as endometriosis are also available.

Look for blogs and websites that share tips and information about menstrual cycles. Bloggers write regularly about menstrual cycle and birth control issues.

Return to Ovulation:

When you come off hormonal contraception, your interest in how your menstrual cycle works -what’s normal, what’s not - may increase. And most women coming off the pill want to know if and when they’re ovulating.

Ovulation is a hot topic. Dr. Prior’s work on the protective powers of ovulation is must reading. It seems that contrary to what women are often told about too much ovulation being bad for them, ovulating consistently with each cycle actually protects women’s breast, bone, and heart health. The health benefits of not using hormonal contraception are worth knowing about.

In addition, regaining ovulatory menstruation can increase libido, improve athletic performance, solve digestive problems, and benefit mood disorders.

To fully grasp how a healthy menstrual cycle unfolds read books like Taking Charge of Your Fertility by Toni Weschler, first published in 1995 and long a bestseller. If you’ve got a teenage daughter or younger sister, give her Weschler’s other book — Cycle Savvy:The Smart Teen’s Guide to the Mysteries of Her Body. The pink girly-girl cover harbors subversive content that every girl in America – preppy to punk – should have access too.

Understanding Fertility Awareness:

Fertility awareness, like riding a bicycle, is a life skill. If you can knit a sweater, read a balance sheet, or master French cooking and Adobe InDesign, you can learn to observe, chart and
interpret your menstrual cycle events.

Referred to as natural birth control, the secular Fertility Awareness Method (FAM), and its religious-based counterpart Natural Family Planning (NFP), are based on observing and interpreting scientifically proven signs of fertility to prevent or achieve pregnancy and monitor your reproductive health. FAM is absolutely not the same thing as the ineffective Rhythm Method, which tries to predict fertility based on the length of past cycles.

Don’t believe those who tell you that FAM doesn’t work; women using it can achieve effectiveness rates as high as the pill – 99.4 percent. But unlike Catholic NFP, FAM is pro-choice and incorporates barrier methods, emergency contraception and abortion.

Women who have regular healthy cycles can teach themselves the method for free by downloading the User’s Guide for the Justisse Method of Fertility Awareness or by reading books like Weschler’s Taking Charge of your Fertility and The Garden of Fertility by Katie Singer. You can join online forums for assistance, and download smart phone apps like FemCal Period and Ovulation Tracker to chart your cycles.

You can find certified instructors through the Fertility Awareness Network or Justisse Healthworks, which trains Holistic Reproductive Health Practitioners who teach the Justisse
Method and provide clinical support to women struggling with messed-up cycles. Skype and online webinars offered by orgs like Red Tent Sisters make it possible to connect with a FAM teacher no matter where you live.

Retooling Relationships:

Talk to your partner, boyfriend, husband or lover about planning for a hormonal contraceptive-free future. If you’re single you should know that using the Fertility Awareness Method in conjunction with condoms with added spermicide during your fertile phase has been shown to be 98.2% effective at preventing pregnancy – so it’s just as suitable for the one-night stand as the committed relationship.

Generally, women report an increased libido when they come off the pill, but if you've been on it for your entire relationship it’s possible you’ll feel differently towards your partner. Your body's natural hormone cycle plays a part in physical attraction.

For men, too, hormonal birth control has long provided a sense of reassurance for spontaneous, worry-free sex, and so it is important to discuss with your partner the effectiveness and ease of use of other methods. Perhaps he’s never liked condoms - shop around and have fun trying out different kinds like the Beyond Seven and Crown barely-there brands. If you’re following FAM and in a monogamous relationship, you won’t need condoms when you’re not fertile.

Partners may benefit in other ways: Many women are more responsive to sex once free of synthetic hormones. If, to be super-safe, you want to avoid penetrative sex during your fertile phase, get creative. Use this time to explore the imaginative and the experimental.

If you chart your menstrual cycle, involve your partner, so that he, too, can be aware of the days that you are fertile. Do your own study – find out if your guy can hear (in your tone of voice) and smell when you are ovulating. Knowing that you can only get pregnant during these days will allay his anxieties, as it does your own. Sharing this new experience can bring you closer and foster intimacy.

Some guys get a geeky satisfaction out of their new understanding. In fact, Ernest Hemingway – the ultimate man’s man – charted his first wife’s cycle on the wall of their Paris apartment.

Taking back control:

For decades, women have been quitting hormonal contraception for various personal and health reasons. With the ongoing culture war over contraception, it remains to be seen how many might be compelled to give it up for political reasons, taking back control of their bodies from politicians, pundits, priests and drug companies.

Laura Wershler is a pro-choice sexual and reproductive health advocate and writer who has volunteered or worked for organizations affiliated with International Planned Parenthood Federation for 25 years. She supports increased awareness of and access to non-hormonal contraceptive methods.

Ovarian Gang Sign:


  1. So well summarised, Holly and Laura, it covers all the issues clearly and succinctly. There is a quiet revolution going on now over contraception, and I think it's about to get a whole lot noisier as women begin to wake up to the damage that hormonal contra does to a woman's body and soul.

  2. Highly irresponsible of you not to mention failure rates. Are you going to take personal responsibility for any unintended pregnancies that arise if someone follows your naive advice? I am old enough to remember when the pill became available and unless you were planning to be a perpetual stay at home mum, it brought great benefits to women's lives.

    1. Hi Chris,

      Thanks for your comment. I'll answer your question by asking a few of my own. Do pill companies take responsibility for failure rates when someone forgets to take their pill every day? Do condom companies take responsibility for when the condom falls off or when someone who uses condoms does not use them consistently every time they have sex? Every method's effectiveness is impacted by the user's ability to use it consistently and as it is meant to be used. For the purpose of this piece, the point was to correct misinformation that is perpetuated everywhere that FAM methods are not very effective. Most comparisons of the effectiveness of various methods consistently underestimate the effectiveness rates of fertility awareness methods with perfect use. Yet they compare them to perfect use effectiveness rates of other methods. If you read the Human Reproduction study linked to in this piece, you'll see that these effectiveness rates are valid.

      I used FAM successfully for 27 years, starting in the early 80s, with one pregnancy fully planned. I, too, remember when the pill became available, and what havoc it wreaked on my health and well-being. We said in the intro that these choices are not for everyone. But you'd be surprised how many women are looking to make these choices. This article is intended to show them how they might do so.

  3. Thanks for putting this important info in one tidy place. I get questions about alternatives so often and see women glaze over as I send them here and there. I can see them thinking---'this is too much trouble! Forget it..!'

    It is great that you are bringing information and resources into the noisy and emotional debates that are so rarely _actually_ about women's bodies and everyday/everynight lives.

  4. I was spreading the word about the adverse effects of the pill 35 yrs ago.It brings about 50 changes in in the body apart from the one it is taken for.
    I was advocating Natural Birth control combined with observing the Moon Cycle. In the 60's Eugene Jonas in Checkoslovakia claimed to prove that 98% of women conceived when the angle between the sun and the moon was the same as when they were born.So if you were born on a full moon that is when you are most likely to conceive.Any astrologer will compute the exact time of the individual sun/moon angle each month this can then be observed together with the biological cycle using mucus and temperature.
    I have had some success using this method in advising women who have been trying to conceive for years to no avail, one woman conceived on the first date I gave her after trying for 6 yrs.

  5. For American residents with reproductive system disorders they should look into NaPRO Technology. It has GREAT success at treating disorders and illnesses such as PCOS and scarless Endometriosis removal and has success rates many times GREATER than IVF for natural pregnancy! Some fertility issues may also just be hormonal imbalances and through using the Creighton Method of FAM this can be diagnosed and treated successfully for a natural pregnancy free from clomid, etc. Dr. Hilgers who founded this technology has even said that if it wasn't for the medical communities focus on IVF (which has such poor rates of success) there would be a CURE for infertility and infertility causing diseases, today.

    For American residents with reproductive system disorders they should look into NaPRO Technology. It has GREAT success at treating disorders and illnesses such as PCOS and scarless Endometriosis removal and has success rates many times GREATER than IVF for natural pregnancy! Some fertility issues may also just be hormonal imbalances and through using the Creighton Method of FAM this can be diagnosed and treated successfully for a natural pregnancy free from clomid, etc. Dr. Hilgers who founded this technology has even said that if it wasn't for the medical communities focus on IVF (which has such poor rates of success) there would be a CURE for infertility and infertility causing diseases, today.

    This is great information listed above. We've practiced the Sympto-Thermal Method of FAM for years and LOVE LOVE LOVE IT! In fact, because I knew I was going to be starting my period today (I'm irregular) i was able to pre-medicate to avoid cramps! Win-Win for us! :)

  6. Such an excellent article, thank you. Women need to know that we have the power to effectively make decisions about our reproductive lives innately. With a little education and self-care we can experience true sexual freedom and equality without compromising our health.

    The introduction of chemical birth control provided a new opportunity to make information about conception/contraception much more accessible and we have much to be grateful for in the way of women being able to pursue other interests. But there are serious questions to ask about the ways these new freedoms can stealthily enslave us. I am thrilled to see women asking these questions and finding that there is an excellent (and effective!) answer that lies within.

  7. The World Health Organization has classified all types of "The Pill" (estrogen-progestogen oral contraceptives) as Group 1 Carcinogens for quite awhile, and severe blood clots are a frequent side-effect. Early prototypes of "The Pill" in the late '50s caused many women to die.

    There are natural, safer, more medically advanced alternatives to "The Pill," e.g., Natural Family Planning. Spread the word!