Feeling in control without birth control
The pill is over 99% effective. So why are so many women choosing to no longer use them? One writer explores the effects of hormonal intervention, and why she feels better off without it.
Illustration by Vivi Maidanik
I quit my job during the pandemic and birth control made me do it. Six months before quarantine I stopped taking the pill I’d been taking every day for nearly 20 years. And as the synthetic hormones drained out of my system, I noticed a few unexpected changes. For the first time since high school, I was really feeling myself. I felt great in my body, clearer in my focus and more confident that I was brave enough and capable enough to get whatever I wanted - basically, everything a woman wants for herself but rarely gets to enjoy.
It’s not surprising that many women are opting to ditch the pill hard-won by feminists of previous generations. I live in Canada, and here the number of prescriptions for oral contraceptives has steadily decreased by about 10% in the last five years. And I’m one of them.
In the early 1990s, birth control was classified as a ‘lifestyle drug’. Pharmaceutical brands marketed oral contraceptives not just as a form of birth control, but as an effective treatment for acne, period cramps and polycystic ovary syndrome (PCOS). I remember so many of the girls in my high school having their own plastic blister pack despite the fact many of them weren’t sexually active yet. I started the pill at 15 for straightforward reasons: I was your standard horny teenager, I had a ‘serious’ boyfriend and I wanted to get laid.
Procuring the pill was easy. In Toronto, medical care is free and pretty easily accessed. It also helped that I grew up in a middle-class suburb where secular, liberal parents were mostly resigned to the inevitability of teenage sex. They promoted safe sex and contraception to us teens at every chance they got. I felt smart knowing that taking the pill would be a choice I would someday make.
When I left my doctor’s appointment with three sample packs and a prescription stashed in my bag, I felt like a ‘real woman’. Two years earlier I’d gotten my first period and even had a Bat Mitzvah, but those didn’t count compared to the pill. This was my rite of passage. I felt grown, mature, sexual and like I was doing it all right. That’s not quite how I’d feel decades after the decision.
A large-scale study published in 2016 suggests that hormonal contraception may cause or contribute to depression. The authors concluded that women who took the pill were at a 23% greater risk of depression than those who didn’t. Women using the progestin-releasing IUD faced a 40% greater risk than non-users; and the risk for those using vaginal rings was 60% greater. They also found that the birth control patch doubled the risk of depression.
Hormonal interventions are the most reliable methods of birth control, with 80-100% efficacy. So then why are so many women, like myself, choosing not to use them?
Arguably, the pill is the 20th century’s most revolutionary medical breakthrough after penicillin. Without it, women’s lives would look very different today. Many women have birth control to thank for their careers, independence and sexual autonomy. Over nine million American women take the pill every day, and another seven million use LARCs (long-acting reversible contraception): the patch, IUD, ring, or implant. Hormonal interventions are the most reliable methods of birth control, with 80-100% efficacy. So then why are so many women, like myself, choosing not to use them?
I had my first panic attack at 25 years old, almost a decade after starting the pill. It was a summer morning, and I remember waking up feeling like my heart was going to explode. I was convinced it was a heart attack, as I stumble-ran to the nearby clinic. The doctor prescribed Lorazepam, an anti-anxiety medication, and the only regular prescription I’ve had to take besides birth control.
I take Lorazepam only when I need it — when anxious thoughts quicken my heart palpitations so much the vibrations become impossible to think over. Or worse, when a complete panic attack comes on, leaving me hyperventilating and crying hysterically. I’ve had the prescription for 10 years, about half the time I’ve spent on birth control, and I usually take a pill once every month or so. Still, the cause of my anxiety remains unknown. Over the years, I’ve blamed my job, finances, caffeine, my parents, a lack of exercise, and the ambient disappointment that comes with being a woman who wants what she deserves. But when the attacks and heart trembles kept coming back even after I’d switched to decaf, saved some money, started a workout routine, and landed a better job, I decided to see a therapist. At my first appointment, the therapist asked why I came to see her. I responded: “Because I want to get better at feeling my feelings.” It was the best way I could describe the dull ache that left me feeling detached, bored, lacklustre and dissatisfied. Joy was difficult to access, and so was anger. I believed that I was destined to be unfulfilled.
Dr. Sarah Hill, author of This Is Your Brain on Birth Control, says many women report a dullness, lifelessness and “lack of vibrancy” while on the pill, and there’s a biochemical explanation why. She tells The Cut: “Pill-takers have lower levels of estrogen and unbound cortisol than non-pill-takers. These hormones are part of the signalizing machinery that make us feel like ‘us.’” Estrogen increases women’s attunement to courtship cues and flirtatiousness, while cortisol helps our brains absorb meaning from our environments. Having differing levels of these hormones, women on the pill’s brains may be less excitable and less able to absorb the depth of their experiences. She adds: “It may make life feel more flat.”
The first major change I experienced once I got off the pill was my sex drive. I wanted to have sex in the morning, before bedtime, while working from home. My partner kept ‘catching’ me getting myself off. It was a second adolescence, but this time it felt even more intense. The second change I noticed was my weight. One morning, it felt like I woke up in a different body than the one I’d gone to sleep in. I went to get dressed and nothing fit – all my clothes were too big. It felt like I’d lost an inch, maybe even two, overnight.
I felt free from constraints and anxieties, and even my fear of failure was losing its grip.
Then, for someone who didn’t feel like she was that good at “feeling her feelings”, I was suddenly feeling so much. All the sensitivity and awareness I was experiencing led me to want to change my career. I started writing voraciously and soon had a crazy number of notes on my phone, and even a few published pieces. It felt incredible. I felt free from constraints and anxieties, and even my fear of failure was losing its grip. After 10 years at a “secure” job, I was giving the younger version of myself, the one who wanted to write, a real shot at existence.
In the same interview with The Cut, Dr. Hill explains that in some cases, women who have stopped taking the pill have found that the things they felt certain about suddenly felt wrong. “There are women who built their whole lives when they were on the pill, and they go off it and don’t know what to do because they feel like they don’t recognize it — they built a life that they don’t want anymore.”
There’s so much uncertainty in the world right now, maybe it was a bit reckless for me to have left my full-time job or gotten off the pill at this time. Or maybe, with so many shifts happening, this is the perfect time for a personal one too. It’s too early to say. From one moment to the next, I feel uncertain and powerful, smart and foolish all at once. But it’s fine because I’m done with being safe, secure and regulated. Bring it on. I want to feel it all.
Words by Sarah Phillips
Illustration by Vivi Maidanik
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