April 8, 2022 – It’s long been known that birth control pills have a checkered history.
Before the era of informed consent in clinical trials, hormonal contraceptives were tested in vulnerable populations.
The warning labels of blood clots and heart attack risk were only added to packaging inserts in 1978. The hormone-emitting NuvaRing birth control method was linked to pulmonary embolisms (blood clots in lung arteries), leading to thousands of lawsuits against Merck.
Still, use is widespread: 12 million women are currently on the pill, and 80% of women have used it at some point in their life either to prevent pregnancy, regulate their periods, or treat their acne.
In The Business of Birth Control, a documentary available digitally and in theaters this week, the filmmakers argue that while hormonal birth control was considered a huge step toward women’s reproductive freedom when doctors began prescribing it 60 years ago, it also isn’t without its share of risks, which may be why more and more women are seeking holistic and ecological alternatives to the pill.
“This film questions assumptions,” says Jacques Moritz, MD, an OB/GYN and medical director for Tia Clinic, a women’s health practice in New York City featured in the film. “There’s a paradigm shift happening right now, where women are more empowered about their birth control options instead of just being given a prescription and told to ‘take it and you’ll be fine.’”
WebMD spoke with Moritz about the film, side effects of hormonal birth control, and how younger women have begun looking for new contraceptive options. The following interview has been lightly edited for length and clarity.
WebMD: The film delves quite deeply into the psychological effects of hormonal birth control such as depression and mood changes.
Moritz: There’s been an awakening now that women are speaking to each other about the neurological or neuropsychological changes the pill can prompt. A lot of people on the pill experience depressive events and had no clue that it could mess up your head. That’s why there need to be more mental health studies on the effects of combination birth control pills. There haven’t been many.
WebMD: Have you noticed that younger women are changing their minds about hormonal birth control?
Moritz: When you’re on the pill, the body thinks you’re pregnant and you don’t ovulate, so you have all the symptoms of pregnancy. The side effects of the pill are exactly the same, whether it’s weight gain, depression, water retention, or moodiness.
This wasn’t talked about so much, but, yes, there’s been this renaissance among our younger patients who don’t want to be on hormonal birth control pills.
WebMD: What are the pros and cons of taking the pill?
Moritz: We know there’s a threefold increase in heart attack and stroke risk – and smoking makes it worse – if you’re on the pill.
On the other hand, we know the pill decreases the risk of ovarian cancer, has a wondrous effect on polycystic ovary syndrome, which affects 1 in 10 women, reduces painful periods, and prevents pregnancy, which is a big deal.
While there are a few studies showing more depressive events among those who take it, what we’re missing are enough studies on the mental health aspects of taking it. In addition, there are some studies on libido, and that’s a double-edged sword: Your libido goes up if you’re not worried about getting pregnant, but can go down if the pill depresses testosterone, making you disinterested in having sex. It goes both ways.
WebMD: What are the best options for women who want to use nonhormonal birth control?
Moritz: This depends on where they are in their relationship. If you need 100% contraception, there’s only one option: The copper IUD, which has a failure rate of 0.2%. But there’s also a downside in that these lead to heavier and more painful periods.
If you’re in a relationship and planning on having kids, but you don’t want to get pregnant right away, I would say you could try the withdrawal method, diaphragms, the cervical cap, and natural planning using the calendar method, but this is limited to those who have regular periods, and there is a pretty substantial failure rate with these methods.
WebMD: What do you want women to think about when considering filling a birth control prescription?
Moritz: I want women to look at all the options available to them, to understand the pill’s mechanism of action and understand this is a bit of body trickery and that there can be side effects.
The pill is relatively safe if you don’t have any medical conditions, if you don’t smoke or drink, or you don’t have a family history of blood clots, which is hard to tell. On the plus side, the pill has been used for a long time, and the dosage has gone down dramatically. Today’s pill isn’t your mother’s – or your grandmother’s – pill.