Last week, Axios reported that OB-GYNs “have seen a wave of patients quitting hormonal birth control.” According to Tina Reed, the author of the Axios Vitals newsletter, there’s a small surge of patients who are opting for “natural” birth control. Some may be making this shift because they’re getting health information from social media.
Reed referenced a study published earlier this year in the journal Health Communication, which analyzed the content of 50 YouTube videos about birth control that were posted between 2019 and 2021 by social media influencers, and found that the videos were “primarily about the discontinuation of hormonal birth control and may provide inaccurate sexual health information.”
If you’ve spent as much time as I have surveying the dark corners of the anti-vaccine and free-birthing social media worlds, you won’t be surprised by the fact that wellness influencers pushing “natural” birth control are all over the place. Sometimes they’re promoting some version of the rhythm method, also known as fertility awareness (tracking your menstrual cycle to figure out when you’ll ovulate and avoiding sex or using condoms on or near those days); sometimes they’re selling some poultice of herbs.
So let’s start there: I have no problem, in theory, with fertility awareness methods — they’re effective if used perfectly, but with typical, human, imperfect use, “12-24 women out of 100 will become pregnant” within the first year of employing these methods, according to the American College of Obstetricians and Gynecologists. I am, however, firmly against misinformation being spread about the supposed harms of hormonal birth control, which is much more effective with typical use in preventing pregnancy (between fewer than one and 12 pregnancies per 100 women per year, depending on the type of hormonal method used). And for many women suffering from problems like endometriosis, menstrual migraines and fibroids, hormonal birth control can make life a lot more manageable, for reasons beyond the prevention of unintended pregnancies.
Part of the reason that some non-hormonal birth control methods seem to have gained such traction on social media is that there is a tendency among some medical professionals to downplay the side effects of hormonal birth control methods that many women experience. Most women who use birth control are completely or somewhat satisfied with their methods of choice, but a minority of them experience reactions unpleasant enough to seriously impede their daily lives.
Over the years, I have heard anecdotally about — and experienced — various side effects to different types of contraception: heavy breakthrough bleeding and abdominal pain with IUDs, mood disturbances with different types of pills, and sexual side effects with everything. Discussion of these issues, often confined to intimate chats among women, was aired out in a great extended bit from the comedian Beth Stelling’s new Netflix special, in which she recounts the various kinds of birth control she’s “experimented recreationally” with over the years. “In my 30s,” she says, “I started taking the pill, just ’cause I wanted to know what it would be like to be a different person.” She asks audience members for their experiences with a particular pill before whipping out a pair of reading glasses and going over a list of potential side effects about another, including vomiting, abdominal cramps, depression and rashes.
As Sara Cravatts reported for Stat in 2021, in an article headlined “Patients and doctors are clashing about side effects of hormonal birth control,” many younger patients have been raised to advocate more assertively for themselves and for their bodily autonomy:
They want physicians to spend more time questioning potential side effects of hormonal contraception and less time questioning the validity of patients’ claims. But some physicians say without data that point to the prevalence of some side effects, they find it difficult to respond. Some choose not to engage at all.
And that lack of engagement leaves patients feeling dismissed, Cravatts wrote. When women — particularly women of color, whose pain has a long history of being undervalued — feel dismissed by the medical establishment, that leaves the door open for all manner of snake oil salesmen.
A paucity of open discussion between doctors and patients about the side effects of hormonal contraceptive methods also allows information to be politicized by those looking to undermine birth control more generally, as Kat Tenbarge reported in a July article for NBC News about how conservative influencers were weaponizing rare issues with hormonal contraceptives that didn’t have solid data behind them.
As Dr. Kate White, the vice chair of academics in obstetrics and gynecology at Boston Medical Center, told me over the phone, “what is happening is that people who have not been listened to, who have been disregarded, are then turning to sources that are not only not board-certified but also have their own agendas to push. And then they’re making decisions out of fear and misinformation.” Particularly in a post-Roe universe, she said, that is “tragic, because at a time that people need more autonomy over their bodies and more information about what the consequences of their choices about what using methods or not using methods means for them, they’re actually working in more of an information vacuum.”
She mentioned an example of a side effect that showed up in patient anecdotes before it was studied, and was at first dismissed by doctors: an elevated risk of vaginal infections in patients who have copper IUDs.
I asked Dr. White — who is not only a board-certified OB-GYN but is also board-certified in complex family planning, which involves an additional two-year training in reproductive health after an OB-GYN residency — how medical professionals can work with their patients to find the contraception that will work best for them based on their personal contraindications, the risks and benefits of each method, and where they are in their reproductive lives.
She described the counseling model that she would like to see implemented: “You say you need birth control. Your provider asks you a series of questions, starting with: What have you used in the past, what has worked for you, what hasn’t and why?” Finding out a person’s contraceptive journey is important, she said, because “The average person is going to use three to four methods of contraception over the course of their life. It’s not typical, it’s not normal to find one method when you’re 17 and stick with it until you’re 40.”
After a patient’s contraceptive history is documented, providers should ask about overall health history, Dr. White said: “Do you have medical conditions that are going to make a difference about what methods you’re eligible for versus what methods could do for you?” And finally, “The most vital question is: What’s important to you about your birth control? Because people are using birth control not just to not get pregnant, but they may need bleeding control, pain control, acne [management], privacy, reversibility.” She also mentioned accessibility issues, both around refilling prescriptions and also the insertion or removal of implanted devices.
I don’t want to overplay the power of the anti-hormone influencers. Hormonal contraception is still very popular among American women. In 2022, the Kaiser Family Foundation polled women between the ages of 18 and 49 about the prospect of an over-the-counter birth control pill (one was approved this year by the Food and Drug Administration and should be available to consumers in 2024). K.F.F. found that 77 percent “of reproductive-age females favor making birth control pills available over the counter without a prescription if research showed they are safe and effective,” which suggests that the backlash against hormones isn’t overwhelming overall trust in the medical establishment or the desire for contraception that’s effective and easy to purchase.
And there’s more good news on the horizon for people whose side effects are so unpleasant that any hormonal contraception is not a good fit for them: In next Wednesday’s newsletter, I’ll discuss the renewed investment in contraception and the development of new forms of birth control that may reach the market in the coming decades.
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November 01, 2023 at 07:00PM
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Opinion | Why We Need to Talk More Openly About Birth Control Side Effects - The New York Times
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