When a pediatrician put Maya Prokupets on the birth control pill at age 15 to prevent pregnancy, she doesn’t remember being given any information on possible side effects. But they soon appeared: weight gain and anxiety. Switching to different versions — Apri, Alesse, Desogen, Yasmin, and finally Yaz — only brought new side effects, such as constant nausea and vomiting. She told her clinicians, but none recommended she stop taking hormonal contraception. She chose to do so anyway at age 21 — and her symptoms subsided.
“My experience with the medical system as a young woman was very minimizing,” says Prokupets, now 35 and working in health tech in Los Angeles. “I was always being told it was something else. No one would ever acknowledge it could be the pill that I was on.”
A divide is taking root as doctors clash with millennial patients like Prokupets, members of a generation that promotes bodily autonomy and self-advocacy. 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 — which, in turn, leaves patients like Prokupets feeling dismissed.
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“I do have patients come in with complaints about things that I do not think are tied to birth control,” said June Ng, a complex family planning fellow at Albert Einstein College of Medicine in New York.
“A patient will say they think their hormonal IUD caused weight gain. While exposure to hormones could potentially lead to weight gain, IUDs have never been associated with weight gain,” added Ng, who said she has told some patients their symptoms might have more to do with lifestyle changes during the pandemic.
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Despite the wide use of hormonal contraceptives, there are few studies on side effects or long-term effects, which physicians told STAT is largely due to two reasons: the lack of incentives to explore a drug that is widely known to be safe, and the difficulty of such studies. A large study conducted in Denmark — where drug prescription data are publicly accessible — suggests hormonal birth control is correlated with an increased risk of depression. Another large study, this one from Sweden, followed more than 300 women who took either oral contraception or a placebo pill for three months. It found that women who took the pill scored lower on a measure of general psychological well-being, though there wasn’t any difference in symptoms of depression between the two groups.
“Oral contraceptive pills are one of the most widely used drugs over an incredibly vast cross section of humanity over a long period of time,” said Michael L. Lipton, medical director of MRI services and professor of radiology, psychiatry, and behavioral sciences at Albert Einstein College of Medicine and the Montefiore Health System, who conducted a small-scale study in 2019 on oral contraceptive pills’ associations with brain structure — specifically the hypothalamus and pituitary. “I think it’s remarkable that there’s not more known about the [pill’s] mechanism of action.”
According to the National Center for Health Statistics, 65% of women aged 15 to 49 used contraception between 2017 and 2019. Female sterilization was most common, accounting for 28% of contraception among women who used any form of contraception, followed by the pill at 21%, long-acting reversible contraceptives like implants and intrauterine devices (IUDs) at 16%, and the male condom at 13%.
The pill has been widely shown to be safe, but as is the case with any drug, it can come with side effects and risks, including an increased risk of blood clots. It’s worth noting that hormonal contraceptives are used not just to prevent pregnancy, but treat certain conditions such as hormonal acne, ovarian cysts, and endometriosis, among others. It can also lower the risk for certain types of cancers — ovarian in particular — when taken long-term.
Still, given how many people take hormonal contraception, the lack of more robust data on side effects is notable, and leads some patients to want to experiment with going hormone-free.
Paula Castaño, associate professor of obstetrics and gynecology at Columbia University Irving Medical Center, said there’s a range of reasons that influence whether patients decide to stop taking the pill.
“I think [that decision] is multifactorial,” she said. “For some women, it’s a feeling or desire that they want to know what they feel like when they’re not on birth control, for some it is a question about whether there are any health reasons why they should, for some there is concern about whether fertility is affected in any way by long-term contraceptive use. A large factor in deciding to stop taking the pill can be influence from friends and family based on their opinions and experiences, whether or not those are based in medical fact.”
One such patient, Amanda Miller, 29, who lives in Brooklyn, N.Y., was put on the pill at 16 for periods that lasted too long. For Miller, hormonal contraceptives seemed to be an almost compulsory step in young adulthood for American women.
“I feel like the pill is so ingrained in US culture — it felt like everyone was on it,” she says. “There wasn’t much discussion at all with my doctor when I first got on it. It was more about ‘better safe than sorry.’”
After years of taking the same brand of pill, Yasmin, with no issues, a change in price caused her to try an IUD, before ultimately returning to her original pill.
But the second time around, Miller experienced emotional side effects, including depression and moodiness. She stopped the medication, but still wanted to use a reliable method to prevent pregnancy, so she turned to her gynecologist for guidance.
“[My doctor] made a comment about how if I wasn’t on birth control, I might as well start taking prenatal vitamins,” she says. “It was passive aggressive, but also didn’t help me in thinking about what my other options are. That broke the trust with me, I didn’t feel safe to talk to her to discuss options.”
Bryna Harwood, director of the family planning division and program director for the obstetrics and gynecology residency at Cedars-Sinai Medical Center, said it’s critical for patients to feel comfortable and confident bringing those kinds of concerns to their providers — and just as important for providers to meet them.
“I would encourage women to speak up, and if your provider is not listening, there are other providers,” she said.
This story was updated with additional data on the prevalence of contraceptive methods.