For much of freshman year, my fear of getting pregnant waged a battle with my fear of getting caught by my mother with birth control pills in my purse. I was a kid who had always played by the rules. In the Catholic household where I was growing up, secretly taking the Pill was beyond unacceptable. So what if I was living at college, hours away from home? Somehow, some way, I was sure she’d just know.
And yet I knew that getting pregnant would be even worse in my parents’ eyes: Not only would God know what I was up to, but the neighbors would find out, too. That sealed it for me. After months of obsessing (and falling for the guy who would eventually become my ex-husband), I finally asked one of my roommates to drive me to her doctor’s office. I took my first Pill on our ride back to our dorm. I felt it catch in my dry, nervous throat.
I read every word of medical fine print that came with that first package. I obsessively took one at the exact same time each night, fearing I’d wind up in the small percentage of people who get pregnant despite these meds. And I hid the tiny packet with care every time I visited home.
But if going on the Pill at 18 felt like a huge decision, staying on it was soon a no-brainer. It was just another part of the background noise of life, and it stayed that way. Throughout my 20s and into my 30s, picking up a pack of pills at the drug store was just another quick errand to remember each month. There were no side effects that I noticed.
My nightly routine was simple and automatic: Wash face, take pill, brush teeth.
According to the Guttmacher Institute, an estimated 27.5 percent of American women who use birth control choose the Pill, and another five percent take similar chemicals via a patch, injection or implant. I’m guessing many of those women give this very powerful medication about as much thought as I have over the years. If it works, it’s one less thing to worry about.
I stopped taking it to conceive our first child, then was back on it (though on a version that was deemed breastfeeding-friendly) one year later. Ditto for the second kid. I was grateful that we could plan our family so neatly. But as years passed, we were too busy moving from city to city and raising these two kids to think much about the Pill. It simply worked. With so much to juggle, I was glad to have at least one thing crossed off my list.
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My family and I spent last summer getting settled in our new home city: Bangkok, Thailand. Life was a blur of unpacking, learning our way around the neighborhood and getting the kids settled at their new school. By September, I was running low on birth control pills, so I added one more thing to my list of errands: Find an English-speaking OB-GYN and schedule a checkup.
Just as I’d always done in the U.S., I sat down for a brief chat in the doctor’s office after the checkup. I assumed I’d be sent home with my usual 12-month prescription. But the doctor wasn’t smiling.
“American doctors have been prescribing you these pills for 28 years, with only two brief breaks for pregnancies,” he said. “And that doesn’t worry you?”
It hadn’t worried me at all until I saw the look on his face.
“You’ve been taking synthetic hormones for your entire adult life,” he said. “Doctors in many countries don’t advise that. I don’t advise that. Maybe it’s time to let your body make its own hormones.”
I walked home from the doctor’s office in a daze, stunned that I’d been medicating myself for so many years without giving it more consideration. I’m a person who researches everything. How did I stay on these meds year after year without considering more seriously what that meant? And how many other women keep taking these pills year after year without reassessing their decision, simply because the mechanics of it fit so seamlessly into their lives?
I didn’t go cold turkey right away after that jarring medical appointment. I had long talks with my husband about how going off the Pill would impact us, and I finally did the exhaustive research I should have done years earlier. But very quickly the decision became clear: 28 years was enough.
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We think about the most obviously life-changing impact of the Pill: It allows us to have sex and avoid pregnancy. But given how automatic it becomes to simply pop one in your mouth and get on with your day, it’s easy to forget all of the other ways it can change you. Beyond affecting fertility, birth control pills can impact your mental health, deplete your energy, lower your sex drive, even make your hair fall out. (Why did no one tell me about that one?)
Birth control pills inhibit the testosterone that women are naturally meant to make. I’d unwittingly lived my entire adult life and been pursuing my career for nearly three decades without that driving force that was meant to be rushing through my veins. Did it make any difference? I didn’t notice a drop in energy or intensity when I first began taking the Pill, maybe because I was an 18-year-old just figuring out what my adult body felt like. Should I have had more energy back then? I’ve assumed through my 30s and into my 40s that any fatigue was an unavoidable part of my overbooked life and a reality of getting older. But would I have had a bit more energy in reserve without popping a daily pill?
The publication of The Doctor’s Case Against the Pill in 1969 drew attention to the risk of blood clots, heart attack, stroke, depression, weight gain and loss of libido in pill-taking women, and Senate hearings on the safety of the Pill began. By the late 1980’s, when I got my first prescription, lower-dose pills had reached the market. But decades later, controversy remains and it’s hard to really know the health impact of this form of birth control. Numerous lawsuits accusing drug companies of minimizing the actual risk to women’s physical and mental health are currently playing out across the country.
It’s been two months now since I reclaimed my own chemistry — my own hormones moving through my bloodstream, instead of synthetic ones. So far my brain feels clearer and my energy level is higher. And perhaps because I’m making testosterone for the first time in decades, there’s a strength and assertiveness emerging in me that’s kind of blowing my mind.
I am grateful that the Pill has allowed generations of women to take charge of their fertility in ways our ancestors never could. I don’t regret being one of them. But I’m realizing that the appealing marketing and easy mechanics of being on the Pill can make a large medical decision almost disappear from view.
I never should have been so complacent about my own health. I should not have assumed that my doctor’s comfort with re-prescribing this drug each year meant it was the right choice for me. Most important, I should have realized that staying on the Pill year after year actually was a choice and not simply a given. It stuns me that I didn’t question it sooner.
We need more progress in the creation of birth control technologies that are healthy for women, but we also need more extensive education about the birth control that’s available today. Relying on pharmaceutical companies to tell us how their products work isn’t enough. Choosing a method of birth control based solely on its effectiveness isn’t enough either. We need to ask more questions about the positive and negative impact of all kinds of birth control, and make sure we get answers. And we need to talk with each other about this subject that affects so much of our adult lives, even if it feels awkward.