Changing the dialogue around contraceptive choice

I am 26 years old and have had my period no more than a dozen times in my life. In high school, I was an intense athlete, so doctors accredited it to my low BMI and told me not to worry. In college, I was on a birth control pill that caused lots of women to have lighter or no periods, so they blamed that. When I finally stopped birth control after college to see what would happen, I still didn’t get my period. Instead, I experienced a sudden onset of intense cystic acne (the type of acne that would make me wake up in tears and too embarrassed to go to work) and extreme mood swings.

I spent three years bouncing from specialist to specialist. I saw ob-gyns, dermatologists and naturopaths, all of whom tried to diagnose each “symptom” and failed to connect the dots between them. I tried antibiotics, gluten and dairy-free diets, and high doses of progesterone to try and force my period to come. None of it worked.

After lots of Googling and research on self-help forums, I finally self-diagnosed myself with Polycystic Ovarian Syndrome (PCOS) — a hormonal endocrine disorder in women. Thankfully, I had top-tier insurance at the time that covered fertility (a privilege that’s sadly, not afforded to the majority of women in this country). A visit to a fertility specialist verified that I was, in fact, correct; it turns out, I’d been living with PCOS for years.

As my doctor showed me the cysts that covered my ovaries through a transvaginal ultrasound, I started to cry. Part of me was relieved to finally figure out what was wrong — the not knowing was the worst part of all. And another part of me began to feel terrified that I may not ever be able to have children if I didn’t get this under control. This was a total mind-fuck to me at age 25, who felt eons away from even thinking about myself as a future mom.

My fertility specialist did his best to assuage my fears, consoling me with the fact that 1 in 10 women of reproductive age suffers from PCOS — and even more have it but don’t realize it. He tried to convince me that PCOS was manageable… so long that I took the necessary steps and precautions to address it.

From birth control to hormone control

As it turns out, birth control wasn’t only necessary to control my acne, mood swings and prevent unintended pregnancy, but essential to ensuring my polycystic ovaries didn’t get out of whack and escalate into something more serious. This wasn’t a vanity thing, or a “nice-to-have” — though, let’s be clear, neither is planning your family — it was a medical issue. PCOS is a leading cause of infertility, and when left unmanaged, can lead to insulin resistance, type 2 diabetes, and heart disease.

As I internalize the ongoing attacks on women’s basic healthcare, I fear not only for the increase in unintended pregnancy and abortion rates that will tragically occur if these laws go into effect, but for the millions of women who rely on birth control to manage chronic health conditions like PCOS, endometriosis, and menstrual migraines. As Lena Dunham, who’s been relying on birth control to manage her endometriosis-related pain for years, called out in her recent New York Times op-ed: “If the Trump administration follows through on its plan… women who rely on oral contraception would suddenly be living in a very different reality, one in which some could become disabled as their disease progressed.”

To name just a few attacks on contraceptive choice from this month alone:

  • The Senate Republicans proposed healthcare bill defunds Planned Parenthood and guts Medicaid, leaving millions of women without insurance and access to birth control (not to mention, no access to cancer screenings, maternity care and beyond).
  • The Trump administration’s leaked plan to rewrite the Affordable Care Act’s contraceptive mandate — which gives 55 million American women access to birth control without a copay today — gives any employer the right to deny birth control coverage to employees for any reason.
  • The Missouri House voted to pass a bill (SB5) that lets employers (and landlords!) fire or evict women based on their reproductive health history — including the use of birth control.

Why my employer or my landlord should know about — let alone be able to dictate — what birth control I take, I will never understand. It does make me wonder though, what if “birth control” was instead called “hormone control” to better encompass the plethora of reasons women might choose to use contraception? Would this whole thing be less politicized?

While birth control will never be entirely uncoupled from women’s sexuality — nor should it have to be — we must start viewing it within the context of traditional medicine and not merely as a lifestyle choice. Unfortunately, events of late make me fear the root cause of the attacks on women’s health stem from a truly misogynistic desire to prevent women from owning their own healthcare decisions.

From patient to founder

Soon after my PCOS diagnosis, I left my job at Google to start Tia — a next-gen women’s healthcare company for millennial women by millennial women. I thought: if I, who am fortunate enough to have the most access to information and high-quality healthcare can’t figure this stuff out, how can anyone figure it out? So, I set out on a mission to reimagine women’s healthcare from the ground up through the lens of the millennial female experience.

Just this month, we released our first product — a personal, private chat-based assistant you message with about birth control and sexual health. Tia aims to reduce the “guesswork” in women’s health, and help women exercise their right to choice in their healthcare decisions, big and small.

Today, Tia’s “superpower” is matching women to the best birth control method for their individual health and lifestyle needs, and helping women find care providers nearby — with or without insurance. Importantly, Tia takes into account the diversity of reasons women might choose to use birth control beyond not getting pregnant — including, to manage health conditions like PCOS and endometriosis. Above all else, we aim to create a new interaction model for women’s healthcare that’s rooted in women being the drivers of their own healthcare decisions.

I am proud and excited about how Tia can fill some of the informational gaps around sexual and reproductive health we see today, and help women navigate an increasingly complex world of healthcare at a time of extreme volatility. However, Tia alone can’t solve the access gaps in care that will result if any employer can deny coverage for birth control, if Planned Parenthood gets defunded and clinics close, and if pregnancy is considered a pre-existing condition. This is a fight that’s bigger than any one of us, that we need everyone to take part in. This starts by changing the dialogue around birth control as a sex-specific issue to a fundamental health issue — one that individual women should control for themselves.

If you have a story, about what birth control means to you, please share it with us! We are working on a storytelling project that delves into why women choose to use (or not use) birth control. Please send your story to choices@asktia.com.