Happy 60th Birthday To You, Dear Contraceptive Pill. It’s Time We Had A Talk.

Sixty years is a lot of years. Sixty years old is a solid amount of old.

If you’re like my Dad, you might decide your 60th birthday heralds the chance to go Level Five Vegan and to also try gold temporary hair dye for the first time.

There are other, less fabulous, ways to celebrate 60 years. For example, you might decide: now’s the time to do a little reflection on the sort of person I am. Consider how I could do better. Ask myself, and others, the tough questions.

Happy birthday to you, dear Contraceptive Pill. In 1956, the United States Food and Drug Administration (FDA) first approved the use of hormonal contraceptive pills for menstrual disorders. It was made available more broadly (albeit selectively, with discrimination against unmarried couples) in 1960.

So, why are we talking about the pill’s birthday? Because the pill celebrated its big six-oh with some serious news. A national study in Denmark, released on 28th September, has revealed the extent to which the pill is linked to subsequent use of antidepressants and/or diagnosis of depression in users, with teenage girls particularly at risk.

This news was released to a crowd of double face-palming womb-havers who all said “ya think?!” and flipped the pharmaceutical industry the bird. The study has been covered in a particularly impassioned article in The Guardian provocatively named “The pill is linked to depression — and doctors can no longer ignore it”, and many conversations have taken off as a result.

This study is important for its large sample size, and its duration, but it is not news. There are previous studies exploring the link between hormonal contraceptives and depression. For example, a 1976 report from the American Journal of Obstetric Gynecology reported that between 10–40% of users experience mild to moderate depression. Happy 40th birthday to that study.

There is also layperson feedback from users, gathered over many years, reported to doctors and (hopefully) passed onto pharmaceutical companies. The pill has adapted regularly over its sixty years — for example, offering lower doses, or different types of hormones — but the major side effect on mood thrives unabated.

Speaking of birthdays, here’s another one to celebrate. Fifty-six years since Germaine Greer wrote The Female Eunuch. There’s a lot of material in there that’s outdated, transphobic and solipsist. But there are certain points that still hold water today. For example, in the chapter “The Wicked Womb”, Greer writes:

“The enormous hoo-ha about the strange impalpable results of vasectomy upon the male psyche results from [a] continuing phallocentricity: the devisers of the pill worried so little about the female psyche that it was years before they discovered that one woman in three who was on the pill was chronically depressed.”

Even fifty-six years ago, the statistics were staggering. All of which leads me to ask: what is so very unimportant about female depression that nothing has changed?

The gendering of contraception

Would men accept this the way that women have? They haven’t had to. The World Health Organisation is still carefully studying the various physical and mental interactions of a male contraceptive pill. Men’s moods are apparently worthy of the very best research and development.

What do some doctors have to say? Surely after scores of patients return to your office, sharing horror stories of mood mishaps, you would start to grow cautious? Dr Cora Breuner, a U.S. paediatrician, is quoted in The Guardian saying:

“An unintended and unwanted pregnancy far outweighs all the other side effects that could occur from a contraceptive.”

I’m a writer, not a Doctor. But I know a false dichotomy when I see one. This issue is more complex than the binary of “pill” and “pregnant”, and to make it so stark ends up negating the suffering of one’s patients.

Reframing liberation

Many women take the pill as a scientifically verified precaution against contraception. It is a form of contraception that is governed by the woman, rather than relying on anyone else’s intervention. This is why the pill is meant to spell women’s liberation: because we make the decision to take it and we have some control over the fertility of our wombs as a result.

So, what happens when a tool of liberation tethers us to a lifetime of side effects such as depression and low libido?

Medication is prescribed as a measure of risk versus reward. Most patients understand that side effects are a rare, but possible, result of taking medication.

My question is: what if we don’t respect female mental health enough to see that we are putting ourselves at much too large a risk, to make any reward great enough? Have manufacturers of the pill benefited from 60 years of women playing down their own suffering or having it deemed unexceptional?

Let’s try to think positively. Perhaps the Danish study will be the push that pharmaceutical companies need in order to look at the risk:reward ratio more clearly. But I’m not holding my breath.

You are not alone

We have to take matters into our own hands. It starts by listening, and sharing. Share your symptoms with your doctor and your community. Open up a space where these conversations are allowed. When you are prescribed mood-altering medication, let your doctor know that you would like to regularly check in regarding your mood symptoms, and ask them their preferred mode for such conversations. If your doctor baulks at the idea of a regular conversation, this is a warning sign. Find a doctor who takes your concerns seriously, who allows you to be a key member in all decision-making around your body, and encourages you to do your own research.

There are many users of the pill who come up trumps in the risk:reward contest. You might be one of them. Or you might never find the right pill, after many failed attempts. If so, weigh up whether this sort of contraception is worth the struggle. Would you be better off spending your fertile years using barrier contraception instead? There is nothing wrong with making such a choice, despite what a lot of popular media might tell you.

Most of all, remember you are not alone, and your body is not defective. This is the small comforting takeaway that can come from the Danish study. The statistics are proving to you, once more, as they have for so many years, that you are not imagining things. You have reason to feel this way.

Take this with you throughout the journey: an odd, bitter, yet important solace.

This article by Jessica Bellamy was originally published at The Vocal.