A recent Instagram post by illustrator Jaime Squire spoke about the need for more easily available information about contraceptive pills. In the post, Jaime talks about how the pills made her a different person and she was just not prepared for it.
Pills are great, don’t get me wrong. Oral contraception offers freedom to women in a manner unlike a lot of other things. If you want to be on it, you go, girl. However, before you do, ensure that you are making an informed choice. Several women, after being on the pill for a couple of months, talk about the unexpected effects of it on their bodies.
Migraine, Suicidal Thoughts and the Female Burden
A case in point is of a 26-year-old professional, Aayushi Thakur Sinha, who was on the pill for over a year due to medical conditions. While it helped her body in many ways, she was also caught unaware with a specific side-effect.
"I was on the pill for 13 months. It was part of the medical treatment I was taking for my ovaries and the pill helped in a lot of ways, for instance it regulated my monthly cycle. However, I was blindsided in one aspect - it triggered my sinusitis and caused severe migraine headaches. The tricky part about the pill is that all bodies will have different side-effects. This is how my body chose to respond." - Aayushi Thakur Sinha
Another common side-effect associated with oral contraception is mood swings. Did Aayushi face them too?
"Yes, there were mood swings, and how bad or bearable they will be is something you realise only when it’s happening to you. That’s not something you can be prepared for." - Aayushi Thakur Sinha
The topic of mood swings brings us to the second case in point, of 27-year-old Garvita Khybri who was on the pill for a period of four months, once again for a medical condition. She adds that the pill affected her mood to the extent of making suicidal thoughts a common occurrence.
"I was on the pill for about four months and was just not prepared for what happened to me. Sometimes my mood got low enough to make me suicidal. I was taking it as part of hormonal therapy, and it triggered extreme changes in my mood. I was not informed about its side-effects at all, so when they began, I just ended up calling my gynaecologist all the time, trying to understand what’s going on." - Garvita Khybri
And lastly, we come to another important concern - why is the burden of contraception only women’s to bear? Several women feel pressured, by parents or peers, sometimes coupled with a desire to please their partner, to go on the pill, without being fully aware of the extent of its effects on their body.
Raising the same concern is Namratha Rao, a 27-year-old public health professional and dog behaviourist.
"Yes, I am aware of contraception methods. However, I was very frustrated that they were for women (such plethora of choices don’t exist for men, and I can’t just rely on condoms). I am also annoyed that so many methods available to us are hormonal. I would feel okay with this if at least some of the onus of contraception was with the men too." - Namratha Rao
Namratha’s concerns are not ill-placed at all. According to the National Family Health Survey, 2015-16, which was conducted by the Ministry of Health, 3 out of 8 men believed that contraception is ‘women’s business’ and men shouldn’t bother about it.
Also Read: What Birth Control Do You Use?
"I dislike hormonal methods, but non-hormonal methods can also have their side effects AND why the hell is the onus only on women!? My bigger problem is not that the side effects are not discussed, but that contraception methods don’t target men as much as women." - Namratha Rao
She was on the pill for 1.5 years and about 2-3 years, at two different points in her life. When it comes to side-effects like weight gain and mood swings, Namratha says she faced neither, but it could also be due to her regular workouts.
To read more about myths and side effects of oral contraception, click here.
In the meantime, we reached out to two doctors to understand the biology of oral contraception better.
‘Do Not Combine Pills With Smoking’
Dr Sonia Naik, Associate Director and Head of Unit, Obstetrics and Gynaecology, Max Multispeaciality Centre, Panchsheel Park, says that we need to remember that all pills are not for everyone.
"This can’t be decided over the counter. All medical conditions need to be considered and only after that can the combination of medication be decided." - Dr Sonia Naik
When it comes to one of the lesser known things about contraception, one very important and harmful habit is smoking.
"What most women don’t know is that they are not supposed to be smoking when they are taking any form of hormone therapy. If you do indeed mix contraceptive pills with smoking, your body becomes prone to clotting. The clot can be anywhere and can, in rare cases, cause life-threatening complications in the form of a stroke." - Dr Sonia Naik
To give perspective, Dr Naik adds that if the chances of a stroke are 1 for every 1 lakh women, when combined with smoking, it increases 20-30 times.
Know Your Family History
Dr Naik cannot emphasise enough the importance of the medical history of your family.
"We have to check if there are any instances of stroke or paralysis in young family members. If there are any liver or migraine related problems, they can get aggravated by the pill. Along with these, we also look for epilepsy, cardiac problems, uncontrolled diabetes, blood pressure or hypertension." - Dr Sonia Naik
She adds that though most girls who approach her for oral contraception are very well aware, they still do not know about the importance of family history and not coupling smoking with oral contraception.
She further adds that young girls should remember to keep themselves adequately hydrated when on the pill, especially in case of a long journey.
"It’s also important for young girls to remember that when undertaking a long journey, they should get enough calf exercise and keep themselves hydrated since hormone medication leads to water retention and can cause thrombosis (blood clotting)." - Dr Sonia NaikNo Scientific Evidence For Weight Gain
Dr Swati Mittal, Senior Consultant, Obstetrics and Gynaecology at Fortis Memorial Research Institute says that when it comes to issues like weight gain, it’s important to note that there really is no scientific evidence to support this.
"You might gain 2-3 kgs, but that is because of water retention. Soon after, it goes away too." - Dr Swati MittalBe Regular, Always
Being regular with the pill is of utmost importance, says Dr Mittal.
"Before people go on the pill, women need to ensure that they know the importance of being regular with it. This includes the proper timing - taking it around the same time everyday." - Dr Swati Mittal
From her own observation and experience, Dr Mittal adds that most of her patients who ask for the pill for contraceptive purposes are around 25 years of age and form only 10 percent of her total patients.
"Of this, only half continue. Most give up the pill after taking it for six months. Those who continue go on for as long as 6-7 years, but the percentage is very small." - Dr Swati MittalEfficacy of Oral Contraception
You need to keep in mind the efficacy of the pill, says Dr Mittal. If you take it immediately after the period ends, it won’t be too effective. You need to take seven pills for seven days before they begin to work. So, if you take it at the close of the period, by the time the efficacy kicks in, seven days later, ovulation would have already happened.
Dr Mittal says that in her experience, women have hardly come to her to take it as a form of contraception. Most take them for medical conditions, she adds. Mostly the age group is women in their 20s.
"Even a 16-year-old can take the medicine, though it’s usually not required and we avoid it. We avoid them after 35 of years of age too, by then most women stop taking the pill themselves. " - Dr Swati MittalPills Don’t Provide Protection Against STDs, STIs
Both doctors also add that before anyone goes on the pill, they need to remember that oral contraception is no protection against STDs and STIs. Hence use barrier contraception as well in the form of condoms.
Dr Mittal adds that oral contraception reduces your chances of ovarian, endometrial, uterine and even colon cancer.
Like Dr Mittal, Dr Naik agrees that pills of this nature reduce the chances of ovarian cancer. They reduce the chances of ovarian cysts as well, but it’s important, she insists, to take into account each woman’s individual detailed family history.
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