Photo of The Pill for article on The Pill by Dr Anne Malatt

The Pill

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Of all the many drugs on the market, there is only one pill known as ‘The Pill’.

The Pill is a combination of synthetic female hormones – oestrogen and progesterone – used to mimic pregnancy and suppress female ovulation and thereby fertility, reducing the chance of unwanted pregnancy.

Women the world over have come to rely on The Pill to control their fertility and their lives, believing that – more than any other form of contraception – it frees us of the burden of unwanted pregnancy and all the risks of either carrying or aborting that pregnancy. We see it as empowering us – that it allows us to decide whether and when we will have our families, thus giving us control over our careers and more options on the playing field of work and of life.

Doctors have embraced the use of The Pill for women, seeing it as an effective form of birth control and a way of giving women control over their fertility and their lives. They see it as a way of caring for women and protecting them from the complications of unwanted pregnancy and childbirth.

To put things into perspective, when the Pill became available in the 1950s, if women became pregnant when they had not planned to, they had to bear the child and raise it or adopt it out; or have an illegal abortion, often under difficult and dangerous circumstances. All of these options were associated with a great deal of shame and stigma, especially for young single women, and serious risks to the health of the women.

Abortion was not decriminalised across Australia until 2021 (1), and there still remain many legal, ethical and practical roadblocks to obtaining one. It is a topic that remains controversial, heated, fraught and still forbidden in many parts of the world.

So the introduction of the Pill was seen by many women and their doctors as a positive step for women’s health and their rights to control their bodies, that was widely embraced.

How did The Pill come to be?

The History of The Pill

The Pill has its genesis in Nazi Germany, where doctors and scientists were testing ethinyl oestradiol (the same chemical still being used in hormonal birth control today), as a chemical sterilisation agent in their Auschwitz concentration camp.

The harms of using synthetic oestrogens, which are powerful chemicals that can affect every cell in the body, soon became apparent, but doctors continued to use them for various ‘off-label’ indications after the war, for post-menopausal symptoms and to ‘prevent miscarriage’.

The use of smaller doses of oestrogens for birth control was resurrected in the 1950s by a collaboration between Dr Gregory Pincus and Margaret Sanger – a woman whose mother had died early after 11 births and 7 miscarriages and who wanted to develop a ‘magic pill’ to prevent unwanted pregnancies. Ignoring the many warnings about the dangers of synthetic oestrogens, they attracted the interest of big names with big money who were already active in the fight for population control.

The use of The Pill was approved by the FDA in America based on a study of only 132 Puerto Rican women who took The Pill for just 12 months. The information presented to the FDA showed its efficacy but concealed its (lack of) safety, as the 5 previously healthy women who had died while taking The Pill and been buried without autopsy were not included in the data. The Pill was approved for use at a time when there was a sexual revolution in the West, women wanted to control their bodies and their fertility and plan their careers, and at the same time there were fears of a worldwide population explosion.

During the first decade of its use, doctors reported women suffering and sometimes dying with clots – strokes and emboli. Despite mounting evidence, the drug companies refused to take responsibility for the grave complications, but employed a public relations strategy to cast doubt on the findings, ironically claiming the numbers were too small to draw any conclusions and more research was needed.

In 1968 the British Medical Journal published the retrospective Inman-Vessey study which showed a 7.5-fold increased risk of death from stroke in young women taking The Pill. It was a large and sound study and the dangers of hormonal birth control could no longer be ignored, yet doctors continued to downplay the risks and encourage women to take it, and women continued to choose it, wanting its convenience and effectiveness and turning a blind eye to its potential risks for them.

Increasing concerns about the side effects of the Pill and many other problems in the pharmaceutical industry led to the establishment of what came to be known as the Nelson Pill Hearings, a Senate inquiry into ‘Competitive Problems in the Drug Industry’ chaired by Senator Gaylord Nelson. The hearings began in 1967 and ran for ten years, looking at the vast range of issues in the drug industry (most of which are still problematic today) and in 1970 the committee turned its attention to birth control, inspired by a letter from Barbara Seamans which included this quote:

“Never before in history have so many millions of people taken such a powerful and unnecessary drug.” (2)

And this quote from Dr Philip Corfman of the National Institutes of Health:

“There is no organ or system in the body which, upon examination, has not been found to be affected by the pill.” (3)

Evidence was shared by expert doctors on a range of complications related to The Pill.

Yet now, 50 years later, it continues to be used by women worldwide and it is not a safer version, as is often stated. The makers of Yaz and Yasmin, today’s most popular brands of The Pill, have paid out more than $2 billion to settle over 10,000 blood clot lawsuits and the numbers continue to rise. And many of the ‘rare’ complications that doctors were attributing to The Pill at the hearings are manifested in large numbers today.

The information from these hearings was suppressed by the efforts of the pharmaceutical industry’s massive public relations machine and millions of women still suffer the consequences of this suppressed information.

The push for population control

The push for population control was very strong at this time and backed by very powerful people, but it was not politically popular, and more subtle means of limiting the world’s population were sought.

In an address to the Association of American Medical Colleges in 1969, Nobel Prize winner Dr Frederick Robbins said this:

“The dangers of overpopulation are so great that we may have to use certain techniques of conception control that may entail considerable risk to the individual woman.” (4)

As Senator Nelson said during the hearings:

“They (many doctors) conclude that population control is so important that no one should be informed about the pill for fear they will not use it.”(5)

As the push for population control was so politically unpalatable, the focus shifted from collective to individual responsibility for birth control. It was Malcolm X who suggested the term ‘family planning’, saying that people would be more willing to plan than be controlled.

The continuing mantra was, and is: The benefits still outweigh the risks. The supposed benefit to society from population control vs the risk to individuals. In the eyes of many, the end justified the means.

Even today, when you begin to research side effects associated with The Pill, you are met with certain responses: (6)

  1. “This doesn’t prove a connection” – usually followed by “More research needs to be done.”

This has hampered those with safety concerns ever since the early days.

  1. “This doesn’t mean women should stop taking The Pill.”

This often comes from the lead investigator who has just uncovered the link to a chronic or deadly complication.

  1. “This only affects X women per 10,000.”

But with millions of women taking The Pill, any number per 10,000 adds up quickly.

  1. “The risk is greater if you are over 35 or smoke.”

Which is true, but young women who don’t smoke are also at risk of serious and life-threatening complications.

  1. “The benefits still outweigh the risks.”

Benefits to whom and risks to whom?

Side-effects of The Pill

There are well known side-effects of The Pill and others that are less well recognised. This is a short summary of what we know.

Many side effects of The Pill occur as common ailments, like breast cancer, migraines and strokes, and these illnesses have grown even more common since the introduction of hormonal contraceptives. They have become so common, so familiar, that we seem to have forgotten about looking for what could be causing them.

Some side effects, such as migraine and depression, can occur soon after taking The Pill but others can take some time to precipitate, which may hinder us associating the cause with the effect. Doctors tend to downplay the effects of The Pill to the point where we often don’t attribute the effects to the drug at all.

  • Migraines

 The correlation between birth control pills and migraines has been known for decades, as has their connection to an increased risk of stroke.

Each year significantly more women die from stroke than from breast cancer, yet we still tend to think of stroke as an old person’s disease, even though the risks of it are climbing in young people, and we don’t identify the risk factors, which include migraine headaches with aura, hormone replacement therapy and oral contraception.

  • Blood clots

The association between birth control pills and strokes has been known since Dr Victor Wynn’s study was published in The Lancet in 1966. Since then, we have also learned that young women can suffer other dangerous and deadly thrombo-emboli and pulmonary emboli.

The veins in the legs of women on The Pill dilate and blood flow slows down, leading to relative stagnation which can contribute to clotting. The facts about The Pill and blood clots have been known in detail since the Nelson Pill Hearings in 1970, yet we have not addressed these concerns and we continue to promote its use. And not only are newer formulations of The Pill not safer, some which contain drosperinone have been found to be two to three times more likely to cause clotting than previous generations of The Pill.

  • Atherosclerosis

The Pill can cause atherosclerosis, plaque build-up or hardening of the arteries, and the risks increase the longer you take The Pill. While clots are a short term, reversible risk (if you survive) the risk of atherosclerosis continues long after you stop taking The Pill and could lead to stroke or heart attack.

Some of the leading factors that can contribute to atherosclerosis include: high blood pressure high blood sugar levels, and high cholesterol levels, all of which can be raised by taking The Pill, through the effect of these synthetic hormones on other hormones in the body.

  • Breast cancer

Before the Nelson Pill Hearings, the pharmaceutical industry had managed to suppress knowledge of their product’s link to cancer, particularly breast cancer, but during the hearings the facts came to light. Despite this, women worldwide have continued to take The Pill for years, and even decades.

At the time of the hearings, in 1970, the lifetime risk of breast cancer in American women was 1 in 20. Today it is 1 in 8, an increase of 210% in 50 years.

In 2017 a large Danish study reported that women on hormonal contraceptives were 20% more likely to develop breast cancer, and this study included the lower dose pills, hormonal IUDs and progestin-only pills. Oncologist Dr Marissa Weiss said:

“Gynaecologists just assumed that a lower dose of hormone meant a lower risk of cancer. But the same elevated risk is there.” (7)

  • Permanent Sterilisation

The Pill is a synthetic hormone. We know that other hormones like steroids must be used with extreme caution in the body, because they can upset the delicate balance of the endocrine system and in some cases cause permanent damage to it.

The use of synthetic oestrogen to override the production of natural hormones can also lead to long term consequences of delayed fertility or even infertility and many women stop taking The Pill when they are ready to have children only to find that they are not able to.

  • Depression and mood disorders

 We frequently dismiss irritability and depression as minor side effects of birth control that can be treated with more medication – antidepressants.

It has been known since the early days that The Pill affected the moods of many women and the rates of depression and suicide had increased. Dr Harold William compiled suicide statistics from 1961 (the last year before birth control became commonplace) and 1967, and the rates had increased dramatically – up to 100% in the 20-24 year age group.

The newer generations of birth control have not eased the problem. A 2016 Danish study showed that women taking hormonal birth control were 70% more likely to experience depression and in 2017 the same research group found that the depression experienced was more intense than that of women who had never taken hormonal birth control and that taking birth control more than tripled the risk of committing suicide.

More recent studies have shown a link between The Pill and autoimmunity and brain inflammation which could help to explain some of these effects and also the fact that many women on The Pill respond poorly to treatment with psychiatric drugs.

“It needs to be emphasized that if you give a patient one drug and counteract it with another, there is a rising curve of adverse reactions.” (8)

  • Autoimmune disease (AI)

Dr Noel Rose first hypothesised the idea of the body’s immune system attacking itself in the late 1950’s and came up with the name autoimmune disease (AI). There are now nearly 100 different diseases under this classification, all of which have in common the fact that they are due to the body’s immune system attacking its own tissues.

There is a genetic predisposition to these diseases, but they are activated by environmental triggers. Natural oestrogens play a vital role in a woman’s immune system, attaching to T cell receptors and signalling the cells to fight disease, which provides an increased level of protection against infectious diseases. But synthetic oestrogens throw this delicate system out of balance and confuse the immune system, which can then attack the body’s own healthy tissues.

Nearly 80% of all autoimmune diseases occur in women.

  • Systemic Lupus Erythematosus (SLE)

SLE used to be a rare disease that was even rarer in young patients. Women on The Pill are 50% more likely to develop Lupus and the greatest risk is in the first three months of taking it. There is clear evidence that taking The Pill often brings on or worsens Lupus disease activity.

  • Multiple sclerosis (MS)

With some autoimmune diseases like MS, sex hormones appear to promote inflammation at normal levels but dampen it at higher levels. During actual pregnancy, the high oestrogen levels improve MS symptoms by 80%. Hormonal contraceptives flood the body with synthetic oestrogen, mimicking pregnancy. This can provide temporary relief of MS symptoms but it disrupts the delicate balance of the endocrine and immune systems, creating devastating consequences for MS patients in the long run.

A 2014 study showed that women who had taken The Pill were 35% more likely to develop MS than women who had not.  In 1940, the ratio of women to men with MS was 2 to 1. By 2000, 4 out of 5 MS patients were women.

  • Crohn’s Disease and Ulcerative Colitis

Crohn’s disease is inflammation of the lining of the gut which affects absorption from the intestine. This can diminish the effectiveness of hormonal birth control and so most doctors switch the patient to a higher dose of The Pill, not realising it may have caused the disease in the first place.

In 2015,  a Harvard study showed that women who took hormonal birth control for five years, more than tripled their risk of developing Crohn’s disease. They also faced a 74% increased risk of ulcerative colitis, another inflammatory bowel disease.

  • Hair loss

The progesterone in some pills can have a male hormone like effect on the hair. If a woman has a genetic tendency to hair loss and then she takes pills which have male hormonal effects, that can trigger the thinning. This is a fact hairdressers have known for decades but one which doctors are not always likely to attribute to The Pill, even though it is listed in the side effects on the pamphlet inside the box.

  • Thyroid

The most frequent side effects experienced by women on birth control parallel the symptoms of hypothyroidism: weight gain, water retention, constipation, decreased libido, high cholesterol…

If a new patient presented to a doctor with these symptoms, they would not miss the warning signs of a hypoactive thyroid, but if they have recently started on The Pill, they say the symptoms are ‘just’ because of this, and not to be concerned about them, as they are so common we have come to believe they are ‘normal’.

Hormonal birth control affects thyroid function in many ways – and up to 40% of women experience some changes in thyroid function related to The Pill. The body responds by producing more cortisol in an attempt to boost energy levels and this can lead to adrenal suppression and long-term fatigue.

  • Liver

The liver is the central organ in the metabolic process, producing proteins which break down fat and hormones, to generate energy. When we overload the body with synthetic hormones, the liver can become sluggish and inefficient. This can set off a toxic cascade of side effects which can lead to inflammation and contribute to chronic diseases. Carbohydrate, lipid and protein metabolism are affected and the effects on the body reach far and wide.

Studies in the 1970’s showed that women who had taken The Pill for eight years were 500 times more likely to develop hepatocellular adenoma, an otherwise rare form of benign liver tumour, with 4% of those becoming cancerous.

  • Gallbladder

The Pill affects cholesterol metabolism and there is significantly more cholesterol in a woman’s gallbladder bile while she is on The Pill. Since cholesterol makes up 80% of gallstones, it is no surprise that studies have shown that women who have taken birth control are 36% more likely to develop gallstones than women who had never taken it. These numbers will increase as the newer generations of pill contain the progestin drosperinone, which increases the chances of gallbladder disease by another 20% over previous formulations, not only by increasing the amount of cholesterol in the bile, but by decreasing the movement of the gallbladder, creating conditions ripe for the formation of gallstones.

It’s not just about women

The World Health Organisation classified hormonal contraceptives as Group 1 Carcinogens in 2005. While the risk may be most significant for those women who choose to take them every day, sometimes for years or decades, they are not the only ones who are harmed.

Ethinyl oestradiol is a synthetic hormone which is 100 times more potent than our natural oestrogen. In order to be absorbed into the body and effective at preventing pregnancy, these molecules cannot be broken down by stomach acid. They pass through the body virtually unchanged, meaning that millions of women are flushing these powerful chemicals into the sewerage system every day.

Environmental scientists have known of the effects of these oestrogens on the feminisation of fish for years, but what are they doing to all of us?

A 2017 study found that sperm counts in human men have dropped by more than half since 1973. The theory is that male foetuses are being exposed to environmental factors in the womb, which are antagonistic to their male sex hormones and are affecting their reproductive development. Depending on when the foetus is exposed to these harmful chemicals, the effect can play out in numerous ways, such as abnormal genitalia, testicular cancer and poor semen quality.

The effects parallel those of men whose mothers were given forms of the earliest marketed synthetic oestrogen, diethylstilboestrol (DES) decades ago, a drug which is still causing problems in the children and grandchildren of women who took it while they were pregnant to prevent miscarriages. 

What do we do with all this information?

It is beyond question that The Pill causes serious health problems for women, and it is increasingly apparent that it may cause problems for all of us. The Pill has come to hold an iconic place in contemporary culture and the narrative has been defined in such a way that ‘birth control’ equals ‘The Pill’ equals ‘Women’s Rights’. Which is fortunate for the drug companies as any ‘attack’ on The Pill can be spun as an attack on Women’s Rights. There is social pressure on young women to take The Pill, and they are assuming the risk to their health while the pharmaceutical companies reap the considerable financial rewards. Women are making their decision based on minimally informed consent, many trusting that their doctor knows best. The same profession that not so long ago told us smoking cigarettes was good for us.

“When you’re privy to information about The Pill, and you know most women haven’t been given that information, does your responsibility change? I think it does.” (9)

Mike Gaskins, author of “In the Name of The Pill”

The above pages are a summary of the wonderful book by Mike Gaskins called “In the Name of The Pill” which was introduced to me by a friend, and I can highly recommend reading the whole book for a heartfelt, detailed and nuanced exposé of the facts. As a 60 year old woman, wife, mother and grandmother, who just happens to be a doctor, I was horrified that I did not know these facts. I was not taught them in medical school, which is one factor that needs to be addressed, but I also took The Pill from the ages of 17 to 35 and had every opportunity to know them from the intelligence of my own body.

Our responsibility as doctors

Our profession has the noble tradition of taking an oath to “First, do no harm.” What is our responsibility as doctors when it comes to prescribing women The Pill? We are taught that the benefits outweigh the risks but after having read this book, I can no longer say this is true. We have been lied to as a profession, by our colleagues, by drug companies, by powerful people with vested interests and agendas such as population control, and we have been complicit in believing and circulating those lies.

Professional opinion was manipulated by doctors and drug companies from the beginning of The Pill’s history. Dr Louis Hellman, the chairman of the FDA committee that approved the use of The Pill, is on record as admitting that the committee believed The Pill was not safe and despite this, he then hit the media circuit to reassure woman that it was, emphasising efficacy and minimising safety issues.

Big Pharma spends $3 billion a year on advertising direct to consumers, but it spends 8 times more on marketing direct to health care professionals, $24 billion annually. A recent study published in JAMA Internal Medicine showed that even a single $20 meal sponsored by a drug company can influence a doctor’s prescribing habits and the impact increases with each meal. These small gifts translate to a huge return on investment.

Most people, including medical professionals, have bought into the storyline that this is old news and newer formulations of The Pill do not have the same problems but this is simply not true.

There is no debate at all that hormonal birth control increases the risk of deadly blood clots. Drug companies have paid out billions of dollars in settlements related to injury and death from these clots (where they don’t have to admit fault and families are not allowed to talk about it) and tens of thousands of women have died from clots related to their birth control.

Researchers are terrified of telling the truth for fear of losing their funding, the media don’t want to offend their pharmaceutical company advertisers, drug companies make big money from The Pill and from the drugs used to treat breast cancer, and doctors are the willing prescribers, so women keep dying of a preventable cause.

When do the risks start outweighing the benefits?

Our responsibility as women (supply and demand)

We may assume that women are innocent recipients of all of this, but how is it that women are willing to override the knowing of their own bodies to take powerful hormones that can have harmful and even lethal effects? We can say that we did not know, but is that really true?

I know for myself, that The Pill made me feel awful. I was irritable and miserable for the nearly 20 years I took it and it is quite possible that my moodiness contributed to the several relationship breakups I went through, and to my seeking relief from alcohol (which only made matters worse). But I had gone through a termination after an unplanned pregnancy at the age of 17 and did not want to go through that experience again. And I wanted to be able to have sex with whom I wanted it, when I wanted it, without the inconvenience of having to take responsibility for the consequences. And herein lies the dilemma. The sexual revolution liberated women, or so we think, but did it? Or did it make us more male in our ways? And did the taking of The Pill and the suppression of our natural hormonal cycles, contribute to this embracing of male energy as our own?

There is something quite lovely about a woman in her sacredness, honouring her body and her natural cycles, and being willing to say no to physically sharing that body if and when it does not feel true for her. But how many of us have the self-worth, integrity, even self-love to do that? How many of us feel we have to be available 24/7 to please our men, no matter how we are feeling and what the consequence may be? How many of us feel we have to put our health and even our lives on the line to make sure that we are sexually available, all of the time?

There are fertility awareness methods (10) that are just as reliable as taking The Pill, when used correctly, but how many of us are willing to connect with, pay attention to and honour our bodies in order to be able to use these methods?

Women as a whole have lost their connection with their inner sense of stillness and sacredness, the essence of what it is to be a woman. We have given ourselves away and settled for competing with men on their playing field … a field we were never designed to be on … for the essence of a woman is the living stillness within her and devoid of this, we are lost and so are our men.

In this lost-ness we can be irresponsible with our bodies and our choices, ignoring our natural cycles and rhythms. We can harden and be more male like in our desires and behaviours, more driven in our ways and oblivious to our innate sacredness. We can think that having on tap sex whenever we want without fear of pregnancy is a benefit worth having irrespective of the costs or consequences.

Until we as women are willing to take full responsibility for our cycles and our bodies, with deep appreciation of our innate sacredness and worth such that we truly listen to and honour our bodies and rhythms, we will remain at the mercy of the drug companies and quick fix solutions with all the inherent risks they entail. It is up to us to start saying no to what is not true for us and honouring what is true from our precious, intelligent, wise and deeply sacred bodies.

The key to restoring our inner sense of stillness and sacredness starts with a stop. Just stop the relentless motion we are in, the eternal doing and striving to be someone or something we are not. We are inherently all beautiful, sacred and divine. When we start to reconnect with this innate loveliness, we begin to honour our beautiful bodies and their cycles and it becomes a joy, not a burden, to live in this honouring way. And the more we honour our bodies, the more we connect with the divine being they were designed to enhouse.

When we begin to live with our Soul, it is only natural to honour the rhythms and cycles of the body, to live in deep respect of them, to nurture the body and the being it enhouses and to enrich our lives and the lives of all those around us from the living stillness, the eternal sacredness, within.

References:

  1. https://theconversation.com/abortion-is-no-longer-a-crime-in-australia-but-legal-hurdles-to-access-remain-156215
  2. Barbara Seamans, p27, In the Name of The Pill

3.. Dr Philip Corfman, p28, In the Name of The Pill

  1. Dr Frederick Robbins, p55, In the Name of The Pill
  2. Senator Gaylord Nelson, p67-8, In the Name of The Pill
  3. p69, In the Name of The Pill
  4. Dr Marissa Weiss, p122, In the Name of The Pill
  5. p138, In the Name of The Pill
  6. Mike Gaskins, p 198, In the Name of The Pill
  7. https://www.followyourflow.com.au/cycle-wise-woman

2 COMMENTS

  1. Thank you for writing about this topic Dr Anne. I took the Pill for many years and I did suffer from severe migraines, depression and exhaustion. Nowhere in my education was there mention of a woman’s sacredness. Sacredness was owned by religion and only applied to Mary mother of Yeshua, or places of worship. In my 70’s I am learning to love and care for this sacred body as I connect to the Soul. It is a very deeply honouring and joyful path to be walking.

  2. Thank-you Anne, Your contribution is powerful and essential work. My personal experience with ‘the Pill’ is very limited, Hence, I found myself reading and pondering on just about every word, certainly on all that you have presented here that reveals the gaps in and falsities of, the information /guidance that has so dominated discussion and practice in these domains of women’s health.
    From the point of view of my responsibilities in a current and relatively new work-role in perinatal and antenatal care, I deeply appreciate the immense value of what you have shared here. It feels awesome to be so wholistically informed and thus more able to bring true support to the women who present to our clinic.

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