Women Are Fearful of Hormonal Contraception

Contraception has been a game changer for many women providing the freedom to plan our lives, pursue dreams and take control of our reproductive health. Yet the topic of contraception is still taboo. Some women are too embarrassed to talk openly about their use of birth control and subsequent experiences.

But each day we are closer to breaking down these stigmas by creating multiple online environments where women can seek support and feel comforted. The Lowdown is a women’s health review platform where women can share their experiences on hormonal or non-hormonal contraception. “There are over 6,000 reviews that women can browse through and read other women’s experiences on the pill, the coil, the implant, and many others” says Dani Conlon, community leader at The Lowdown.

Dani said that since launching, due to their success they have expanded into areas such as fertility, PCOS and endometriosis as these were the topics, they were commonly asked about by people who wanted to learn more about other women’s experiences with those journeys.

“The Lowdown’s main goal is to help inform women about their choice, especially with their reproductive rights.” She says.

 

The widespread of social media:

Social media can influence people’s perceptions and decisions, including towards contraceptive methods. While it can provide valuable support and educate us, misinformation can be amplified causing confusion amongst the content consumers.

With platforms such as 'TikTok' and 'YouTube': “If it's a bad news story, it gets shared. And if it's a good news story, it doesn't get shared. So, I think there's an amplification effect sometimes with bad news” says Dr Susan Walker, associate professor at Anglia Ruskin University.

She adds: “Humans are sort of programmed to warn each other, and that is probably a good thing. But we can pass on warning stories much more than we pass on good stories.”

It’s great that women are sharing their experiences on hormonal contraception, “but it might add some scare mongering to the story, when maybe all that you need is to chat to a doctor about what the best option for you is,” says Dani.

This is exactly why The Lowdown exists, she added that: “It is a place for people to find answers. We have a wealth of blogs and knowledge, and you can get your answers straight away.”

Joanne Goodman is an Advanced Clinical Nurse Lead specialising in reproductive and sexual health at the Dorset Sexual Health Clinic. She says that it all comes down to effective communication, as it can sometimes be difficult with online information. “Not all resources are legitimate, and it is sometimes about dispelling myths and rumours about certain methods to reassure people that there is a method to suit them.”

 

Contraception effects on women:

The NHS released a report on their website in 2017 which found that 59% of females in the UK used a dependent method of contraception, and 41% used Long-Acting Reversible Contraceptive (LARC), with over 30% of LARC users being under 20 years old, and 55% aged 35 years and above.

But in more recent years (2021 and 2022), 56% of women between the ages of 16 and 17 years old were using dependent contraceptives, compared to 44% of women using LARC, according to Statista data results. It is clear that dependant methods, such as the combined pill, are most commonly used by younger age groups compared to older age groups.

Joanne Goodman says that the majority of people have little or no problem with hormonal contraception, “however it is a trial and error to find a method that suits each individual.” She explained that with the combined pill for example, the most common side effects are headaches and erratic bleeding for those on the progestogen only methods.

Dr Susan Walker, who specialises in contraception behaviour, says that with the combined pill the worst-case scenario that a woman can experience is a blood clot. But she reassured that “it’s a very, very rare side effect.” So which age group is more likely to get a blood clot from the hormonal pill?

According to Lloyds Pharmacy website, people on the combined pill are at three times higher risk of blood clots than those who aren’t on it. In numbers this means that twelve  in every 10,000 women on the combined pill get a blood clot. Women over the age of thirty-five are more likely to experience blood clotting whilst on the hormonal pill, but some younger women can get it due to family history, or because of a disease or condition that might cause them to develop a clot, Dr Walker said.

Lorayne Bell is 55 years old, and she has only been on the oral contraceptive. She said that whilst on the pill she had aching joins and felt very tired. “Eventually I was diagnosed after 11 years with lupus and the first thing that they told me to do was to stop taking the contraceptive pill, which had a completely dramatic effect on the blood test results that came back,” said Lorayne.

As soon as she stopped taking the pill, the blood test results plummeted, and the lupus was much more manageable. She has not used any hormonal contraception ever since as she was afraid that her diagnosis would come back and flare up. Lorayne said: “Because lupus causes me to have sticky blood, I have blood that clots easily. And the pill does have a side effect of causing blood clots. So, for that reason, I wouldn't take the pill either after that, because the risk of blood clots is quite high.”

Joanne Goodman said that with combined hormonal methods like the pill and the patch, there is a risk that the hormone, oestrogen is not suitable for women with hypertension, cardiac problems, and history of blood clots. “Oestrogen can increase the risk of clotting and any pre-disposing factors will increase the risk of an ischaemic episode such as blood clots or stroke,” she added.

Dr Susan Walker clarified that blood clots are hard to acknowledge but a tender and swollen leg is something to look out for, “but 50% to 60% don’t produce that, so it can be quite tricky.”

Dani Conlon had her own unpleasant experience whilst on the implant. The 26-year-old said that she was on the hormonal implant for one year. “First of all, it was great, I didn’t have a period and I was really, really pleased. And then unfortunately I got my periods back, my mood changed, and I actually lost my sex drive. So, it kind of didn’t really feel right for me to be on the implant anymore,” Dani said.

She used The Lowdown herself to look through other women’s experiences, and saw that other people had the same experiences as her. At the moment Dani is hormone free, but she says that there is a sense of worry that if she went on a different type of contraception, she is going to feel similarly to how she felt on the implant. She said that “platforms such as The Lowdown are so useful because you can really compare and share you experience with other people and help them make a better choice. And so now when I go on my next hormonal contraception, I will always check The Lowdown.”

Joanna Goodman said with the combined pill, the most common side effects a women can experience are mood swings, acne, decreased or increased appetite, headaches, nausea, and breast tenderness. Jamiee Phillips is 20 years old, and she has been on three different combined pill prescriptions and one mini pill prescription. She said that the combined pill did not help regulate her periods and made her acne “ten times worse.” She felt very depressed and during her last prescription she was diagnosed with polycystic ovaries and had to go to A&E due to the pain she was experiencing. Jaimee said that the medics told her to come off the pill straightaway.

“They always tell me to try the coil because I still suffer with really irregular periods. But I don’t think I will feel comfortable putting anything permanent in my body, just because I know how these things have reacted with me,” she added.

Erin Harding is currently 17 years old, but she first started using hormonal contraception at the age of fifteen. She was prescribed the pill which she said made her gain weight after two months of taking it, as well as experiencing mood swings. Due to this she changed her pill prescription but this time she said that she lost a significant amount of weight and felt very down. Erin opened up that whilst taking the pill she got pregnant, and due to this she decided to come off the hormonal pill as she said that “there was no point for me to be on it anymore.”

The medics have suggested that she goes on the implant which she recently got. Erin said that it has been about to two months and that “so far it hasn’t been amazing, but they told me to give it time.” She added that her appetite is all over the place, “Some days I struggle to eat because I feel very sick for the whole day, but other days I am really hungry.”

Before going on the implant, Erin Harding said that she was very scared of the idea because all that she could think about is how it was all going to be the same, and that she is going to feel depressed and put on weight.

 

Why the fear?

The widespread of social media has had a positive and negative impact on individuals. But do we blame just social media for discouraging women about hormonal contraception?

Dani says that women are fearful about the side effects of hormonal contraception because unfortunately they can’t predict what would happen if they went on the combine or mini pill. She adds: “Their doctor is going to advise them but for some women it just doesn’t work out for them, in my case exactly.”

Joanne Goodman says that “there is sometimes hesitancy for people to try different methods once they have had a bad experience with one.” She explained how more information about side effects can deter people from trying certain methods, so within the clinic, they try to give all women the options before they make a final decision.

But do all medical professionals provide the same sort of support that Joannes clinic does?

Jaimee Phillips said that she did not feel supported by her medic. She felt that she was given a generic recommendation based on everyone else and then told her to give it three months.

Erin Harding had a similar experience with her consultant. When getting her implant, she said that she wasn’t told much about it or given any warning of what she is getting into. “They just kind of put it in me and told me let me know how it goes,” she adds.

Erin advised that girls should do their own deep research before they go on it. “They don’t really talk a lot about what they are actually putting you on. I feel like I should have researched the pill a little more and with my implant as well, I read after getting it that I will be bleeding for a long time. So, I didn’t expect that. They didn’t tell me that.”

So, what can medical professionals do to reassure women better about the birth control?

Dani Conlon said: “I think that women need longer consultation with their GPs when they get prescribed their different kinds of contraception. But especially in the UK, the NHS are so strapped to the time that you can only really get ten minutes.”

Dani added that what she finds a lot when talking with women, they say that they don’t feel like they are not being listened to by their GP. “And that isn’t because the GP doesn’t care, but because they don’t have the time,” she says.

Dr Susan Walker expressed that one of the difficulties with any conversations about risks and side effects, it is extremely difficult for people to understand, as well as doctors and nurses who also find it difficult to know how much the risk is chancy.

She used the analogy of peoples fear of flying on planes more than they worry about travelling in cars, when statistically it is proven that travelling in a plane is much safer. Through this she was proving that that the fear towards hormonal contraception is purely just fear but factually safer than taking aspirin or paracetamol, which statistically are much more dangerous, though we still take them without thinking about it too much.

Agreeing with Dani, Dr Walker also said that if there is one thing doctors and nurses could do to improve would be sitting down with women and talk about the risks for half an hour. “Unfortunately, at the minute doctors and nurses don’t have that time,” she said.

 

How can we educate men about it?

When talking about contraception its always focused on women because at the moment there are more female contraceptives than there are for men. But this shouldn’t mean that men don’t need to learn about female birth control and how it can affect their female partners, colleagues, or family members.

Dani says that its quite often that she finds herself speaking to people who tell her how they are spending a lot of time educating their partners on hormonal or non-hormonal contraception. “I think that men should really be taking an action to educating themselves. There is a lot of stuff online where they can research, including The Lowdown,” she adds.

Both Erin and Jaimee similarly suggested that men read about female contraception online as this can help them understand and comfort their partners or family members when they might be in a bad mood. Jaimee said that when she was in year five, the girls were taught more things about contraception and sex education than the boys. She thinks that if men were given the equal amount of education on contraceptive methods, they would be more aware about the side effects and how it can affect women.

Dr Susan Walker also said that the lack of male education on birth control is a big problem. “One of the things I would do is I would make sure that boys in school receive the same information and classes about contraception as girls do, you might need to give them in a separate class. Sometimes I think boys and girls like to be separated. But I wouldn't exclude boys from that kind of contraceptive information.”

Are women fearful of hormonal contraception?

The answer varies with each female individual and it’s important to remember that every woman’s experience on the hormonal or non-hormonal contraception is different. Listening to other women’s experience shouldn’t make us fear to go on birth control, instead we should these stories as a source of education through which we should feel like we have gained more knowledge on effects of hormonal contraception.