Friday, February 21, 2014

Sweetening the Pill

Or How We Got Hooked on Hormonal Birth Control

                The medicalization of women’s bodies has a dark and bloody history. Throughout history, but perhaps most prominently from the Victorian era onward, women have been subjected to all sorts of poisons and ills to “treat” those processes which indicate good health. Why is it that the very things that make us women, (menstruation, gestation, ovulation, lactation, birthing, and menopause) have so often been treated by the medical field as problems to be dealt with? Perhaps because the medical field has been dominated by men for the past several thousand years, with the exception of midwifery and “witchcraft,” which in some cultures may have simply been female herbalists who used spirituality and natural treatments for common ailments. But most of what we think of in the past two thousand years as “medicine” has been a male-dominated field. Are hormonal birth control pills a conspiracy of the patriarchy to oppress women? To reduce and regulate those frightening menstruations, to render women infertile, to blunt the effects of testosterone and other “raging” hormones, and make women more available sexually? Maybe.  Is it a conspiracy of capitalism to make women buy a drug that they need to take every day, even when they are perfectly healthy? Just as women need to buy tampons and pads, shavers and creams, moisturizers, make-up, deodorants, and a hundred other products, just to function daily as a woman? Maybe that is also true.
                These aren’t my ideas; I came across them in reading Holly Grigg-Spall’s wonderful work, Sweetening the Pill. Grigg-Spall is a feminist and writes from a non-religious perspective on the dangers of hormonal birth control and lauds fertility awareness methods and other non-hormonal forms of birth control. I found reading this book refreshing and empowering. It has been sometime since I read truly feminist literature, and I felt as though reading this helped put me in touch with the broader struggle women face today.
                Grigg-Spall posits that ditching the pill can be an act of rebellion against the patriarchy, and encourages women to reclaim their bodies and their biology. She discusses feminist groups in California who meet in circles and use speculums to observe the changes to their cervixes and mucus throughout their cycles, and also learn first-hand the many variations of the female body. It is a radical act of taking gynecological knowledge into their own hands. Most women have never seen their cervix, or even looked properly at their own genitalia, and this allows women to familiarize themselves with their own bodies. I loved this example, although just one of many instances in which Grigg-Spall describes women reclaiming their biology through self-knowledge and awareness. I love it because it is a metaphor for NFP or fertility awareness methods of birth control. These methods are first and foremost about KNOWLEDGE of a woman’s own body. So many women don’t understand why at certain times of the month they find a lot of fluid and mucus, and may even think this is abnormal, such as an infection, and don’t realize it is a sign of healthy fertility! So many PMS symptoms, risks of miscarriage, hormonal imbalances, PCOS, and other health problems can be detected from charting a woman’s cycle.  Grigg-Spall argues these health problems can be treated best, not with the magical cure-all pill, but with synthetic hormones that very closely mimic the ones in our own bodies, which is not the same thing as what is in most hormonal birth control products.
                Right as I was finishing this book, I attended a talk by Dr. Nolte of the Gianna Center in New York City. Her talk was on infertility, the bioethical problems of IVF, and the alternative of NaPro Technology. It is funny how Dr. Nolte, a conservative Catholic, and Ms. Grigg-Spall, a secular feminist, agreed on so many things. For one, they both agreed on the use of synthetic hormones that more closely match real estrogen and progesterone to treat hormonal problems in women. Too often the pill is used to “treat” these conditions, when in fact it does nothing to treat the underlying cause of the hormonal imbalance. Dr. Nolte says she does a full hormonal profile, which means drawing blood every few days from the woman for a cycle, to see exactly which hormones are out of balance and in which part of the cycle. Then she will use the closest thing to the actual hormone that is available, and only administer it during the part of the cycle it is needed. For example, if a woman is not making enough progesterone, she will take progesterone supplements, but only AFTER ovulation, which is when that hormone naturally spikes. To take it over her entire cycle would actually shut down the cycle and suppress ovulation (which is what some birth control pills do.) Dr. Nolte has found that women who have undergone this particular therapy who previously had a very high incidence of miscarriage, have been able to successfully maintain pregnancy to term, and have even had their cycles begin self-regulating, increasing natural progesterone and dispensing with the need to medicate. 
                Grigg-Spall and Nolte both would agree that hormonal contraceptive is grossly overprescribed and that most women are lacking a basic understanding of their own biology. For example most women don’t know that they are in fact only fertile for 12 to 24 hours a month, with sperm able to survive for a few hours to 5 days. The length of sperm survival actually depends on the woman and HER mucus. If she has fertile cervical mucus that nourish the sperm and allow them to enter the cervix, they can live for days. But if there is no cervical mucus, the sperm die in a matter of hours in the acidic vagina. Most people don’t know this! Why isn’t this basic biology knowledge taught in high school? (Well, I am teaching it in my classroom, but I can’t vouch for other biology teachers.)
                Or course Dr. Nolte and Ms. Grigg-Spall would have their differences. Grigg-Spall is still pro-abortion and pro-condom, and favors a form of fertility awareness that is not kosher in the eyes of the Catholic Church. Ms. Grigg-Spall did not say much if anything regarding IVF in her book, but one of the downsides to hormonal contraceptives she did highlight, was the sometimes months or even years it can take for a woman’s natural cycle to return fully after quitting hormonal contraceptives. Dr. Nolte pointed out that many women are on hormonal contraceptives for most of their fertile years, and then when they want to conceive, have difficulty doing so. Part of the problem though, is lack of patience. A couple may feel their biological clock ticking, and rather than waiting and taking the time to chart cycles and detect the underlying problem, will go to an infertility specialist, and if they have the money, they are inevitably offered IVF. One of the main bioethical problems of IVF, from a Catholic perspective of course, is the creation of extra embryos, and the subsequent freezing of them. There are millions of embryos in frozen storage from IVF, and this in the eyes of the Church, is the same as creating human beings, with souls, and freezing them indefinitely. Big problem. Moreover, there is low success rate with IVF (around 30%) and this number doesn’t even account for the women who drop out due to complications before the IVF process is complete. It is very expensive, and has a high risk of multiple births. Often if a woman becomes pregnant with more than twins in IVF, she will be counseled by her doctors to “reduce” the pregnancy, by selecting one of the fetuses to be terminated for the sake of the other two. So now, after the heart-break of years of infertility and desperation for pregnancy, the woman is put through the painful decision of deciding which of her children to terminate. Dr. Nolte has had a very high success rate with her use of NaPro Technology, and boasts much higher success rates than IVF, although granted her process takes longer. She also has very rarely had twins, although it has happened. In the spirit of honesty, I should note that Dr. Nolte is my OB/GYN, although I have only just been recently seeing her. So far I have been extremely happy with her and the Gianna Center clinic. The level of care and concern was phenomenal. She didn’t just treat my reproductive system, but takes into account the whole individual. It was the first time I had an OB/GYN ask me about my diet, exercise, vitamins, etc. It was the first time I had an OB/GYN screen me for PMS and other hormonal problems. These are the things you would expect from your gynecologist, but usually all they are checking for is STDs and cancer and then they ask you what method of birth control you are using.
But I digress. Even though Dr. Nolte and Ms. Grigg-Spall may not see eye to eye on the sanctity of the embryo, I think they have a surprising amount of common ground and if women came together over fertility awareness, instead of arguing over our differences, much good could be accomplished. For example, I think both women would agree that fertility awareness could be taught in a high school biology curriculum. They might disagree on some of the details, but the basics of biology, the hormonal, mucus, temperature, and cervical shifts over a woman’s cycle, should and can be taught to young women (and men.) They both agree that hormonal contraceptives are over-prescribed and often have undesirable side effects such as depression and loss of libido.
My only major critique of Sweetening the Pill is a lack of citation for her scientific facts. Most of her science, to the best of my understanding and from what I have read in other sources, seems accurate. But it would strengthen her arguments if she bothered to properly footnote her statistics and facts with references to peer reviewed science journal articles, or at least something. She does reference many other books, most by fellow feminist authors, and she gives those books proper credit. She also has a list of recommended reading and resources in the back. Still, there is nothing like a good-old footnote to support your point if someone calls into question the integrity of this or that fact. Furthermore, I think she could have discussed IVF and infertility treatment and the modern process of birthing as yet other ways women’s bodies have been medicalized. But in her defense, the thrust of this book is the use of hormonal contraceptives and the effect on the bodies of women, and some topics she touches upon, such as menstruation, she does not have time to delve into in this slim book.
As for my own personal experiences, like Ms. Grigg-Spall and millions of women, I went on hormonal contraceptives at a young age. I was 17. Unlike Ms. Grigg-Spall who was put on the pill by her mother, almost as a rite of passage into womanhood, I chose the pill for myself, against my parents’ wishes. I was on it for nearly four years. During that time I experienced weight-gain and depression. I don’t personally attribute my depression to the pill, as I was going through many life-crises at that time, but Grigg-Spall recalls many anecdotal cases, particularly with Yasmin/Yaz, of women suffering from depression and lack of energy while on hormonal contraceptives. She claims that doctors and the medical industry don’t take these complaints seriously, but dismiss them, putting the blame on the women, not on the drug. There must be something else wrong with them, it can’t be the drug they are on, even though so many report mood changes when going on the pill, and then that fog lifts once they go off. But no, it couldn’t be the pill! Grigg-Spall seems to indicate that this dismissal of women’s reports of emotional side-effects, is yet another way the medical industry is silencing women and delegitimizing their experiences.  It was Grigg-Spall’s own struggles with depression on Yasmin/Yaz and her subsequent recovery after eliminating hormonal birth control that prompted her to write this book.  How many of my friends have suffered similarly? I don’t know. Although almost all my female friends have been on hormonal contraceptives at some point in their life, it is something we sadly don’t talk about. I do know that I had one friend become hospitalized from a blood clot that was partly a complication from her birth control pill. I also had a friend who always had very regular periods her entire life, experience loss of her menstrual cycle after using the morning-after pill. Her entire cycle shut-down and she went months without a period. Her doctor finaly had to put her on hormonal contraceptives just to restore her cycle. It was never the same after she used the morning-after pill.
Maybe what we need is some sort of Wikipedia space for women to report out about these side effects and document them publicly. There are many online forums where women gripe about this or that hormonal contraceptive and the side-effects they are experiencing. We need to make our voices form a collective and get these numbers to the FDA. Too many women bear their suffering in silence and alone, thinking it is just them, it must be a problem with their body, not the drug.
As an exciting development, just as I was writing this, several friends shared with me that Ricki Lake is teaming up with Abby Epstein to make a film documentary based on Sweetening the Pill. Awesome! I think a documentary by Ricki Lake will reach a wider audience than Grigg-Spall’s book alone. Women need to not be afraid to take on Big Pharma, and challenge what the ads claim is “natural, safe, and effective.” That fine print, those warning labels, need to be given a face and voice. Even if the percentage of women experiencing these side-effects is small (which it probably isn’t) with over 80% of women taking birth control pill at some point in their lifetime, we need to take these side-effects very seriously, and ask ourselves, is it worth it? Is this truly the best and healthiest way for women to prevent pregnancy? I hope Ms. Lake’s documentary will include alternatives, such as fertility awareness methods.

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Thank you for this thoughtful writeup. I just hope people read it and the underlying book, and it makes a difference.
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