Let's take a minute to talk about birth control and medical gender bias because it is real. And as I explain in Beyond the Pill, it leaves a lot of women sick, struggling and sometimes dead.
Women have been waiting decades for the day that a male contraceptive (birth control) is approved for use. Looks like we’ll be waiting a little longer, ladies.
A recent trial of injectable male contraceptive was stopped after determining that the risks to men’s health outweighed the benefits.
What brought researchers to that conclusion?
Out of 320 men, there were 20 who said they couldn't tolerate the side effects, which included pain at injection site, acne, and depression. Yes, based on 20 men saying they were uncomfortable with these symptoms, they stopped the trial despite it being 96% effective.
To be clear, these are the EXACT same symptoms women experience at a higher rate when taking the pill and other forms of hormonal birth control.
Well, not the exact same symptoms. While most women experience low or absent libido using oral contraceptives, these men experienced an increase in libido.
But for the most part, the injectable male contraceptive has the same side effects that women have dealt with since the FDA approved the first birth control pill in the 60s. Side effects that women have voiced concern over. Side effects that often go dismissed.
The medical community and pharmaceutical companies have long perpetuated the narrative that being a woman is inherently awful and something that we will deal with our entire lives. That hormones make us crazy, give us acne, make periods unbearable and the only solution is to grit our teeth and bear it, take side effect inducing hormones or remove our organs, as is the case with a hysterectomy.
Many women, about 100 million worldwide, opt for hormonal contraceptives, which deliver the same side effects and more compared to the male version, yet deemed completely acceptable for women.
Let’s explore some of our hormone based options… or rather, the side effects:
Oral Contraceptives (aka The Pill):
Headaches, stroke, heart attack, depression, loss of libido, acne, nausea and vomiting, inflammation, low testosterone, thyroid disruption, gut dysbiosis, breast tenderness, bloating, weight gain, hair loss, and increase risk for certain cancers.
The Pill is also known to cause Post-Birth Control Syndrome, a myriad of hormone, digestive and immune symptoms that arise within months of stopping the pill. It isn't pretty and it is rarely, if ever, talked about before a doctor prescribes the pill.
Read more about What Doctor’s Don’t Tell You About Birth Control.
Depo-Provera (Hormone Injection):
Headaches, bone loss, depression, type 2 diabetes, pain at the injection site, menstrual irregularities, loss of menses, delayed fertility, hair loss.
Nuvaring:
Vaginitis (inflamed vagina), vaginal dryness, breast tenderness, disturbance during intercourse, loss of libido, acne, mood changes.
Norplant:
Menstrual irregularities, headache, weight gain, acne, breast tenderness, emotional lability, and abdominal pain.
Mirena Intrauterine Devices (IUD):
Expulsion, perforation of the uterus, increased risk of pelvic inflammatory disease, mood disorders, loss of menstruation, pelvic pain, headaches, migraines, ovarian cysts, acne.
All of these hormonal contraceptives are currently available to women with an FDA stamp of approval and plenty of studies to say that the benefits outweigh the risks.
But hold up. Those are the same side effects of the injectable male birth control that was deemed too risky to pursue further.
And when it comes to answering the question of risk versus benefit, the research takes a different tone regarding a woman’s quality of life.
Birth Control & Medical Gender Bias
A recent study in JAMA of over one million women showed that women were more likely to be prescribed an antidepressant when taking the pill. Only the women who actually filled their antidepressant prescription were measured, which means the number of women affected by symptoms of depression could be much higher. Keep in mind — women have reported depression as a side effect of birth control since the 60s.
There was also an increased risk in newly diagnosed cases of depression.
While many critics have stated that the increase in diagnosis is minimal, it is important to understand that the measurement of newly diagnosed cases was limited to women receiving a diagnosis in a psychiatric hospital—which would only include extreme cases of depression.
This is an important point — a woman would have to experience such extreme depression to warrant hospitalization in order to be counted as newly diagnosed. Women who had less extreme forms of depression were not measured.
Despite the issues with the study design, it still baffles me how quick doctors were to dismiss the correlation of mood disorders and hormonal contraception in women, with many authorities citing that they benefits still outweigh the risks.
Yet, when a trial shows the same side effects in men it is halted.
It should give us all pause that hormonal contraceptives with well studied and well known side effects are readily dispensed to women without a mention of the potential life threatening and debilitating risks they carry, while a male contraceptive carrying a fraction of the side effects is deemed unacceptable.
Early Birth Control Trials in Women and Men
Early trials of birth control were performed on women who didn’t understand what they were taking or the side effects. Many women left the trial early because of they couldn't tolerate the side effects—bloating, blood clots, nausea, mood changes, and breast tenderness.
Their results showed that 15% of women had side effects and 3 women died, without investigation, leading one of the doctors overseeing the study to deem the pill unacceptable for women and to advise against the formulation that was in use.
In the recent male injectable contraceptive trial, the two reasons cited for ending the experiment were based on 4.7% of men experiencing mood swings and 2.8% who reported depression. Again, the original study on female contraception showed that 15% of women experienced symptoms. Despite the high side effect profile, they released that same formulation to women across the nation.
And not a lot has changed where double standards are concerned…
While 4.7% is deemed an unacceptable rate to continue a male trial, the latest FDA-approved Kyleena IUD showed adverse reactions in greater than 5% of women.
According to Bayer’s trials, the most common side effects “… were vulvovaginitis (24%), ovarian cyst (22%), abdominal pain/pelvic pain (21%), headache/migraine (15%), acne/seborrhea (15%), dysmenorrhea/uterine spasm (10%), breast pain/breast discomfort (10%), and increased bleeding (8%).”
They also found that 22% of women chose to have the device removed due to adverse reactions. Yes, more than 20% could not tolerate the side effects, but the IUD went to market despite these findings… in the same quarter that we saw the male birth control trial come to a halt.
The difference is significant between the genders—why would they stop a trial with less side effects for men, but continue to push to market birth control options with higher and broader side effects?
In the early days of birth control development they had considered a male contraceptive pill, but reportedly assumed women would put up with the side effects more than men… and they weren’t wrong.
Why Would Women Willingly Take the Pill?
Women have been fighting for equality for a long time and the ability to control our reproductive health with contraceptives has been an instrumental part of that battle.
It wasn’t that long ago that it was illegal for women to get contraception of any kind. Before the 1960s, women in the U.S. were at the mercy of their ovulatory cycle and had few and frightening options—postpartum hysterectomies and unsanitary abortions top the list.
The ability to prevent unwanted pregnancies has been revolutionary for women. One study found that pill was in part responsible for a 10% increase in wages beginning in the 1960’s with estimates climbing to 30% by the1990s.
Additionally, there is data to support that access to the pill contributed to increases in college enrollment and completion rates among women from the 1960s-1970s.
Why Might Women Willingly Subject Themselves to These Side Effects?
Enjoying the same freedoms and opportunities men have been afforded through their basic biology makes the pill more than appealing.
The burden of pregnancy has always weighed heavier on women’s shoulders. And so many of us, myself included, have opted for an effective means to prevent pregnancy at some point in our lives.
Perhaps there is a perception within the pharmaceutical industry that men won’t tolerate the side effects and that they’d prefer the burden to be passed to women.
But that raises the question—what choice do we really have?
When our jobs, our education, our quality of life are all at stake it would seem that passing the buck on birth control is an easy decision for the pharmaceutical industry.
Women’s reproductive freedom will always be part of the equality conversation. And we still have a very long way to go, especially in medicine.
As clinicians, as health care advocates, as a country, we can do better.
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