Words: Roxanna Pearl Beebe-Center
Before taking the first pill, I drew a bath, unfurled the pharmaceutical warnings that came in the pack and read them all. When I’d finished, the bath had gone cold.
When I began taking the pill in high school, it was, admittedly, because most of my friends were on it. Every day, as we sat in cliques at lunch, the sterile silence of the linoleum was punctuated by the circadian rattling of phone alarms, and small, silver packs were withdrawn from rucksacks. I wasn’t sexually active, but friends assured me of multiple reasons to go on the pill. At my next doctor’s appointment, I feigned some excuse – irregular periods, acne. While I did hope that the pill would mitigate my pubescent skin issues, I was elated at the thought of having a prescription of my own and a secret to keep from my father. I felt I had finally grown up.
Over the next 3 years, I became lax about taking Nikki, as my contraceptive was perkily named. I’d never read the instructions, figuring the preeminence of the ritual in pop-culture was instructive enough. I didn’t notice nausea or weight-gain, as some did, but my acne also seemed unchanged. Then, just as Nikki rendered herself useful, I became wary. A boyfriend’s mom swore that the pill had given her breast cancer. Friends brought up its oppressive nature – why was the onus for being sexually responsible on women? Every tan, lean woman I followed on Instagram advocated for – alongside the carnivore diet and raw milk – ‘fertility awareness’, where a woman monitors her basal body temperature and cervical mucus daily. By tracking these and other biological cues, she determines her ovulation period and avoids unprotected sex in that window. It seemed perfect – no side effects, no extraneous hormones. These endorsements suggested – sometimes explicitly – that hormonal contraceptives were the easy way out, and cycle-tracking reunited a woman with some natural, purer iteration of herself. I went off the pill several times over the next few years.
Nikki and I reunited this past December, when I went home for the winter holidays. I resolved to do my own research. Before taking the first pill, I drew a bath, unfurled the pharmaceutical warnings that came in the pack and read them all. When I’d finished, the bath had gone cold. The pill, also known as COCs (combined oral contraceptive) usually contains estrogen and progesterone, preventing pregnancy by halting ovulation. In the UK, about 17% of women of reproductive age relied on the pill as of 2022. In the US, it’s closer to 13%. The most common side effects of the pill are migraines, nausea, mood changes, sore breasts, and breakthrough bleeding. With Nikki, these mild side effects appear in less than 2% of users. The biggest concern when it comes to estrogen-based birth control is risk of blood clotting – that’s why smoking is discouraged for users. Additionally, there is evidence to suggest that COCs slightly increase a woman’s chance of developing breast cancer and, to a lesser degree, cervical cancer. However, this risk is reported to disappear entirely 10 years after pill usage stops. These results are all gathered from observational studies, which cannot definitively demonstrate links between cancer and the pill. Oral contraceptive usage has also been linked to lower rates of ovarian and endometrial cancer – these benefits persist long after pill use ends.
According to Caroline Timmerman, M.D., an Alaska-based emergency room doctor, most of the more severe potential side effects linked to oral contraception occur in older women who use estrogen-based contraceptives. Timmerman suggests that ‘higher rates of cervical cancer are related to the young age of when you start having intercourse and smoking’. Additionally, Timmerman only recommends the fertility awareness method for those trying to get pregnant, as it can help optimise chances of conceiving, although this practice isn’t viable for those with irregular periods.
When I nervously inquired if Timmerman endorses oral contraceptives, she was unequivocal. ‘Side effects are side effects, and some people may not have them, some people may have them… And the ultimate side effect of not taking birth control is that you have a baby’. Timmerman chuckled and continued, ‘that’s probably the biggest unwanted side effect… So, I think, again, everything has to have pros and cons. Every medicine you take… you have to look at the pros and cons, and I think there’s very few cons with estrogen in young people’.
So. After doing my own research and consulting medical professionals, I finally feel less trepidation about taking Nikki. While the sheet of side-effects is intimidatingly long, reading between the lines, the pill seems mostly innocuous, and the increased risk of cancer quite low. The pill isn’t for everyone, but it is for me.
Links: https://www.drugs.com/sfx/nikki-side-effects.html#serious-side-effects https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the -contraceptive-pill-increase-cancer-risk#:~:text=Cervical%20cancer%3A%20taking%20the%20c ombined,the%20pill%20was%20never%20used. https://www.nhsinform.scot/healthy-living/contraception/natural-family-planning-fertility-aware ness/ https://pmc.ncbi.nlm.nih.gov/articles/PMC4982257/ https://www.mariestopes.tl/services/womens-health/combined-oral-contraceptive-pill-coc/#:~:tex t=The%20combined%20anal%20 contraceptive%20 pill,egg%20each%20month%20(ovulation). https://www.statista.com/statistics/1063613/contraception-use-among-women-in-the-uk/ https://www.cdc.gov/nchs/products/databriefs/db327.htm https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/oral-contraceptives-fact-s heet https://www.nhs.uk/contraception/methods-of-contraception/combined-pill/side-effects/
