Pill problems

The contraceptive pill revolutionised our lives in the 1960s, but many women today are fed up with the side effects. Should we still be taking it, asks Anita Chaudhuri ? If not, what are the alternatives?

One pill makes you larger, and one pill makes you small." For anyone who has ever struggled to find the right brand of oral contraceptive, the words to the psychedelic anthem will have particular resonance. Weight gain  and sometimes weight loss  not to mention fluctuating levels of self-esteem, libido and depression, are just some of the known side-effects of the pill.

It is still the most reliable method of contraception, and the most popular in Britain, where 28 per cent of all women aged 16 to 49 are on it  an estimated three million people. However, a recent survey revealed that only a third of women felt they had been offered any alternative to the pill by their doctors.

In a sense, it has become a victim of its own success. The pill revolutionised women's lives, yes, but it has become the default choice for many doctors, and women don't always understand that it might affect them emotionally as well as physically.

Now it looks as though a grassroots backlash is on the way. The internet is awash with blogs and forums devoted to women's disenchantment with different brands. Holly Grigg-Spall is the author of one, at sweeteningthepill.blogspot.com. "It used to be uncool to speak out against the pill," she says. "People used to view you as either religious or pro-abstinence."

She was inspired to set up her blog after a bad experience with one such pill, Yasmin, and has since been overwhelmed by the number of women who have written to her with their own stories about the pill. "When I first started taking it, I lost weight and my skin looked great," she says. "But about a year later I started having awful changes in my emotions and outlook. I felt disassociated and unresponsive. I became paranoid and experienced uncontrollable rages."

Ms Grigg-Spall began comparing notes with friends who were also taking the drug. They, too, had endured negative experiences: one had panic attacks and couldn't leave the house, another was seriously depressed. However, she did not immediately link her own symptoms to Yasmin. "I spent four to six months analysing my life. Women tend to look for reasons outside themselves if they feel bad. But if they are on the pill, they should certainly look to that. Eventually I made the connection and came off it."

Katherine Davies, 25, tried eight different brands before calling it a day. "In two months I gained two stone," she says. "I'm only 5ft 2in, so the change was drastic. I became very depressed. Nobody warned me this could happen," she says. "I've switched to Mirena, the hormone-based coil, and I've had no problems with it."

Having talked to hundreds of women about their experiences for her book, The Pill: Are You Sure It's for You?, Alexandra Pope asserts that, by and large, doctors are not taking women's pill concerns seriously. "You go along and they'll say, 'But you're going to have these symptoms whether you're on the pill or not'  usually in response to low mood or lack of sex drive." Pope points out that many women are unaware of how the pill works. "Because you're not ovulating when you're on it, it flattens everything out," she explains. "You go from a cyclical being with peaks and troughs, to frozen in a particular place. Logic should tell you that it is going to affect things."

A study at Monash University, in Australia, indicated that pill users were more likely to experience depression. The cause is believed to be progestin, one of the hormones in the pill that is known to lower brain serotonin levels.

Dr Shirley Bond, a doctor at the London Medical Centre, agrees that the pill is prescribed too readily  largely because it saves time. And in her experience, the current wave of young pill users, by which she means the under-35s, is not adjusting to the drug as well as previous generations. "They genuinely seem to be having more problems, but I'm not sure why," she says. "Extreme dieting, stress and environmental pollution might all be factors."

However, Helen Jenkins, a contraceptive and sexual health specialist, recommends that it is worth persevering with the pill, even for those women experiencing problems. "First, it takes a few months for most women to settle down to a particular brand. If you keep switching, it could be the case that you're never giving your body time to adjust. Second, although the doses in the pill are very low, some women have a high sensitivity to artificial hormones. In this case, you should try different brands."

She says Britain's department of health is promoting the use of long-acting reversible forms of contraception (known as Larcs), which include injections, implants and intra uterine devices (IUDs).

For anyone with pill concerns, Ms Jenkins offers some reassurance: "The pill is one of the safest drugs: 100 million women use it worldwide. The problem is, we're trying to find the perfect contraceptive method for every individual, and it's not 'one size fits all'. Every drug has side-effects  it's about weighing up whether those effects are manageable or not." Sunday Times

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