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How To Be On Birth Control (Or Not)

As attacks on reproductive rights happen across the U.S., contraception is more important than ever...
Firefly Women Talking Together 99146

In her decade of using contraception, Erin has tried and tried again: combination pills, the minipill, the ring. “I’ve used six options over 10 years,” she says. After originally starting the Pill at 19, she found the first five years of her birth control journey to be smooth sailing. But then she started feeling…off.

The 31-year-old switched to the ring when she thought the Pill was making her hair fall out. From there, she found another pill that worked great for a while, until it began affecting her moods. Meanwhile, she was being served videos on social media daily from women raving about their decision to fully go off birth control. Doing so felt too risky to her, but finally, after a year of conversations with her fiancé (and her doctor) about their family planning goals and her ongoing issues, she decided she was done.

No more frustrating symptoms. No more hand-wringing over what to try next. “I’ve felt better since I stopped taking it,” Erin says. “But the only reason I’m okay with not being on it is because I know I’m going to try to start a family within the next year. No one should stop unless they’re all right with getting pregnant.”

As Erin discovered, deciding to be on—or off—birth control as a young woman in America in 2023 is an unfortunately fraught decision. Without the protection of Roe v. Wade, abortion is harder to access, if not totally illegal, in more than 20 states. At the same time, attacks on birth control access are also ramping up. In December of last year, a federal judge in Texas barred federal clinics—a long-standing bastion of birth control access for young people—from prescribing birth control to minors without parental consent. Experts expect infringements like these to continue, and the effects could be huge, says Alecia Fields, DO, an ob-gyn based in Kentucky and a fellow for the advocacy group Physicians for Reproductive Health. “We are seeing ob-gyns leaving some of the states that are becoming hostile to reproductive rights,” she says. “That is going to create problems for access to birth control.”

While this is happening, birth control (especially highly effective hormonal options like the Pill) is experiencing what might be called a bit of a reputational crisis. Misinformation about risks and benefits runs rampant on platforms such as TikTok, Reddit, and YouTube, so much so that docs are seeing an uptick in patients who are bringing unfounded concerns about contraception to their visits. “All of a sudden, everyone is coming in worried they’ve been on birth control too long—even bringing screenshots with them,” says Molly McBride, MD, a Manhattan-based ob-gyn.

25% of females aren’t using their preferred contraception. And only 30 percent of females said they had all the info they needed before choosing a BC.
Source: Kaiser Family Foundation

It leaves women like Erin stuck in the middle. Hormonal birth control can have side effects. And it may not be for everyone. But at a time when having reliable and effective protection is paramount, it’s also critical to have accurate information. “You have to be aware of what the algorithm is feeding you,” says Erin, who is just glad she unpacked her ups and downs with her partner.

Even without all the baggage, finding your BC match can be a complex journey. This is partly because we’re blessed with a plethora of options, from the Pill to the IUD to nonhormonal gel. “Ultimately, it’s your body and your choice,” says Suzanne Fenske, MD, an assistant clinical professor of obstetrics, gynecology, and reproductive science at the Icahn School of Medicine at Mount Sinai. “But you want to make an educated choice.”

Ahead, we’ll delve into the ongoing shifts in the conversation and separate fact from fiction so you can make an empowered decision.

How To Know If Starting (Or Staying On) The Pill Is Right For You
While the Pill is still the most commonly prescribed form of contraception—25 percent of women in the U.S. who use any type say it’s their method of choice—there
appears to be a gradual decline in usage since 2002, recent data suggests. The reasons are unclear, but some users say they randomly feel crappy on their pill after years of taking it; some are curious about how their mind and body might feel without a regular substance in it; and others have concerns about the impact of being on a drug for, say, a decade. (Some long-term Pill users have shared on Web forums, podcasts, and more that they felt “clear in the head,” “happier,” “seeing the world in color,” or more aroused after going off.)

Many doctors previously brushed off worries about mood changes, brain fog, and more, Dr. Fenske says—largely because there just weren’t very solid studies on how common side effects really are, or who will experience them. Plus, pregnancy prevention and the ability to treat medical conditions like painful periods with the Pill often greatly outweighed those concerns, at least from the doctor’s perspective. “For many years, the pendulum swung toward everyone being put on combined hormonal contraception pills in this country without question,” Dr. Fenske says. Now, she’s witnessing firsthand younger women pushing back against that and asking more questions.

Basically, there’s a disconnect between what many women feel is a concern versus what doctors and researchers believe is the actual issue. The Pill is a generally safe drug, but it’s not always an enjoyable one. The side effects are real for women who are sensitive to them. But that doesn’t mean it’s dangerous or that you need to consider going off it when you’re free of side effects. And that’s what more docs are seeing: women who are seemingly happy with the impact of their pill but freaked out by the constant stream of people saying they are quitting it for a host of reasons.

The majority of those taking it tolerate it well and enjoy not only the baby-free benefits but also the ability to control painful, heavy periods and even their acne. “The pills that are available today are very low-dose. They can improve your life and be a good method of birth control,” Dr. McBride says.

One more point of comfort: If one type or brand isn’t working for you, “you can choose a different one or a different generation,” Dr. Fenske says. And if you simply don’t want to take a pill every day? No problem. “There are always more effective methods coming out,” says Dr. Fenske. For example, you can talk to your doctor about an IUD or implant for long-lasting protection, the ring, or even newer nonhormonal options like Phexxi, which is a gel approved in 2020 by the FDA that you insert into the vagina before intercourse.

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