Ditching the pill for good

New health concerns have women looking for different choices


Teresa Lambert was 15 years old when she first went on the pill. Her family doctor, she says, talked up its benefits: “She said my skin would be clear, and I’d know when my periods were coming.” At the time, it sounded “great,” she says, but 10 years later, she’s feeling differently: the 26-year-old recently went off the pill, and says a lot of her friends are doing the same. “I didn’t want to be taking something that altered my body any more,” says the Calgary native, who now uses condoms instead.

Lambert isn’t alone. While the pill remains one of the most widely used methods of birth control in Canada—only the condom is more popular—a growing number of women are feeling ambivalent about it, or ditching it altogether. In fact, oral contraceptive prescriptions in Canada levelled off in 2008, reports pharmaceutical industry analyst IMS Health Canada. Health care workers are seeing a growing demand for non-hormonal methods. Spurred by concerns about their health, the environment, or even frustration with family doctors, who sometimes seem to push the pill as a modern-day cure-all, Canadian women are looking for other options.

In this age of organic produce and yoga studios on every block, it’s no surprise that a growing number of women don’t want to take hormones every day. Yet a spate of recent studies left some, Lambert included, doubly concerned. In April, U.S. researchers announced that birth control pills seem to impair muscle growth: in 73 healthy women aged 18 to 31, those who weren’t taking oral contraceptives gained 60 per cent more muscle mass than those on the pill. Birth control pills typically contain a mix of estrogen and progesterone, the “pregnancy hormone,” says Steven Riechman of Texas A&M University, one of the study’s authors; the results could be due to the fact that, “when you’re pregnant, you’re not building muscle, because you need to reserve resources for the fetus.”

To prevent pregnancy, the pill suppresses ovulation, which is why Emma Lind, 28, avoids it. “I consider ovulation to be my most powerful time,” says the Ottawa resident, who uses condoms. “My skin clears up, I’ve got lots of energy, and I’m physically present.” Before this fertile phase, a woman’s estrogen and testosterone levels peak, causing a spike in libido, says the University of British Columbia’s Dr. Jerilynn Prior, scientific director of the Centre for Menstrual Cycle and Ovulation Research. In women who take the pill, hormone levels stay relatively flat.

It isn’t just a woman’s sex drive that might be affected by the pill; experts speculate it could even impact their taste in men. In a recent paper, University of Sheffield researchers concluded that women on the pill don’t show the same preference for more “masculine” features—like dominant behaviour, or competitiveness—that ovulating women do. What’s more, they’re less likely to choose partners who are genetically dissimilar from themselves. (When genetically similar couples have children, it can cause health problems for the baby.) Though the reasons aren’t fully understood, it seems that men respond to a woman’s cycles, too. Prior cites a surprising study in lap dancers which found that, right before ovulating, they got the most tips.

For Lind, the environment was also a factor in her choice of birth control. Synthetic estrogens from the pill, as well as those naturally produced by our bodies, are passed through human urine, ending up “in the sewage treatment plant,” says Vance Trudeau, a biologist at the University of Ottawa. Trudeau’s work has shown that, when these estrogens find their way into the ecosystem, they can turn male frogs into female, a result that Lind declares “scary.”

How to explain the pill’s lasting popularity? For one thing, it’s effective: about 98 per cent, if used correctly. In spite of the wide range of birth control options available to Canadian women, from the contraceptive ring to the patch, women stick to the condom and the pill, notes a recent report from the Society of Obstetricians and Gynaecologists of Canada.

That’s partly due to a lack of familiarity with other methods: health care workers are often “more comfortable talking about the pill,” says Dr. Amanda Black, an assistant professor at the University of Ottawa and lead author of the study, and lack the time to walk a patient through several other options. Even so, many women increasingly lack patience with this. “I’m amazed how many contraceptive devices there are out there that you just don’t hear about,” says Toronto resident Emily van der Meulen, 32. Meanwhile, “you go into a university washroom, and every second ad is for the birth control pill.”

As women look for other options, the intrauterine device is making a comeback: the Mirena IUD, for one, releases small amounts of hormones directly into the uterus, levels that Black says are almost undetectable in the bloodstream. But several women told Maclean’s that, when they approached their family doctor about being fitted for one, they had to be referred to another doctor. “Not all doctors are comfortable putting them in,” Black agrees. “Sometimes there’s an extra step that isn’t there with the pill.”

Of course, that’s not the only reason the pill is prescribed. It offers benefits beyond pregnancy prevention, she adds, lowering the risk of endometrial and ovarian cancer. (Some studies have suggested an increased risk of breast or cervical cancer, she notes, but more research is needed.) It’s often prescribed to treat everything from menstrual cramps and acne to hirsutism (excessive hairiness).

Not all women, though, are happy to take hormones to treat what they see as perfectly natural conditions. Stephanie Bialik, a 25-year-old Calgary-based writer, was prescribed the pill at the age of 13 to help her heavy periods; looking back, she wonders if it was necessary. “I wasn’t really used to my cycle, or how it felt,” she says. She’s not taking the pill anymore.

The pill does have some side effects, Black notes, but most of them—like headaches, nausea and bloating—are simply a “nuisance,” and will soon go away. Indeed, millions of women take the pill today with good results. Prior agrees that most doctors would advise women to “take the pill and not worry about it,” but she takes a slightly different view. “There’s an emotional identity attached to achieving your own menstrual cycle, and being able to read your body,” she says. “When you’re on the pill, it’s the doctor who’s controlling your cycle. You don’t own it.”
Since going off the pill, Lambert’s been watching her own body change: “I always had really clear skin, and now my skin’s breaking out,” she says. “It’s not awesome being 26 and having acne, and trying to figure out your periods.” Even so, she says, “I’m glad I’m doing it.”


Ditching the pill for good

  1. It really isn't that hard to control your fertility naturally either. I only have one daughter that we planned for. I'm not saying that it is as absolutely effective as the pill, and you do have to be careful, but as long as you work together it is a viable (if not fullproof) solution.

    It does require a stable marriage with people willing to restrain their sexual appetites however. It also has to involve some amount of willingness to accept that you might have an extra child along the way if you're not careful enough. We consider it a fair trade-off for undiminished pleasure during sex, no surgery, and no imbibing hormones over your lifetime.

  2. My wife and I have used the Billings Ovulation Method for 30 years. It allows a woman to observe when her fertile period is, and enables a couple to abstain or try to achieve pregnancy. Our use of the Billings Method is partly due to our Catholic faith and partly due to health concerns mentioned in the article.

    Note: the Billings Method is NOT the same as the old "Rhythm" method. Rythm just predicted, unreliably, when fertility would occur. Billings allows the woman to observe it.

    • That is good news that you have used the Billings Ovulation Method of natural fertility regulation. This Method is being used by millions of Chinese couples who are not Catholic and often have no religion at all. The same is found in India where the poorest of the poor village women keep track of their fertility and learn the four commonsense guidelines to avoid pregnancy. Couples trying to get pregnant who are having difficulty succeed 80% of th time. We never know the religion or lack of it when people come and learn with us on Vancouver island.
      Early disease is picked up from the Billings Chart which is a very accurate home based bioassay. Keep posting those messages and people will embrace it all the more..

  3. I can confirm that comment about men responding to a woman’s cycles. Since we ditched the birth control pills, some 17 years ago, I have developed a rather visceral response to my wife’s fertility cycle. I always *know* when she’s fertile, and it’s sufficiently reliable that we don’t bother charting her fertility signs any more. And yes it works: 3 pregnancies, all of them planned, and timed exactly when we wanted them. Being that connected to her is seriously wild too. Sex on the pill was a mere shadow of the real thing.

  4. It's striking (to me) how often in history one finds something being taught by religious authorities on the basis of noble reasons which gets resoundingly rejected by society (usually with a lot of invective and contempt along the way) because it seems difficult, only to be sheepishly embraced by society later for considerably less noble reasons.

    • Is it Leviticus where hormones are prohibited?

      • You'd be surprised what an interesting discussion the ethics of the pill can be, if you approach it with an open mind rather than simplistic ridicule.

        • I'm afraid I'd get nosebleeds, were I to ascend to the lofty heights of your wisdom and perspective. I must admit, though, it makes me smile to see you pontificate about open mindedness.

          • Have it your way friend. The millions of people who see issues with the pill are just fools, and the centuries of thought concerning the ethics of contraception is just chatter. At the very least, I'm happy to know I provide you with some amusement.

  5. My husband and I have used the Sympto-Thermal Method as taught by Serena Canada for our 12 year marriage. It has been effective (2 planned children) and a great relationship builder. Furthermore, it has helped me to understand my body and embrace my femininity.

  6. Our daughters learned to be aware of their fertility cycles while still teens. They were able to know when to expect their menses, and were able to better understand how their bodies reacted to things like stress.

    In fact my third daughter told me that her sisters advised her to chart her cycle, as this would give her the ability to plan her school work more effectively.

    One aspect of NFP that we had not anticipated was how open and comfortable our children would be in talking about their sexuality. In fact one of our daughters wrote a school essay arguing that NFP enhances family life.

    Our four married children must have seen a benefit in our use of NFP, as they all use it in their own marriage, and our son and his wife have gone on to qualify with SERENA to teach NFP.

  7. When we married over 39 years ago we used calendar rhythm because the Church said there was no other choice. By the time we found the Sympto-Thermal Method of NFP (needing tthe confirmation of the post-ovulatory temperature rise that the Billings Ovulation Method doesn't offer) we had the four children we had thought were the perfect family from the start. But being taught HOW to live periodic abstinence by SERENA teacher-couples gave us more than a way to plan our family: before long we were also a SERENA teacher-couple, my formerly Anglican husband now a permanent Catholic deacon, and the good little Catholic wife sheepishly saying, we no longer used NFP because the Church said there was no choice, but because of the life it brought to us as a couple.

  8. "Though the reasons aren't fully understood, it seems that men respond to a woman's cycles, too. "

    What is known is that a woman's sexual 'preening' peaks just prior to ovulation. This likely accounts for the extra attention? Of course the study example you chose kind of obfuscates any instinct toward truth. Why always go for the sex angle? Who cares….

  9. Although I am really pleased this article was published, I think it unfortunate that the article didn't provide more direction to women about where to go to look for alternatives. Some Natural Family Planning organizations have been mentioned above by readers but I would also like women to know that if they are uncomfortable with some of these religiously rooted organizations, we do have our very own Canadian, pro-choice, feminist, secular-based fertility awareness organization called Justisse Healthworks for Women. While this post is somewhat self-serving in that I am an instructor for the method, I came to my decision to ditch the pill for all the reasons mentioned in the article (and more) and never would have felt connected to the theological and philosophical underpinnings of the SERENA, Billings or Creighton methods – so I feel it is important for women to know that there is another option.

    • I agree with you. I want to look into natural contraceptive methods, but I'm uncomfortable going to a religiously motivated organisation. "Natural family planning" implies that we are talking about a married couple, for example, and I'm not interested in being judged for my sexual choice. I would require a secular pro-choice feminist environment, and I am quite surprised at the lack of information I'm finding. I'm in Montreal and while it was a relief to hear of Justisse, I wonder if you know of any organisations in Montreal, or elsewhere in Canada. (There should be a list somewhere! grr)

  10. The Billings Ovulation Method is taught widely in China and provides a healthy, safe and effective way of planning pregnancy or avoiding becoming pregnant. It is also taught in India and Africa and has great success among village women. Religion doesn't come into it. Teachers of the Method only have to say that they will never promote other contraceptive devices or medications. This is to keep authentic teaching of the four commonsense guidelines that have been validated by Prof. James Brown, world renowned estrogen expert, and Prof. Erik Odeblad, world authority on the cervix that responds to hormones
    and tells the woman when she is possibly fertile and when intercourse cannot possibly end in pregnancy….It works so well when cycles are irregular or elongated (ending in a fertile phase hopefully as is the case in coming of the contraceptive pill.
    Go to http://www.woomb.org for a teacher near you. It is not costly to learn…just a few dollars. The book, "The Billings Method" by Dr. Evelyn Billings is in the library. If you want answers contact me at infobillings@shaw.ca

    • “Teachers of the Method only have to say that they will never promote other contraceptive devices or medications.”

      Yeah, that’s enough to put me off. I prefer instructors to feel free to share all options with me. I wouldn’t go to this.

  11. It's an interesting article and a question that I think naturally starts to grow once you have been on the pill for a while. I have been on it for 10 years, and then recently went off for a month due to a pharmacy error (they told me I had no refills – in fact I did have one- but I was not able to get into the doctor for a new prescription in time, so I went off. There were noticeable changes in my mood and sex drive. Now, back on the pill, life is much more moderated. I prefer the knowledge that I am very unlikely to get pregnant (my partner and I use condoms as well) but am now considering whether the artificial hormone stream is something I want to keep swimming in.

  12. I studied some courses in human biology at university because I was always amazed by the concept of homeostasis in the human body. After getting married and having difficulty conceiving, I shared by concerns with a friend who then told me about the NFP organization Serena. My husband and I were taught the sympto-thermal method and within six months, we were expecting our first child. We were so impressed by the science behind the method and wondered why this science was not taught in university biology classes and high school health classes since everyone, but especially women, could benefit tremendously from this knowledge. If NFP were taught properly and seriously in schools, I believe many more people would choose it instead of the pill.

  13. Anne, I could not agree more. Whether sexually active or not, EVERY Woman, and even the men, should know these basic NFP Principals of fertility. There is no reason we should fumble around in the dark, having the world tell us that our fertility and ovulation is a hidden mysterious event – its not!

    Maybe they are afraid we will not rely on their products any longer to prevent births, and lose all that revenue for contraceptives?

  14. Not taking the pill may be all fine and dandy, but for a sexually active teenager do you think that charting cycles is really an alternative?
    Also I'd be weary of just using condoms, my experience has been that they break a lot more often than they are supposed to. Once it breaks, the only real immediate option is Plan B, which is a huge dose of hormones, is that really much better? Though I agree that the pill is pushed too much (mostly by the companies themselves) and more information should be available on other methods. There is info available if you search for it, it's just that the pill is used so widely that you usually don't have to go far to learn about it.

  15. What about the ring.

  16. as someone who used to have dibilitating, heavy, painful periods each week I think the pill offers a great advantage. Can anyone tell me what other product would offer the same relief?

  17. My wife used to use pills ofr quite some time now, she never had any side effects to be honest.

    I think they've improved the hormonal levels, and side effects, for the pill to be quite safe.

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  18. it's no surprise that a growing number of women don't want to take hormones every day.I very much agree with this.

  19. That was great to hear those words from anne .

  20. “I didn't want to be taking something that altered my body any more,” says the Calgary native, who now uses condoms instead.

  21. My husband and I have used the Sympto-Thermal Method as taught by Serena Canada for our 12 year marriage. It has been effective (2 planned children) and a great relationship builder. Furthermore, it has helped me to understand my body and embrace my femininity. vehicle shipping

  22. Yes my friend has affecting with the same problem

  23. Just after my doctor recommended the pill, I felt depressed, had no pleasure in having sex with my husband, got a cyst in my right cortex and I couldn’t move my right leg. I put an IUD and all the hormonal and health issues went away. I think pills are some junk we all have to ban from our lives.