We went to the experts to find out whether taking the Pill is really doing us a disservice, or whether the shade is all hype.

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Photo: Megan Madden / Refinery29 for Getty Images

For more than 50 years, the Pill has been celebrated-and swallowed-by hundreds of millions of women around the world. Since hitting the market in 1960, the Pill has been lauded as a way to give women the power to plan their pregnancies-and, in effect, their lives.

But in recent years, a birth control backlash has been brewing. In a wellness world that prizes all-natural everything-from food to skin care-the Pill and its exogenous hormones have become less of a godsend and more of necessary evil, if not an outright enemy.

On Instagram and on the internet, wellness "influencers" and health experts alike expound the virtues of going off the Pill. The apparent problems with the Pill include issues like low libido, thyroid issues, adrenal fatigue, gut health issues, digestive distress, nutrient deficiencies, mood swings, and more. (Here: The Most Common Birth Control Side Effects)

Even major websites are joining in with headlines like "Why I'm Happier, Healthier, and Sexier Off Hormonal Birth Control." (That particular piece credits going off the Pill for increasing the writer's sex drive, breast size, mood, and even her confidence and social skills.)

Suddenly, going Pill-free (like going gluten-free or sugar-free) has become the hottest health trend du jour. It's enough to make someone like me, who's been on the Pill for 15 years, wonder whether I was hurting myself somehow by swallowing that little pill every day. Did I need to quit it, like a bad habit?

Apparently, I'm not the only one wondering. More than half (55 percent) of sexually active American women currently use no birth control method, and of the ones who do, 36 percent say they would prefer a non-hormonal method, according to a survey conducted by The Harris Poll for Evofem Biosciences, Inc. (a biopharmaceuticals company dedicated to women's health). Plus, a Cosmopolitan survey found a shocking 70 percent of women who've taken the Pill reported they've stopped taking it, or have thought about going off it in the past three years. So, has the once-celebrated medication become a thing of the past?

"It's an interesting trend," says Navya Mysore, M.D., a primary-care physician specializing in women's health at One Medical, of the Pill backlash. "I don't think it's necessarily a bad trend since it pushes people to look at their overall nutrition, lifestyle, and stress levels." It can also be linked to the fact that more and more women are opting for a hormone-free IUD, she notes.

But, the generalizations and slogans about the "bad" effects of BC aren't necessarily accurate for every person. "Birth control should be a neutral topic," she says. "It should be an individual choice-not an objectively good or bad thing."

Like anything else circulating on the internet, we need to be wary of something that sounds too good to be true. A lot of those posts promoting birth control freedom may sound promising, but there may be ulterior motives, says Megan Lawley, M.D., family planning fellow at the Emory University Department of Gynecology and Obstetrics.

"Often you might find that those people who argue that contraception does more harm than good are also encouraging people to spend money on health treatments or products that have unclear benefits," she says, "so make sure that you are choosing good sources to educate yourself." In other words, don't believe everything you read on the 'gram!

The Perks of the Pill

First of all, the Pill is, for all intents and purposes, safe and effective. It does an excellent job of living up to its main promise of preventing pregnancy. It's 99 percent effective in theory, according to Planned Parenthood, although that number drops to 91 percent after accounting for user error.

Plus, the Pill does offer health benefits. "Hormonal contraception can help women with issues such as heavy periods and/or painful periods, preventing menstrual migraines, and treating acne or hirsutism (excessive hair growth)," says Dr. Lawley. It's also been shown to reduce the risk of ovarian and endometrial cancers and helps women with conditions such as polycystic ovarian syndrome, endometriosis, and adenomyosis.

As for the claims that it leads to scary side effects, from weight gain to mood swings to infertility? Most don't hold water. "For healthy non-smoking women, the Pill has no long-term side effects," says Sherry A. Ross, M.D., women's health expert and author of She-ology: The Definitive Guide to Women's Intimate Health. Period. 

Here's the deal: Side effects such as weight gain or mood swings can occur, but they can be mitigated by experimentation with different versions of the Pill. (Here's how to find the best birth control for you.) And, again, every person's body is going to respond differently. "These side effects are usually temporary," explains Dr. Ross. "If they don't go away in two to three months, talk to your doctor about changing to another type of Pill, because there are many different types and combinations of estrogen and progesterone depending on your side effects and body type." And keep in mind: "Not all 'natural' supplements are safe, either," Dr. Mysore points out. "They have their share of side effects as well."

As for the rumor that having been on the Pill can make you infertile? "There is absolutely no truth to that," says Dr. Mysore. If someone has healthy fertility, having been on the Pill will not impede you from getting pregnant. And unsurprisingly, there's zero scientific research that shows skipping the Pill will boost your confidence or social skills. (Peep these other common birth control myths.)

The (Legit) Drawbacks

All that said, there are certain reasons for passing on the Pill. For starters, not everyone is a good candidate for hormonal contraception: "If you have high blood pressure, a history of blood clots, strokes, you're a smoker over the age of 35, or you have migraine headaches with an aura, you should not take oral contraception," says Dr. Ross. Plus, the birth control pill over time may have an increased risk of breast cancer, although it's "a very, very small risk," she notes.

Another good reason to go off the Pill is if you decide the IUD is a better choice for you. The IUD gets high marks among ob-gyns as a highly effective and safe birth control method and has been recommended as a "first-line" option for contraception for all women of reproductive age by the American College of Obstetricians and Gynecologists. "For those who are sensitive to hormones when taken orally, the IUD offers a viable alternative," says Dr. Ross. "The copper IUD contains no hormones and the progesterone-releasing IUDs have minimal amounts of progesterone when compared to oral contraception."

Ending the Relationship

Of course, if you go off contraception cold turkey, you risk an unplanned pregnancy. Many of these wellness influencers who are going off the Pill say they will use fertility tracking apps or the rhythm method to prevent pregnancies. You may have even seen sponsored posts for the Natural Cycles app, which has a robust influencer marketing campaign.

While it's a viable non-pill option, it's worth noting that this method has some risks as well, says Dr. Mysore. Since you have to manually record your temperature every morning at the exact same time, it can make a big difference in the reading if you're even a few minutes off. That said, its effectiveness is comparable to the pill, given that both are at risk for user error. In a study conducted by Natural Cycles that followed 22,785 women through two years of menstrual cycles, the app was found to have a typical use effectiveness rate of 93 percent (meaning it accounted for user error and other factors vs. if you followed the method perfectly), which is on par with hormonal birth control pills. The Swedish Medical Products Agency also confirmed this same effectiveness rate in a 2018 report. And, in August 2018, the FDA approved Natural Cycles as the first mobile medical app that can be used as a method of contraception to prevent pregnancy. So if you're going off the pill and intend to go the natural route, using an app like Natural Cycles is far more effective than traditional fertility tracking methods, which are only about 76 to 88 percent effective in the first year of typical use, according to the American College of Obstetricians and Gynecologists.

If you're simply curious to see how your body reacts to going off the Pill, Dr. Mysore supports the idea of taking a "birth control holiday" every three to five years to make sure your cycles are regular. "Get off it for a couple months to see what your period looks like: If it's regular, you can get back on it to continue to prevent pregnancy," she says. Just make sure you're using a backup method, like condoms, during the break. (Heads up: Here are some of the side effects you can expect from going off birth control pills.)

Above all, remember that staying on or going off the Pill is an individual choice. "There are many reasons to be on contraception, just as there are reasons that women choose not to be on contraception," Dr. Lawley says, and any decision should start with a conversation with your medical provider about your health priorities.

Comments (5)

Anonymous
March 7, 2019
It is too bad that this article does not mention the scientifically based and researched natural methods available that equal or exceed the effectiveness of the birth control pill. The ovulation methods and symptothermal methods are excellent effective means of family planning, and have the added benefit of empowering women and couples with the knowledge to understand the woman's body and cycle, and work cooperatively with the body. Some methods have actually been developed to work as tools for medical diagnosis and treatment of gyn problems.
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