A bitter pill

Unwanted pregnancy outweighs the side effects of contraception? It’s just not that simple, says Clare Foster-Pickup.

strip of contraceptive pills
Recent research has shown that women taking hormonal contraception are more likely to be treated for depression. And we already know that those with pre-existing depression may have their symptoms worsened by the pill.

Tell us something we don’t know.

I’ve avoided hormonal contraception completely since a devastating experience in my teens. Mood changes are the top reason why people discontinue using the pill.

But some of the responses to this research have made me pretty cross. I’ve been trying to make sense of why for the last couple of days. Here’s where I’ve got to so far. Maybe this is really obvious stuff. But maybe it needs to be said again and again until people start to listen.

Unwanted pregnancy far outweighs ALL side effects? The worst comment I‘ve seen is “an unwanted pregnancy far outweighs all the other side effects that could occur from a contraceptive”.

That feels like the sort of thing that someone who hasn’t experienced depression might say. I wonder if an equally debilitating (and potentially life threatening) physical health problem would be treated so casually.

It’s still overwhelmingly down to women to manage contraception. Would men put up with the same assumptions about protection versus side effects? I doubt it, but they shouldn’t have to – nobody should.

I’ve had an unwanted pregnancy and an abortion in my 20s. And I was prescribed the combined pill (aged 15) with no guidance, no discussion of side effects and without being offered alternative options (I wrote about it here).

The causes of mental health problems are complex and under-researched – but I’ve always felt that the six months of desperation, confusion and trauma I suffered before I realised the pill was to blame, was the start of long-term problems with depression and anxiety. I still occasionally have nightmares where I’m trapped in that time and those feelings.

Unwanted pregnancy can be awful (and can be associated with an increased risk of mental health problems too). But the mental health consequences of getting medication like hormonal contraception wrong can also be devastating and can last a long time.

“Another woman’s GP refused to remove the contraceptive implant from her arm, despite the negative physical and emotional effects she reported, because ‘It gets better after six months and it’s worth putting up with it until then.'”

Others agree. A woman I spoke to online said: “Yes, yes, yes! I’ve had both an unwanted pregnancy and a termination and long-term mental health problems aggravated/caused by the pill. And it wasn’t the first one that was more traumatic and terrifying.”

It’s not about unwanted pregnancy versus depression, it’s about choice.

But whether an unwanted pregnancy or depression is worse isn’t really the point. The fact that I feel the need to clarify that I’m not suggesting that people should have terminations instead of taking the pill, shows how reductive the discourse on this topic tends to be.

This kind of broad-brush and simplistic response makes me cross because it is harmful. It diminishes the impact of mental health problems. It makes it so much harder for women of all ages to have their experiences taken seriously. It stifles open conversations with doctors. It prevents women making genuinely informed choices about which of the enormous variety of effective contraception is right for them.

Another woman described how her GP refused to remove the contraceptive implant from her arm, despite the negative physical and emotional effects she reported, because “It gets better after six months and it’s worth putting up with it until then.”

How could that GP possibly make that choice for her? What right have they to decide how much her mental health was being affected and whether it was ‘worth it’? Why didn’t they accept her decision and support her to choose a different contraceptive method? (That also made me pretty angry.)

We should be given real choice about our lives and our bodies. Choice based on discussion, understanding and research (yes, well-funded research into both mental health and women’s reproductive health would help, and would be more likely if people took our experiences more seriously).

Of course, there’s a decision to be weighed up and a line to be drawn – but we need all the information we can get to draw it for ourselves. Not reductive comments that try to make this issue into a simple binary choice – whether you are better off pregnant or not pregnant.


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Written by Clare Foster-Pickup

Clare is trying to breathe more and run less. She's slowly untangling her eating, anxiety, exercise and depression at