Back in the 2000s, smartphones weren’t yet a thing, let alone apps that could help you track your menstrual cycle. It was an era in which teenage girls starting their sex lives were ushered onto oral contraception, only encouraged to explore other methods if they were met with problems such as weight gain, acne or heavy bleeding. Once each girl found the fit for them – be it the implant, injection, pill, patch or coil – many stayed devoted for the long-haul.
Fast forward 20 years and that means today there are women in their thirties who have been using the same or various forms of hormonal contraception for years. They have been on it longer than they've been off it. And as the fertility bell rings, alongside a trend of moving away from synthetic hormones to natural family planning, some may want to drop the pill, end the injection or extract the implant. But that can be a daunting prospect.
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Who will I actually be without the trickle of hormones I’ve had running through my veins? How much has my chosen method altered my moods and mental health? What will my periods be like, my temperament, my cramping? These are some of the thoughts 22-year old marketing specialist, Izy Winter, is having as she debates whether to take a break from hormonal birth control. She has been using various methods consistently for nine years, since she was prescribed the mini pill at age 13 to temper painful periods. 'One of my biggest concerns is ‘what if what I believe to be my identity starts to shift?' Winter shared, explaining that 'I’m quite scared of what I would be like without it because it’s, in theory, all I’ve known… Under 13 you’re completely different to who you are as an adult.'
Today’s Western women have the luxury of access to modern medicine, which provides them with choice over whether to have children and when; although research reveals two-thirds of women believe men should harbour more responsibility for contraception. Certain contraceptives also offer a solution, for some, to horrible hormonal fall-out like bad skin, crippling cramps, and fluctuating moods. In short, these treatments are a medical marvel, offering many women a safe haven in which to hormonally climb into only to leave them confused as to what might await them should they decide to venture outside.
'The idea that from the age of 14 we give young women synthetic hormones until they’re 30, they come off and expect to get pregnant and then [they think] ‘where’s my cycle?’ ‘who am I?’ is very difficult,' said Kate Muir, a women’s health expert and author of Everything You Need to Know About the Pill (but were too afraid to ask), to be released next year.
Aside from harbouring fears about a change in her identity, Winter is also worried about the return of excessive pain. Dr. Jane Dickson, a consultant in sexual and reproductive health, said this concern isn’t unfounded. Any issues hormonal contraceptives are used to treat, such as heavy periods, acne or cramping, may still be there once the method is removed.
Even women who haven't experienced such symptoms can see changes to menstrual cycles, mood and skin as their body transitions away from the hormones they’ve become accustomed to. In the initial months, heavy periods can be common, said Dr. Lisa Chavda, a GP and contraception specialist who runs a private clinic in Harley Street. She tells patients to come back if they persist after three months (the majority don’t need to).
None of Chavda’s patients have complained of a personality change, but this notion is what drove Tessa Deterding, a 29-year-old PR professional, to have her implant removed after eight years. 'I was nervous because I’d spent the entirety of my twenties on it,' she said, explaining that she wanted to know who she might be without hormonal intervention. Thankfully, she doesn’t feel any different, but she did experience an initial heavy period and now has a more regular cycle with accompanying cramps, unlike when she had the implant.
The plus side is that she feels more connected to her body and her libido is higher. 'The first month afterwards, I felt like a horny teenager again,' Deterding shared.
Changes in libido can happen, said Dr. Frances Yarlett, medical director at The Lowdown, a women's health review platform. One thing she warns against is the claim that coming off contraception can alter your sexual preferences; something Winter said she’s daunted by the thought of. 'Being in your twenties is quite a confusing time anyway. I’m always scared that if I come off of it, it will rob some of the identity I know about myself already,' she shared.
But Yarlett said the idea of not being attracted to the same person, depending on contraceptive use is 'a huge myth… doing the rounds on social media.' 'There have been millions of women who use contraceptives, who then come off those contraceptives whose worlds do not end. They stay in the same relationships and marriages, they get on with their life and so we have this huge body of evidence from the entire world that you can come off contraception and it’s not going to ruin your life,' Yarlett said.
Plugging this gap, The Lowdown connects women with a professional specifically to address concerns about leaving hormonal contraception behind. 'We know it's an area with very little information out there about,' Yarlett said, adding that it’s important for women wanting to come off hormonal contraception understand other options to prevent unplanned pregnancy.
'For some women, contraception doesn’t make a big difference to their personality or health, but for a percentage of women it can mean massive change,' says Muir.
For those who are worried what life on the other side will be like, there’s little reassurance and support in a society where conversations around contraception have historically been taboo.
The hope is that initiatives like The Lowdown, and more women speaking out about their experiences, will allow others to feel more educated on the topic, empowered to make a choice that’s best for them and supported should they choose life sans synthetics.
