Dear Virginia Sole-Smith,
First of all, congratulations! I understand that you’re pregnant. Awesome. Buena suerte. Having been on that particular journey myself, I can say it’s always an adventure. Also, pregnancy hemorrhoids are real.
It sounds like you’re pretty thrilled about being pregnant, since in addition to bringing a new life into this world, your endometriosis is finally under control. Bonus!
Oh wait. As I understand it, your endometriosis was actually pretty well-controlled for years. Because you were taking the Pill (capital P, right?). The same Pill that you just wrote an incredibly lengthy and meandering article criticizing? Right. That one.
And here we come to the reason why I felt compelled to write you this little note. Because I came across this article, with its eye-catching title (“The Weird Way the Pill is Effing with Your Health” – ooh, they said “effing”! So edgy!) and thought, hm, I wonder what her angle will be?
See, I prescribe a lot of birth control. Sometimes (often) to prevent pregnancy, sometimes not. And for some reason, birth control pills tend to inspire passionate opinions. I prescribe plenty of other medications as well, but people don’t generally get quite as fired up over their albuterol inhaler. (Maybe they should?)
It appears as though you’re already familiar with some of the more common non-contraceptive reasons we prescribe the Pill. Which is super, because that means we have less to review! As you rightly pointed out, in addition to being used as a form of birth control, combined oral contraceptives (aka THE PILL) can be an effective means of treating a wide variety of hormone-sensitive conditions, including polycystic ovarian syndrome, menorrhagia, acne, and – your favorite and mine – endometriosis.
The thing is, the things that the Pill treats tend to be chronic conditions. Chronic meaning ongoing, maybe for years, without a clear endpoint. Like any of the above-mentioned conditions, or, you know, fertility. (No disrespect meant, fertility, but you have to admit, you can be pretty high maintenance.) We don’t typically have a CURE, per se, for chronic conditions, but often, we have things we can do that can control or otherwise reduce the severity of that condition until it (hopefully, maybe) resolves on its own.
If you strip it down to the details alone, your story almost sounds like an advertisement for birth control pills – which makes the title of the article, and the tone, a little confusing. Apparently you developed severe dysmenorrhea (painful menstrual cramps) in high school, so you went on the Pill. AND IT WORKED. And when you started having sex, you also relied on it to prevent pregnancy. AND IT WORKED.
Unfortunately, you started to experience some side effects. Nothing scary, but bothersome. So… You stopped taking the Pill. You tried some other stuff, but nothing worked as well at controlling your cramps (besides pregnancy, OBVS). Bummer.
So here we have a patient, with a chronic condition, who takes a medication to reduce the severity of her chronic condition. The medication works, but she stops taking it because of unpleasant side effects.
I think we’ve just described pretty much any person who’s ever had a chronic medical condition, ever.
When someone discontinues their metformin because they’re running to the bathroom with diarrhea all day long, do they get angry with metformin for existing? Do they grow suspicious of their provider’s hidden agenda, even if it’s completely unclear what that agenda could possibly be? Do they blame the metformin for causing their diabetes in the first place? Maybe they do (pretty sure I’ve seen these patients before, actually) but at least Cosmo isn’t giving them a platform to state their case, because metformin and diabetes don’t inspire nearly the same fervent emotional response and conspiracy-theory-level paranoia that oral contraceptives seem to.
So while I also take issue with some of the other points you make because incorrect information and half-truths hurt my brain, this is my biggest gripe: WHAT IS YOUR POINT? Do you want us to stop prescribing medication that’s been proven to be safe and effective for millions of women because your Pill made you moody? Really?
I agree that it would be super spectacularly fabulous if we could have a brand new shiny array of options for contraception, and treatment of endometriosis, and PCOS, and all the rest. I also think that it would be pretty fab if that elusive “cure for cancer” unicorn could be discovered. But until that happens, the Pill is really, truly, seriously, a more-than-decent option to have.
In summary, if you like your Pill, keep taking it. If you don’t, don’t. (Preferably after talking about options with your trusted medical provider.) NBD either way, so let’s not make it one.
Thanks and best wishes for your pregnancy,
PS: to say that the Pill “delayed” diagnosis of your endo suggests that earlier diagnosis would have changed the course of the illness for you. Not true. In fact, I would be willing to bet that at least one of your providers over the years was suspicious that you might have had endo well before you were told you did, since it’s a very common cause of severe menstrual cramps, but didn’t say the word out loud, since a) the only way to definitively diagnose it is through surgery, and b) it was kind of a nonissue, since you were on the Pill – the first line treatment of choice – and it was working!
PPS: the suggestion Ms. Northrop provides for women to simply use fertility awareness methods instead of the Pill to avoid pregnancy is irresponsible. If you happen to be someone with very regular cycles, who is also very in tune with her body, and more than likely in possession of a high level of health literacy, then FAMs are fabulous. But, first of all, 95% with perfect use isn’t quite as high as many patients who feel strongly about “no babies” would like it to be. And beyond that, let’s not forget that nearly half of all pregnancies are unplanned, and that percentage swings wildly with socioeconomic status. The Pill is most definitely not the ONLY available contraceptive method out there, but I’d much rather encourage my 18-year-old patients to get an IUD than to start checking their basal temps and cervical mucus.
PPPS: I hate to break it to you, but with your history of migraines with aura, there might a better reason than mood swings not to go back on the Pill after the babe arrives.