My letter to Cosmo, or, why the Pill may not actually be “effing with your health”

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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,

LB

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.

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16 thoughts on “My letter to Cosmo, or, why the Pill may not actually be “effing with your health”

  1. Wow. If you were my healthcare provider, I’d dump your ass so fast. It’s interesting that you rage on about how no one else cares about other medications, but the thing is, if someone has a problem with a medication due to side effects, most CARING doctors change the medication or look for alternatives.

    When it comes to the Pill (capital P, lol), doctors blatantly do not give a crap if the woman is experiencing side effects, as your thoughtful commentary shows. “Just keep taking it.” “Here we’ll put you on a different brand.” Medicine needs an overhaul in women’s health and all of this news about women who have problems with the Pill could lead the revolution.

    Let me give you another example, my sister had been experiencing amenorrhea since she was about 15. The doctor put her on the BCP saying “hopefully this will get your body working, we will take you off in a year.” A year went by, she went off, nothing. No period. The doctor said “okay, let’s just do it again.” Another year, nothing. Again, the doctor suggested she go on BCP. Now, dear doctor, what is the definition of insanity? Oh right, trying the same exact thing over and over again, expecting different results.Not one physician thought, “Hm, what could possibly be going on to cause this amenorrhea?” When my sister turned 18, she started to worry she would never have children. What did the doctor say? “We’ll worry about that later. Here’s a script for the Pill.” No blood tests, no sonograms of her ovaries, NOTHING. Now she is 21 and we have finally found a doctor of Naprotechnology who actually cares enough to look for the reason she does not get her period, rather than hide it with the Pill and hope something changes. Hopefully this will provide some answers. Either way, it’s better than the poor, careless treatment your peers provided for my sister.

    Maybe, next time, before you belittle women (How EMPOWERING, by the way) who are unsatisified with being handed a script for a pill that only hides their symptoms, maybe you should stop and realize that there is no “one size fits all” in healthcare. Check your judgmental distaste at the door. -Sincerely, a graduate nursing student

    • Dear graduate nursing student Sam,

      Perhaps you should stop and think for a moment before starting off with “If you were my healthcare provider, I’d dump your ass so fast.”

      This blog is written by a graduate nurse: a nurse practitioner. She isn’t suggesting that the Pill (or any medication, for that matter) is the solution for everything. If your sister were your patient, would you treat her the way her doctor did? I wouldn’t, no way in hell. And I doubt this NP would either. Sounds like your sister had a really crappy doctor. Is it the fault of the medication? No. Is this NP to blame? No. Do you agree? I suspect that you do, but that is not what your post is implying.

      And I am not sure what you think is belittling to women in this blogger’s post. Please do clarify.

      No matter what the title, there are bad medical providers in all specialties. This blogger actually has a post about that (when she discusses supervision).

      No responsible provider / prescriber (this one included) would ever treat a medication as a fix-all; ALL medications come with both benefits and possible side effects. This cost-benefit-risk analysis is what we prescribers do all day, every day (and you will, too, if you are pursuing a clinical graduate degree in nursing). This NP is suggesting that perhaps the Cosmo article (yes, that great source of medical expertise, Cosmopolitan) was neglecting the huge benefits that millions of women (including the Cosmo article’s author) have reaped from OCPs in her drumming-up-paranoia. The truth is, that the Pill has been around for many decaded and benefitted many women immensely. Has it been poorly prescribed? I guarantee you that it has, and also that every prescription medication has. Again, is it the fault of the medication? No, it is the fault of a bad prescriber.

      OCPs can cause side effects, of course. A different “brand” (meaning slightly different combination of hormones) can, and does, often result in an improved side-effect profile, while maintaining the same benefit. Is this a worthwhile option? Absolutely (as long as there is not another option the patient prefers). In the end, it is between the patient and her medical provider to decide the best option considering all the possibilities- and then to follow up and evaluate how it is going.

      One more thing- do a little research on female empowerment in relation to the availability of oral contraceptive medication as an option.

      Best and good luck in school-
      Another NP

  2. PS: With perfect use, FAM methods are over 99% effective. I have irregular cycles. Sure it’s harder, but it’s not impossible.
    PPS: You jump from BCPs to IUDs? That’s impractical for people who may want kids within a few years. But I realize that the medical community salivates over IUDs, so why teach FAM and proper use of barrier methods?
    PPPS: You’d rather have your patients be on hormonal contraceptives that have negative side effects when they could follow the natural rhythm of their body? Do you try lifestyle changes in patients with pre-hypertension or pre-diabetes, hoping you do not have to medically intervene and that they can manage without medications (that have those pesky side effects)? Medications should NOT be our first line of defense, if it can be helped.

  3. This is a foul display of arrogance, disrespect and unprofessionalism from a medical professional. If only you knew exactly HOW foul the tone will read to the writer. I am appalled. Also – you make a lot of ridiculous statements – calling Dr Northrup irresponsible being one. You are every thing that is wrong with the mainstream medical profession. To align fertility with ill health and to dismiss women’s experiences of quality of life threatening side effects…actually I can’t even go on. Your hubris is going to prevent you from hearing me anyway.

    • Holly,

      I don’t know how many women you know who have been on OCPs, but ask around and find out how these women feel about their quality of life and their use of OCPs. Because I would wager that many more women feel their quality of life has been significantly improved by OCPs than he other way around.

      You can also just do a little research into how popular these medications are among women. That’ll give you another clue into the kind of quality of life these medications can provide.

      Also- nowhere is this NP aligning fertility with ill health. Just to make note of that.

      • Hmmm. Let’s see. I’ve written a book on the topic (sweeteningthepill.com), prior to which I wrote a blog about OCPs for over three years so I THINK I know how A LOT of women feel about the Pill and many many many of them are not happy with it. Their popularity of this drug speaks far more of the lack of information and options provided by those in the medical profession, not to mention the power of profit.

      • And, this “lack of options” you mention- how exactly would you like us in the medical profession to address this? We have, unfortunately, a limited number of options available- there are only so many medical solutions for any given situation, and until something new and better comes around, we are rather stuck with what we’ve got, pluses and minuses that they (all) have. We can’t recommend, prescribe, or suggest something that doesn’t yet exist.

      • Holly-
        p.s. Allow me just to suggest also that before you start throwing around words like: “foul,” “arrogance,” “disrespect,” “irresponsible,” “everything that is wrong with the mainstream medical profession,” etc. that you keep a couple things in mind:

        1. This is a fully licensed, fully credentialed medical professional who writes this blog. She knows the risks and dangers well. (In fact, you should look back at her other post about why she will not prescribe OCPs in patients with migraines even when their previous provider has been prescribing them for years.) She is not dismissing side effects, nor life-threatening dangers. All possible problems that come with any prescription are very, very real to those of us who prescribe, even the non-life-threatening possibilities. The risk in writing a prescription is not only to the patient, the risk is ours (as prescribers) as well. We lose sleep over these things.

        2. Please be specific in your objections, because calling someone negative names doesn’t actually help further conversation or discussion- it doesn’t help anyone, actually. (Unless it helps you, but only you would know.) If you actually articulate your objections maybe we could drum up a worthwhile discussion about it all.

  4. Ok, I’m sorry, but people can and do cure many hormonal “chronic” conditions DAILY. It takes work, sure, but it is absolutely not impossible for most people. Hormonal contraception is not treating those conditions. It’s suppressing the symptoms associated with them. While I would personally respect anyone’s decision to use combined oral contraceptives to suppress their symptoms, I think it is downright negligent to act like that is the only option. Particularly the only responsible option.

    I’m not saying you do this, so don’t get me wrong, but many young girls are put on COCs simply to “regulate” their cycles, even though they haven’t yet had time to regulate on their own. This is a huge problem. They are first line of action and SHOULD NOT BE.

    You don’t need regular cycles to practice the sympto-thermal method, which is over 99% effective (effectiveness study: http://humrep.oxfordjournals.org/content/22/5/1310.full). You DO, however, need regular cycles to practice something like the standard days method/use cycle beads (same thing, different delivery). That is the method that is 95% effective. While I do occasionally see cycle beads in health food stores or something of that ilk, they are rarely promoted in the US. There are often groups that will teach women to use them in third world countries (which is great, something is better than nothing for those who want it).

    You also do not need keen body awareness, you check a measly two things (as you mentioned BBT and cervical fluid), which, really, most women notice, anyway. You just have to pay a little more attention and chart it so you don’t forget. I’m not saying it’s right for everyone, but for those it is they are often strongly discouraged by their doctors. It’s also a major benefit to start having that body awareness, rather than total disassociation and lack of care.

    I’m also not saying this is you, but I just want to give you some examples of things that I have heard in case you haven’t, just to give you an understanding of why we do need to see media letting women know that there may be side effects and it not all in their heads. So, the example: A women who wanted to switch to the sympto-thermal method went into her doctor to talk about getting off of COCs because she was having side effects that were effecting her in her everyday life. The doctors told her not only that those side effects weren’t bad, but that since she was planning on getting pregnant in a couple of years, anyway, she should just deal with it until that time. This is extremely sad and infuriating, and I am betting you feel the same. We need more advocates for these women and we need to not act like they only have one choice.

    I would be happy to talk to you about any of this if you so desire.

    • Hannah- I don’t like the way doctors treat their patients in these comments. Please know that a lot of us would never respond that way.

      A patient saying that any medication of any sort is having detrimental side effects is a flag that the provider needs to talk to her more about it, not tell her to “deal with it.” Ever. That is just bad patient care, bad medical practice altogether.

      [Now if we can just get to a place where we are not being pushed from all sides to spend less and less time with out patients- drives me absolutely batty, as it directly undermines our patient care-]

      • I know you definitely have it difficult. I am very pro the many doctors who are moving towards not accepting insurance. I would love to see more doctors charging just enough that patients can afford it, they can get money for their hard work, and they even have some room for “pro-bono” for those that can’t afford it. That is what I work towards in my own business. Everyone deserves to be paid for their hard work, but at the same time, when your work is in a care position you don’t want to deny anyone who can’t pay, either. Hopefully the economy will change to a model where we can all take care of each other better.

  5. This is an interesting perspective! I have never heard a nurse admit that -yes all pharmaceutical drugs have chronic long term side effects, big deal-What would the AMA do to you for giving that perspective? While I disagree with the majority of everything you wrote, I will share two additional comments. 1. The majority of Fertility Awareness Based Methods work with regular cycles within 26-32 days long (Cycle Beads, Rhythm Method, etc.); however, the Sympto-Thermal Method of Fertility Awareness (Natural Family Planning, Fertility Awareness Method) is up to 99.6% effective when used correctly by women with irregular cycles as well as regular cycles. Because this method is observational and not statistical, it is used successfully by women with all types of cycles and further functions as a platform for them to see the irregularity and seek advice from a health professional. 2. Until you have walked a mile in someone else’s shoes, then it is condescending and illogical to belittle another person’s suffering and sweep it under the rug so to speak.

  6. 7-10% ovulation occurs while on your precious Pill. If nearly 50% of pregnancies are unplanned wouldn’t it make more sense to educate women on their cycle and their body so they’re aware that it’s more than just getting a prescription and an easy out. The 95% you claim that people aren’t satisfied with….How exactly is 50% better? Not to mention the chance to abort life. (Or do you have the mentality of what people don’t know, won’t hurt them?) Also, there is never a medical need for birth control. Never. That is a lie that has been brought to you by the mainstream, birth control pushing, medical community. If you haven’t heard of NaPro technology, check it out. It will change your life. Can you tell me why you’d encourage IUD or other forms of contraception than actually educating women….or wait, are you even educated enough to truly understand the FAM’s? I would bet to say you need to do some more reading yourself if you are under the impression that it’s only for women with regular cycles. On a side note, you don’t need to have a high level of health literacy to learn FAM’s either. That statement is a disservice to women being capable of learning a simple, free, and empowering way to learn how their body works and to recognize if there are underlying issues. The Pill, along with other contraception just masks a deeper issue. Your mentality is to fix the issue instead of looking at the bigger picture of why? Quite frankly, this type of mentality is most likely causing the discovering to cure cancer to be delayed seeing as how these scripts can develop forms of cancer.

  7. Wow, these comments really validate the author’s statement that the topic of The Pill inspires “fervent emotional response and conspiracy-theory-level paranoia.” the angry, insult-slinging commentary, delivered whilst accusing the author of being arrogant and disrespectful) were particularly entertaining. For the record,
    Ms. Ladybits, I heartily do not blame you or your “mentality” for the callousness/incompetence of other providers, nor do I hold you complicit in humanity’s failure to cure cancer.

    I read this piece twice and never saw anything advocating a “just take the pill and don’t ask questions” approach. There actually is some discussion of why alternatives may be valid (assuming the patient complies and is willing to accept sunbstantial pregnancy risk). And the author also mentions that there are times to avoid the pill…note the end of the article. My impression is that she is clearly arguing against knee-jerk dogma of the “the pill is bad and will make you sick” variety. Most of the responses I’m reading here seem to me an example of this type of dogma.

    As a postscript, my wonderful first child was conceived during faithful practice of FAM. There is no such thing as “perfect,” and the actual practice failure rate of FAM ranges from 3-25%. My equally wonderful second child was conceived within a few tried after removal of an IUD, so I find the statement that IUDs are inappropriate for women wishing to conceive “within a few years” to be downright puzzling.

    Thanks for a measured and, dare I say it, entertaining perspective.

    • Impartial-
      Yes, right, thank you, I was confused as well- these other responses seem to be replying to something altogether different than the blog post (and the blogger) above. I see the emotional thing, too. Wow!

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