Yes! Birth Control side effects ARE real.

From the number of blogposts and podcasts I’ve done on birth control, you might think I’m passionate about contraception. 😉 No, actually, I’m just a temendous believer in making informed decisions around family planning! And, the fact is that most* women either consider or use some method of birth control during their reproductive years. My goal is for frum women to have a real understanding of their options – information tailored to the frum lifestyle and observance of halacha.

*I don’t have a statistic on this one, but it 50%+ seems safe to assume in the frum population too! Birth control pills aren’t used only for contraception, they’re often prescribed for conditions such as PCOS and endometriosis, or to help teens with acne and irregular cycles.

Ok – now that I cleared that up, let’s have a chat about the side effects of birth control. Specifically hormonal birth control, especially birth control pills and other combination methods such as patches and the Nuvaring.

Why is hormonal birth control so popular?

Before we delve into the side effects of hormonal birth control, it seems worthwhile to review why it’s so popular. Let’s be clear on something: we call all these meds “birth control” because they’re really good at exactly that – controlling birth a.k.a. preventing pregnancy. When the first oral contraceptive pill was released to the public in 1950, it was an unbelievable thing. So remarkable and exciting that it came to be known simply as “The Pill” – despite the fact that there are thousands of other pills out there! It’s kind of hard to imagine a world without it, and the impact it has on women’s health and rights, etc., in the world at large is tremendous.

Now, from a frum woman’s perspective, it’s also tremendous deal. Hormonal birth control bypasses the issurim that come with what we call “barrier” and other non-medicinal methods, plus it doesn’t require a woman to separate from her husband around mikvah time to avoid her fertile period, with the halachic and hashkafic factors that make that complicated. We had and still have the mitzvot of pru urvu and lashevet yitzrah, but there have always been reasons why a woman may need or want to avoid becoming pregnant for some time, most obviously for her mental or physical health.

So we’ve established why millions of women (frum women included) around the world take birth control pills – why does the topic of side effects deserve its own post?

There’s a tendency in the medical world to minimize birth control side effects.

After all, we have over 50 years of safety data to tell us what the REAL risks are and aren’t, and when we need to be most careful. After screening you for a blood clotting disorder, family history of breast cancer, hypertension, smoking, etc., your medical provider is likely to list you exactly the side effects you’d find on a Google search:

They’ll reassure you that these side effects will likely resolve within a couple months. AND THEY PROBABLY WILL. Many many many women use hormonal birth control happily and successfully for years. They benefit from the contraception, the cycle control, lighter bleeding, dependable moods, etc.

On the flip side, it’s becoming more accepted that there’s underreporting and underacknowledgement of the “milder” side effects of birth control. So while we have 50 years of data, that research has mostly had a safety focus, to study “adverse effects” – things that would put a hard stop on taking The Pill. It’s important for women to know the “mild” side effect exist and are even fairly common. For some, those side effects are actually quite significant, if not life threatening.

Here’s some examples:

• A woman may experience a generally lower mood that’s not necessarily depression, but still pervasive. If that woman started taking her birth control pill in her teens (to control acne or menstrual pain, let’s say), she may not even be aware that it’s impacting her until she goes off of it to get pregnant. Suddenly she discovers the world is a brighter place, she finds more things joyful and funny, etc.
• A woman may expect that after going on a birth control pill, her cycle will immediately bounce back to what it was beforehand. If it takes her some time to re-regulate or resume menstruating, it can be very alarming and/or delay conception for some number of months (though it is not expected to cause long term problems).
• Decreased libido and vaginal dryness are two separate side effects women experience. The latter can be helped to some extent with lubrication, but a lack of desire can have further reaching impacts. Both feed into a pattern of intimacy dysfunction if that intimate relationship isn’t a pleasant and mutually satisfying experience.

Sometimes the trade off is worthwhile to prevent becoming pregnant. Especially for a limited time, for medical reasons, etc. Knowledge and empowerment are key.

What can a woman do if she’s experiencing side effects from her birth control?

1. If you and your provider feel that a hormonal option is best for you, and your side effects are mild (i.e. you don’t swing into a major depression, you can carry on with your day):
   • It’s probably worth waiting 2-3 months to see if the side effects resolve once your body gets used to the medication. Most really do.
   • Another option is to change medications to one with a different type of progesterone, because that’s the part you’re most likely responding to, and there are many options on the market.
   • Lastly, some women have fewer side effects with the Nuvaring than the patch, pill, or shot. And most will not have systemic side effects at all from a progesterone-only IUD (though spotting remains a significant issue).
2. If you have concluded that a hormones are not your best option:
   • You may want to consider a copper IUD for highly effective and long acting contraception. (Poke around this website for more info on those!)
   • Speak to your Rav about using a diaphragm for contraception. Because there is a barrier component, this is generally a “second tier” method, reserved for those who do not have success with others. (Tip: when combined with the fertility awareness method, use of a diaphgragm can also be minimized.) **I encourage women to recongnize their negative response to birth control as something meaninful and valid when approaching this topic with their LOR. Some are not yet familiar with the growing body of evidence that The Pill just isn’t for everyone.**
   • Other options are a) just using spermicide, or b) following a fertility awareness method. Both of those work well for some women, neither is consider as dependable as the other methods.
3. If you are starting a birth control pill for something other than contraception, do some research on non-hormonal methods to address your concerns. Sometimes exercise, a certain diet, or complementary medicine may hold the key. Approach the topic with an open mind and you’ll find many resources for hormonal regulation that do not involve artifical hormones.