Gasping for breath, 23-year-old Charlotte Foster collapsed at her workplace and was taken by ambulance to a hospital. Three days later, she was dead. A coroner ruled after her death in January 2016 that the business graduate from Shropshire, UK, whose family described her as "lively, intelligent, beautiful and caring," had suffered a "massive" blood clot in her lungs caused by the oral contraceptives she had begun taking only a few months earlier.
Another inquiry ruled that her doctor, Sunil Simon, who saw Foster three weeks before her death and recommended she go for a "spa day" for what he thought was muscle pain, had failed to recognize the Pill's extensively documented deadly side-effects.
Although embolisms (clots) from the Pill are not exactly commonplace, thousands of women have suffered these serious adverse events. Foster's case is a tragic illustration of how, despite decades of marketing the Pill as one of the 20th century's greatest medical achievements and a symbol of women's liberation, its most dangerous drug side-effects have still not gone away and are instead frequently overlooked, even by the doctors who prescribe them.
Furthermore, the Pill's increased risk of serious heart attacks, strokes and pulmonary embolisms have proven to be at the far end of a broad spectrum of nasty side-effects, ranging from blurred vision and gum disease to depression, weight gain and loss of libido.
New generation, old risks
In fact, while the general perception is that the Pill has become safer than it was when it was first introduced, newer versions of the Pill are proving to be even more dangerous than their predecessors.
Foster was reportedly taking a 'new-generation' drug known as Dianette in the UK and Diane-35 in other parts of the world—which contains cyproterone (a form of the female hormone progesterone) and ethinylestradiol (an estrogen), which effectively suppress the actions of testosterone and have contraceptive effects. In both the UK and Canada, Diane-35 is also approved as a treatment for acne when antibiotics and other topical treatments have failed, but its use for this should be limited to just one year.
An inquiry following the deaths of four girls taking Diane-35 in France revealed that this acne medication was also being widely prescribed as a contraceptive, but the elevated risk of blood clots resulted in its being banned from the market there.
There are no figures for how often Diane-35 is prescribed incorrectly, but Foster is not the first British woman whose death has been linked to the drug. It has been found to have caused at least seven other deaths in the UK, including that of Charlotte Porter, a 17-year-old taking the drug for acne, who collapsed in agonizing pain and died in March 2010 from a blood clot in her lungs caused by deep vein thrombosis (DVT). Her doctor had dismissed the white spaghetti-like veins in her leg because he thought she was too young for DVT.
In Shannon Deakin's case, her doctor diagnosed the swelling and redness in her left thigh and "knife-like" pains as an infection. She was prescribed antibiotics and anti-inflammatory drugs, but died 12 hours later.
Higher risk of blood clots
Studies have linked Diane-35 to a sixfold greater risk of developing a blood clot compared to non-users of oral contraceptives,1 although nearly all oral contraceptives come with heightened risks. And the risks climb as you add in other known risk factors. Among women who had used oral contraceptives, the risk of a heart attack was nearly 14 times higher among those who smoked, for example, 17 times higher in those with diabetes and 25 times higher in those with high cholesterol.2
Two other so-called 'new-generation' birth-control medications from Bayer, Yaz and Yasmin, are formulated with a new, synthetic progesterone and are widely marketed to preadolescents and upward as a treatment for acne. They've become global bestsellers within the past decade.
But it wasn't long after their introduction that adverse-event reports began pouring in, including claims of Yaz-related strokes, heart attacks and gallbladder disease. In Canada, the Canadian Broadcasting Corporation (CBC) obtained government documents showing that, between 2007 and February 2013, doctors and pharmacists reported 600 adverse reactions, including 23 deaths where Yaz or Yasmin were the suspected cause. More than half the reported deaths were women under age 26, with the youngest being just 14. Most of them had only recently started taking the contraceptives.
One young woman, 18-year-old Miranda Scott, suddenly collapsed while on an elliptical machine at a University of British Columbia gym. On autopsy, her body was found to be riddled with blood clots, and the coroner ruled that a blood clot in her lung had killed her.
But it was her mother who made the connection with her daughter's taking Yasmin just over a month earlier. "And that was all it took, five weeks start to finish, and that was the end of a beautiful, beautiful girl," she told the CBC.
Scott's was one of the more than 13,000 lawsuits alleging serious harm, including blood clots, strokes, heart attacks and gallbladder damage, from these two drospirenone-based contraceptives. Plaintiffs have routinely argued that the drug maker hid the known risks to young women and girls.
By July 2015, according to Injury Lawyer News, Bayer had agreed to pay out no less than $2 billion to roughly 10,000 Yaz/Yasmin plaintiffs, including virtually all claims relating to gallbladder injury and venous blood-clot complications. Yet Bayer continued to refuse to concede its pills were related to strokes and heart attacks—until the eve of the trial, when Bayer announced it would allocate another $57 million to settle 1,200 more cases.
Eventually, the Food and Drug Administration (FDA) conducted wide-ranging investigations into the drug's safety and mandated stronger warning labels for the two pharmaceuticals.
Nevertheless, Bayer continues to sell its controversial contraceptives wherever it can, and it has plenty of incentive to do so. The Pill is by far the most popular contraceptive pharmaceutical worldwide, taken by more than 200 million women. It is currently prescribed to roughly 10.7 million American women, nearly 20 percent of all 15- to 44-year-olds.
According to one market report, oral contraceptive pills make up the largest and fastest growing share of the global contraceptive market. It's projected to exceed $23 billion by 2018, up from $16 billion in 2011.
A big chunk of that growth is due to an increase in marketing the Pill to preadolescent girls on up as a treatment for acne, irregular menstrual cycles, premenstrual syndrome (PMS) and virtually any symptom that might be hormone-related. According to the Guttmacher Institute in New York City, 14 percent of the 10.7 million American women and girls taking the Pill are using it exclusively for these non-contraceptive reasons.
Nevertheless, the majority of women use it for the sexual freedom to plan their pregnancies around their careers and lifestyles. This freedom comes with a price, though, as any cursory look at women's internet health chat rooms will reveal.
Complaints are rife about the Pill's side-effects—weight gain, anxiety, depression, mood swings, acne, flu-like fatigue, hair loss, poor circulation, hypoglycemia . . . and on and on.
What follows are some of the conditions linked to the Pill that are rarely mentioned, even when doctors are prescribing them.
Breast and other cancers
Cancer growth and development is well known to be influenced by hormones—a connection strengthened by the latest, definitive evidence that the use of hormone replacement therapy (HRT) can triple the risk of breast cancer.3 Women naturally produce estrogen hormones in their ovaries, adrenal glands and fat cells.
"A woman's estrogen levels fluctuate throughout the month, but the Pill can be 20-50 times the amount of estrogen that the body produces," explains Donna Gates, author of The Body Ecology Diet (Hay House, 2011). "Taking these unnaturally excessive amounts of estrogen makes a woman estrogen-dominant, which is linked to estrogen-related cancers. In other words, a build-up of estrogen in the body is dangerous."
In 2005, the UN's International Agency for Research on Cancer (IARC) issued Monograph 91, which reclassified the Pill as a Group-1 carcinogen (like tobacco and asbestos) based on a number of recent studies that found a positive connection, particularly with those containing levonorgestrel.4
This meant that health advisory organizations, which had categorically denied any association of the Pill with breast cancer for years, were finally forced to admit a possible raised risk for breast cancer, cervical cancer and liver cancer.
On the other hand, other studies have found that oral contraceptive use lowers the risk of uterine and ovarian cancers, leading some advocates for the Pill to claim that the overall risk is the same as for non-users—but the figures don't add up, as breast cancer alone is six times more prevalent than uterine and ovarian cancers combined.
What's more, studies have shown that women who use the Pill for more than a year have a 2.5 times higher risk of developing the subtype of breast cancer called 'triple-negative' breast cancer, which has a higher mortality rate.5
As far back as the 1970s, oral contraceptives have been associated with gallbladder disease. However, a more recent retrospective cohort study found only a "small, statistically significant" association with formulations containing desogestrel, drospirenone and norethindrone compared with levonorgestrel.6
But when millions of women are taking a drug, even a "small" effect can translate into big numbers, as the Bayer lawsuits demonstrated. And a retrospective study isn't looking at the actual effects of contraceptive steroids on individual women.
The studies that have, like the one published in The New England Journal of Medicine, found that "cholesterol saturation was significantly higher in gallbladder bile during [oral contraceptive] use than during normal menstrual cycles."7 Clearly, this isn't an effect it's prescribed for.
Depression, mood swings, loss of libido
Some of women's most frequent complaints about the Pill are that it causes them to gain weight, lose hair, flatline emotionally and become irritable or depressed. These symptoms often accompany one of the most common reasons—from as far back as the 1960s—that women give for stopping the Pill: loss of libido. Just when you're free to have sex without consequences, you're just not that interested.
It makes sense that the Pill would have such a wide variety of side-effects when you consider that it works by tricking the body into thinking it is pregnant with synthetic hormones that never act in isolation. "Synthetic hormones like those in combined oral contraceptives that contain estrogen and progestin increase thyroid- and sex hormone-binding globulin (SHBG), effectively decreasing the available testosterone and thyroid hormone in circulation, which can render you of nun-like libido and functionally hypothyroid or depressed, constipated, overweight, cloudy and with dry skin and hair to boot!" says New York integrative psychiatrist Kelly Brogan, author of A Mind of Your Own (Harper Wave, 2016).
Research published in The Journal of Sexual Medicine in 2006 suggests that the Pill not only suppresses desire by raising levels of SHBG fourfold, but can also do so for months after a woman stops taking it.8
Brogan also points to research showing that the Pill promotes oxidative stress in the body that creates damaging free radicals, which are reduced by supplementation with antioxidants like vitamins E and C.9 The Pill also depletes vitamins, minerals and antioxidants, especially coenzyme Q10, an essential component of mitochondria, which drive all bodily processes,10 and trace elements like zinc, selenium, phosphorus and magnesium.11
That's why when Brogan sees patients suffering from a myriad of vague and depressive or anxiety symptoms, one of the first questions she asks is: "Are you on the Pill?" She then counsels that the last thing they need is "synthetic hormones and the pharmacologic burden they bring."
Controlling women's choices?
Holly Grigg-Spall is one of the thousands of modern women who started to wonder if her emotional flatness, loss of libido, poor immune function and other symptoms were related to her 10 years of compliantly swallowing the public-health and physician endorsements of oral contraception.
When she looked, not only was she astonished at the wealth of research on the dangers of hormone suppression and the benefits of fertility, but she also found recent studies on how birth control jams up a woman's normal hormone-driven mate-choosing ability and even alters memory function, something that she contends in her book, Sweetening the Pill: Or How We Got Hooked on Hormonal Birth Control (Zero Books, 2013), is rather akin to patriarchal
A new kind of freedom
Like Grigg-Spall, more young women today are objecting loudly to living in a state of permanent hormonal interference and dependency. A typical example is YouTuber beautifullybookish, who describes her "terrible" experiences with various forms of the Pill—from loss of menstruation to blurred vision and extreme hair loss—as she details her journey over five years to becoming Pill-free.
Others offer advice on websites like www.goingoffthepill.org, started by an anonymous 24-year-old from Toronto who noticed "incredible improvements both physically and emotionally" when she stopped her oral contraception, especially the end of her weekly incapacitating migraines.
The Australian video blogger for Sarah's Day describes how she decided to stop her birth-control pills for acne and deal with the underlying problem behind her hormonal imbalances, rather than "mask them" with a pharmaceutical. She visited a naturopath and discovered she had polycystic ovarian syndrome, so she revamped her diet and started taking a B-vitamin complex and a number of herbal remedies, including Vitex agnus-castus, to bring her hormones—and her skin—back into balance.
Agnus-castus, also known as 'vitex' and 'chaste tree,' is a shrub that grows in the Mediterranean and has been used for centuries to regulate hormonal symptoms, including PMS, cramps and menopausal symptoms. Its efficacy has been borne out by recent studies.12
As well as rethinking old staples like condoms and diaphragms as less risky alternatives to hormonal birth control, many women are also now looking at natural methods.
Natural ways to avoid pregnancy
Because women's eggs have a very short lifespan outside of the ovaries, getting pregnant is actually limited to a narrow window of fertile opportunity that usually lasts only from six to 48 hours per monthly cycle. But as sperm can live longer, this extends the opportunity for fertilization to several days each month.
The fertility awareness method (FAM) and natural family planning (NFP) work by teaching women how to recognize their body's signs of ovulation, such as the quality of their cervical fluid and basal body temperature. This lets women identify when they are most fertile, and which days it is necessary to abstain from sex or use a barrier contraceptive method to avoid pregnancy.
Like artificial contraception, FAM and NFP don't protect against sexually transmitted diseases and so are best used when couples are in a monogamous stable relationship. When used correctly, they are just as effective as most other contraceptive methods (99.6 percent).
Fertility awareness requires only a sensitive glass or digital basal body temperature thermometer accurate to 0.10 degrees. Many apps and books, like Taking Charge of Your Fertility (Vermilion Publishing, 2003), and websites are now available to explain how to use thermometers to track the temperature changes (taken at the same time on arising each morning) that signal ovulation.
As well as costing nothing and having zero side-effects, fertility awareness helps women to better understand their bodies and their fertility and, thus, to conceive when they want to.
The Pill and an inflamed gut
The Pill's link to Crohn's disease, a disorder in which the patient's own immune system begins to assault the gastrointestinal (GI) tract, was recently confirmed by major studies.1 There's also a link between Pill users who smoke and ulcerative colitis and Crohn's.2 Several mechanisms have been proposed to be behind the connection, including damage to the ecology of the gut microbes, or microbiome, by the Pill. The good news: the risks dropped back to normal, and the disease may sometimes be halted, in those who stopped taking oral contraceptives.
Effect on gut bugs
There is evidence that the hormones in the Pill have negative impacts on the microbiome. Numerous studies document how it can shift the flora in the mouths of users to favor certain Candida species and so increase the risk of severe periodontitis and gingivitis.1
As gum disease is commonly found in patients with chronic heart failure,2 dementia, rheumatoid arthritis3 and diabetes, this may be a sign of more than just changes in the mouth.
Research has shown that 9,000 genes—almost a third of the entire human genome—are expressed differently during the onset and healing of gingivitis.4 This may explain why thousands of women have complaints that range from acne to vaginal yeast infections and urinary tract infections that happen because they're on the Pill.
"We've known for some time that intestinal cells have receptors for estrogen," says microbiome expert Donna Gates. "Excess estrogen feeds the yeast in the gut and in the vagina, and causes it to grow and multiply quickly. Yeast quickly outnumbers any other microbes living in both these two inner ecosystems."
Once Candida has overgrown, it can grow 'tentacles' that burrow into the gut wall, creating sites of infection and a leaky gut. "This leads to systemic yeast overgrowth as the yeast cells multiply, leak through the gut wall and infect other areas of the body. The infection then becomes systemic," says Gates. "It's a vicious cycle."
What's more, she adds, the lack of a hardy, diverse inner ecosystem also weakens a woman's immunity, leaving women vulnerable to infections.
The chemical matchmaker
Oral contraceptive use has been found to influence the sort of man a woman chooses as a partner, altering the natural biochemically driven tendency to seek a man who is genetically dissimilar.1 Indeed, the Pill is linked to women apparently eschewing more masculine features, like heavy brows and large jawlines, for more feminine traits in their partners.2 This appears to affect women's sexual satisfaction with their partner and, in turn, the stability of any long-term relationships.3
The IUD vs the Pill
What about the many intrauterine devices (IUDs) as an alternative to the Pill? These T-shaped devices are inserted into the uterus and prevent the survival of sperm and ova in the womb by releasing copper. However, many IUDs instead release the same synthetic hormones as found in oral contraceptives, and so carry similar hormone-related health risks.
In fact, famed people's advocate Erin Brockovich is currently investigating the Mirena IUD for its side-effects, and several class-action lawsuits are already underway alleging the dangers of this device.
Copper IUDs (or coils) are a first-line alternative for women at high risk of deep vein thrombosis (DVT) and cardiovascular events because they don't carry the hormone-induced risks of the slow-release hormone IUDs.
However, while copper is necessary in trace amounts for an array of vital bodily functions, including bone growth, hormone secretion and more, an excess of copper, especially nonorganic copper, has been linked to oxidative stress, brain damage and neurodegenerative disorders.
One study found that trace amounts of copper in drinking water (90 percent below the accepted Environmental Protection Agency levels) can increase the risk of Alzheimer's disease by stimulating the production of brain proteins and creating "log jams of the protein that the brain's waste disposal system cannot clear."1 Raised copper biomarkers have also been noted in other neurodegenerative diseases, such as Parkinson's and vascular dementia.2
Women using copper birth-control devices have significantly higher copper levels in their blood, and also evidence of more inflammation and oxidative stress.3 Researchers now advise that copper IUDs should not be used for more than two years to avoid such tissue damage.4
In addition, women with IUDs are three times more likely to have vaginal Candida and to suffer heavy periods, endometrial changes and inflammation of the cervix. Other risks include:
• perforation of the uterine wall or cervix (0.6-16 cases/1,000 insertions)
• pregnancy with the IUD in place
• ectopic pregnancy
• embedding of the device in the uterine wall
• pelvic inflammatory disease5