Niamh Doherty couldn’t understand why she kept crying. At the age of 17, she was repeatedly experiencing bouts of low mood. It took months for her to realise the persistent sadness had arisen soon after she began the contraceptive pill.
“My mom wanted me to go on contraception because I had my first boyfriend. I immediately saw weight changes. I went from being quite flat to having huge boobs. And I had terrible mental health. I wasn’t sure if that was just from being a teenager or what,” the now 25-year-old says.
“I didn’t really have a consultation when I went to the doctor. I said I wanted contraception and she said ‘here’s the pill’. There were no conversations around it, what the effects might be and whether that suited my body.”
The side effects of the pill was a topic she and her friends spoke about frequently. “Loads of my friends suffered from mental health issues, switching from pill to different pill to find the right one.”
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It’s a situation familiar to almost every woman. As a teenager, you attend your GP seeking contraception for pregnancy prevention, period regulation or a combination of both. And from that moment, as soon as that prescription is handed over, these foil blister packs, each filled with 21 or 28 days of hormonal pills, become a constant companion for many years – in some cases, decades – to come.
The monthly packet sits on the bedside locker as a reminder to take the pill first thing every morning, or is hidden carefully in your handbag or backpack so it’s never too far out of reach. Phone alarms are set as a daily prompt, ensuring the 24-hour interval between “baby -blocker” pills is strictly adhered to.
Then if there are any side effects – commonly reported symptoms include weight gain, low mood, tender breasts, lower libido – you return to the doctor only to be prescribed a different brand of pill, beginning what campaigners have dubbed a “pill roulette”.
After several years of such trial and error with various pills, Doherty who lives in west Cork decided to come off the pill entirely. Last year she had the non-hormonal copper coil inserted into her uterus, and is “really content with it”. “For seven years, there were hormones being pumped into my body. I didn’t know if it was bad to be on hormones for that long, I still don’t. There’s just no education there,” she adds.
In the UK, NHS data shows the percentage of women using the pill as their main form of contraception has fallen from 46 per cent in 2014-15 to 28 per cent in less than a decade. While no comparable data is available for the Republic, anecdotally more women are opting to bin their pills in favour of other methods of contraception, from non-hormonal coils and intrauterine devices, to more “natural” methods using fertility tracking apps and wearable technologies.
Kate Muir, a Scottish writer and documentary maker, says the world is experiencing a “pillquake” as concerns grow around the physical and mental side effects of hormonal contraception.
In her recent book, Everything You Need to Know About the Pill (But Were Too Afraid To Ask), Muir explains that the various types of pill have a different hormonal make-up, with some containing more androgenic and masculinising hormone types, while others are more oestrogenic and feminising. These hormones affect women in different ways, and sometimes changing to a different pill brand can result in much better outcomes.
As part of a 2023 documentary she produced with Davina McCall for Channel 4 called Pill Revolution, she commissioned a survey of 4,000 women and non-binary people across the UK about their experiences on the pill. Seventy-seven per cent of respondents said they had experienced side effects, 57 per cent were worried about their mental health while on the pill, and 36 per cent cited anxiety, depression or low mood as the main reason they stopped taking it. Twenty-one per cent reported lowered sex drive.
“People are really afraid to talk about it in the medical profession,” Muir tells The Irish Times, “because they don’t want loads of young women coming off the pill and having to get the morning after pill or the abortion pill.”
She believes there is a “gaping hole” in our knowledge around the possible link between depression or anxiety and the pill, due to a lack of research.
“We’ve been on the pill since the 1960s, so why haven’t people looked at that? The only side effect they’ve really looked at is around clots and strokes, because they have real world consequences and death,” Muir says.
“But in terms of mood, weight, sex drive – these are all things that people say are in women’s heads. It is a real case of gaslighting. We’ve also self-gaslighted; we’ve just put up with it. We’ve just thought it’s a part of life. A new generation is questioning it.”
In one popular TikTok video, a woman says the pill is 99.9 per cent effective at “ruining my life”. In another clip, a young woman sits on her bed crying, drinking from a water bottle while taking her pill saying it “does nothing but affect your mood and emotions”. In a third, a teenager spreads out the paper information leaflet outlining side effects of her contraception on her bed, covering a quarter of the mattress, with the caption “girlhood”.
Such viral videos have become so influential that the NHS felt compelled to issue a warning that they were leading to a rise in the number of young women coming off the contraceptive pill and risking unwanted pregnancy. Last September, the Faculty of Sexual and Reproductive Healthcare (FSRH), which represents 14,000 healthcare professionals in the UK, said doctors were being told by patients that they would never take the pill after researching it on social media.
This has been supported by academic research – a recent paper published in the academic journal Social Science and Medicine on declining rates of the combined oral contraception pill in western Europe found social media “delegitimises the role and authority of health professionals”.
“The vast majority of scaremongering around adverse health effects from long-term use of contraception is exactly that: scaremongering,” says Dr Ciara McCarthy, the Health Service Executive’s clinical lead for women’s health.
The circulation of misinformation about contraception online is also a concern here in Ireland; the HSE is currently working on guidance for women.
There is a “very small increase in the risk of breast cancer” among those who use hormonal contraceptives in the long-term, Dr McCarthy says, but that is associated with how long that particular method has been used for, and the “risk returns to baseline once you stop that particular method”. She adds: “That can be hugely over-represented.”
Some trending social media posts have suggested long-term hormonal contraception use can negatively impact fertility. But Dr McCarthy says there is no evidence to support this.
“What we forget sometimes is that we go on contraception in our late teens, often when our fertility is at its peak, and we come off contraception in our 30s,” she says. “Unfortunately our fertility in our 30s is not as high as it was in our 20s, but it’s nothing to do with contraception. It’s to do with natural ageing.”
She says the shift from the pill is difficult to quantify in Ireland due to a lack of data analysis – the HSE does not collate data for people paying privately for prescriptions, including contraception – but anecdotally, healthcare staff have noticed a reduction in the number of women seeking the pill.
Looking at Irish medical card prescriptions, data shows a drop in combined pill use over the past decade and a half, but a corresponding increase in use of the progesterone-only pill, and long-acting reversible contraception (LARC) methods like the copper coil, contraceptive implant or hormonal coil.
The free contraception scheme launched in 2022 – now available to women aged 17 to 35 – may also have changed demand. For many women, cost was a prohibitive barrier, particularly for LARCs like the bar implant and the coil, which have a much higher upfront cost than the pill.
According to the Irish Family Planning Association’s (IFPA) 2023 annual report, the clinic fit a total of 1,241 LARCs that year, of which 60 per cent were for clients aged 17-30, suggesting “the scheme is encouraging women to choose more effective methods” of contraception.
Liz Westendorf who is originally from Ohio but now living in Cork, is among this wave of women opting for LARCs over the pill. She went on the pill in her teens. As an athlete, she wanted something to regulate her cycle as she experienced heavy bleeding, and it also served as a form of contraception.
“When I was around 24, I felt I wanted to get off it. I didn’t know my cycle,” she says.
“I couldn’t tell what my actual mood was or what was caused by hormones, and I was very discombobulated. The faux period it produces and the synthetic hormones – I didn’t feel comfortable with it.” She came off the pill and decided to use condoms as her main form of contraception and “felt better”.
After the birth of her second child last year, 37-year-old Westendorf wanted to be on contraception again but was adamant it would not be hormonal. She got the copper coil inserted in December.
“I felt like [my doctor was] assuming I would go for the hormonal coil and when I said I wanted the copper coil, they were like ‘well your periods will be heavier and more intense’,” she says.
“She was very kind, but I did feel like I was being steered towards [the] hormonal.”
Feeling like they are not being listened to by their doctors, some women are opting to take contraception into their own hands – with technology aiding a move to “natural planning” or “fertility awareness” whereby a woman tracks which stage of the menstrual cycle she is in, and only has sex on non-fertile days.
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The creation of apps or wearables such as the Oura ring has made this method increasingly popular. Natural Cycles is one such app, which claims to use an algorithm to determine a woman’s fertility status based on body temperature, with a 93 per cent success rate, they say. It has gathered 2.5 million registered users since launching in 2013. In 2018, it became the first birth control app to be cleared by the US Food and Drug Administration. Other popular tracking apps include Flo, Clue, Ovia and Luna. Women with irregular cycles will need to pay particular attention to finding the best one for them.
Justine Simon, a 20-year-old student from MTU Kerry, now uses an app as her main form of contraception. She was first prescribed the combined pill when she was 16 and was on it for a year.
“It was fine for the first six months. But then I started drastically gaining weight and my mood swings were quite heavy. My partner at the time, the day we broke up I stopped taking the pill,” Simon says.
“The way that I viewed myself was completely different […] before and after […] taking the pill. I will never, ever again be on hormonal contraception. I hear horror stories and I just don’t see how it’s worth it.”
Now in a new relationship, she pays for the premium version of Flo. “I check it often to see when I’m ovulating. If we were getting closer to when I’m on my period we’d use condoms just to be safe, but usually we don’t.”
She used to be quite nervous and “would get a pregnancy test once a month to ease my mind”.
“But the app I have is so accurate, it’s never even a day off about getting my period so I don’t have time to freak out. I don’t think it would be the end of the world if I got pregnant, so I’m less worried than most people,” Simon says. “I just think the risk outweighs the reward for hormonal contraception for me.”
You get told you’re going to have side effects but they won’t be as bad as what we’re trying to remedy
Dr Laura Cullen, a general practitioner in west Cork, says GPs do not generally recommend cycle tracking as a form of contraception due to its failfure rate. Clinicians, she explains, use something called the Pearl Index, which measures contraceptive effectiveness through academic research. The lower the number, the more effective the contraception type.
“The Pearl Index of cycle tracking and cycle tracking apps is about 2 with perfect use. With typical use it’s 7. With something like a hormone coil, the pearl index is something like 0.16,” she says.
The bar has the lowest Pearl Index of any contraception at 0.02. The combined contraceptive pill measures 0.9.
That doesn’t mean there isn’t a place for cycle tracking apps, Dr Cullen says. They can be valuable for providing women with insights into their menstrual cycle, and helping them identify and understand their feelings at various points throughout the month.
“Some people are quite hormone-sensitive. I find there is generally a contraception [type] for everybody,” Dr Cullen says.
“But some people just really don’t do well on either oral, injectable or implantable hormones. For those women, they may be more willing to use the tracking apps to try and prevent their use of hormones.”
This, she says, is when it’s particularly important to have a “good patient-doctor relationship” to stave off the “tsunami of information”, often misinformation, available online.
“People are often a little bit sceptical about what I’m saying, and I’m okay with that. [In the] doctor-patient relationship, I should be able to explain the advice I’m giving to them,” Dr Cullen says.
There are “absolutely valid reasons” why some women shouldn’t be taking certain types of contraception, she says, citing a recent academic paper in the BMJ in 2024 which associated certain forms of progesterone in HRT products with increased rates of a rare breast cancer.
“That caused an upswing in concerns around hormonal contraception. But your doctor is going to be able to explain how that particular piece of data applies to you individually,” she says.
“I really like when people advocate for themselves and go off and do their own research and come back to me with questions. That’s a really good thing. But [as a doctor] I’m able to say this research is relevant to you, but that one isn’t.”
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For some women, hormonal contraception offers much more than just prevention of an unwanted pregnancy – it is a lifeline in managing debilitating symptoms of conditions like polycystic ovarian syndrome (PCOS) or endometriosis, where tissue similar to uterine lining grows outside the uterus, often in the pelvic area, causing pain, heavy bleeding, and potential infertility.
“It doesn’t necessarily get rid of disease, but anecdotally we would see people have a longer symptom-free time than those who don’t go on hormonal treatment,” says Niamh Daly, a consultant at the Rotunda Hospital and senior lecturer in obstetrics and gynaecology at the Royal College of Surgeons in Ireland.
A portion of women have reported mental health side effects. “Their mood went up or down, and they didn’t feel like themselves and they didn’t like it so they didn’t want to continue it,” Dr Daly says.
“I go along with whatever women say and offer alternatives. But it is a shame for diseases like endometriosis, there are no real non-hormonal suppressive treatments yet. It is a hormone-dependent disease, so it would be great to see research into alternative drugs for that.”
Muir agrees that there is a need for better contraception options, too. She refers to recent studies around a non-hormonal male contraceptive pill called YCT-529, and a sperm-blocking injectable gel dubbed the “temporary vasectomy”, both of which are currently in clinical testing.
“There [are] quite a few things [being developed] for men that are a lot better than what we have,” Muir says. “But we’re in a sort of U-bend of neglect for women with contraception that really needs to change. We could be doing far, far better.”
Annabel Biddulph, a law student studying at Technological University Dublin, also believes women are neglected when it comes to contraceptive options. She was on the combined pill from age 16 to 20.
At that point, she says, “I realised it was doing more harm than good” so she changed to the progesterone-only pill which was “absolutely awful”.
“I suffer badly with premenstrual anxiety. I ended up really anxious all the time. My depression got really bad,” Biddulph says.
She then tried the bar, which lasts for three years, but she had it removed after one. She has been “au naturel” – tracking her cycle – ever since, in combination with condom use.
The 22-year-old says she is “pretty chill” about tracking her cycle. “As long as you’re doing everything right you’re fine. I know my body very well. I know when I’m ovulating. I know when my downtimes are. I’m very careful.”
Some of the other side effects she experienced while on hormonal birth control, she says, were tension headaches, joint pain, weight gain and hair loss.
“You get told you’re going to have side effects but they won’t be as bad as what we’re trying to remedy. But for me, it’s so much worse. I’m much hier now without it.
“When I came off the hormonal birth control, everything became so much better.”
