Birth Control Explained
Birth control is any method and / or technique practiced with the goal to prevent pregnancy. There are ginormous amounts of different types of birth control out there. In order to give you a better understanding of the options available, in this week’s Slutty Science we will be dissecting birth control: the options, their history, the pro’s and the con’s.
But in order to understand how to prevent pregnancy, we must first understand how pregnancy really works. In order to be able to understand that, we must first understand how the menstrual cycle works. Click here to read all the in’s and out's about the menstrual cycle.
During ovulation a mature egg is released from the fallopian tubes. From there it travels to the uterus. As soon as the egg is released it can be fertilized by sperm cells.
The world health organization estimates that when a man ejaculates, on average 1.5 to 7.6 milliliters of sperm is released. They found that each milliliter of sperm contains anywhere between 15-259 million sperm cells. This means anywhere between 22.5 and 2000 million sperm cells are released per ejaculation. When this ejaculation takes place inside the vagina, sperm cells swim through the cervix, to the uterus where they begin looking for an egg to fertilize.
When the egg is fertilized by a sperm cell it will proceed to implant itself into the uterine lining. This phenomenon is called pregnancy and – when carried to term – this will eventually lead to the development of a brand new human being.
Now that we know more about both the menstrual cycle and the occurrence of pregnancy, let’s talk about what we’re really here to discuss: how to prevent pregnancy. There are a plethora of options for birth control, but they all make use of either one of the following ways in which they prevent pregnancy. Birth control can:
- Prevent ovulation;
- Physically prevent the sperm from reaching the egg;
- Prevent the fertilized egg from implanting into the uterus.
Contraceptive methods can be hormonal – like the pill for example, but may also be non-hormonal – like a diaphragm. They can be meant particularly for people with penises – like condoms, but may also be meant for people with uteruses – like Intrauterine Devices (IUD’s). They can be temporary – like hormonal patches or injections, but may also be permanent or semi-permanent – like a tubal ligation or a vasectomy.
For a full overview of the most common types of contraceptives, with a classification regarding whether or not they are hormonal, for what sex they are meant, whether or not they are permanent and in what way they prevent pregnancy – head over to www.TheSlutShow.org
The history of birth control
The term birth control was coined by Margaret Sanger, an activist and social reformer who made it her life's mission to develop “The Pill.” Its development – and eventual FDA approval, on May 9th 1960 – ushered in an era of sexual anatomy and revolution for people with uteruses. However, it is impossible to discuss female liberation, without shedding light on how the emergence of this hormonal birth control pill is heavily intertwined with both the eugenics movement and colonialism. Although Sanger is often referred to as a feminist, her strive for The Pill was largely motivated by her underlying beliefs supporting both eugenics and racism. Not a very feminist agenda, if you ask me.
The Eugenics Movement
‘Eugenics is the practice or advocacy of improving the human species by selectively mating people with specific desirable hereditary traits. It aims to reduce human suffering by “breeding out” disease, disabilities and so-called undesirable characteristics from the human population. Early supporters of eugenics believed people inherited mental illness, criminal tendencies and even poverty, and that these conditions could be bred out of the gene pool.’ One of the most notorious practitioners of eugenics is Hitler, whose obsession with creating the Aryan race resulted in the brutal murder of well over 6,6 million yews.
Sanger ‘saw birth control as an innovative and safe way to medically allow for limiting the abilities of certain populations to reproduce [...] greatly affecting African American populations in America and furthering beliefs that people of color were lesser than or appropriate for being used as test subjects for medical advancements.’
Prior to the development of the pill, the eugenics movement launched sterilization programs. These programs led to the – oftentimes forceful – sterilization of nearly 7,600 people (in North Carolina alone) over a 45 year period of time. Victims were as young as 10 years old. 40% of which were from African American and Native American minorities and 85% of which were female. These programs ‘were tailored not just to control the size of a presumably dysgenic black population [...] but to breeding-out a presumably genetically unfit and unproductive black surplus population.’ It is painfully obvious that it is black people who were disproportionately targeted for these types of medical procedures. In total ‘as many as 70,000 Americans were forcibly sterilized during the 20th century.’
Development of The Pill
When researchers began developing the precursor of what is now known as The Pill ‘birth control was strongly regulated by state laws that made it effectively illegal to research or distribute.’ Yet, together with obstetrician John Rock, biologist Gregory Pincus began researching the matter in an attempt ‘to figure out if it was possible to use progesterone [...] to prevent pregnancy in women.’
After lab testing on both rats and rabbits had positive results, a small number of women* tested the drugs in a trial disguised as a so-called “fertility trial.” Pincus, Rock, Sanger and their associates knew they would need trials performed at larger scales in order to get the drugs approved, but left without legal opportunities in the U.S. – they moved their trials to Puerto Rico. There ‘poor women were given a strong formulation of the drug without being told they were taking part in a trial or about any of the risks they’d face.’ Although three women* lost their lives during these trials, no autopsy was conducted and thus supposedly ‘it remains unclear if their deaths were linked to the drug.’
Pro-pill history fact sheets now state things like ‘A Smashing Success,’ but considering the deaths and countless side-effects experienced by these minorities, its so-called “success” remains up for debate.
The first Pill vs. today’s Pill
For reference, today’s Pill contains around 150-3000 micrograms of progestin and approximately 10-35 micrograms of estrogen. Enovid – the first pill to come out – ‘contained 10,000 micrograms of progestin and 150 micrograms of estrogen.’ That very first pill thus contained anywhere between 4-15 times more synthetic estrogen and anywhere between 3-66 times more synthetic progesterone than today's average hormonal birth control pill.
Hormonal birth control
Hormonal birth control does NOT regulate the menstrual cycle
When it comes to hormonal birth control, there are a couple of things which are absolutely essential to understand. For starters – opposed to contrary belief – hormonal birth control does not regulate your cycle. Yes, hormonal birth control gives off a stable amount of hormones each day, however, that does not mean it stabilizes the menstrual cycle. In fact, it does quite the opposite. By chemically preventing ovulation, hormonal birth control suppresses the menstrual cycle altogether.
Withdrawal bleeds, not menstruations
The withdrawal bleeds that may occur when using hormonal birth control are often mistaken for a menstruation, but in in reality are nothing like it. An actual menstruation occurs as the result of natural hormone fluctuations. When hormonal birth control is taken, ovulation doesn’t take place at all. Therefore the uterine lining doesn’t thicken the way it would during a natural menstrual cycle and thus there is no real reason for this lining to shed. It is the sudden drop in synthetic hormones during the pill, patch or ring free week, which causes the withdrawal bleeding. But don’t be mistaken, a withdrawal bleed and a menstruation are two entirely different things.
Hormones on the combined Pill (“What Does Oral Contraception Do to Your Hormones?” n.d.)
Hormones on a natural cycle (“What Does Oral Contraception Do to Your Hormones?” n.d.)
Birth control: the most popular (hormonal) options
Alright, let’s take a closer look at some of the most common types of birth control used by people with uteruses: intrauterine devices, the patch, the ring and lastly, the Pill.
Intrauterine Device – IUD
IUD stands for Intrauterine Device. They are tiny t-shaped contraceptive devices – with a size of approximately 3 by 3cm. They are placed into the uterus, through the cervix, by a healthcare provider like a gynecologist or general practitioner (GP).
IUD’s are highly effective and can be both hormonal and non-hormonal. After placement an IUD can be worn several years, with some remaining effective up to 10 years post placement.
Hormonal IUD’s contain exclusively progestin, a synthetic version of the natural hormone progesterone. Hormonal IUD’s prevent pregnancy by preventing ovulation, as well as physically making it harder for the sperm to reach the egg
Non-hormonal IUD’s, like the copper IUD, prevent fertilization by creating a toxic environment for sperm. As their name suggests, they do not contain hormones.
The hormonal birth control patch is a plaster-like patch, which is applied to the skin in a similar manner to a plaster. Most patches are replaced for a new patch after wearing it for 7 days. This process generally repeats for 3 patches in a row and is then alternated for a patch-free week. During that week you get the previously discussed withdrawal bleed, which is often wrongfully referred to as a menstruation.
The patch prevents pregnancy by preventing ovulation altogether. It contains both the synthetic version of progesterone (progestin) and the synthetic version of estrogen (ethinyl estradiol). There are no birth control patches which exclusively contain progestin.
The hormonal birth control ring is a small and flexible ring, which is inserted into the vagina. It can be worn for three weeks, after which it should be taken out for a ring-free week. During that week you get a withdrawal bleed.
The ring prevents pregnancy by preventing ovulation altogether and contains both the synthetic version of (progestin) and the synthetic version of estrogen (ethinyl estradiol) – just like the patch. There are no birth control patches which contain exclusively progestin.
The hormonal birth control pill is a pill which is taken orally each day, for 21 days in a row, followed by 7 days off the pill or on placebo pills. During this week you get a withdrawal bleed.
The combination pill prevents pregnancy by preventing ovulation altogether and contains both the synthetic version of progesterone (progestin) and the synthetic version of estrogen (ethinyl estradiol).
However, there are also progestin-only pill's, which are often referred to as the 'Mini Pill'. This Pill contains only the synthetic version of progesterone (progestin). It prevents pregnancy by physically making it harder for the sperm to reach the egg.
Bioidentical versus synthetic hormones
There is hormonal birth control that contains so-called bioidentical hormones. These ‘bioidentical hormones are structural replicas of natural hormones,’ which ‘keep the body in balance by binding to specific receptors.’ However, as stated repeatedly, most hormonal contraceptives do not contain not contain “real” hormones, but rather synthetic hormones.
- Progestin is the synthetic hormone used to replace progesterone;
- Ethinyl estradiol is the synthetic hormone used to replace estrogen.
Synthetic hormones were developed in hopes they would be more stable and would allow for better dosage control. Even though they were designed to mimic the effects of “real” hormones, they are known to be ‘capable of cross-reactivity within the body’s receptors, causing hormonal imbalances and other uncomfortable side effects.’
To this very day synthetic hormones are most commonly used, however, because these types of hormones can be can be patented, allowing manufacturers to protect their formulas and obtain the exclusive right to manufacture specific formulations.
The risks of hormonal contraceptives
A plethora of research shows that the use of hormonal contraceptives blunts the body's natural cortisol responses, but what even is cortisol?
Cortisol is one of the most important hormones in the human stress response system. Every morning when you wake up, the cortisol awakening response takes place. This is a change in cortisol levels that occurs naturally and helps you wake up. When a dangerous or stressful situation presents, cortisol levels also rise. Such a spike in cortisol allows the body to mobilize its ‘energy supply in order to provide readily-available energy for dealing with the current stressor.’ In a similar manner ‘acute increases in immune system activity facilitate healing, should injury or infection occur as a result of the current stressor.’
When the body’s natural cortisol response malfunctions – as it does in most people on hormonal birth control – you become less equipped to handle stress and are more susceptible to both infection and sickness. Low-cortisol levels have also been linked to anxiety, depression, brain fog, more severe concurrent insomnia symptoms,  mid-day lack of focus and cravings for salty or sweet foods and thus it is no wonder lower cortisol responses are associated with increased BMI and behavioral problems. Shockingly, dysregulated cortisol levels are even considered a risk factor for suicide.
A delayed cortisol awakening responses – as often found in those who use hormonal birth control – can lead to fatigue and morning sluggishness. In women,* low cortisol levels are also associated with loss of libido, interrupted sleep, feeling cold all the time and unexplained weight gain.
Hormonal contraceptives alter both noradrenergic and glucocorticoid responses. Data suggests norepinephrine and cortisol act independently to enhance emotional memory. It is no wonder that a lack of these chemicals may thus cause memory problems. Low-levels of norepinephrine have also been linked to other common side effects of hormonal contraceptives like anxiety, depression, headaches and sleeping problems.
15-19 year old girls who use combined oral contraceptives are at an 80% increased risk of depression, in comparison to their non hormonal contraceptive using peers. Those amongst that age group using progestin-only pills are even more than twice (120%) as likely to get depressed.  Therefore it shouldn’t come as a surprise, oral contraceptives are associated with increased first time antidepressant use. Depending on the type of hormonal contraceptive, the use of first time antidepressants increases by:
- 23% on combined oral contraceptives;
- 34% on progestogen-only pills;
- 40% on levonorgestrel;
- 60% on etonogestrel vaginal rings;
- Norgestrolmin patches make an individual even two times more likely to begin using antidepressants. 
The use of hormonal birth control is linked to increased levels of anxiety, as hormonal birth control suppresses the body's natural cycle and leads to continuously low levels of estradiol. Although low estrogen levels are normal in certain situations, like during the premenstrual part of the cycle, as well as post-partum, perimenopausal and postmenopausal. The continuously low levels of estradiol hormonal contraceptives result in, are thought to ‘lead to impairments in the natural extinction of emotional responses in the aftermath of trauma,’ which has in turn been linked to ‘the development and maintenance of PTSD and anxiety disorders.’
Hormonal contraceptives & sex
Moreover, combined oral contraceptives lead to increased levels of sex hormone-binding globulin (SHBG) and decreased levels of testosterone. Testosterone is a reproductive and growth hormone, produced in both males and females. Testosterone deficiency has been linked to symptoms like unexplained and persistent fatigue, but also sexual function changes like decreased libido, decreased vaginal lubrication, increased likelihood of pain during sex and even clitoral shrinkage. ‘Other potential signs or symptoms include loss of bone density, decreased muscle strength, and changes in cognition or memory.’
In addition, hormonal contraceptive use has been found to cause clitoral shrinkage, vaginal dryness, decreased lubrication and both low- and decreased libido. All consequences of the low testosterone levels hormonal contraceptives cause.
It should therefore come as no surprise that combined oral contraceptive use makes women* anywhere between four to nine (!) times more likely to suffer pain during intercourse.  Research found that the likelihood for the occurrence of such pain increases amongst women* who began using the contraceptive in question before the age of 16.
Furthermore, an expanding body of literature is demonstrating how hormonal contraceptives alter so-called “mate choices.” This alteration takes place, because these drugs suppress ovulation and thereby prevent natural hormonal fluctuations from taking place. This is thought to disrupt women’s* ‘attractiveness to men and their ability to compete with normally cycling women for access to mates.’ It also disrupts the fluctuation in partner preferences, which naturally occur during the menstrual cycle.
Interestingly, the initiation of hormonal contraception is even thought to cause changes in facial preferences amongst (potential) partners. Associating elevated progesterone levels to ‘increased attraction to facial cues associated with possible direct benefits’ regarding reproduction. These findings ‘suggest that women's face preferences are influenced by adaptations that compensate for weakened immune system responses during pregnancy and reduce the risk of infection disrupting foetal development.’
For this reason women* who use oral contraceptives ‘scored lower on measures of sexual satisfaction and partner attraction, experienced increasing sexual dissatisfaction during the relationship, and were more likely to be the one to initiate an eventual separation if it occurred.’
Stroke & migraine
‘Stroke is the second highest cause of disability in developed countries and the second most common cause of death globally.’ There are different types of strokes. An ischemic stroke is when a blood clot blocks one or more blood vessels. An hemorrhagic stroke is when a blood vessel in the brain ruptures or leaks.
Studies show that a history with migraine doubles your chances at having an ischemic stroke. However, the use of combined hormonal contraceptives makes you almost five (4.9) times more likely to suffer ischemic stroke and the use of combined hormonal contraceptives, in women* with a history of migraine, has been associated with a six-fold increase at ischemic stroke.
Studies show that the current use of hormonal contraceptives increases your chances at having an hemorrhagic stroke by 39%. Although smaller doses of estradiol were associated with lower risks of both ischemic and hemorrhagic strokes, the risk for all types of strokes remains elevated regardless of the dosage of hormones in birth control.
Some hormonal contraceptives have also been associated with deterioration of bone density. Research studying one particular Pill observed a mindboggling loss in bone density of up to 5,7% over the course of the first 24 months after starting on that particular Pill. 
Besides that, certain hormonal contraceptives can even elevate the risk of breast cancer.
Another troublesome side effect of oral contraceptives is the fact that it has been found to deplete the body of a variety of vitamins and minerals. In particular decreased concentrations of the vitamins B6, B9 and B12 and the minerals zinc, selenium and magnesium were observed repeatedly. Supplementation thereof is thus advised, as deficiencies in these vitamins and minerals have been linked to an endless list of nasty side-effects.
Folate deficiency – just to name one – has been associated with infertility, certain cancers, cardiovascular disease, depression, dementia, decreased cognitive function and even Alzheimer’s disease. Imagine the problems a deficiency in all six of these vitamins and minerals can cause.
Hormonal contraception prevalence
The United Nations estimated that in 2019 well over 407 million women* aged 15-49 made use of hormonal contraceptives. 23 million of them used an implant, 74 million used injectables, 151 million were on the pill and 159 million had an IUD.
With this many women (and people with uteruses) on a drug with this long of a list of side-effects, which are often not even discussed, it should not come as a surprise that these risk statistics translate to both deaths and injuries.
Pharmaceutical company pay offs
However, it wouldn’t be the pharmaceutical industry, if they wouldn’t have thought of a “solution” for that. In February 2014, pharmaceutical company Merck, paid a total of $100 million to settle about 1.850 claims of cases of injury and death, as a result of people using their NuvaRing.
In 2009 pharmaceutical company Bayer spent $20 million on corrective advertising, following misleading TV commercials. Bayer too has spent years paying off women* who suffered complications as a result of their products Yaz and Yasmin.
- In 2012 they paid $56.9 million to settle about 1.200 claims for heart attacks & strokes;
- In 2015 they paid $21.5 million to settle about 7.200 claims for gallbladder injuries;
- In 2016 they paid $2.04 billion to settle about 10.300 claims for blood-clot injuries. 
These pharmaceutical companies spend mind boggling sums of money – every day – to pay for the silence of their victims. And the worst part is, the money these companies spend on these types of lawsuits is calculated into their annual budget. Instead of spending money on improving their products, these companies continue to set aside unimaginable stacks of money – year in, year out – to cover the costs of the deaths and injuries their products cause.
“So long as the punishment is financial, the crime is legal.”
Yes, hormonal contraceptives have allowed for enormous progress when it comes to the rights of women and people with uteruses. But if you ask me – it’s no longer a matter of applauding the wonderful things these products have brought into this world, considering not just the risks, but the history of birth control and the tragedy so many victims were put through.
Not to even name the enormous amounts of risks these drugs come with, which are structurally insufficiently disclosed to the people put on these medicines. With teenagers who’ve barely begun menstruating being put on these drugs, often without having a clue as to what these pills will do to their body, it’s time to change the conversation by offering people factual information and non-hormonal alternatives.
The prevailing narrative is that people with uterus’ don’t need to ovulate unless they want to reproduce, but this notion is bizarre at best. Having a regular and natural menstrual cycle is essential for a woman to function best, in every single aspect of her life. Just the way she was designed.
No, we don’t need to stop using hormonal contraceptives altogether, but in my opinion the most feminist approach to birth control is transparency, knowledge and options.
If you want to use these drugs, because they help you, then I will do nothing but applaud you for it, but I so hope this was your informed choice and not the result of anything other than that.
For that exact reason I invited Ghislaine Kalff onto the show, to talk about her experiences with (hormonal) birth control and to share what we’ve learned – in hopes t allow you to make a more informed choice about your body.
Interested in hearing more? Check out the full episode of The Slut Show on your favorite podcast platform, by clicking here! Or head over to our Instagram @TheSlutShowWithEllenMoore for your daily dose of intersectional feminism. Want to send in questions for our mail-segment? Want to be on the show yourself? Know someone who should or want to request an episode about a particular subject? Don’t be a stranger. Our DM’s are always open ❤
We hope to see you on our socials and for now, sluts out!
Lots of love,
The slut show is about way more than sex. It is about breaking taboos, asking questions and fucking the patriarchy, by having real, raw, uncensored and heartfelt conversations about topics that matter. In a safe space we aim to make room for the voices of marginalized folks, creating a place to listen to the pain, sorrow, hopes and dreams of those who came before us. Found in & by intersectional feminism, we believe that everybody should have the same opportunities and get treated equally - regardless of the color of their skin, the size of their body, the gender they identify with or the people they choose to love. Let it be known that the feminism we know today rests upon the foundation black, indigenous, people of color & the queer community built for us. May the battles they fought and the struggles they overcame keep the raging fire in our hearts alive, to make sure that they - nor their legacy - will ever be forgotten.
*Please note: we aim to write our articles in such a manner that we are inclusive towards people of all gender identities and sexes. When we refer to women, instead of people with uterus’ / people who menstruate / people who cycle, we do so because the source we are basing our statement upon did research on women – not all those who menstruate.
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