NYT OP-DOC: BIRTH CONTROL YOUR OWN ADVENTURE
By SINDHA AGHA JAN. 9, 2018
In September 2016, I curdled under the fluorescent light of a psychiatric clinic in San Francisco, trying to tune out the maddening buzz of the ballast. Opposite me sat a young psychiatrist with an expertly rehearsed concerned listening face. As she fondled her pearl necklace like prayer beads, I talked about my mind as if it were a lost key — bashfully, impatiently. Where did I have it last?
I’m only 24, but I’ve spent over a decade of my life cycling through hormonal contraceptives, seeking a treatment for the chronic pain caused by endometriosis — a painful disorder that 1 in 10 American women suffer from but no one ever seems to have heard of. With each new contraceptive, I observed my personality mutate, my grasp on reality fluctuate, and my sense of sanity slip farther and farther out of reach. I came to learn that my experiences tie into a broader pattern of the pharmaceutical industry failing to inform women about and protect them from the side effects of hormonal contraceptives. “Birth Control Your Own Adventure” is my response, an excruciatingly personal short film about my birth control story.
As early as fifth grade, I missed several days of school each month because of painful periods. During my first gynecological exam, the OB-GYN who delivered me tried to determine the cause of my pain while I tried not to think about how she was my classmate’s mom. She presented a clinical diagnosis of endometriosis in an understated Midwestern tone, the way someone might repeat back a food order over the phone. Luckily, she said, the treatment was simple: Yaz. The innocuous pink pills would stop the pain, and I wouldn’t have to miss any more school. There was no talk of side effects, only an ambiguous directive I would come to hear repeated in OB- GYN offices over the years — to wait three months and “see how you feel.”
Yaz got me through high school and college free of debilitating menstrual pain. Meanwhile, I struggled with depression, and no doctor ever suggested my birth control could be the cause. Instead it was identified as a lack of vitamin D, or being a teenage girl or what happens when you raise a synesthetic child in the monochromatic subdivisions of central Illinois. Write some poems, listen to Bobby McFerrin, get on the elliptical, try talk therapy and phototherapy, grow up and move away — it will go away.
I accepted my depression, and besides celebrating when my prescription became free under the Affordable Care Act, for many years I never gave any special thought to taking the pill. Until I did.
A week after going off Yaz in my early 20s, I was a different person. I felt happiness. Not euphoria, but that baseline, pastel contentment I had always assumed was mythological. I rode a joyful wave of ambition and energy for a month. And then I got my period.
I tried to brave the acute pain of endometriosis for a few months and it quickly became clear that I couldn’t function with it. I wasn’t willing to go back on Yaz; I didn’t want depression to be the cost of treating pain. Now that I knew what it felt like to be me, the idea of losing myself again was heartbreaking.
Thus began the year and a half of contraceptive roulette chronicled in my film. On the levonorgestrel IUD, I suffered through bouts of derealization — the external world becoming unrecognizably remastered, colors rendered garish and sounds warping nonsensically, the distortion sometimes trespassing the border of my body; I’d look in the mirror and not recognize who I saw. On Lo Loestrin, I woke up each morning cloaked in viscous sadness. And the NuvaRing gave me generalized anxiety so severe and intolerable that after three months of “See how you feel,” I threw all my rings in the trash with an uncharacteristic lack of consideration for the smallmouth bass that undergo sex changes when hormonal contraceptives pollute waterways. I tried one pill after another, each modifying my mind and my body. By the time I arrived at the San Francisco psychiatric clinic, my self-esteem dragged a mile behind on a thin string.
The psychiatrist wrote me a prescription for propranolol — a blood pressure medication that slows your heart rate and has shown some success for diminishing the peripheral symptoms of anxiety. I stared at the script skeptically, and she tried to reassure me by explaining, “It’s what symphonists with stage fright take to perform.” Maybe all I needed was some medication for my medication. A slower heart. To live as the symphonists do.
A couple of weeks after visiting the psychiatric clinic, I read the headline “Contraceptives Tied to Depression Risk.” A 13-year Danish study of over a million women between the ages of 15 and 34 found that users of hormonal contraception had a 40 percent increased risk of depression after six months. Progestin-only pills were shown to more than double the risk, and the levonorgestrel IUD tripled the risk. In my bathroom cabinet sat a six-month supply of Lo Loestrin, one of the lowest-dose hormonal contraceptives available. I had been waiting for “See how you feel” to pass, waiting to get used to how I felt. Now I realized that maybe these side effects were not the sort of thing I could ever expect to get used to. That no one should be expected to. I was too drained for rage, the smallmouth bass were spared — I buried the birth control at the bottom of my desk drawer. When my next period arrived, I lay in bed and missed two days of work.
Not long after, I came across the headline “Study on male birth control canceled due to slew of side effects.” Three percent of the male participants had reported depression as a side effect. A biology professor’s quote in The New York Times sank my slowed heart; “Twenty percent or 30 percent of the women who take oral birth control pills experience depression and have to take medication for it. So the difference just struck me.” Had I been a boy, would they have let me keep my mind?
It gives me pause to criticize contraceptives. American public discourse doesn’t digest nuance well, and I fear not being heard if I criticize birth control and in the same breath assert my right to it. But these beliefs are not mutually exclusive: I deserve to make decisions about my body, and I deserve a health care system that doesn’t consider what’s unacceptable for men to be the gold standard for me. Yes, I deserve birth control, but I also deserve better birth control.