Shrinking ovaries, “withdrawal bleeds” instead of periods, and all the symptoms and side effects your doctor never told you about hormonal birth control. Patti and Aleks dive in deep with Holly Grigg-Spall, author of Sweetening The Pill: Or How We Got Hooked on Hormonal Birth Control. In Part 1 of this conversation they talk about the history of hormonal birth control, why as many as 80% of women will take hormonal birth control at some point in their lives, and the stinging anger we all feel as we, once again, shake our fist at the patriarchy.
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Transcript: The Pill
Holly Grigg-Spall: One of the big myths is the idea that the pill regulates your periods.
Aleks Evanguelidi: This was the freedom pill.
Patti Quintero: Who are you without the pill.
Holly Grigg-Spall: They decided to stop testing on men because their testicles would shrink. Guess what happens when you take the pill as a woman.
Patti Quintero: Welcome to under the hood. I'm Patti.
Aleks Evanguelidi: And I'm Aleks. And today we're talking with Holly Grigg-Spall. She's the author of "Sweetening the pill, or how we got hooked on hormonal birth control."
Patti Quintero: Holly's background is in journalism and after realizing her 10 years of taking the pill might be the cause of her health woes, she decided to dive in deep and discover why. Her answers led to this book. And we were lucky enough to sit down with her and explore some of our own questions.
Aleks Evanguelidi: So this theme of asking "why" is something we'll be exploring throughout the season. Our own curiosity is part of what inspired this podcast. And we're not pretending to have all the answers, but we're inviting all of you to be brave enough to ask why with us.
Patti Quintero: Our conversation with is packed with information we think every woman should have access to. Because of that we've divided the episode into two parts.
Aleks Evanguelidi: In today's conversation we'll be talking about the history of the pill and some of the side effects you might not realize are related to taking hormonal birth control. We recognize that this information might make you angry to hear, it actually made us angry too. We think it's a good thing. We might need to get a little angry around this topic.
Patti Quintero: So take your time with this one. And let's dive in together.
Aleks Evanguelidi: I would love for you Holly to tell us and our listeners exactly what brought you to this point of writing the book and maybe share of your own experience.
Holly Grigg-Spall: Yeah. Well actually it came out of my own experience. So I was a film journalist writing film reviews, interviewing actors directors and I'd been on the pill for about seven years and I'd always swap between different pills because everybody does. Usually for what was perceived as by myself or my doctor is kind of minor side effects. But then eventually I was prescribed a pill called Yasmin which was a new what's called third generation pill with a new progestin, drospirenone.
Holly Grigg-Spall: And this was marketed really heavily in the U.S. but it also filtered down to the U.K. where I was at the time. And it was presented essentially as a pill that wouldn't have as many side effects as other pills but it was also presented as a pill that would have some benefits like weight loss, clearing your skin, solving PMS symptoms, and so a lot of people I knew were on this pill including my sisters. A lot of my friends and I was prescribed. I was on it for two years and it was probably the worst-. Well not probably, it was the worst experience of my life to be on that pill. About 18 months in to that, was when I realized that it was the pill that was causing the health issues that I had. But it took me that long to make that connection.
Holly Grigg-Spall: So for those 18 months I had a variety of really terrible side effects physical from like chronic UTI's, feeling like I had the flu for a week a month, muscle aches, headaches, terrible fatigue, to what I focus on a lot in my book which is the mental health side effects which was everything that you could put under the banner of subclinical depression. So anxiety, panic attacks, agoraphobia, obsessive thoughts, social anxiety, just a sense of dread, very low self-esteem. And this built basically from the moment I started taking it, I have diaries and I can look back and actually see how I was trying to figure out at the time, why do I feel so different, to 18 months and when I finally made that connection, oh this is why I feel so different because I'm taking this pill.
Holly Grigg-Spall: And that connection that I made let me down a path of doing my own research. I'm a journalist and I wanted to know why it was doing that. And I wanted to know how it was doing that to me. And so I looked into it. And from there my research became a blog. And about two weeks after I started the blog I decided to come off the pill completely. So I came off completely after, to at that point ten years of using the pill from 17 to 27. And I used the blog partly for my research and then I ended up using it as a way to document how going off the pill made me feel. It was subtitled who am I when I'm not on the pill. It became a book and then it became a published book. And then it became a documentary which is currently in post-production.
Patti Quintero: Amazing. In your book you mentioned how there was just this lack of education, you know, something prescribed that's a very powerful hormonal modifier at such a young age. Let's just talk a little bit about what the pill is actually doing.
Holly Grigg-Spall: So I write a lot about the myths that are passed from generation to generation about the pill and in my workshops that I do that help women come off the pill from an emotional relational standpoint, we talk about this a lot. Because having the knowledge of how the pill works in the body as well as how my body works, we're really the two things that helped me to come off the pill confidently to avoid pregnancy. And now eight years in to have that be a completely positive experience for me.
Holly Grigg-Spall: So one of the big myths is the idea that the pill regulates your periods. And actually the truth is that you don't have a period as such when you're on the pill. You have what's called medically a withdrawal or bleed, which is not physiologically the same as menstruation you can actually only have menstruation if you're ovulating and of course, although not always of course, if you are on combined oral contraceptives you are not ovulating.
Holly Grigg-Spall: So it is not regulating your period what it's doing is replacing your cycle and replacing the hormone cycle with an artificial stream of hormones that is essentially static. The other myth is that those hormones are the same as the hormones your body produces. That's not true. They're actually chemically structurally very different. It's called synthetic estrogen but then the progesterone isn't anything like the progesterone that you create it's called progestin.
Holly Grigg-Spall: So that's a big myth! Then of course is the idea that you don't need to have it period I think, as well. So there's a couple of elements in that. There'a you don't need to have a period, and that fertility is only useful when you want to have a child. Those are kind of the big ones as well, I think, because that's like the overarching mythology that helps us to justify what we're doing, which is medicating women from teenage years throughout their lives for everything from acne to cramps to endometriosis–
Patti Quintero: To their emotions.
Holly Grigg-Spall: Yes. Being moody, in quotation marks
Patti Quintero: Yeah.
Holly Grigg-Spall ...or having PMS. Exactly. All of that is how we can sell the pill more easily essentially and not all of it is the work done by pharmaceutical companies. Some of these mythologies have been around a lot longer and of course most of it is very much founded in misogyny.
Patti Quintero: Exactly. Yeah that's all I was thinking when I was listening to you speak.
Aleks Evanguelidi: Who's in charge here. Right.
Patti Quintero: Yeah I mean it's like the female experiment.
Aleks Evanguelidi: Well I would like to read a bit about that whole cycle of a woman's body and just touch on it. As you know Patti and I are both in the field of birth and we work with women and we confront their feelings and experiences about their body throughout their whole womanhood. So you wrote:
Aleks Evanguelidi: "Like many young women I was petrified of pregnancy. I believe the intensity of this anxiety had much to do with the length of time I took the pill. Through a decade of pill taking. I was completely cut off from any sense of my body's true physicality. In fact I had come to fear the potential of my body. My fertility was something I felt needed to be fought constantly. I was suspicious of my body's capabilities and felt they needed to be restrained at any cost.".
Holly Grigg-Spall: It starts very early obviously you get your period, that's a lot of shame and misinformation and ignorance. And there's a lot going on there, the effects as we've seen from a lot of studies, young women's self-esteem and how it changes their outlook and how how they behave and things like that. And then of course that's a prime moment to go well, you can take something where you can control what's happening with your body and you can feel in control. So you know I think we begin to associate the idea of having hormones and being hormonal as a negative state. Now we also think of it as only a female state whereas of course males also have hormones and hormone cycles and are hormonal but we associate the idea of that with being female and that then allows the pharmaceutical companies to come in from the side of fear and shame and lack of education and say well this is the answer for you so your hormones are going to make you spotty. They're going to make you fat. They're going to make you greasy they're going to make you unattractive. They're going to make you moody. They can make you angry inappropriately they're going to make you know all these things. And this is going to put an end to that. And I think that's very seductive, but it's difficult because then you feel like you're in control.
Holly Grigg-Spall: But as I experience you realize that you're not really in control and as much as learning how the pill actually works in my body was really important for me, the even more important part of what I had to learn was how my own body worked. And knowing how I had to cycle, why I had a cycle, what was going on was very empowering and necessary for me to make that transition off the pill. And I think it's unfortunate that often women don't come to know that now until they have a baby, give birth sometimes. And that can be the moment when they start going, oh okay I see now what's going on with my body. And learning about the fertility cycle was massively important for me. So as I said in that piece that you read out the idea of being fearful of your own fertility and your body is because you grow up thinking that you get pregnant by sitting in the wrong hot tub or from like you know being on a dirty bedsheet. We were really trained to think like your body wants to get you pregnant you're going to get pregnant you're going to have an unwanted pregnancy. This is going to happen. You gotta lock all that down so that you're not going to worry about that. Right? But of course it's not true because you're actually only able to fall pregnant on six days per cycle. Most women get way into their 30s until they even realize that, because they're not taught in any kind of useful contextual situation.
Aleks Evanguelidi: Nothing.
Patti Quintero: If a contraceptive has hijacked who you are all the way through those formative years. Then when you come out on the other side and you are looking to get pregnant, have a baby. It's terrifying because you don't know your body and you don't know your cycles and you don't know really how to work with them efficiently or with a sense of ownership.
Holly Grigg-Spall: No. You're in the dark completely, and that's also preyed upon by the same people.
Patti Quintero: Oh yes.
Aleks Evanguelidi: You know if you go back in history and you see how a pregnancy was really perceived as almost like your ball and chain because we don't have power, because we don't have education. There has been no educational system in place throughout, I'm sure my mother's life, my grandmother's let me you know you can go back and there's really been no clear understanding in Western culture about our rhythms and our cycles and what they mean and how to work with them. So when you had the 60s come around and suddenly this was this this was the freedom pill. This was a way to release yourself from the burden of what the cultural identity of what womanhood meant. Suddenly had this opportunity. Burning bras in the street, standing for this women's liberation movement. It became a great sell at that time.
Holly Grigg-Spall: It did and it was a sell in the same way that feminism is used to sell products now and was used to sell products then. While absolutely that's true and I don't like to take away from that too much you know obviously that was a very powerful moment in that, as I mentioned in my book also helped women integrate into careers and work outside the home which was important.
Holly Grigg-Spall: I mean obviously not without cost to us as always but you know there's also a lot to be said for how useful that was and the idea of the directive of Make Love, Not War was about not really women's freedom and choice. So it's a complicated past.
Holly Grigg-Spall: I've written elsewhere about the history of research of the pill and how it was originally tested on men and women. But they decided to stop testing on men – and all of this was done as you can imagine in horrible circumstances usually without consent usually on people who could not consent – because their testicles would shrink when they were taking it. And I always joke that's kind of funny because guess what happens when you take the pill as a woman? Your ovaries shrink.
Aleks Evanguelidi: In your research. You found that as women would go to the doctors and complain about these what you call effects, not even side effects. Right. Like this is just the symptom of taking this medication. Then they would be kind of brushed off by their primary care providers or given other medication to deal with these effects from the pharmaceutical of the pill.
Holly Grigg-Spall: Oh yeah. From the top down. So you're talking about mental health side effects. Absolutely. Most women are told it's everything but that, that's causing it. And usually then we'll be offered antianxiety medication antidepressants and that's more common now I think, I'm 35. It was common in my generation but it's probably more common now of women currently in their 20s and late teens. But then as they say from the top down.
Holly Grigg-Spall: So I've heard so many stories of women who've gone to their doctor presenting with blood clots symptoms like really obvious blood clot symptoms and their doctors gone oh no you just must've pulled a muscle. You must have just done that when you were carrying groceries, take a hot bath you'll be fine. Some women who've gone back multiple times and being fobbed off. So I mean we're getting to the point now I think when we're realizing what negligence occurs in the medical industry in terms of how we treat women, whether it's birth control side effects or heart attacks or pain in any form. It's pretty horrifying the amount of stories I heard when I was writing the blog and I continue to hear today, of doctors who either send women home with severe side effects with more medication. They never think of the pill or they are dismissive of the idea that the pill would even be on the list of possibilities as to why it's happening to them. Yeah to really dangerous situations actually.
Aleks Evanguelidi: It almost seems like being female has been described pathology itself. Or the...what did you say in your book about...
Holly Grigg-Spall: Barbara Seaman was the, basically the originator of the concept of the women's health movement. And she wrote a book in the 60s called The Doctors Case Against The Pill. She interviewed doctors about the side effects of the first brand of pill which was called Enovid and she said that being female is a disease. So that's how doctors view it. We are seeing what that looks like more and more now really than she even did then because what we're seeing now is that teenagers are being put on the pill within their first period essentially.
Holly Grigg-Spall: And then women are being told to stay on it until they either decide to have a child and then definitely go back on it afterwards or until menopause and sometimes beyond now. So it's becoming like you go from the pill to HRT hormone replacement therapy essentially. Yes. So being female is medicated by, as a standard.
Patti Quintero: Which takes us back to that question of like well who am I really without all of this modification.
Holly Grigg-Spall: Yeah the thing is is you know I was 17 you know that's pretty old for now, I Would say. Now it's more often the hormonal implant or the hormonal IUD. But of course your reproductive system hasn't matured and it doesn't mature for several years if it's left alone. So what you're doing is actually just pressing the pause button on reproductive maturity. It's an endocrine disruptor actually. So it's changing everything about your brain chemistry too because the only way that your reproductive system works is how it talks to your brain, hormones are how you communicate with the world and how the world communicates with you.
Holly Grigg-Spall: So if you're messing with that and you're changing it and replacing what is there with an artificial stream of hormones that is static, it is going to change everything about how you are as a person on a very fundamental level.
Aleks Evanguelidi: It seems to make sense as we are reaching the stage where fertility rates are dropping and we're seeing a lot more like IUI IVF Clomid, you know the introduction of this whole new wave of supported pregnancy, medically supported, medically induced pregnancies. Do you think the research is linked? Do you see it in what you have come across, that perhaps all of this consumption of hormones synthetic hormones is affecting our fertility?
Holly Grigg-Spall: I think what we can say about that for sure, is that women come off the pill or any hormonal contraceptive not knowing about their cycles. And we can say for sure that the majority will go to a doctor and they will say you ovulate around the midpoint of your cycle, track your periods or just have sex twice a week or you ovulate on day 14, some version of that. Right. We can also say for sure that you will be told your infertile after about a year of trying. I mean at least as in the UK think it's the same in the U.S. It's about a year. And that we can also say for sure, that a lot of women are coming off the pill and not getting their periods and cycles back for many many many many months.
Holly Grigg-Spall: So while there will be women like myself it will come back within one or two months, and some women will come back within three to six months. There is definitely women who won't come back for a year or more. And that's because their body hasn't been creating the hormones to ovulate for however long they've been on it. And so then your body has to learn to ovulate again and it has to produce its own hormones again. And if you have a poor diet, really stressed out you have any other health issues, you have PCOS, you have undiagnosed hormonal imbalances, which is possible. You have nutritional deficiencies, you have oh so many different factors will prevent your body once you come off the pill from making the hormones it needs to make for you to be fertile to ovulate. Right.
Holly Grigg-Spall: So all those things are definitely true. On top of that they have done research into whether women who are waiting on or in the process of getting IVF know when they ovulate beyond when their last period was. And a lot of them don't.
Aleks Evanguelidi: They just never ovulate.
Holly Grigg-Spall: They don't know that they're ovulating and even if they are ovulating they don't know when it happens, because they're using the misinformation of approximate it from between your periods for the middle part of your cycle. That's probably when you ovulate. Figure it out. Like they're not tracking in any effective way. Their doctors are not tracking in any effective way. And so I dread to think how many women are going into IVF unnecessarily.
Patti Quintero: So I always go to this visual of a switchboard again we're taking a young body and we're turning switches off artificially and then when we want to, or it's that time in life, we suddenly try to turn these switches on artificially again. And it's scary. So being where we are now with these facts and so much more evidence that's coming through. Where do you see hope for change or a healthier decision?
Holly Grigg-Spall: So I've been asked this question a lot over the years and you know a lot of the time it would be something along the lines of like what do you think needs to happen or how do you see the future of fertility or what can we do?
Holly Grigg-Spall: And I always say, I really believe in teaching women fertility awareness from high school onwards, just so that they have that information to make informed decisions, and have informed consent about those decisions. Not so that they go on to use it solely to avoid pregnancy. Every single one of them. Some of them will but not all of them will. Even if they choose to go on the pill at least they have that information and they're able to spot side effects much quicker because they have that information and then they can come off it if they need to without suffering unnecessarily in the same way that I was.
Holly Grigg-Spall: I would just like everybody to come from a place of knowledge and feeling the power of that and then being able to make decisions from that point. But I always say as well that this happen, for women to have that from school, and for us to be able to use it if we want to to avoid pregnancy ongoing in our relationships, and for us to see change in society i.e. women not being thrown on the pill like it's nothing. Having those choices, being aware of the choices that they have, being aware of the fact that they have a fertility cycle, they have a fertile window, they have a time when they can't get pregnant, and they can know when to track that etc. All of that also needs feminism. Like you can't you know we're not going to get one without the other. On an individual basis sure. Yes. Like one person to one person to one person. You know I've worked with technology companies that have created devices that make it very much easier for women much more accessible for women to track their fertility.
Holly Grigg-Spall: So I have a lot of hope there, but I also know if we were ever to see it become something that is...going To have a really large scale impact we need to change how we see women. And we need to change how men and women relate to each other, because this isn't something you can do if you're not in a supportive relationship with somebody who doesn't expect you to be on hormonal contraceptives. Doesn't expect you to put up with the side effects and trusts you and cooperates with you and respects you and wants to partner with you in this idea of fertility awareness is a way of avoiding pregnancy.
Holly Grigg-Spall: Yeah there's ways you can do it ad hoc. Absolutely. I know a lot of women who do it with partners who aren't like perfect by any means, they're not sort of like feminist angels, but I think that large scale if we're talking about paradigm shift, we're talking about education, fertility awareness, or I call body literacy, plus feminism. You can't separate them really.
Aleks Evanguelidi: We'll continue this conversation next week, so stay tuned!
Patti Quintero: For more information on Holly Grigg-Spall and updates on the upcoming documentary inspired by her book, you can head to her website sweetening the pill dot com.
Aleks Evanguelidi: You can also follow her on Instagram at Holly dot Grigg-Spall which is G R I G G S P A L L and twitter at Holly Grigg-Spall, one word. If you have any questions, head to our web site at under the Hood podcast dot com and send us your thoughts.
Aleks Evanguelidi: And for more information on upcoming new episodes and upcoming events. Sign up for our newsletter and follow us on Instagram at under the hood underscore podcast.
Patti Quintero: Many thanks to our executive producer Chelsea Levy for making this episode come together. And to our producer Jennie Josephson for her editing and recording magic. We'll see you next time when we go under the hood.