Disclaimer:This is my personal story about finding the right birth control method for me. This article is not intended to persuade anyone to choose any certain type of birth control. Ladies, please consult your gynecologist when choosing the right birth control method for you.
Today is day three of my period: the sleepy, mopey day. It was a real struggle to get out of bed; luckily, it’s Sunday. I could only drag myself out of bed and into some very forgiving tights after two hours of hugging a heating pad to my stomach and watching videos of baby sloths napping and getting a bath. My understanding manfriend, who quietly observed the hour of our brunch reservation slip by, supplied both the heating pad and the videos. Yesterday, day two, I was full of angsty, agitated energy. We passed a baby laughing in her stroller and I called her a “phony.” Day one felt like sweet release. Three days before my period, my breasts were so incredibly tender and heavy that I had to take my bra off one boob at a time, cupping them with my hands before I could get to a stretchier, more comfortable bra. For two weeks each month, my body and mind go through these dramatic and reliable stages of my natural menstrual cycle. Despite the discomfort, I am grateful to have reached this point with my body. It’s been a long way coming.
About a year ago, I decided to have my IUD removed. I had the Skyla – a low-dose hormonal intrauterine device – inserted a couple weeks before moving from my hometown, Houston, Texas, to Washington, DC. Bayer released Skyla, its “little sister” to the Mirena IUD, in February 2013, and my gynecologist recommended it for me in June 2013. I had a history of my body responding negatively to hormonal birth control, and I told my doctor that I was concerned that I would have similar bad side effects (fatigue and depression) with a hormonal IUD. She suggested Skyla because it is a lower dose than the Mirena and smaller than both the Mirena and Paragard (non-hormonal copper IUD), which would be more comfortable in my pre-baby uterus. This all sounded appealing, especially the facts that IUDs are 99% effective at preventing pregnancy and I wouldn’t even have to think about it.
From Summer 2013 to Summer 2014, I loved my IUD. I thought I had finally found the perfect form of birth control for me. Aside from some serious cramping the day of the insertion followed by a couple days of spotting, I had no side effects on Skyla. My periods were light and only lasted a few days. And the best part was I never had to think about it. My IUD was like the silent, unobtrusive guardian angel of my uterus.
That was until Fall 2014, when every two weeks I became unable to get out of bed in the morning. It was like the colors in my life would suddenly dim to shades of grey. During the two weeks after my period, I felt almost normal, like I was finally coming up for air. But the week before and during my period everything was a struggle. I started canceling plans with friends and showing up for work later and later. All I ever wanted to do was crawl into bed and sleep. I felt guilty and powerless to change. It didn’t matter if I showed up to work on time, anyway; nobody cared about me. Or they were all judging me behind my back, and rightfully so. On the rare good day I would get to work early and feel like I was turning a corner, but eventually sink back into my sad routine of hitting snooze for an hour by the end of the week. I was living a cycle of depression and repair, and depression was quickly taking over. One day my sense of dread was so overwhelming that halfway through my walk to the train I turned around and walked back to my apartment, put my pajamas back on and cried in bed, feeling completely hopeless. My mother implored me to visit the doctor, recognizing the signs. “You can’t have these spells every month, honey. Do you think it’s your birth control again?”
I started my first form of hormonal birth control in 2006 at the age of 16. During my first visit to the gynecologist, my doctor suggested I try Yaz, a new hormonal oral contraceptive released to the market that year. Yaz was marketed as “the super pill” that not only prevents pregnancy but treats acne and the unpleasant symptoms of premenstrual syndrome (PMS), like bloating and mood swings.
Depression is not listed as a possible side effect on Yaz’s website; the closest warning is for “irritability” and “mood changes.” At my first gynecological visit, my doctor perfunctorily mentioned Yaz’s possible side effects: headaches, weight gain, irregular periods, moodiness. I did not give these much thought; I was so used to hearing the clipped hum of “common side effects include…” on TV commercials that I just accepted these risks as a given. Yaz was the brand new, shiny pill that would erase my pimples and make me, a 16-year-old girl, pretty.
It wasn’t long after I started Yaz that I started experiencing severe side effects, most notably anxiety and depression. I had terrible insomnia and bags formed under my eyes. My grades suffered. I was extremely irritable and moody, even for a teenage girl. Every night for about a month I called my boyfriend (now my live-in manfriend) crying on the phone, sobbing that I felt hopeless and wanted to die. I didn’t hurt myself, but I thought about it a lot, for the first time in my life. This was a shocking 180° from the positive, energetic girl I was only a month before.
Mom called my gynecologist’s office and described my drastic mood change. Our nurse said that irritability was a common side effect and that it’s normal to experience changes when starting birth control; she suggested staying on Yaz for at least three months to see if my body would adjust. I am lucky to have my mom, because despite this medical advice, she saw how serious my condition was and encouraged me to stop taking Yaz the next day. Within a few days, the aching knot of dread in my gut unwound, and my nightly, tearful phone calls to my boyfriend stopped. I was better but shaken by how fast and hard my body had turned against me.
Despite the challenges I faced with Yaz, the idea that I needed to be on some form of hormonal birth control persisted. This was entirely self-motivated; my mother encouraged me to be safe, but she never pressured me to be on “the pill” or any other form of contraception. My boyfriend and I agreed that we wanted to wait to have sex until we were older, but I wanted to be prepared for anything. I thought it was the smart thing to do; smart girls do whatever it takes to protect themselves from unwanted pregnancy.
At my next visit to the gynecologist, my new doctor (my first doctor had retired) and I discussed my options for birth control. I told my doctor about my negative experience with Yaz; the sleepless nights, depression and mood swings. She suggested I try Ortho-Tricyclen Lo, a low-dose combination pill. She thought my issues with Yaz may have been due to having too high a dose of hormones. Each active pill in Yaz contains the same level of hormones, while the active pills in Ortho Tri-Cyclen Lo release three different doses of hormones. My doctor through that Ortho Tri-Cyclen Lo’s gradual increase in progestin each cycle would suit me better, and she was right.
On the pill, I experienced no noticeable side effects other than some slight weight gain. My mood felt normal and I experienced no signs of depression. My period was like clockwork and light. The pill wasn’t my kryptonite, after all! The only pitfall I experienced with the pill was the inconvenience of having to remember to take it every morning. For a college first-year with inconsistent sleeping patterns (wake up at 8 a.m. Mondays, 10 a.m. on Tuesdays, noon on Saturdays, etc.), the pill didn’t fit into my lifestyle. While my body was responding positively to Ortho Tricylcen-Lo, I talked to my doctor about switching to a more convenient form of birth control; one that I didn’t have to take daily.
My sophomore year of college, I switched to the NuvaRing, which you insert vaginally once a month and remove the week of your period. Like on the pill, I experienced little to no side effects on NuvaRing. The main advantage of the pill was, for three weeks out of the month, my NuvaRing was mostly out of sight and out of mind. I loved not having to think about taking a pill every day. It was a little awkward to insert at first, but eventually it became second nature, like inserting a tampon. The only time I could feel the NuvaRing was during sex, which was a major downside. We could both feel it, and one time it even came out. I stayed on NuvaRing through the end of college, despite the slight discomfort it caused during sex. I wasn’t completely happy with it, but I was thankful to have a form of birth control that was convenient and worked with my body. After college, I spoke to my gynecologist about changing to a form of birth control that was fail proof and hassle free. Enter Skyla, the 3-year hormonal IUD designed for women who have never given birth. It hit the market in 2013, and shortly after it was snuggly nestled in my uterus.
This has led me to wonder: Is it a coincidence that, already twice in my young life, I have suffered terrible side effects while on brand-spanking-new birth control products pushed by my gynecologists? Why didn’t I ask more questions about these new drugs?
Let’s break it down:
Most combination birth control pills contain ethinyl estradiol, a synthetic estrogen, and one of eight forms of progestin, a synthetic progesterone. Progestins are broken down into four generations with varying effects on the body. I have labeled the progestin in the above table by generation, which you can read more about here.
Not being a medical professional, I am unable to draw any conclusions about the right combination of hormones for my body from this chart. This table is to help me track the history of my birth control use and its effect on my body and mind, and I encourage any woman struggling to find the right form of birth control to do the same. Know what is in your medication, of any kind, and have a discussion with your doctor about possible side effects. It took me many years of trial and error to finally listen to my body and consider my overall health when choosing birth control. For so long, the focus was simply not to get pregnant, and I tried to accept the side effects as part of the price of being “smart” about my sexual health.
I support women having a choice in their birth control, and I believe that having access to information about the effects of birth control on your body is part of that choice. I encourage any woman, and the men who care about them, to educate themselves on the hormones and mechanisms behind birth control. I am not against hormonal birth control, and I am grateful to have access to and freedom to choose from a wide variety of birth control methods. I can say, given my experience with four different types of hormonal birth control, that it is difficult to find the right balance of hormones for my body, and the discovery process was painful at times.
My struggle to find the right birth control has taught me how important it is to advocate for yourself when consulting your gynecologist. As a young person, I assumed that my doctor was the expert and knew what was best for my body; I deferred to their expertise without asking questions. I wish my mother and I had asked more questions about Yaz, and I could have discussed my history of hormonal imbalance with my doctor more in depth before choosing Skyla. My doctors had my best health at heart, but ultimately it was my decision how to menstruate. My cycle, my life.
Now I am rounding out the first year of living without hormonal birth control since I was 16; the first year in 10 years that I am experiencing my natural menstrual cycle. It has been a year of rediscovering my body, actually tracking my cycle and moods. For the first time in my life, I feel in tune with my body and comfortable with my cycle.
The transition from hormonal to non-hormonal birth control was not immediate and has presented new challenges, what with the aforementioned breast tenderness, cramping, nausea, drowsiness and baby sloth videos. My flow is heavier and these symptoms are more intense now that I am off hormonal birth control, but all of that beats the volatile mood swings I endured each month on hormonal birth control. Also, my symptoms are reliably regular every month (within a two week window), and they taper off by the end of my period. While I was on Skyla, my period was less noticeable and irregular; I could be one week late with only three days of light spotting, and then have intermittent spotting the following week. Some women experience spotting or stop having their periods altogether with IUDs, so that wasn’t unusual. On Yaz, Ortho-Tricyclen and NuvaRing, my periods were regular, short (3-4 days) and light, and I experienced mild nausea and cramping.
Unfortunately, it’s difficult for me to say how long it took me to feel “regular” after the removal of my Skyla. I was experiencing a lot of change at the time (quitting my job, moving to a new apartment) and, honestly, I had never experienced a “regular” period off hormonal birth control in my adult life. Before I started birth control at all, my periods were irregular and I had no side effects (no cramping, nausea, drowsiness…lucky kid). I do remember feeling like my mood stabilized about a month after the removal of my Skyla; it was easier to wake up on time and I stopped canceling on my friends. Everything felt a little easier over the next several months, and now I am able to track my mood and cycle pretty reliably. I know that my breasts will get painfully tender about three days before my period starts, and that I will have one or two days of very heavy flow and cramping. The other two weeks of the month, I feel like myself. It’s not like before, where, any given day, I could be a completely different person. My personality is much more consistent, and I am better able to deal with adversity. I rule my emotions more than my emotions rule me now.
I’ve learned that, for my body, it is best to stick with non-hormonal birth control. Now my manfriend and I use condoms, a choice that allows me to leave my hormone levels alone. Since we have been dating for 10 years, he is intimately acquainted with my cycle struggles, and has noted that I seem happier these days. I do miss the added protection against pregnancy I had with the IUD and am considering trying the copper IUD (non-hormonal) in the future. For the time being, I am loving my natural cycle, because it feels like it’s finally mine.