In researching this Family Practice series (Part 1), on contraception and family planning, one of the things I’ve been most surprised by is how much we women are willing to put up with when it comes to birth control. Let’s set aside for a moment the very real (and huge) issue of access to affordable reproductive health care — including birth control coverage by health insurance. That’s a big piece all on its own. (And a pain in the ass all on its own.) For this post I want to talk specifically about the big bad world of contraceptive side effects.

Holy hell we put up with a lot of side effects in the name of birth control!

For example (and these are from various forms of birth control, not just The Pill): Weight gain. Nausea. Fatigue. Acne. Rash. Sore breasts. Vaginal dryness. Loss of libido. Headaches. Bloating. Mood swings. Depression. Blood clots. Pulmonary Embolism (I know two women who had PEs before they were 30 and it was attributed to birth control pills). Stroke. Cancer. Hair loss. Hair growth in unwanted places. Insomnia. Abdominal pain. Cramping. Bleeding. Potential for ectopic pregnancy. Abdominal surgery (from complications). Loss of fertility. Even death. …

Need I go on?

It surprises me that we not only we put up with all or some of these side effects but that they persist in such a variety of contraceptive forms. Hormonal methods — such as The Pill, NuvaRing, et al — certainly come with what seem like long lists of side effects. But barrier methods — including condoms, diaphragms and IUDs — aren’t without their own long lists, too. (IUDs are a physical method but not a barrier. And one does have hormones.) It seems like either way, you’re screwed. (No pun intended.)

But it’s a problem that affects a lot of women! According to a June 2010 Guttmacher Institute report on contraceptive use, 7 out of 10 of the 62 million women of child-bearing age (ages 15-44) are sexually active but do not want to become pregnant. Here are some other interesting points:

• Virtually all child-bearing-aged women have used at least one form of birth control.
• About a third of all child-bearing-aged women are infertile, pregnant/postpartum, or not/never been sexually active.
• Among the 43 million fertile, sexually active women who do not want to become pregnant, 89% use contraception.
• Since 1982, The Pill and sterilization have been the two leading forms of birth control in this country.
• Some 6.2 million women rely on condoms, which came in third in percentage of use overall (16.1%) after The Pill (28%) and tubal sterilization (27.1%). (Interestingly, vasectomy came in a distant fourth with 9.9%.)

In talking with women, reading a lot of blogs/online chats, and pulling from my own experiences, it seems like side effects and/or complications play a major role in choosing a contraceptive method. (Cost and convenience were big factors, too.)

Plenty of women refuse to use The Pill because they either can’t stand the side effects or dislike the idea of taking artificial hormones. Or worse have suffered near-death experiences, like my two friends who had PEs. But to be fair, there are some pretty serious complications associated with barrier other methods, like IUDs, which can pierce the uterus and puncture other organs in the abdomen causing serious damage, infertility and possibly death. Of course, there is sterilization but that is not a realistic option for the majority of approximately 62 million American women of child-bearing age. (It is possible to reverse it, but that is a gamble.)

(And just an aside: Speaking of gambles, I was really amazed how many people use the pull-out “method.” 5.2% according to Guttmacher. I put method in quotes because to me that’s not a method at all. Since there is seminal fluid in the pre-ejaculate, it is still very much a possibility to get pregnant before withdrawal. And it has a 27% failure rate! Seriously… not a very good method. Sorry. That’s my opinion.)

As Aisha O’Brien shared in the comments on my post with a poll on contraceptive use:

I used to take ortho lo for a year and it gave me unbelievable nausea. After reading about all the side effects of the pill and other chemical contraceptives, I switched over to more “natural” methods of birth control, i.e. condoms. I would however like to try the copper IUD.

Another reader, Lilith, commented:

After having been on the Pill for 4 years with my first partner, I was relieved to stop using it when I was single. Condoms took some getting used to, but turned out to be practical and fun and safe, and much better than the side effects of the Pill. For me those are: having to actually remember to take it, decimation of my precious libido, oversensitivity to touch, and a dislike of the idea of using hormones.
I have a very irregular period but might one day want children, so I don’t want to mess with my hormonal imbalance any more than necessary.
I’m aware that there are different Pills out there, but my insurance only covers the cheapest kind and those give me most side effects (though Yasmine and the Nuva ring both have quite strong effects on me too).
Another good reason for me not to take the Pill, are my sexual habits. I might one day have children, but at the moment a pregnancy is a frighting thing in my life. Since I am in an non-monogamous relationship and have several partners, it is important to protect myself and others against STI’s. And while in the heat of passion it might be easy to decide that the risk of chlamydia might be worth it, the risk of an unplanned pregnancy never is. Not being on the Pill actually helps my sexual health in that way!

Indeed, the most popular option chosen in my non-scientific poll was condoms (62.5% versus 12.5% on hormonal methods). In my talks with women I was surprised to find so many monogamous, long-term partnerships relying on condoms as long-term contraception. Don’t get me wrong. I think condoms are a perfectly good option and I’ve used them at times during my 13-year marriage. Certainly, they are an important part of any active sex life in which there are multiple partners. And they are cheap and easy to get. No doctor visits or prescriptions and very few side effects unless you have an allergy to latex or spermicides. (And even then, there are options.)

Myself? I’ve tried a few options including condoms, depo-provera, and the sponge. But for most of my sexually active life I’ve used The Pill. Since having my baby 8 months ago, I’ve been looking into more long-term options and am trying out an IUD (more on that in a future post). And in all this time, I still feel like I’m looking for a method that (1) works great and (2) doesn’t have something about it that either makes me feel like shit or makes me worry that something weird is going to happen. (I have a depo horror story, but I won’t share it for fear of being sued. Let’s just say, it was not the right method for me.)

It’s amazing to me that it’s 2011 and we’re still having these conversations about problems with birth control. (And that’s not even going into access to it; sex education; etc.) And I feel like there is an embedded societal message in all this. Clearly, women still shoulder the majority of the burden of birth control and therefore its side effects. I can’t help but feel like it is a bit unfair. Sometimes reality really does bite.

What do you think? Is modern medicine letting us down or is this as good as it gets? Tell me your thoughts in the comments!

(PS: Before you send me a bunch of e-mails/comments about how I didn’t mention abstinence… think about the point of this post. Of course, abstinence is always an option. But I’m talking about sexually active women. So obviously, abstinence doesn’t apply to that group. If they wanted to be abstinent, they would be!)

Please check back for the next installment of the Family Practice series (Part 1, Part 3) on contraception and family planning!