There's a lot of chat right now about quitting hormonal contraception. What's going on?
'I'm off the pill now about three years and I felt that cloud lift and everything is so much clearer.'
'Took my [contraceptive implant] bar out after 10 years and I've never looked back.'
When social media content creator Clóda Scanlon posted on Instagram late last year about her decision to come off hormonal contraception, she received many public and private messages of support from other women who had done the same.
It's almost three years since Ireland's free contraception scheme was launched. At a time when contraception is more accessible than ever, some young women are increasingly wary of artificial hormones' effects. Some are opting out.
Up-to-date Irish data on uptake of prescription and hormonal contraception is not currently available. However, there are clues that a backlash against hormonal contraception – the pill, the patch, the implant and most intrauterine coils – may be under way. The full implications of that in Ireland are not yet clear.
International data suggests an emerging trend in developed countries. Analysis for the UNFPA, the UN's sexual and reproductive health agency, found hormonal contraception use on the increase in only one of nine European and North American countries for which recent data was available. In six it was declining.
Doctors working in women's health in Ireland told
The Journal
that despite the availability of free contraception, they still meet women who do not plan to go on it, or who are concerned about effects they have experienced while taking it.
For Scanlon and other women in their 20s who spoke to
The Journal
about their decision to come off hormonal contraception, the growing conversation among women about side effects and alternatives is a logical continuation of the empowerment of women that contraception itself brought, 40 years after it was fully legalised in Ireland in 1985.
'The conversations are changing,' Scanlon said. 'Female health is really, really becoming a topic of conversation – and thank god, it's about time.'
Ciara McCarthy, a Cork GP who is the clinical lead for women's health at the HSE and Irish Council of General Practitioners, said: 'It is certainly a conversation that seems to be happening now.'
She suggests two factors may be at play. First, there's what women are seeing online, some of which, on TikTok in particular, she characterises, as misinformation and disinformation. Secondly, there's the reality that some women are more sensitive than others to the side effects of hormonal contraception. Other doctors who spoke to
The Journal
made the same inferences.
The UNFPA said it can't draw definitive conclusions about the influence of online content on the apparent decline in uptake of hormonal contraception in some countries, but it said this has been raised with it anecdotally.
'Cost is not a factor'
Shirley McQuaid, medical director of the Well Woman Centre in Dublin, said there is 'definitely a move away from hormonal contraception', evidenced by a surge in the popularity of the copper (non-hormonal) intrauterine coil.
A decade ago, this was an unusual choice among women attending the Well Woman Centre, which specialises in family planning and sexual health but its popularity has steadily increased.
This increase has happened despite the fact that the copper coil was not reimbursable on the free scheme until early 2023. The full cost of consultation, fitting and the device itself is almost €300.
Copper coils as a percentage of all intrauterine contraception fitted at the Well Woman centre 2005-2022: there has been a steady increase.
Well Woman Centre
Well Woman Centre
The copper coil is not a universally suitable or attractive alternative to hormonal contraception, however. It can cause longer and heavier periods.
McQuaid said that she is seeing sexually active women 'every day' who don't want to get pregnant but aren't taking contraception.
Was that always the case, say 10 or 15 years ago?
'It was, but I had always thought it was related to the fact that access to contraception wasn't freely available,' McQuaid said.
'I had always assumed that cost was a factor. But there is still an issue, even though cost is not a factor.
Now, some people just say they don't want to get pregnant but they don't actively do anything to prevent it.'
Side effects
No-one disputes the fact that hormonal contraception can cause side effects.
However, some side effects may not be officially recognised. For example,
the NHS website
states that there is not enough evidence to show that headaches, nausea, mood swings, weight gain, sore breasts or acne are caused by hormonal contraception.
This will seem bizarre to many women, who have either experienced one or more of these side effects themselves, or whose friends have.
McCarthy, of the ICGP and HSE, said contraceptive care needs to be very carefully individualised.
'We can look at the guidelines, where they'll say there's insufficient evidence that such and such causes mood changes or weight gain, and on a population level that may be true. But on an individual level, women can experience significant side effects and some women are more sensitive than others,' McCarthy said.
Psychologists in UCC interviewed 11 Irish women
about their experience on the pill. They found that while the women felt more in control of their fertility, they experienced both physical and mental side effects. The women did not feel this experience was taken seriously by doctors.
Caitríona Henchion, medical director of the Irish Family Planning Association, agreed with McCarthy that hormonal contraception 'does not suit everyone' and some people seem to be more sensitive to negative effects. These are usually associated with progestogens – synthetic forms of progesterone.
'However, the majority, who are likely to have little or no adverse effects, are being frightened off even trying it,' Henchion warned. 'Many fears are based on totally false claims made, usually on social media.'
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Dr Caitríona Henchion
Andres Poveda
Andres Poveda
She said hormonal contraception is not only an effective way of avoiding unintended pregnancy but can also reduce period pain and cause lighter bleeding, and significantly reduce the risk of developing ovarian cancer.
Doctors say that if women have a poor experience on one pill – for instance, low mood, associated with progesterone, or breast tenderness, associated with oestrogen – trying another pill or form of composition is likely to help.
'Oftentimes, women won't have an issue with the second pill they try,' said McQuaid, of the Well Women Centre.
However, women
The Journal
interviewed about their decision to discontinue hormonal contraception spoke unhappily of being automatically told by doctors to try a different pill or form of contraception when they raised concerns.
They said they didn't like the idea of taking artificial hormones, and they found it easier to understand their own mood and feelings when they were able to track their normal menstrual cycle (most hormonal contraception other than the hormonal coil prevents ovulation).
There seems to be a sense in which women are further alienated from hormonal contraception when they feel the health system is not listening to their concerns about it.
Trainee clinical psychologist Ailsa McGuinness, who led the UCC research on Irish women's experience of taking the pill, said that while the pill is physically safe, women feel that there is not enough research on or understanding of its mental health impact.
She suggests the gap that has opened up between women's experience, which they share informally with each other, and official medical advice and messaging may be where the online 'wellness' industry has crept in with its alternative views on contraception.
Frequently, in social media discussions of contraception, including among Irish women, someone will advocate using menstrual cycle-tracking apps such as Natural Cycles as a form of contraception. This particular app has been promoted as contraception by at least one Irish alternative health practitioner with a large social media following.
Natural Cycles, which also encourages women to check their temperature to know where they are in their cycle, said it has a small Irish user base but is not actively marketing itself here. It claims to be 93% effective with typical use and 98% with perfect use, and claims to be 'just as effective' for women with an irregular cycle.
Claims that cycle tracking can be over 90% effective in preventing pregnancy are not supported by Irish health authorities.
Natural Cycles
Natural Cycles
In 2018, the British Advertising Standards Authority banned a Natural Cycle ad billing the product as a 'highly accurate' contraceptive tool, ruling that the claims made were misleading and the effectiveness of the app exaggerated.
The Irish government's new sexual health strategy
states that unplanned pregnancy rates for 'natural family planning methods' are estimated at 24-25%, and warns that there is a 'clear need' for more public information on cycle tracking as a form of contraception.
Henchion, of the IFPA, said: 'I have met several women using period tracker apps for contraception. Unfortunately, the context in which I usually meet them is unintended pregnancy.
'If an unintended pregnancy would not be a crisis and if you have a very regular cycle, it is perfectly reasonable to use a tracker app instead of contraception. But the failure rate is significantly higher than with any modern contraceptive method. Even with a very regular cycle, ovulation may vary from one month to the next,' she said.
Social media
If there is an emerging trend of more women opting out of hormonal contraception, it seems very likely that social media is playing a role.
Research
analysing YouTube vlogs about hormonal contraception, for example, has found they are disproportionately about discontinuing it.
One
2023 study
, based on interviews with women, concluded that social media shapes their sense that there are hazards associated with the pill, shifting the perceived risk from questions around the reliability and basic safety of the drug to questions of individual physical and mental wellbeing.
Young women interviewed by
The Journal
who have come off contraception were self-aware about this aspect of social media: they could see that it individualised discussion of hormonal contraception to particular women's experience – and they saw this as a positive.
They viewed social media as playing an empowering role in enabling women to share their own experiences and decisions with others.
Olwyn Hanley (29) was on various forms of hormonal contraception from age 17 to 24. She believes social media has given women both information and education.
'I feel like the generation before us were very accepting because they didn't have that access to information online. They thought, 'if the doctors say so, it must be right, and we'll just go by that'. I think we're very much a generation who asks questions,' Hanley said.
Hanley said that being able to track her menstrual cycle and understand why her mood might be different at different times of the month has been beneficial. She is in a long-term relationship and uses condoms.
There may be other factors at play, not least the other side of the story when it comes to pregnancy or avoiding it: men.
One 26-year-old woman from Cork said her boyfriend has put no pressure on her to go back on contraception. They use condoms.
'I think the men in this generation are more educated,' she said.
Clóda Scanlon, the 28-year-old whose Instagram video on her experience of coming off the contraceptive implant after 10 years received a warm response from other young women, said she has no plans to go back on.
Like other women
The Journal
spoke to, she feels more in tune with her body now that she is tracking her normal menstrual cycle.
'My feelings have more clarity,' she said.
'There would have been times when I would have maybe struggled with my mental health, and I kind of wonder, would the [artificial] hormones have had an effect in some way, because I wasn't actually feeling my true emotions, my body wasn't taking its natural course?' she said.
A clearer picture of what is happening in Ireland will soon emerge. The next Healthy Ireland Survey, to be published this year, will contain an update on contraceptive use, while the University of Galway will conduct a major survey for the HSE in 2027.
McCarthy, of the ICGP and HSE, advises women who are going to a medical consultation about contraception to write out what they've been on before, how long they took it for and what issues they experienced, to help them to build as clear a picture as possible.
To anyone experiencing side effects she says: 'Talk to your GP: they want to find a method that is going to be right for you.'
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