60 years ago, the contraceptive pill triggered a social revolution by allowing women to take charge over their reproductive health. Yet, hefty side effects threaten these same rights. THINK analyses what science has been doing to overcome these side effects.
In THINK Issue 42, we covered the contraceptive pill and how it affects women’s reproductive rights, overall health, and life choices. We also went into great detail on the side effects of the contraceptive pill, since they can pose a barrier to the access of quality contraception, before analysing Malta’s landscape when it comes to contraception and access to family planning.
While writing this article, one question became more and more pressing. In the face of so many side effects varying from mild to serious, what was being done to improve the contraceptive pill so that women could control their reproductive health without facing a decrease in quality of life?
As we explained in the printed article, ‘although the action mechanisms of the contraceptive pill are well understood, there is still a tremendous gap in knowledge about its side effects. There isn’t much research exploring the impact of the contraceptive pill on the behaviour and psychological well-being of women.’
Where Is the Money Going?
There are a variety of complaints among people taking the pill, which makes it even harder to find solutions. Genetics and hormonal sensitivity all affect the impacts of the pill, and physicians cannot predict who will develop which symptoms. By understanding how the hormones in the contraceptive pill affect the body (beyond the reproductive cycle), it would become easier to identify the best candidates for each type of pill, as well as to develop tailored drugs.
An article in The Conversation compared the number of clinical trials for contraceptives and other drugs funded by the pharmaceutical industry between 2017 and 2020. There were 600 trials for cardiovascular drugs, 140 for treatments for eye disorders, and 23 trials for contraceptives. Only 2% of the profit from contraception sales is invested back into research and development. This lack of investment in the development of new contraceptive methods may underlie another problem: the lack of care towards women’s complaints.
Most of the current efforts to develop contraception focus on improving existing hormonal methods. Adapting an already existing and ‘well-understood’ mechanism is seemingly easier than creating new methods from scratch because the approval process is long and tedious. The long process of development and approval, with low to zero financial return, scares investors away.
Yet, claiming that the contraceptive pill is well-understood may be an exercise in wishful thinking. A variety of side effects, a lack of predictability, and even opposing effects (you may recall from the printed article that the pill can be prescribed to lessen migraines, yet some women develop migraines as a side effect) show that the pill’s impacts are not as clear as claimed.
The same article in The Conversation that looked at the number of industry trials involving contraceptives tried to justify the lack of investment in the field. As one of the only sources that we could find with concrete arguments for the lack of funding, we would like to directly address these arguments in this article.
Why Is there Limited Funding?
First, the article points out the low incentive to improve the available methods, since the main purpose of the contraceptive pill, preventing pregnancy, has already been accomplished. However, studies show that dissatisfaction with a contraceptive method makes it less likely to be used consistently. Decreasing side effects would be advantageous for the sake of contraception, even if not for well-being.
The article then mentions that ‘funding bodies are often interested in areas of research that affect all people – not just women – so funding will be prioritised to them.’ Contraception, even if targeted at female bodies, should not be a women-exclusive concern.
One third of women who take the pill stop doing so because of side effects
Finally the writer points out that ‘women will also continue using birth control despite side effects because they don’t want to get pregnant – so many developers may not see improving formulations as necessary.’ Yet, one third of women who take the pill stop doing so because of side effects. So decreasing side effects may be met with an increase of sales.
According to these arguments, pharmaceutical companies don’t see the point in investing in something that already works, even if its downsides severely affect a significant portion of the population.
Nonetheless, for 91% of women, no contraceptive method has all the features they think are extremely important. A 2012 study analysed what women truly want in a contraceptive method: effectiveness (84% of respondents), lack of side effects (78%), and affordability (76%).
It is important to consider that affordability can vary from country to country. For example, in Portugal, some contraceptive pills are given for free in health clinics, and others are sold at a discount price when presenting a medical prescription (which can be obtained quickly through free appointments). As addressed in the printed article, at time of writing, in Malta there is no free distribution of the contraceptive pill, and accessing free family planning or gynaecologist appointments is difficult.
What Is Being Done?
‘Research interests have focused on the development of new delivery systems and extended dosing of hormonal contraceptives that increase choice and improve compliance, but a truly radically different method has not evolved,’ reports the Guttmacher Institute, a nonprofit research and policy organisation on sexual and reproductive health. It seems that, at least in the United States, funding of contraceptive research has fallen to nonprofit organisations funded by donations and the public sector.
From pharmaceuticals, in 2022, vaginal rings, patches, IUDs, and progesterone-only-pills feature new formulations or hormone concentrations, with increased shelf-lives enabling a longer period before having to be replaced. These are important advancements, no doubt, but they still do not address the impact of hormonal methods on women’s quality of life.
In academia, some research is looking into new targets through genomics. Genes, proteins, and enzymes in both men and women have been considered necessary for reproduction and may one day be modulated to prevent pregnancy. For example, researchers are looking for ways to stop sperm maturation by manipulating a specific protein. A different protein is linked to sperm’s ability to swim, and researchers are testing compounds that can switch it off. Other strands of research are looking at ways to prevent ovulation.
Despite these efforts, no new methods have passed into human trials yet.
Even if we do not find new contraceptive methods, being more precise when prescribing hormonal contraceptives would be a huge advancement. Understanding which genetic factors make certain side effects more common and carrying screenings before prescribing contraception would help mitigate some of the side effects. For example, there are known genetic risk factors for thrombosis which could be screened for before prescribing the contraceptive pill.
In 60 years of the pill, we are still using the same hormone combinations that affect women’s well-being and don’t really reflect their needs. Isn’t it time to shake it up, and create hormonal contraceptives that prevent pregnancies and let women live their most fulfilling, comfortable lives?
Further Reading
Blake, K., Arthur, L., & Casto, K. (2020, October 2). How is the contraceptive pill affecting your mood?. Pursuit. https://pursuit.unimelb.edu.au/articles/how-is-the-contraceptive-pill-affecting-your-mood?fbclid=IwAR0zAEsP5no-mQxODEujQC6d7fBGplnHRCp99Z–QJ6jxW47sIt3HmidTTw
Key, A. P. (2023, May 3). Birth Control: The Latest Research. WebMD. https://www.webmd.com/sex/birth-control/birth-control-latest-research
Lessard, L. N., Karasek, D., Ma, S., Darney, P., Deardorff, J., Lahiff, M., Grossman, D., & Foster, D. G. (2012). Contraceptive features preferred by women at high risk of unintended pregnancy. Perspectives on Sexual and Reproductive Health, 44(3), 194–200. https://doi.org/10.1363/4419412
Schwartz, J. L., & Gabelnick, H. L. (2022, August 25). Current contraceptive research. Guttmacher Institute. https://www.guttmacher.org/journals/psrh/2002/11/current-contraceptive-research
Swift, B., & Becker, C. (2023, June 8). Birth control continues to fail women – so why has nothing changed?. The Conversation. https://theconversation.com/birth-control-continues-to-fail-women-so-why-has-nothing-changed-164195
Wenner, M. (2008, December 1). Birth control pills affect women’s taste in men. Scientific American. https://www.scientificamerican.com/article/birth-control-pills-affect-womens-taste/
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