Editor’s note: This is the first installment of our fact-check column: a summer column dedicated to researching and evaluating the accuracy of information and claims found on social media.
Self-diagnosing and self-treating have long been trends on social media — but recently, one health topic in particular has picked up traction, especially with young women, both on social media and in peer-to-peer discussions: the apparent dangers of hormonal birth control and the effectiveness of alternative non-hormonal contraception. Some of this information is accurate and genuinely helpful to women making decisions about how to handle their reproductive health — however, every action has an equal and opposite reaction, and with the surge in verifiable, useful information about non-hormonal birth control has come a similar surge in dangerous misinformation.
Birth control has never been a cut-and-dry topic, and the recent push against the status quo may just be an evolution of the long-standing questions surrounding women’s health. As long as pregnancy has existed, so too, it seems, has the desire to prevent unintended or unwanted pregnancy.
The documented history of birth control begins in 350 B.C., when Greek philosopher Aristotle is believed to have developed one of the earliest spermicides using natural ingredients like frankincense, cedar oil and lead ointment.
In more recent history, natural contraceptive methods began to gain traction in 1873, after the U.S. Congress passed the Comstock Act. The Comstock Act prohibited the shipment and interstate sale of contraceptives — like cervical caps, condoms, diaphragms, sponges and douching syringes — as part of broader anti-obscenity legislation. Through the legislation, the U.S. classified contraceptives as “obscene content” and in doing so became the only Western nation with legislation that criminalized birth control, forcing women to turn to other forms of family planning.
During the Great Depression, for instance, Lysol soap became a popular form of birth control following an ad campaign that promoted the product as a feminine hygiene care product that was infection- and odor-preventing. Labeling a product as “feminine hygiene care” at the time served as a signal to women that it was intended as a form of birth control when it was illegal to outright call it contraception.
Not only did the Lysol cause vaginal blistering and bleeding in some cases, but it was also an ineffective contraceptive. A 1933 study conducted at Newark’s maternal health center found that almost half of a cohort of 507 women using Lysol as birth control ended up pregnant.
Thankfully, scientists have since developed safer — and more effective — forms of hormonal and medical birth control. Intrauterine devices, for instance, were invented at the turn of the 20th century. Though IUDs on the market today are around 99% effective and safe, with both hormonal and non-hormonal options available, one of the original IUDs — the Dalkon Shield — was found to cause pelvic infections and even death because it facilitated bacterial entry into the uterus. This created a widespread distrust of IUDs which, for some women, persists today.
Though once widely viewed as safe and non-invasive, in recent years, oral hormonal contraceptive pills have garnered a negative reputation, particularly in online spaces. First approved by the U.S. Food and Drug Administration in 1960, oral birth control introduces specific amounts of hormones like estrogen and progestin (a synthetic form of progesterone) to prevent pregnancy and regulate the menstrual cycle. However, like nearly all pharmaceuticals, taking these hormones can cause adverse side effects, including increased risk of blood clotting, nausea, spotting between periods and irritability. In part as a response to those side effects, some of the skepticism pushing anti-pill rhetoric is a result of valid concerns — but many concerns surrounding “the pill” follow common misconceptions.
Let’s evaluate the accuracy of some of the viral claims surrounding birth control, the menstrual cycle and pregnancy prevention.
CLAIM 1
“The pill is made of synthetic hormones and when we take this pill every single day it puts our body in a hormonal state that tricks it into thinking that it is already pregnant. It also very closely mimics the luteal phase of your cycle which is the week before you get your period. Essentially what it’s doing is it’s skipping over ovulation so there’s not a chance to get pregnant.”
VERDICT: MORE MYTH THAN FACT
While birth control pills do contain synthetic versions of hormones produced naturally by a woman’s ovaries — estrogen and progestin — with dozens of different options on the market, not all work the same way to prevent pregnancy and conflating all of the types creates more confusion, not more clarity.
This user is correct that taking the pills puts the body in a hormonal state that prevents egg implantation. However, birth control pills don’t “trick [our brain] into thinking that it is already pregnant.” During pregnancy, estrogen and progesterone levels do become extremely elevated, with progesterone playing a part in the signal pathway that stops the body from beginning a new period or ovulating. But if anything, taking oral hormonal contraceptives puts the body in a state more similar to that of a post-menopause body than a pregnant one. Post-menopausal women have lowered levels of estrogen and progesterone, and the quantity of synthetic hormones found in hormonal contraceptives are low relative to the levels expected in a pregnant or naturally cycling woman.
The second half of the initial claim is also a bit misleading. Oral hormonal contraceptives work to thin the uterine lining, while during a typical luteal phase, the uterine lining would thicken to prepare to accept a fertilized egg. Technically, most oral birth controls do ‘skip’ ovulation, but not in the sense of skipping the ovulation phase of the menstrual cycle. Rather, oral contraceptives replace the normal menstrual cycle with an artificial one triggered by stopping hormones on day 21 of taking the pill.
There are currently three main groups of oral contraceptives: progestin-only, combination estrogen-progestin and extended/continuous use pills.“Minipills” contain only progestin. They change the uterine lining to stop implantation of a fertilized egg and thicken the cervical mucus to prevent sperm from reaching the egg. Some minipills prevent the release of the egg, but not all. With a 95% efficacy rate, progestin-only minipills are a viable contraceptive option for women who react negatively to increased estrogen or are breastfeeding.
The “combination pill” works by both stopping the ovaries from releasing eggs and changing the uterus and cervix to prevent implantation of the egg and entry of sperm. If used as directed, these have a greater than 99% efficacy rate. “Continued use pills” are another type of combination pill, but they reduce the number of menstrual periods from 13 periods a year to four. Chemically, they function similarly to the traditional combination pill.
CLAIM 2
“Maturing is realizing birth control changes your body type and make you gain tons of weight that’s hard to lose.”
VERDICT: MORE MYTH THAN FACT
Anecdotally, many women report that they gained weight while taking hormonal birth control. However, while the Depo-Provera birth control injection has been found to cause some weight gain in users, in 2014 researchers meta-analyzed 49 studies encompassing 52 forms of birth control containing estrogens and progestin and found no evidence to demonstrate that the combination of these hormones caused weight gain.
Some of the side effects of hormonal birth control, though, can cause weight gain. Progestin, for instance, can increase appetite levels, and increased estrogen quantities can lead to fluid retention. A caveat for the latter, though, is that current hormonal contraceptives have decreased levels of estrogen in part to minimize this side effect, meaning any water weight users may gain is typically temporary.
The propagation of this myth has made weight gain among the top reasons women stop taking hormonal contraceptives or avoid them entirely, Penn State College of Medicine researchers found in 2016.
CLAIM 3
“I practice something called the symptothermal method of FAM [Fertility Awareness Methods] and I love this method for two reasons. Number one, is that it’s highly reliable. This method has been shown to be comparable to most forms of hormonal birth control in terms of efficacy rates. The second reason is that it gives me total control over my body. There is no more hoping or wishing or crossing my fingers that my birth control works. I know what’s going on, I’m in control.”
VERDICT: HALF MYTH, HALF FACT
The symptothermal method is one of the most effective FAMs. With measuring the time since menstruation and the cervical mucus, it is possible to estimate the start of the fertile phase and avoid intercourse until another indicator, like the cervical mucus or basal body temperature, suggests that the fertile window has closed. A 2007 study published in Human Reproduction reported that, in a cohort of 900 women following 13 menstrual cycles, the unintended pregnancy rate out of 100 women was approximately 1.8, decreasing to 0.6 when the symptothermal method was accurately used.
However, when discussing the efficacy of contraceptive methods, it’s necessary to consider the difference between so-called “perfect use” and “typical use.” Perfect use is defined by the National Health Service as when an individual uses the form of contraception correctly every single time; typical use is defined as when contraception is used correctly some, but not all, of the time. Typical use data accounts for factors like a condom breaking or a user forgetting to take a pill. So, while FAMs may have between 91-99% estimated efficacy through perfect use, with typical use they have around a 76% efficacy. Oral hormonal contraceptives, on the other hand, have over 99% efficacy in perfect use and 91% efficacy in typical use. So, while appearing to have near equal efficacy in perfect use, with typical use FAMs have lower success rates in preventing pregnancy than hormonal and medical birth controls.
Ultimately, deciding which kind of birth control to use is an extremely personal choice. Many women may use contraceptives for other medical reasons that have nothing to do with pregnancy, in which case they should consult their doctors on the form of birth control most effective to address their concerns. For those seeking to prevent pregnancy, though, understanding the science behind and efficacy of the available options is an extremely important step in making an informed decision.
For individuals whose bodies don’t react well to disruptions to their natural hormone levels, those who have religious objections to hormonal birth control or people who have mistrust in the medical and pharmaceutical industries due to past traumas, FAMs can be an alternative form of pregnancy prevention.
It is important to keep in mind that FAMs are not inherently bad — they can work in certain circumstances. But, when employing these methods, it’s important to have a clear understanding of their limitations and apply the level of care required to make them work as intended.
