The development of the first hormonal contraceptive in 1960 was considered one of the most important inventions of the 20th century, and worldwide it has continued to pave the way for sexual freedom and reproductive choice. Besides family planning, it has been lauded with a multitude of health benefits, such as endometriosis relief and menstrual regulation, and its clear contributions to healthcare and female empowerment cannot be disputed.
Despite this, the association between contraception and sexual activity has unfortunately always meant that it is tied to shame, particularly for female bodies. While certain parts of the world have become largely liberal in regard to attitudes towards sexual agency, there are other elements of birth control and shame that remain unaddressed: their side effects, particularly surrounding mental health.
Concerns about this have largely been ignored in medicine, despite a growing amount of research gaining traction worldwide in recent years. Gender bias—especially regarding exclusively female-bodied issues like birth control—is rampant in the healthcare system, and I believe that the constant denial and belittlement of contraceptive mental health side effects is a form of medical gaslighting and is directly linked to the concept and feelings of shame.
When I was administered the contraceptive injection in 2016, it triggered intense depressive episodes and anxiety, both of which I had never experienced beforehand. Research has supported findings of Hormonal Birth Control (HBC) linked depression and anxiety across a multitude of studies and associated with various types of hormonal contraceptive methods but at the time, because the clinicians I had met with prior to receiving the shot had cautioned me about weight gain and acne but nothing had been brought up about mental health, it took me a while to suspect the role my birth control might have been playing. When I finally did reach out to the sexual health clinic that I had attended to ask if what I was feeling had anything to do with my HBC, they replied that sometimes, mood swings could come and go while on hormonal contraception, and that when it wore off in three months’ time, I’d go back to feeling normal.
This doesn’t feel like mood swings, I’d thought. It felt like something much more extreme.
For the next few months, I went to various doctors for both my declining mental health and its physical manifestations, most notably chronic pelvic pain and fatigue. The narrative was the same:
“Something is wrong.” I would say, to which doctors would reply, “No, there isn’t”.
As sexual and mental health face a lot of social stigma, even bringing up my concerns in the first place felt taboo. I was rarely asked about if I was on a contraceptive method, and when I volunteered that information, it was pushed aside, instead being replaced with suggestions for more exercise, change in diet, or over-the-counter pain killers. I was ashamed of my supposed paranoia, convinced that I was being overdramatic and sensitive. If the doctors said I was fine, I had to be fine. They were the professionals, not I, and if they claimed that nothing was wrong, then why did I feel so terrible? It was not that the medical practitioners were being intentionally dismissive; they just did not see a potential causal link between my health and my contraception. Medical gaze has been noted for its narrow scope on female health in general, and the medical world views hormonal methods, particularly LARCs (Long-Acting-Reversible-Contraception) as the gold standard for birth control. Suggesting anything less than glowing praise for them is seen as a lack of gratitude.
Though my experience is my own, and every individual will have different bodily reactions and responses to HBC and interactions with their doctors, I was surprised at how many friends and colleagues came forward with similar stories to mine. They, too, had been met with disbelief and belittlement, and, like me, had their experiences deprecated and written off as a passing phase. Many were told their symptoms were all in their head (which, a friend commented to me, was ironic), and others shared that they were told to expect side effects that matched ‘what you get on your period’, and were subsequently shocked when the outcomes were negative mental health. Like me, many of them felt ashamed after these medical appointments, wondering if they were imagining things if they were the only ones who saw their symptoms as an issue, when licensed medical practitioners who had gone through years of rigorous training did not see a problem.
These experiences support research that has demonstrated that female patients are often deemed “emotional” and “complainers”, viewed by society as too sensitive and demanding for out pain to be taken seriously, and thus treated differently than our male counterparts due to patriarchal constructs and implicit sexism within the healthcare system. Furthermore, studies exploring gender bias and awareness (or lack thereof) regarding female mental health found that it was often overlooked because of gendered (mis)understandings of conditions such as depression. This may be why it is easier for the healthcare system, and society as a whole, to label HBC mental health side as “mood swings”, diminishing their potential severity and importance. In comparison, in a study done on men to test out a new potential male contraceptive method, those same “mood swing” side effects were called mood disorders, and testing was halted because it was deemed unsafe.
The outcome of these dismissive interactions with physicians meant that, until I moved away, I stopped seeking out help, a situation once again mirrored by many of my colleagues. Because both female sexuality and mental health are regarded through stigmatized lenses, it was difficult enough to advocate for ourselves when we already made to feel like we were the ones at fault, much less have to do so while juggling fluctuating mental states and worrying about being perceived as “too much”. As the experiences within healthcare settings began to further exacerbate my mental health, I began to believe the stereotype of shame that was built for me: I felt guilty, embarrassed, of being ‘overly sensitive’, ‘not “strong enough”’ to handle these supposedly expected symptoms and wasting professionals’ time by feeling the way I felt. For decades, research has pointed to medical gaslighting and gender bias directly leading to the continuation of healthcare disparities, and stigmatizing language contributing to patients not returning for follow-up appointments for medical issues. Put simply, when we are ashamed, it is more difficult to ask for help and get the help we need, and without being able to get that support, the cycle of health disparities, in this case, directly concerning female bodies, continues.