The pill without a prescription

Image description: a sheet of contraceptive pills on a pink and blue background

It was announced at the end of July that the contraceptive pill, specifically the progesterone-only pill (HRA Pharma’s Hana and Maxwellia’s product Lovimacan) can now be sold over the counter at pharmacies without a prescription due to a change in classification. Yet I question the decision to make more freely available contraception that is potentially so life changing and harmful to those who take it. It is not the availability of contraception I object to, but this particular form.

The pill has often been seen as a lifesaver, a game changer for those who menstruate . It apparently balanced the treatment of the sexes, ‘unshackling women from the home’ and so forth. But, whilst this narrative was presented to me, not a single one of its side effects as a medication was.

Theoretically the pill is supposed to contain oestrogen and progesterone, both of which are naturally occurring hormones. In reality, all pills actually contain synthetic versions of both because the real deal hormones would break down too quickly if ingested orally. Oestrogen is replaced by ethinyl estradiol, and progesterone by one of eight synthetic progesterones, called progestins. Ethinyl estradiol prevents the body from releasing an egg every month, while progestins thicken the mucus at the entrance to the cervix and makes the womb inhospitable. 

This all sounds fine and dandy until further research uncovers that these synthetic hormones do not behave in the same way as their natural equivalents. Side effects can include acne, sweating, weight gain, unwanted hair growth and occasionally a deepened voice. The masculine effects of contraception are well documented and if you talk to anyone on the pill they’ll be able to give you a run down of their own personal symptoms.

I initially found this shocking, but on closer inspection found that this was not anything new. The first progestin ever made in 1951 by Luis E. Miramontes, norethindrone, was androgenic. Pregnant mothers who had taken it noticed excess body hair and acne and 1 in 5 baby girls born to mothers taking it had masculinised genitals. Whilst today androgenic progeststins are much less androgenic having been further developed and the doses are smaller, often being combined with synthetic oestrogen. However masculine effects such as excess body hair are still considered normal side effects on the official Norethindrone website.

Several different versions of the pill later, there are now forms made from synthetic progesterone which have the opposite effect and are used to treat acne and excessive hair growth. The only downside is that these versions are not readily available because of their expense. those who menstruate  instead, are all given the same contraceptive androgen pill whatever the reason for taking it, and whatever their medical history.

With all this in mind, I was therefore surprised to hear that the government’s consultation had resulted in the contraceptive pill being available over the counter. Some have hailed this as excellent news with access opening up to many those who menstruate  for whom it is a lifeline. The health concerns have been side-lined in favour of easier access and promises that pharmacists will be well prepared and waiting to ask the necessary questions which, if necessary, may include obtaining a customer’s medical record.

But should this be where our worries end? The pill is a massive medical step for most those who menstruate  and the effects vary widely. Whilst, naturally, pharmacists are trained medical professionals, not even a blood pressure test will be required before obtaining a course of the pill. This seems irresponsible given that the pill is strongly advised against for those with a family medical history of migraines, thrombosis and clotting and is also used as a treatment for a variety of conditions including, as birth control, regulating periods, as a mitigator for pain experienced as part of endometriosis and and comes with a long list of possible effects. Yet, without a single consultation with a GP and/or other specialist you can walk away with a month’s treatment.

I do not wish to dictate to those who menstruate what they can and can’t do with their bodies. Their reproductive choices are their own. I instead question the use of the pill in its current form as a medication at all considering its side effects and relatively limited research into it. Before researching this article I was unaware of the side effects listed above or the differences in hormones and I can imagine that’s the case for many those who menstruate  offered it. We regularly give those who menstruate  the pill without a second thought to the repercussions of it on their bodies and brain and I fear that a freely available, over the counter pill will continue a reliance on a contraceptive method likely to wreak as much havoc on our bodies as protection and has a darker side yet to be properly acknowledged. 


Image credit: Reproductive Health Supplies Coalition on Unsplash