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7 February 2024

Who, in this Wild West of contraception, can you trust?

Whatever the method, reading the endless lists of side effects is a preventative in itself.

By Pippa Bailey

It’s 1.00am and I am stuck in a Reddit hole from which I cannot emerge unchanged. It is always a grievous mistake to ask medical questions of the internet – this I know from the time I convinced myself I had a tumour when what I actually had was a swollen gland because of a wisdom tooth coming through. And from the amount of NHS 111 time I once wasted convinced I had a blood clot after a flight (I had sunburn).

I never meant to end up here. It occurred to me, 48 hours before I was due to have a contraceptive implant fitted, to search YouTube for someone getting the procedure. I am not squeamish, and so it was not the injection, or the incision, or the gun-like machine, or the visceral tugging as the thin, 4cm plastic rod was settled between skin and muscle that concerned me. It was the comments. Hundreds of women posted horror stories: of acne, weight gain, loss of libido, infections, prolonged or continuous bleeding. It might take three months for your body to adjust, and to work out if these effects are temporary or long-term, the internet tells me. Give it a chance, and if it doesn’t suit you, have it taken out. But a possible three months of continuous bleeding? Perhaps that is why the implant is one of the most effective contraceptives…

I text a close friend who once had the implant (she has also tried the pill and the coil, and given up on all three because of the side effects): “People probably only write online about bad experiences, not good ones, don’t they?” Don’t they?! In the end, I cancel my appointment. I do not love the pill, and – despite taking it on and off for 15 years, and despite the reminder alarm that rudely interrupts my colleagues every afternoon – am not brilliant at remembering to take it. But I certainly prefer it to continuous bleeding, or to getting pregnant, which at this point in the early hours seem to be my only other options.

There is not a single contraceptive with a 99 per cent efficacy that doesn’t have such trade-offs. Sure, the natural, family-planning method doesn’t involve introducing synthetic hormones to your body, but I know of only one friend who uses it and she has had two unplanned babies in three years; I don’t like those odds. The lengthy lists of side effects accompanying hormonal contraception typically involve some combination of headaches, nausea, breast tenderness, mood swings, weight gain, loss of libido, acne and irregular bleeding. Irritatingly, an otherwise promising trial for a male contraceptive was halted because these exact side effects were considered unconscionable. The paper sheet of side effects and contraindications included with the pill is so large Gen-Zers post TikTok videos pretending to use it as a blanket.

But the problem, I reflect to my friend, is not necessarily that contraceptives have side effects – I would choose them over the side effects of pregnancy any day – but that there is so little reliable information about their prevalence. Perhaps quality studies simply haven’t been done; gender bias in medical research is well documented. But “some women may…” is not all that useful when it comes to making informed decisions. The NHS England website does not mention  in its list of implant side effects the months on end of bleeding reported by the women of the internet, warning only that “your periods may be irregular or stop altogether”. The Nexplanon website (for the widely used brand of implant) says one in ten women stop using it because of “an unfavourable change in their bleeding pattern”. Google gives varying levels of prevalence for infrequent, prolonged or continuous bleeding, from three in ten users to half of them. Among those posting their stories to YouTube and Reddit, it must be far higher. My GP surgery does not fit the implant, and the sexual health clinic that does doesn’t offer consultations. Who, in this Wild West of contraception, to trust?

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I try canvassing a group of close girlfriends for their experiences, and find the majority have ditched hormonal contraception for condoms – or, says one less anxious than I, are “risking it”. Another, who is gay, proffers simply: “Abstinence.”

[See also: The sexual revolution that failed]

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This article appears in the 07 Feb 2024 issue of the New Statesman, Who runs Labour?