birth control roulette
the unintended consequences of f*cking with your hormones, a typical IUD insertion (horror) story, and what happened after breaking up with birth control
Growing up in Oklahoma, my “sex education” was as lacking and sparse as the yellowing landscape. In the fifth grade, we got a grainy video about periods that left us girls watching in hushed embarrassment while the boys giggled nervously in the next room, watching their own 80s relic about erections and armpit hair.
We learned about the value of deodorant, what tampons were, and even saw a friendly-looking cartoon uterus—but never once addressed sex.
Sex was an unspoken ritual, some mysterious act you’d only hear whispered on the cautionary wind of a pregnant ninth-grader three schools over.
Teaching teenagers the ins and outs of fertile windows, safe sex, and birth control would imply that sex was a real thing that real people did. And in Oklahoma circa 2008, there would be no. such. thing.
The reality, of course, is that young people have sex—and lots of it. Oklahoma currently ranks fifth among U.S. states for the highest teen birth rate, a drop from second place back when I was seventeen—when the scores of my pregnant classmates reflected the ranking accurately. Clearly, our teenagers are uninformed about their options. I know I was.
It turns out that relying on a cocktail of denial and fear-mongering doesn’t work! Shockingly, birth control does.
For sexually active teenage girls not using birth control, pregnancy scares are frequent and endlessly anxiety-inducing. It’s pretty hard to focus in class when you’re convinced you’re pregnant. Your period is late, and WebMD.com is telling you that sore gums might be a sign of pregnancy!
The panicked thought drowns out everything else: How will I deal with an unplanned pregnancy?
Now, with a statewide abortion ban, Oklahomans and others in abortion ban states are forced to either travel across state lines or face nine months of pregnancy. The stakes have never been higher, and my heart aches for Oklahoma teenagers who now have fewer rights than I did just a decade ago.
Even with more options back then, I still found myself in the middle of the terrifying whirlwind that is pregnancy prevention. It took a year of being sexually active and two Plan B purchases before I finally bit the bullet and got on birth control.
The options weren’t endless, but there were plenty: the pill, the patch, the shot, the cervical cap, the IUD. I went with the pill, as it seemed to be the least invasive and most straightforward option.
I brought home my plastic pack of tiny pills, took one, and threw up the next morning. This repeated itself for days on end. For the next few months, I was on a rollercoaster of nausea and mood swings. It wasn’t long before I hardly recognized myself, my emotions, my outbursts, my anxieties, or the depression that was swallowing me.
At first, I thought it was just part of being eighteen and Going Through It™️. Maybe it was all developmental. Maybe it was purely situational. It took me half a year before I started to wonder if it was something more.
Feeling alone and confounded, I did what I do best: anxiously googled my symptoms and scrolled through Reddit threads.
Every article I found from a woman’s perspective was accompanied by hundreds of comments from women sharing similar negative experiences. For every personal account, though, there seemed to be a research-based rebuttal, insisting the pill caused none of the symptoms we were experiencing.
We couldn’t all be crazy, could we?
“Experts—mostly men—have lined up to tell us not to be alarmed, concerned, or deterred from using hormonal contraceptives,” Holly Grigg-Spall, author of Sweetening The Pill, writes.
But a 2016 study from the University of Copenhagen, among others, suggests some of these concerns are well-founded.
Published in JAMA Psychiatry, the 13-year study found that young women on the pill were 34 percent more likely to be diagnosed with depression than those not using hormonal birth control—confirming a reality many young women, like myself, had been experiencing firsthand.1
Other research further supports this link. For instance, a 2018 review published in Frontiers in Neuroscience indicated that hormonal contraceptives can disrupt the brain’s emotional processing pathways, leading to symptoms like anxiety, mood swings, and emotional dysregulation.2
Similarly, a 2019 study published in Psychoneuroendocrinology found that women taking hormonal contraceptives experienced decreased emotional recognition abilities and heightened cortisol responses to stress, adding yet another layer of evidence that ties hormonal birth control to emotional instability and heightened anxiety.3
Is anxiety not an alarming side effect? Is depression—a disease that leads to suicide for over 700,000 people each year—not a valid concern?4 Is fundamentally not feeling like yourself dismissable?
For years, women’s experiences have been treated as peripheral, as if the toll on our mental and emotional health somehow doesn’t count. Concerns about mood swings, anxiety, and depression are often dismissed as mere anecdotes or “just part of it.”
Meanwhile, the research that does support these effects rarely finds its way to patients, leaving many of us wondering if it really is all in our heads.
Finding research that validated my symptoms didn’t make them go away, but it did bring me some relief. I wasn’t alone, and my experiences were real. Exhale. But as I came off birth control and my symptoms slowly subsided, the familiar fear that had driven me to it in the first place crept back in.
After all, my original concern hadn’t magically disappeared—I still wanted reliable protection against pregnancy. Weighing my fear of hormonal side effects against my fear of an unwanted pregnancy became an exhausting ritual I revisited every month, and after one too many pregnancy scares, I decided it was time to try again.
My appointment for the hormonal IUD came on a cold January day. It was dreary and wet outside, and I watched as Trump was inaugurated on the waiting room TV. For a number of reasons, I didn’t feel so good. I got undressed and waited in the cold, sterile seat, my paper gown rustling with every movement.
They examined me, and it hurt. Then they measured my uterus, and it hurt a lot. Then they said, “Now, here comes some pressure.”
Have you ever had an internal organ stabbed? Or the deepest part of you punctured with a rod? That’s what it felt like. The assisting nurse, a young woman with braces on her teeth, looked on in horror. No reassurance there.
I Want a Hippopotamus for Christmas was playing softly over the speakers. I’ve never hated a song more.
I kept saying, “I can’t do this,” while the doctor repeated, “Almost there.” The pain dragged on for what felt like an eternity.
According to a Washington Post article, many patients report not being warned of the potential for pain or offered options to manage it. I certainly wasn’t. While local anesthetics and sedation are available in select practices, many clinicians don’t readily offer them.
In one study, 200 women reported their IUD pain an average of 65 on a scale of 0 to 100. But doctors rated it at about 35, underestimating the pain by nearly half.5
The pain didn’t end when the procedure was done. Not when I left the doctor’s office, not when I hobbled to the car, and not when I lay in bed all day, doubled over, nauseous, and wounded.
Recently, I had a biopsy done on a suspicious mole on my leg. Skin cancer runs rampant in my family, so it was better to be safe than sorry. I was nervous about the appointment—enough so that my partner came along.
The nurse offered me a squeezy ball to ease my nerves. I braced myself as the numbing needle went in, expecting the worst, but by the time I was ready, it was already over. I laughed at the absurdity.
Where was my squeezy ball when they were shoving a plastic device through my cervix? Every woman I’ve spoken to about it has mirrored my words: “The worst pain of my life.”
Somehow, the word “pain” escapes our doctors, as if it’s too strong a word for someone about to endure something potentially traumatic, as if acknowledging real pain is harder than enduring it.
Five years of a duller, more manageable dose of hormones later, I had accepted the tradeoff—chronic hormonal discomfort and horrifying pain for the convenience of surefire protection against pregnancy.
But when it was time to replace the IUD, I panicked. I made it all the way to the appointment, armed with Ativan and my partner at the time, yet still couldn’t go through with it.
At the last moment, my doctor paused and reminded me there were other options. When she suggested the NuvaRing as a less invasive alternative, I agreed. But once I got home and did a quick Google search, I found the risks my doctor hadn’t mentioned: a significantly heightened chance of blood clots, hair loss, and, once again—mood swings.
Was this really the price of birth control?
Around this time, an Instagram friend shared her journey of balancing her hormones after getting off birth control. She shared how she finally felt free from a medication that was hurting more than helping, and how she now felt confident preventing pregnancy through intricate cycle-tracking.
I was intrigued, though a bit dubious. I dove into a Google frenzy—researching articles, books, forums, and anything that felt credible.
What I learned genuinely floored me. Not once had anyone explained to me how my cycle worked, let alone how birth control affected it. One of the first things I discovered that shocked me was how ovulation works.
Each month, the body goes through a “fertile window”—about six or seven days when conception is possible. Right at the midpoint of this window, ovulation occurs, releasing an egg and boosting levels of estrogen and other hormones.
The fact that you can’t actually get pregnant on any day of the month blew my mind. Why wasn’t this included in our grainy fifth-grade video on periods? How did it take me 25 years to learn something so fundamental?
During those six or so high-fertility days, research shows that women often feel sexier, more open to new experiences, and, strangely enough, tend to wear more red. Whether that’s some primal signal or just a funny coincidence, I don’t know. But ask any woman who’s paying attention, and she’ll tell you: ovulation has a way of making you feel on.
I discovered that sex hormones influence billions of cells throughout the body, with a significant impact on the brain. They affect everything from attraction and sexual motivation to stress responses, hunger, eating patterns, emotional regulation, friendships, aggression, and more.
I discovered that the hormones from the pill and IUD weren’t just preventing pregnancy or clearing my skin—they were shifting my brain chemistry, emotions, and how I moved through the world. They influenced who I was attracted to, how I handled stress, how I learned, and even how I experienced pleasure.
These realizations, and so many others, led me to finally consider getting off birth control for good. And despite my struggles, quitting still wasn’t a decision I made quickly.
I journaled about it for weeks. I talked to every woman in my life, called my mom, read books, and listened to podcasts. I kept waiting for the world to end—for a public breakdown, my hair to fall out, my skin to erupt.
To my own shock and delight, things mostly just got…better.
For the past 18 months since getting off, my cycle has regulated itself little by little. I broke out pretty badly about a year in, but that’s since settled down. My cramps and flow are manageable, my hair’s growing faster, and my sex drive is through the roof—all things well worth celebrating, in my book.
Now that I’m experiencing the highs and lows of my cycle for the longest stretch since high school, I’m realizing just how differently I felt on birth control. What eventually became my augmented “normal”—the mood swings, the fatigue, and that strange detachment from feeling like myself—was my body telling me it was in a constant state of dysregulation.
Of course, this is just my experience. I know plenty of women, my twin sister included, who are perfectly content with their IUDs, the pill, or whatever form they’ve chosen. And I get it—this isn’t some rallying cry to yank out your IUD in solidarity. That’s not the point.
For full transparency, I’m still constantly worrying about accidentally getting pregnant! Cycle tracking isn’t as simple as it sounds, but props to those who keep up with it. Personally, I’m a big fan of condoms—98% effective when used correctly.
All the same, I keep a stash of pregnancy test strips under my sink and take one every month, without fail. About a week ago, my period started right in the middle of taking one. Talk about instant results!
Anyways—what I’m getting at is an idea we’ve all heard, and I think most of us agree with: we should each be able to make our own choices for our own bodies—and those choices should be fully informed.
If we had comprehensive sex ed that actually taught us how our bodies work—how hormones shape our inner worlds, the real risks of birth control, how a non-cartoon uterus functions in real life, and the unequivocal choice of whether or not to go forward with pregnancy—maybe making the best choice wouldn’t feel so much like birth control roulette.
Would it have changed anything if I’d stayed off birth control all those years?
I can’t say for sure, but I still wonder: who might I have been if I’d been spared hormonal pandemonium during the most formative years of my life?
Would I have worn more red?
a note…
I finished this piece a week before the election. It comes as no surprise that a Republican president-elect who ran on a largely anti-choice platform poses an unimaginable threat to women’s reproductive rights in America.
If you’re feeling anger, grief, or disappointment, my heart is with you. I’m frustrated by the lack of options we’re given, by the reality that we can send people to space and create world-altering AI, yet still haven’t innovated better options or an effective birth control alternative for men.
I don’t have answers, only this understanding: access to birth control and abortion is essential, life-saving healthcare that will always be needed, regardless of any laws that try to prohibit it. I hope we show up and support one another as access becomes increasingly limited, and that we continue to care for one another in all the ways we know how.
📚 recommended reading…
You or Someone You Love: Reflections from an Abortion Doula by Hannah Matthews
A powerful guide to compassionate community abortion care in a post-Roe U.S., Matthews blends personal stories and practical insights to show how we can support and protect those seeking abortions. This was an extremely eye-opening read that touched me deeply.
This Is Your Brain on Birth Control by Dr. Sarah Hill
Hill dives into how hormonal birth control affects everything from mood to attraction to identity. Some readers (a few of my friends included) take issue with the fact that some of her research is more suggestive than definitive, but I still found it to be an eye-opening starting point on the pill’s psychological effects.
When Everything Changed: The Amazing Journey of American Women from 1960 to the Present by Gail Collins
Collins gives an expansive look at how American women have progressed over the last six decades, covering the social, political, and cultural shifts that shaped women’s lives—including the impact of birth control on autonomy and freedom. If you want context on the evolution of women’s rights, this is a must-read. It’s beautiful and engaging, and I learned so much.
Beyond the Pill by Dr. Jolene Brighten
Brighten covers symptoms that can arise after stopping birth control and shares tips for balancing hormones naturally. Personally, I found her protocol really helpful for making my transition off birth control smoother.
Skovlund, C. W., Mørch, L. S., Kessing, L. V., & Lidegaard, Ø. (2016). Association of hormonal contraception with depression. JAMA Psychiatry, 73(11), 1154–1162.
Velasco, C., Eickhoff, S. B., & Kasper, L. (2018). "Hormonal Contraceptives and the Brain: A Review of Functional Magnetic Resonance Imaging Studies." Frontiers in Neuroscience, 12, 256. https://www.frontiersin.org/articles/10.3389/fnins.2018.00256/full
Montoya, E. R., & Bos, P. A. (2019). "How Oral Contraceptives Impact Social-Emotional Behavior and Brain Function." Psychoneuroendocrinology, 110, 104421. https://www.sciencedirect.com/science/article/abs/pii/S0306453018306319
World Health Organization. “Suicide.” WHO, 18 Sept. 2024, https://www.who.int/news-room/questions-and-answers/item/suicide.
Maguire, Karla. “Providers Underestimate Pain Intensity During IUD Insertion.” Contemporary OB/GYN, 18 Oct. 2024, https://www.contemporaryobgyn.net/view/acog-providers-underestimate-pain-intensity-during-iud-insertion.