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Second Puberty: Thoughts on Birth Control

PCOS Series

Last time we talked, we were chatting about periods and bleeding to death. At the end of that story, the ER’s on-call OBGYN said I needed to get on the birth control pill to stop my excessive bleeding. When you’ve almost died from blood loss, anything that makes you stop bleeding sounds like a good idea.

To be honest, the thought of taking birth control made me feel… mature. I was a junior in college who was not sexually active and wasn’t interested in being sexually active. Waiting to have sex until I was with my spouse was something I personally valued. But I had so many friends who were on birth control, whether it was for acne or cramps or otherwise. Like my cheerleading teammates whose neon green tampons I yearned to borrow in high school, I felt like I was joining the ranks of young adult womanhood by having a tiny pill to take every day.

I am sure there is something to be said here for how modern-day feminism has sold women’s physical (particularly sexual) independence. Pill packs come in all sorts of candy colors. IUD ads populate romcom commercial breaks. It is glamorous to have a habit that suggests sexual maturity. Much work has been done breaking down the harm this push for birth control does to women. Of biggest concern to me is the way this glamour masks a lack of informed consent and comprehensive sexual education.

The Church situates itself staunchly against this idea of a woman’s maturity or freedom meaning dependence upon sterilization, abortion, or contraception. However, only very recently has the reasoning for this set of beliefs really shifted towards “wanting women to understand their bodies, chart their cycles, and get to root causes in defense of human dignity for every life” and away from “these medications and practices encourage sexual immorality and irresponsibility.” This is in no small part due to the increase of lay women driving Catholic conversations online. As a result, there seems to be a greater space for topics of sexual violence and medical complications among these discussions. But between the old-school concerns about a slippery sexual slope and contemporary “wellness culture” that says you should be able to know and treat your body’s concerns 100% on your own by peeing on a test strip, charting cervical mucus daily, taking your temperature as soon as the alarm goes off, and using a unique blend of herbs and spices designed to balance your hormones, the Catholic world still doesn’t talk much about situations like mine.

Taking birth control for a valid health reason does not violate Catholic Church teaching.

Let me say that again: It doesn’t violate Church teaching to take hormonal birth control for a health reason independent from contraceptive use. Even if you’re married and having sex! If you are using hormonal birth control primarily for a valid health reason separate from contraception, then the intended consequence takes primacy over the secondary consequence of preventing pregnancy. This is what’s called the ethical principle of Double Effect. But, you have to 100% NOT intend the secondary consequence. So if there’s even a small part of you utilizing hormonal birth control for a contraceptive reason, then yes. That would violate Catholic Church teaching.

What we see is a confusion about what it means when the Church requires a marriage be “open to children.” When the Church says “openness to children,” it means that you agree to not act in such a way that intentionally prevents children and, if you were to become pregnant, you would bring that child to term. It is confusing: hormonal birth control prevents children 91% of the time. But if you do not intend to prevent children, and are taking birth control because you are literally bleeding to death, you’re in the clear.

There may be a bit of debate around weighing the proportional significance of certain outcomes. For example, if you are a married person taking birth control pills to prevent acne primarily, all the while it is acting as contraception secondarily, the Church might say that the secondary outcome is proportionally greater than the first. Proportional justification is difficult, and I’ve taken us into the weeds a bit with medical ethics. But it is important to me that YOU, reader, know that you don’t have to forgo birth control and put yourself at risk of reproductive injury (or death) to receive the Eucharist. And hey you, if you’re on birth control, Jesus wants to be with you in every part of your life, no matter the reason you’re on it (even if it IS for contraceptive reasons.)

The number of church leaders, men and women alike, who have articulated to me in one form or another that it is impossible for women to not implicitly desire contraception when on birth control is astonishing. Time and again we see the theme that women are intrinsically sexual and seductive, dating all the way back to our girl Eve. This anti-pill rhetoric is reminiscent of the mid-20th century, where ads arguing against birth control displayed a new type of woman that was dangerous, feminist, financially independent, sexually exploratory, and a threat to traditional, maternal family values (a type of rhetoric we now often see used to characterize LGBTQ+ folx…)

But these are not the only groups that suffer from discrimination within conversations of birth control. For decades, it was customary to put women with disabilities on the pill, regardless of symptoms or circumstances. This custom was both eugenic and predatory: It was designed to combat the potential for the passing on of “compromised genes,” all the while making it easier for disabled women to be sexually abused in care facilities. The justification for the procedure was often that intellectually disabled persons had heightened sexual appetites, in some cases even believed to be natural-born sexual predators. Sometimes, it was done simply to make caregivers’ cleaning jobs easier: No menstrual blood. Many disabled women were also forcibly given hysterectomies.

This violence against disabled people is sickening. For these reasons, contraception among the disabled community is a tricky subject. It is important to combat stereotypes about heightened sexual desire. However, disabled persons also suffer from paternalistic infantilization that suggests the disabled are more childlike and lack sexual appetites completely. Even well-meaning parents can minimize their children’s sexuality, often viewing pubescent and adult family members with disabilities as younger than they are. This is also dangerous and untrue. People with disabilities can experience attraction just like anyone else, and to restrict opportunities for dating, marriage, and intimacy would itself be discrimination as well.

Care must be given to acquire full, informed consent, given to the degree that it can be from the individual (secondarily, the individual’s family.) Just as we work to dismantle the virgin/slut dichotomy under which women are held to both “pure” and “sexy” standards, so too must we work to dismantle the same dichotomy as it appears to oppress disabled persons.

Disability complicates this theological discussion of birth control in important ways. The Church would say that prescribing birth control for contraceptive reasons is always wrong, and to encourage sexual intimacy outside of marriage is wrong as well. However, we must understand that the acceptance of the Church’s moral teachings falls to the responsibility each individual has to their own conscience. To force a Church teaching upon a person who does not fully comprehend it, in a way that would infringe that individual’s rights to self-determination, if that person expressly articulates the desire to act in a contrary way, and in a circumstance where that individual depends upon assistance to achieve their goals, is something we should consider a sin. It is perfectly acceptable for us to say, “It would violate my conscience to help you do that, so you might need to find someone else to help you.” But, to outright deny a person the aid they request or to implicitly work to prevent it is prejudicial.

Through conversations I had with youth ministers, pastors, and teachers while I was on the pill, it became clear that hormonal birth control is still largely viewed as a “gateway drug” to sexual behavior. “Once you have the pill, what’s stopping you from having the sex?” Well…. self-control. Lack of desire. Lack of partnership. Personal values. Religious values.

The reality is, birth control pills are medicine. Even if they shouldn’t be medicine.

There is no reason we ought to accept birth control as the height of women’s medicine. With the immense amount of risks and side effects involved, with the uneven distribution of pressure it places on women for sexual responsibility, and with the ignorance of the female body that it fosters among medical communities, I think it’s about time we kick hormonal birth control the curb and discover something else!

But for now–and back then, when I myself got on birth control– the pill is the near-universal response to hormonal disruption and reproductive concerns. I didn’t want to have sex. I just wanted to stop bleeding and cure my iron-deficiency anemia. I wanted to be able to go to a store while on my period. I wanted a pair of underwear to last longer than a month.

For all of these reasons, I never asked my doctor any follow-up questions about hormonal birth control, and he provided me no facts. Other than an aside from the pharmacist that birth control can increase risk of cancer and that I should invest in compression socks when traveling to avoid clotting, I was told nothing.

At first I was put on the “low dose” pill. But after a week of pills, which should have indicated to my body that my period was done, I was still bleeding from that original period that induced my hospital stay. My doctor indicated to me that this meant the pills were not working, so he put me on a higher dose. Looking back now, I can see what my hormones were trying to say: something was really low.

The higher dose worked immediately. I FINALLY stopped bleeding.

But you know what else happened immediately? Weight gain. Within 2 weeks of birth control pill-taking, I grew two cups sizes and none of my pants fit. I had to go shopping for all new bras, underwear, bathing suit, pants, and even some shirts.

I don’t think women quite talk about this enough, the financial strain and frustration of fluctuating weight gain. Shopping for clothes when your body looks and feels unfamiliar is extremely challenging. I felt like a stranger to my body, and I didn’t know how to dress her or make her feel like me. I still don’t. Even after all these years, I’m still dealing with weight gain, stretch marks, hair loss, and more that have left my body feeling like not-my-body. This isn’t about being upset at my body’s largeness, it’s about being upset at my body’s unfamiliarity. At first, I felt so much shame in those feelings. I felt like I was betraying my friends and family whose bodies mine now looked more like. But there is a way to articulate disappointment at weight gain that isn’t inherently judgmental or fatphobic. My body has changed. That is hard.

Besides the weight gain, only one other side effect became immediately apparent: Sensitivity to sugar. My sophomore year of college I pretty much only ate Captain Crunch. From the moment I started on birth control, my stomach was upset when I ate anything sweet. Those frosted cake cookies from Safeway? I couldn’t eat a single one without feeling nauseated. I. Was. Bummed.

In many ways, I noticed less happened than I expected. My acne persisted. My iron-deficiency improved dramatically. I even started having cramps during my periods, something I’d never experienced before. But between my new body and my new surges of hormones, my emotions were all over the place. I cried at the drop of a hat (still do.) My rage felt stronger than before (still is.) I felt like I was going through a second puberty. Women will respond to hormonal birth control differently. Many women I know started taking it specifically to quell acne and cramps, with success. This wasn’t my experience.

Things plateaued for Madison. I went through my junior and senior years of college relatively unperturbed. But I still had to buy new bras and clothes every few months as my weight steadily increased. There was one instance my senior year where, for my trip to India, I took both an oral typhoid vaccine and daily malaria pills. I’m not sure which was contraindicated, but I started bleeding at the airport and bled for 17 days. It wasn’t a high quantity of blood, but it was a long period, despite me being on the pill.

Things got more serious the year after I graduated college. My year of post-grad service was challenging for a host of reasons, so my feelings of depression at first felt circumstantial. But as months went on and I established a regular workout routine of boxing, in part to deal with my negative emotions and in part to combat the weight gain that was still ongoing, I realized that neither were improving. They were, in fact, getting worse.

I began watching fitness videos on YouTube, to supplement my serious lack of income with which to pay for regular boxing classes, which led me down a rabbit hole of videos on hormonal health and fitness. (More to come on which channels/YouTubers helped me the most!) Through these videos, it occurred to me that we never did any work to determine the root cause of my immense bleeding before I got on birth control. When a pelvic ultrasound came back inconclusive, the doctor scrapped it and said “eh, it’s probably not an issue.” When I asked to do hormonal blood work, they said “You’ve lost too much blood and your hormones are already too out of whack for us to glean anything from them.” And in the years since, every time I saw the doctor, I was told that being on birth control was the best thing I could be doing anyway, and it wouldn’t serve anyone to look into my reproductive health any further until I was ready to have children.

I know this is a refrain many women hear. This is how doctors have been trained to respond to women’s health! Hormonal birth control has been sold to doctors as the magic solution to a host of women’s hormonal ailments, and so it is sold to us. Childbirth is sold as the be-all, end-all of a woman’s vocation. It doesn’t occur to doctors that a woman might value her health in and of itself rather than as a tool for her future childbearing. What about women who don’t want children? In case I haven’t said it in a while: God cares about your body, regardless of what it can or will do or produce.

It is good for you to be healthy, and to have greater knowledge about your body, regardless of whether or not childbirth is a part of your story.

In my upcoming post on the educational tools, tips, etc. that I found helped me in my understanding both of the way birth control works and the contributing factors to root cause diseases, I will refer you to the medical professionals I myself leaned on. I am not a doctor.

I will say, through my initial research that post-grad year, I leaned that the hormones I was putting into my body were not bio-identical. Progesterone and progestin are different: The first is what your body makes, the second is a chemical that looks like it. All of this to say, the bleed you experience while on birth control is not a period. It’s a “withdrawal bleed.”

What’s more, I began to see that if hormonal imbalance was at the root of my heavy bleeding, supplementing my body’s natural cycle with artificial hormones was not going to allow my body to “right itself” and start cycling properly. I was, however, hopeful that my body might have learned something after 2 and a half years on the pill, and that my cycle might come back a bit less heavy afterwards.

(Spoiler alert: It did not come back. At all. Still hasn’t. Not really.)

The April of my post-grad year, I transitioned off of the birth control pill. I was tired of feeling like I wanted to crawl into a void every day, like no one would miss me if I were missing or dead. I had never had thoughts like those before. I was also tired of working hard on strength training only to find that I was still gaining an average of 10 pounds every 6 months.

What happened after I transitioned off the pill was the scariest place I’ve been health-wise. That will be the subject of the next installment in this series. Want a sneak peek? It has almost nothing to do with hormones or my period, and everything to do with my gut.

I am proud of the way I made the most of being on hormonal birth control. It got me thinking about the Church’s stance on birth control. It got me researching my cycle for the first time. And I used my experience as a launch point for discussions with religiously conservative friends and family with whom I tried to expand on limited views of hormonal birth control and women’s sexuality.

What’s more? I told my middle school students I was on the pill. Think that’s crazy? TMI? Breach of boundaries? Inappropriate for a Catholic school? I would’ve thought so too, but 1) they asked 2) I don’t lie and 3) it ended up being the best lesson I ever had with my students. I wouldn’t change a single thing. I’ll be writing about that soon too 🙂

In brief? Women are in control of their bodies and sexuality. Providing all women with accessible healthcare is important. Birth control is healthcare, but that doesn’t mean it’s the pinnacle of healthcare. We can do better and we should, because birth control’s side effects are extremely dangerous. Disability is a part of this conversation. And you should never be afraid to pursue genuine medical help as a Catholic woman.

Looking forward to talking more soon about tools, gut health, PCOS, and comprehensive sex education.

Hug — Madison

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