A very British call to arms: BBC Horizon’s pill documentary
Last Wednesday night, the BBC broadcasted ‘The Contraceptive Pill: How Safe Is It?’ fronted by Dr Zoe Williams, GP. It was a sorely needed, measured reflection, after nearly 60 years of disoriented public health conversation on the UK’s most popular form of contraceptive. And, in being so, it was a quiet call to arms.
Misinformation and missing information
There are two different aspects to public concern about the ‘safety’ of the pill that the documentary helped to iron out. There are the unfounded scare stories, and the genuinely troubling side effects that, although widespread, have gone unrecorded by the NHS.
The first is a result of the current news media climate. The most popular, profitable outlets are sustained by clicks on shock-factor headlines that distort scientific research in order to prey off female insecurities. This makes it possible, as one of the documentary participants noted, for the same newspaper to publish articles with contradictory views on “whether the pill is good or bad.”
We see her scrolling through The Sun’s hot pink-stained ‘Fabulous’ women’s magazine section, between a headline that warns hormonal contraception can increase cancer risk “more than experts first feared”, and another that celebrates “Endometriosis and 5 other conditions the pill can help treat.”
The programme explains that negative headlines often exaggerate findings on an increased relative risk of breast cancer on the pill, which, they remind us, is 20%. In absolute terms, 13 more women for every 100,000 per year develop breast cancer whilst on the pill than would otherwise.
This additional risk declines every year they are not on the pill, while a woman’s risk of cervical, endometrial, and colorectal cancer actually decreases on the pill. And so, Dr Zoe assures us, pill users certainly don’t have an increased risk of cancer compared to non-users.
Obscuring this type of information from women is a huge violation of our autonomy, yet it seems such an obvious thing to be explaining
The second aspect of public concern over pill safety is fear surrounding its perhaps lesser known side effects. I’ve suffered from water retention as a result of hormonal contraception (with my feet shrinking one and a half sizes when I came off the first pill I took) and so it was particularly interesting to hear Professor Philip McTernan explain that he’s found all hormonal contraceptives, whether oestrogen-based, progesterone-based, or combined, to increase fluid retention. It’s essential to build awareness and understanding of women’s experiences of side effects on the pill, to undercut myths and misinformation while helping women understand risk in its true context.
The documentary also spoke to Professor Ojvind Lidegaard from the University of Copenhagen, who helped produce a 2016 study of over one million women which concluded that hormonal contraceptive use was associated with a first-time diagnosis of depression. The study also found that a hormonal contraceptive user’s risk of suicide was three times that of a non-user.
This kind of data is accessible in Denmark because all Danish citizens are given a pin code when they are born, and each time they buy medicine it is recorded in a central database. Journalist Victoria Spratt explains that after a freedom of information request, she discovered that the NHS is not monitoring for similar data on women taking hormonal contraception and depression diagnoses.
The right to choose
Each woman has a different level of sensitivity and response to different sex hormones, and each woman should have the opportunity to apply what she knows about herself to her choice of contraception. For example, I’ve learnt that contraception with higher progesterone levels gives me symptoms of anxiety.
So why doesn’t every GP have to hand a copy of the resource Professor Anne MacGregor was shown with (known as the ‘progestogen ladder’), explaining which types of pill are more or less oestrogenic by function? Obscuring this type of information from women is a huge violation of our autonomy, yet it seems such an obvious thing to be explaining.
“We need a bandwagon to roll. We need patients to push for it, we need doctors and nurses to push for it, and we need the pharma on side”
But the even more outrageous revelation was that the pill-free week, a staple of the 21 days ‘on’ 7 days ‘off’ pill regime, is not only unnecessary but detrimental to our wellbeing. It was initially designed this way to reassure women about its efficacy, as well as to try and persuade the Pope to accept it — which did not work.
“We’ve taken 60 years to wake up to the science,” explains Professor John Guillebaud. His studies show that if women were to take a lower dose pill without a break, not only would the contraceptive benefit increase, but women would not have to suffer from headaches, PMS, or cramps that come with having a period. It’s licencing laws and guidelines that currently prevent GPs in the UK from prescribing the pill in this way. No periods and more effective contraception would be an incredible option for women to have.
Pushing for change
Dr Zoe also introduced us to a team of scientists from Wolverhampton, who are working on a non-hormonal male contraceptive, which simply inhibits sperm motility. It would likely be administered through a nasal spray, just before sex.
But until these scientists succeed, and with EU-funded research in the UK under threat from Brexit, we need to campaign for Professor Guillebaud’s recommendations to be put in place. “I need help with this,” he tells Dr Zoe politely. “We need a bandwagon to roll. We need patients to push for it, we need doctors and nurses to push for it, and we need the pharma on side.” It’s a very subdued, and very British, rallying cry.
We’ve had nearly 60 years of misinformation and unnecessary bleeding, but the Horizon team’s careful combing of the facts has shown we need no longer suffer. Let’s get this bandwagon rolling.