Could experts like Dr Zoe Williams finally steer the conversation to ending healthcare gender bias?
The Contraceptive Pill: How Safe Is It? aired on BBC Two last week. An investigation by GP Dr Zoe Williams (pictured) into the combined contraceptive pill, the most popular form of contraceptive in the UK, this documentary explained not just the science behind the pill, but the incredible chasm between medical research and women’s reproductive health. You’ll have to forgive me for only just catching up with this brilliant documentary, but I’m so glad I did. Dr Williams explains the science so clearly throughout, and there’s a lot to be said about having an expert – a female expert at that – finally breaching the chasm between medical research and women’s health.
“The contraceptive pill is 99% effective, easy to use, and when it arrived in Britain in 1961 its impact was revolutionary. Today it’s the most popular contraceptive in Britain, but like all medicines the pill can cause side effects,” Dr Williams says in the teaser. “Over the decades the pill has consistently been caught up in medical scandals, from claims it increases the risk of cancer to causing deadly blood clots, and some of these claims can have devastating consequences.”
These medical scandals include last year's reports that the pill is linked to a 20% higher risk of breast cancer in women – but conversely the pill also provides protection against other forms of cancer. Dr Williams says: “When it comes to understanding the pill’s safety, the science can be conflicting and with over 3million women taking the pill in Britain today, the stakes could not be higher.”
In addition to the myriad potential physical side effects of the pill – weight gain, decreased libido, spotting, breast tenderness – we're finally starting to see breakthrough studies put numbers to the psychological side effects. A BBC survey linked to this documentary showed that more than one in four women – a quarter! – say the pill has an impact on mental health, while independent studies have shown a marked increase in anxiety, depression and panic attacks in women using the oral contraceptive pill. The pill can also increase migraines and insomnia.
So why, if the pill has been around since 1961, are we only just getting the proof of this now? Why are so many women still not offered alternative forms of contraception? Why is it up to us to propose different treatments, rather than getting advice from our doctors?
I’ve always had painful periods – in fact, the reason I decided to start taking contraceptives was because a friend advised me it might help with cramps. I couldn't take the pill because of my migraines, so instead I was put on the mini-pill and later the implant – again, on a friend's recommendation. A few years down the line, even the implant wasn't helping with that pain. I began to get constant mild water infections and lower back pain bad enough that I went to the doctor. Years of semi-invasive tests, cameras in uncomfortable places and medical speculation later, I still haven't had an official diagnosis beyond 'it's probably high oestrogen'. Along the way I've had some fantastic doctors – and some pretty callous ones, like the guy who told me I very likely wouldn't be able to have children based on absolutely no concrete evidence – but what was incredibly clear to me throughout was that there was far more guesswork involved than ever other medical problem I've ever had.
Maybe it was a bad run, but I was left with the worrying feeling that the research just wasn't there. And it's not just female reproductive health that seems to have this problem. There are many areas where women say they feel the impact of sexism in medicine – and while it might not be quite as dire as our ‘hysterical’ past, women are still dramatically underrepresented in medical research.
According to The Contraceptive Pill: How Safe Is It?, even the pill’s 21-days on, seven-days-off cycle is simply because the inventor (a man) felt women would still like a monthly period. Women are seven times more likely to be misdiagnosed and discharge while having a heart attack, because our understanding is based on male physiology. There's the famous tests on how obesity impacts uterine cancers without a single female research subject but, laughable as this seems, as recently as 2015 clinical trials were made on 'female viagra' to see how it mixed with alcohol – and 23 out of 25 subjects were men.
Gender isn't the only bias in medicine but, for me, this incredible dearth of critical knowledge is a basic and essential example of how far we have to go – but thanks to experts like Dr Williams bringing aspects of this into the harsh light of day, we can join in the conversation, and be confident that our health is finally moving in the right direction.