What you need to know about the pill – before your daughter takes it

Over 77 per cent of contraceptive pill users in a new UK study reported experiencing side effects. Photo / Getty Images

Melissa is a lawyer and has two daughters – Jane, 17 and Jemima, 19. Both have taken the pill. “We’ve always talked about things as a family,” explains the mum of two from Cheshire. “When Jemima got a serious boyfriend at university we had a chat about contraception and she went to her GP there and got given the mini [progesterone only] pill. When Jane got a boyfriend during the first year of sixth form we had a similar chat about contraception and she asked if I would go with her to the doctor.

“We went together – her dad and I are pleased she is happy with her boyfriend but we don’t want her to get pregnant. We were with the doctor for less than 10 minutes. First the doctor asked if Jane was in a steady relationship (which Jane thought was a bit “judgy” and none of their business). And then they said did she want the combined pill or the mini pill. They said the mini pill has less risk of bloodclots – and Jane knew that was what Jemima was taking, so Jane said she’d have that.

“I was surprised there was no conversation about any other alternatives. But we walked out with a prescription for three months’ supply and that was that.”

In the weeks following the appointment, Jane had some breakthrough bleeding and her skin broke out in waves of spots. “It’s calmed down now and she seems happy to stop worrying about getting pregnant,” says Melissa.

Her older sister Jemima, however, fared worse. “The first mini pill she tried made her feel very low,” explains Melissa. “The second one completely blocked up her digestive system. So she’s stopped taking it after six months of hell. Now she is using condoms and I am worried.”

This family’s experience is typical. Over 77 per cent of pill users report experiencing side effects and 33 per cent said these were so bad they stopped taking it, while 36 per cent experienced low mood or anxiety, according to a new Savanta survey of 4000 respondents conducted by Channel 4.

The survey is part of a new British documentary called Davina McCall’s Pill Revolution. The programme aims to do for contraception what McCall’s two earlier documentaries did for menopause - turbocharge a national conversation about why women are so poorly served when it comes to this basic aspect of their health. And the “Davina effect” should not be underestimated. In the aftermath of the last two programmes, demand for hormone replacement therapy (HRT) in the UK’s public health system soared by a third.

“For many of us, contraception is a struggle that goes on for decades,” explains McCall when we meet at a screening of her new documentary. “As young women we’re just chucked on the pill and expected to get on with it. I started taking the pill when I was 15. I was wildly in love for the first time so I went to a sexual health clinic and they put me on the pill. I didn’t ask any questions; I was terrified. But my life at the time was carnage. I was in a bad place mentally and I don’t know if being on the pill contributed to that.”

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Speaking to many young women and seeing the experiences of her own daughters (now aged 21 and 19), who also suffered side effects, the TV star realised there was a problem. “When we go back [to the doctor] with concerns, too often we don’t feel like we’re being heard. But a conversation is growing about the lack of support and lack of information.”

It’s a conversation that is long overdue.

The brutal truth is that since the pill was invented 60 years ago, not much has changed. The same pill McCall was given 40 years ago is still being handed out to women. “Are you telling me that we’ve had 30 varieties of iPhone and we’re still dishing out a pill as a first choice which is now an exhibit in the Science Museum?” she asks. “And we still don’t know how many women experience side effects and to what degree? It’s a scandal.”

The answer is there have been only a handful of studies over the last decade into the contraceptive pill’s side effects, one of which found combined pill users aged 15-19 in Denmark were 80 per cent more likely than non-users to be prescribed antidepressants. 

“Given that 15 per cent of the global population are taking contraception at any one time, this isn’t good enough,” McCall says. “And a younger, more mental health-aware generation are rebelling.”

Here are just some of the comments from young women in the film: “It’s just difficult finding a pill that helps,” says one. “It’s like playing roulette with your health,” says another. “Contraception is literally the devil, you either have to cope with it mentally destroying you or get pregnant.”

Enough have read Caroline Criado Perez’s book Invisible Women on the lack of research into women’s bodies to know this is part of a pattern.

Alice Pelton is one of them. She is the founder of online site The Lowdown, a review platform – think Trip Advisor – but for contraception. With doctors and scientists, it provides expert advice for women seeking answers. Pelton founded the site because of her own bad experience with the combined pill. “I was 16 years old, I would have these uncontrollable outbursts and cry at stupid things. I got real lows, everything was flat.” This stopped as soon as she stopped taking it. “That’s when I realised this pill had played havoc with my emotions for years.” A further bad experience with a coil and the difficulty of obtaining information led the former journalist to set up her site.

So should we be putting our daughters on the pill?

“It’s really important to point out that the pill - orally taken - contains the same combination of hormones that are in the injection, implant, hormonal coil, patch and ring,” explains Pelton. “These methods all put hormones into our bodies to prevent pregnancy. I wouldn’t blanket advise women to go on the pill, but I would say in comparison to other hormonal contraceptives, the pill is a great starting point, and the most commonly reviewed and popular method overall on The Lowdown.

“It’s really easy to stop and start, [and] if you’re worried about side effects, doctors say to give it three months,” Pelton adds. “The combined pill (with both oestrogen and progestogen) does have some great benefits, like improving acne and managing often-debilitating symptoms associated with conditions like polycystic ovarian syndrome and endometriosis. But there are of course risks which you should discuss with a doctor.”

The data at The Lowdown from its contraception recommender tool that’s been used by over 30,000 women shows that 79 per cent of women are open to using hormonal contraception. “The majority of women are happy with hormones,” says Pelton, “but don’t want a coil (63 per cent), implant (62 per cent) or injection (67 per cent). With the coil they are worried about the pain of insertion. In terms of hormonal methods, that leaves the pill, patch and ring (which all contain the same hormones) to choose from, and most women choose the pill because it is the easiest.”

It seems that the pill, a bit like democracy, is still the least worst contraceptive solution for women. Davina McCall and Kate Muir, the producer of Davina McCall’s Pill Revolution, are adamant that they are not telling women to stop taking it - just calling for more research, support and information for those who do.

They also warn against misinformation on social media, particularly TikTok, and counsel against the use of fertility cycle-tracking apps, promoted as “natural alternatives”. As McCall jokes at one point, “What do you call people who use the rhythm method of contraception? Parents.”

In a bid to encourage more women to consider a coil rather than the pill, McCall, bravely, has her own coil (a Mirena which releases progesterone as part of her HRT)  fitted live on camera. It takes 10 minutes and, thanks to anaesthetic gel, it isn’t too painful.

“The Mirena has been a lifesaver”, she says, by stopping her periods completely and only requiring changing every five years, “so I can forget about it”.

However, Dr Nighat Arif, a leading female health GP, warns that there are already long waiting lists in the UK to get Mirenas fitted, training GPs to fit them is expensive and the NHS is already overloaded to breaking point.

Davina McCall’s Pill Revolution is a powerful documentary and persuasive on the lack of research into side effects and options for women. But it is also important to remember that the pill brought women huge gains; for the first time in history, it allowed us to enjoy active sex lives, free from the fear of pregnancy. It is unquestionably one of the most important scientific and social breakthroughs of all time.

New-generation pills with natural rather than synthetic hormones are now widely used in Europe. These drugs, such as Drovelis and Qlaira, are more expensive, so less widely prescribed in the UK. So far the evidence on their side effects is limited, although Pelton says reviews of them on The Lowdown are largely positive.

Dame Lesley Regan, a leading gynaecologist and the UK’s first Women’s Health Ambassador, says: “Easy access to contraception is the most cost-effective intervention the NHS can make. This is not rocket science, it’s just basic maintenance which allows women to get on with their lives.”

She cited new data showing that 45 per cent of pregnancies and a third of births in England are associated with feelings of ambivalence, and that in 2021 the percentage of conceptions leading to legal abortion reached a record high of 26.5 per cent. Shockingly, some of the women seeking abortion had been on waiting lists for insertion of coils or implants for up to a year. Regan is in charge of setting up new Women’s Health Hubs. But as MP and Minister for Women Maria Caulfield admits: “This isn’t going to happen overnight.”

* Eleanor Mills is the Founder of Noon.org.uk, a platform to empower women in midlife