Breaking the silence: Birth control and its side effects

Today’s young women are self-aware and wise.

‘THE VAST majority of women are prescribed oral contraception with little to no instruction about how to take them, and with no mention about the emotional and physical stress it may cause.’ (photo credit: Wikimedia Commons)
‘THE VAST majority of women are prescribed oral contraception with little to no instruction about how to take them, and with no mention about the emotional and physical stress it may cause.’
(photo credit: Wikimedia Commons)
The invention of “the pill” gifted women with the ability to reliably prevent pregnancy and provide for themselves and their families by enabling them to sustain a stable career. While the historical and societal significance of oral contraception need not be underestimated, decades later its negative physical impact on women deserves renewed scrutiny. These side effects are universal, but specific aspects of them are even more challenging for Orthodox brides and their spouses.
In my limited experience as a kallah teacher [preparing Jewish brides for marriage], I have seen the pill cause women to fall into depression, suffer from anxiety, turn into crying, moody messes during an already stressful time in their life, suffer from hormonally caused sexual pain, and try and grapple with the myriad changes they encounter on their path to marriage and intimacy while feeling emotionally compromised. Most websites listing its side effects laconically describe mood swings, spotting and “not feeling like yourself” for the first few months on the pill. But these symptoms often accompany a couple throughout the entire first stage of their marriage, many times after dating for a relatively short period, in the case of Orthodox couples. Women experience compromised sexual desire, moodiness, and general discomfort until trying to conceive, a stage of life which brings with it additional instability and bodily changes. The havoc created by oral contraception deeply impacts the wife, her husband and their newly formed home.
The vast majority of women are prescribed oral contraception pills with little to no instruction about how to take them and with no mention about the emotional and physical stress they may cause. Sometimes due to lack of available appointments with gynecologists, women receive prescriptions from family doctors who are technically allowed to prescribe oral contraception in Israel but often do so without any accompanying instruction. Let it be clear: discussion of the pill’s side effects is not a self-fulfilling prophecy. Hormones control every aspect of the human body and when a woman swallows them artificially, tectonic shifts are inevitable. Oral contraception has its time and place, but lack of preparation and proper forewarning never do.
Today’s young women are self-aware and wise. They have a developed sense of self and attachment to their bodies. They do not want to enter marriage as a different woman altered by a pill. They worry that their husband will think they have married a monster. But many women still underestimate the influence of birth control pills on their bodies. They assume – sometimes for months – that their blues or discontent is due to moving cities, living with a new partner, or their new hair covering. Some had mild anxiety as a teen that was being revived by the stress of marriage. Doctors didn’t tell them that this could happen from contraception, so they thought it must be something else.
Women tend to blame themselves and self-agonize before ever assuming that disproportionate emotionality might be caused by their oral contraception. This often leads to elongated periods of suffering during which many of them feel utterly alone and confused. This issue is further complicated for Orthodox brides who are sometimes ill-informed about other forms of permissible contraception, like the diaphragm and various forms of spermicide. No method is perfect, but once a woman has felt mismanaged on the pill, her dedication to barrier methods is often greatly increased.
How can we create significant change in society’s nearly blind acceptance of the pill and its side effects? A woman’s choice of method is often influenced by a number of people, all of whom can potentially minimize her suffering and help her make a more educated decision.
While the 10- to 15-minute treatment slot awarded to patients here in Israel does not create an ideal setting for proper medical care, at a bare minimum every woman prescribed oral contraception should receive a user-friendly hand-out with explanations and illustrations. While the Internet may seem accessible, many women will struggle to apply even the most accurate online information when treading on such unfamiliar ground. Some women choose physicians because they are simply available, but most seek integrity – especially in their gynecologist – and willingly wait an hour in a waiting room if they know that on the other side of the door is a kind, caring and informative physician. Give them an email address to contact with questions and follow up concerns, because making another appointment can take months of waiting during which the woman and her marriage may suffer tremendously.
Women are not used to complaining, and because this entire aspect of life is shrouded in novelty and discomfort for new brides, they tend to assume the problem is theirs alone. You may be the only person many women ever discuss this topic with in their lifetime. If you don’t help them, in many cases no one will.
Kallah teachers
The instruction a woman receives before her wedding is an opportune window to review the biology of her monthly cycle and explain how different contraceptive methods work. Discussing healthy sexuality with brides must include at least a theoretical conversation about contraception, even if she does not plan to use it immediately. You do not need a special degree to teach the basics. Organize the material in a digestible way for these already overwhelmed young women. Gather samples of contraceptive methods and make the lesson illustrative.
Many Orthodox brides also want this conversation put in a halachic framework in order to understand the religious principles governing its use. If a bride does choose to use oral contraception in the months before her wedding, follow up and ask how she is feeling. In meetings or conversations with her afterward, ask again and keep your ears open for any oddities that may be traced back to the pill. For the many women who experience breakthrough bleeding from their oral contraception, proper instruction in the laws of staining is invaluable so that they don’t elongate the niddah period and define themselves as such unnecessarily.
Additionally, for many couples, hormonal manipulation affords them respite from the on-off system of halachic intimate life. A woman can skip periods through the use of seasonal oral contraception or by joining packs together and eliminating the placebo week. While physicians once deterred women from doing this, today many support these manipulations if desired by the woman. This is one of the greatest advantages of oral contraception for both new and veteran Orthodox couples.
While this phenomenon deserves its own article – as it underscores how challenging the laws of niddah are for many couples – a specific point regarding kallah teachers is relevant here: a kallah teacher should not find herself endorsing pills so that a bride can avoid niddah status on a regular basis. It puts the young woman in an unfair position wherein she potentially sacrifices her own well-being in order to alleviate the couple’s halachic reality. Relief for couples who feel overwhelmingly challenged by the observance of these laws must come from somewhere else.
If you see that your bride/wife is suffering after beginning to take oral contraception, do not hesitate to kindly bring this to her attention. As it is, she likely feels overwhelmed by her new responsibilities in the halachic and biological realms of Jewish marriage. Your concern and support for whatever she decides to do is of monumental importance.
Daughters need to be taught the biology of their monthly cycle and the basic principles of fertility. Never learned this yourself? Order Taking Charge of your Fertility by Tony Weschler and read it with your daughter. It’s a fascinating and rather simple read. If that does not feel right, you can sponsor her enrollment in a workshop that teaches these fundamentals when she is ready to learn them. She may still choose hormonal contraception or a number of other methods in the future, but she will know that knowledge of her fertility belongs to no one but herself. Teach your son these basic principles as well. It will make him a more empathic and aware spouse.
Last, but not least, the women
The blanket acceptance society has given oral contraception has caused emotional and physical damage to many women, but those who suffer can become the most effective and impassioned advo- Today’s young women are self-aware and wise. They have a developed sense of self and attachment to their bodies... But many women still underestimate the influence of birth-control pills on their bodies cates of change. Share your experiences with friends. You will be surprised to hear you are not alone and they will be comforted to know the same. Contact your physician and ask to change pills or switch methods altogether.
However, be aware that this information is often best facilitated by women trained in natural family planning and who can offer you more time, support and information while you deliberate your chosen method. Don’t accept the status quo if it compromises your daily functioning. You know yourself and your body better than anyone else. No pill can ever take that away.
The writer holds a doctorate in Bible from Bar-Ilan University and teaches Bible to women of all ages. She also teaches private courses for new brides and married women. She lives in southern Israel with her husband and three daughters.