When the first oral contraceptive pill was approved by the FDA in 1960, it changed the world. The pill enabled women to have control over how and when they got pregnant, and thus to discover what womanhood could look like when motherhood became a choice instead of a default. It was the ultimate symbol — and tool — of feminist liberation. But feminism has changed a lot since 1960. Now that reproductive freedom is taken for granted — at least in the liberal enclaves of North America where I have lived, though certainly not everywhere — women are demanding more. More options, more choices, and crucially, more information. What they are finding is that there is a surprising lack of research into the way the birth control can affect womens’ brains, and in turn, everything else in their lives.
Dr. Sarah Hill, a professor of psychology at Texas Christian University and the author of the new book This Is Your Brain on Birth Control explores all the things we know and don’t know about how birth control affects every aspect of womens’ daily existence—from our mental health, to our sexual libido and career performance. We called up Dr. Hill to find out about the surprising ways that birth control could be affecting our ability to get good work done, and why it’s important that all women have enough information to make informed decisions about their contraceptive choices.
Image by Allison Smith/The Observer
How did your interest in the pill begin?
I had been on the pill for more than a decade of my life, pretty much non-stop. When I went off of it, I felt like I'd woken up. I suddenly felt fully alive and everything felt deeper and brighter and more textured. But I didn't really begin to probe those questions until I was at a research talk where somebody had mentioned that women who are on the birth control pill don't have the same type of release of stress hormones when they're experiencing a stressful situation as other healthy, high functioning adults. That’s when it dawned on me that of course, I felt different when I was on birth control pills, because it influences our sex hormones, which have, profound influence on the activities of almost all major systems of our body. That was what led me into researching the world of hormonal contraceptives on women’s psychological experiences.
Why is this information so hard to come by?
I think that all of us have a tendency to shift into this Mind-Body split kind of thinking. Even people who study neuroscience for a living, and who study how our psychological experiences are created by the activities of signaling molecules in our brain, that kind of academic research is still so profoundly at odds with what it feels like to be a person with thoughts and feelings. I think that we lapse into forgetting that who we are and how we experience the world and all of our ridiculous random thoughts and preferences are all the results of chemical and electrical signaling going on in our brain. And hormones are one of these signaling compounds that our brain uses to create the experience of who we are. I think that we all have a little bit of a blind spot about hormones and sex hormones in particular; when we hear that, we tend to think about things like puberty, endometrial lining, pimples, moodiness before my period, sexual performance. But we don't really think about the fact that that hormones are a lot more than that and how profound the role of hormones is. I didn't learn about the way that my hormones influenced my brain until I was getting a PhD. That's absurd. I think that each one of us should be taught in school about how our bodies work, because I think it would change the game in terms of how we treat our bodies.
But of course as you write in your book, there’s also a political and feminist dimension to how we teach people about the pill and about hormones.
Right, there’s two arms of the political argument. One arm is that for some feminists, particularly older generation feminists, the idea of talking critically about the birth control pill is is seen as something you don't do, because then you're basically giving ammunition to people who might want to take it away from us. In addition to that, it's also political to have to talk about women's sex hormones and their involvement in the brain at all. I think that this, again, has to do with the way that we've misunderstood what hormones do. We tend think about sex hormones and how they influence the brain as being something that's only female, and that it changes across the cycle and that it so it makes us, quote unquote, irrational. For a very long time women were treated as less rational versions of men because we have cyclically changing sex hormones, so I think that for a lot of women, the idea of acknowledging hormonal involvement in the brain is seen as a little bit dangerous because it could put us in this position of being marginalized because our sex hormones change. But, men’s sex hormones are actually a lot more variable than ours are, and theirs actually change in a much more capricious, you know, unpredictable manner than ours do.
In your book, you have findings in all sorts of areas, like how the pill can affect everything from our choice of partner to how much we enjoy music. I want to talk specifically about work. One thing you do say is that studies show that when women are on the pill, they tend to attain higher education and fulfillment in fields that were previously closed off to them (like law, medicine, science and business).
This is one of those things that I hadn't really thought too much about until I was in the process of writing this book. And every time I think about it, it kind of gives me It gives me goosebumps, because when we think about the birth control pill and the ability that women now have to regulate their fertility -- I'm of a generation of women who has totally taken for granted the fact that I'm able to do these things, and I never pause to think like how the world would be different if if I wasn't able to know with complete certainty that I wasn't going to get pregnant unexpectedly. Put yourself in the shoes of your great grandmother, and imagine yourself thinking about, for example, going to medical school or going to law school or going to get a PhD – the prospect of staying non-pregnant that whole time was a much more sort of precarious and risky endeavor for our great grandmother. And there was a real chance that all of your hard work was going to be totally laid to dust halfway through because you would end up with this unwanted pregnancy that you would have to manage. Prior to the pill being made available to single women, right around 1970, when you look at the proportion of female applicants to these programs that require being in school for a very long time, it was like 10%. And you flash forward just 20 years later, and women are like 50% of applicants.
But then of course, there’s a flipside. You said that going off the pill changes how we respond to stress. How might that affect women in the context of work, whether that be our focus or our ability to succeed professionally?
Everything in life cuts both ways. When it comes to the birth control pill, on the one hand, the pill allowed us to do all these amazing things with our careers. But on the other hand, what the research shows in terms of stress response is that it could actually be detrimental to women's ability to meet their career goals.
What’s the science behind that?
Normally, when a person is experiencing something stressful -- say you've got a really tough deadline coming up or you're giving a presentation in front of a group of people or you're being chased by a pack of hungry wolves -- your body kick starts a stress response, and part of that stress response is characterized by an increase in the stress hormone, cortisol. Cortisol kind of gets a bad rap just because it’s associated with stress, but it actually doesn’t cause stress, it’s life that's causing stress. Cortisol is the thing that our body is doing to help manage and cope with stress. When something stressful is going on in our environment, our body releases cortisol, and that helps get our brain ready for learning and memory. And this is good because our brain wants to remember all the things that were happening around the stressful situation so that's if it happens again, we're better able to cope. It also helps us regulate our emotional responses to stressful situations. What the research shows is that when women are on the birth control pill, rather than experiencing this big surge in the stress hormone cortisol when they're experiencing stress, they don't exhibit any changes in cortisol, and so they have no sort of change in stress hormones that occur in response to stress. This isn't something that minimizes the experiential sort of aspect of stress. Women who are on the birth control pill feel just as stressed out as naturally cycling women do. It's just that their bodies aren't putting into process all of these things that help our bodies and our brains cope with stress. And not having this response can be associated with problems with learning and memory, particularly for emotionally intense events. There is some evidence suggesting that women who are on the birth control pill do seem to have differences in remembering things that are emotionally intense.
So how exactly would that affect someone within a workplace context?
Like I said, there is some evidence suggesting that women taking birth control may have some impairments in terms of remembering emotionally valenced events. But, it wouldn't be a terrible surprise to find that, given the research, that pill-taking women may have more difficulty concentrating, learning and remembering things. We have a paper right now that I was actually working on, right when you called me, where we've got some research demonstrating that pill-taking women seem to have a more difficult time persevering on tasks when they're challenging. They seem to be sort of rushing through things, and not mentally grabbing onto what it is they're supposed to be focusing on. And this is something that we found was associated with performance deficits. So for example, in one study, we gave women math GRE questions, which aren’t super duper hard, but they're a pain in the rear end, right?
Oh yeah, I did the GRE, I’ve been there. It was rough.
Exactly. And you have to do a lot of effortful cognitive control in order to get through them. And what we are finding is that the pill-takers weren't able to focus on the problems and they were rushing through them, and as a result, they were doing worse. This isn't to alarm women into thinking that they should ditch their birth control pills immediately. I don't think that it is probably going to change you from being an A student to a C student, but rather that it just might make it more challenging for some women to stick with their goals.
But as you said, there’s two sides to everything. I imagine this isn’t the case for all women.
Right! The pill can also positively impact some women in their career goals and their performance at work. A lot of research shows women that women who experience PMS and PMDD, which is like severe PMS, tend to be sort of incapacitated psychologically at certain points in their cycle. This is because their brains, for whatever reason that science doesn't totally understand yet, don’t respond well to the cyclical changes that naturally occur across a natural menstrual cycle. So for these women, taking the birth control pill that's overriding the natural hormones that your body would be producing, this consistency and getting the same hormonal message every single day is actually really beneficial. For these women, being on the birth control pill can help with both scholastic performance and career performance, and I've heard from a number of women who felt like everything in their work life was so much smoother once they were on the birth control pill.
Much of your book focuses on anxiety and depression and how they can be linked to hormonal contraception, and of course, our mental health really affects our ability to do good work.
There is substantial evidence now, especially in young women whose brains are still developing, that hormonal contraceptives can be associated with an increased risk of anxiety or depression. Pill use seems to increase women's risk of subsequently developing depression and anxiety, and this risk is particularly magnified in women who are 19 and younger. It’s not all women but unfortunately, the science isn't yet in a very good place where we can make really good predictions about who's going to respond what way to what.
I’ve written about my own experience going off the pill and how it helped decrease my anxiety, and I definitely saw that affecting my own work from a productivity standpoint. In some ways, it helped motivate me to complete tasks that I'd otherwise have procrastinated on because they made me too anxious. On the other hand, my anxiety had often been a motivating force to get my work done, and when I didn’t feel that same urgency, that sometimes stopped me from being as ambitious as I should have been.
Right. That's so fascinating. Ultimately, it really is a theme in the book and it has been a theme in this conversation, that everything cuts both ways. And it’s about what trade off you want to make as an independent woman and what your goals are. If your goal, based on your lifestyle, is to be zen and Kumbaya, then you're not going to want the anxiety. But if you're somebody who wants to perform, and you're willing to suck it up when it comes to anxiety, then you're going to make the other choice. It's really just all about having the information so that you can make the tradeoffs that you want to, and allowing women to, for the first time ever, really strategize their birth control in ways that are going to better allow them to create the lives that they want.