When a teen girl recently posted on TikTok about the “pros and cons of birth control,” almost 120,000 people hit the “like” button.
Of the pros, the girl said her birth control made her period disappear and referenced its “99%” success rate at preventing pregnancy. Of the cons, she said it’s made her constantly bloated and sad — but never hungry. She said it’s also triggered dizziness, hormonal acne and bad migraines.
It’s there, in similar posts and comments sections around the internet, where social scientists are seeing more and more of what they’re calling the “nocebo effect” taking shape: the experience of attributing symptoms to a medication that might not have to do with the medication itself — and, in some situations, shunning that medication as a result.
In the case of birth control — a set of seriously under-studied drugs with little verified research on its many potential side effects — it’s especially hard to tell fact from fiction or legitimate medical concern from TikTok hot air.
Researchers at Sheffield University in England wanted to see if and how the nocebo effect was influencing women’s opinions on birth control — and whether it’s contributing to the overall downward trend of oral contraceptive use in women of reproductive age.
In a recently published study, they detailed how some of the negative associations that women have with birth control can potentially become a self-fulfilling prophecy. They also highlighted that some women might be exaggerating their symptoms or incorrectly attributing them to their oral contraceptives.
Though birth control pills remain the top choice for contraceptives, research shows that as many as 60% of users opt to discontinue the meds after 24 months, often because of reported side effects.
Using data they’d collected from 275 women ages 18 to 45 who had taken birth control pills in the previous 18 months, the Sheffield researchers were able to determine that side effects, whether real or perceived, are virtually ubiquitous.
Nearly every survey participant reported experiencing at least one symptom, ranging from headaches to nausea, mood swings, acne, weight gain, weight loss and many others.
Roughly 46% of participants said they discontinued use of their oral contraceptive during the 18-month study period.
Of that cohort, 33% switched to a different oral contraceptive; 38% changed to a different form of contraception and — of the highest concern to the researchers — 27% abandoned contraceptives altogether.
A co-author of the study, psychology professor Dr. Rebecca Webster, told The Independent that these numbers could be a reflection of negative social attitudes toward birth control pills more than a reflection of negative side effects of the pills.
“If someone goes on the pill thinking, ‘I’m likely to feel bad or have side-effects,’ that expectation itself raises the chance they’ll notice symptoms and attribute them to the pill,” Webster said.
Side effects like mood changes, fatigue and headaches are “non-specific,” she added, which means it’s difficult to know what’s really causing them. Such symptoms that are common in the general population might fluctuate for reasons other than the pill.
“Distinguishing whether the pill caused them versus a coincidence is difficult,” Webster continued. “What we do know is that psychological factors (expectations, beliefs, perceived sensitivity) may themselves generate or amplify symptom experience and attribution.”
But when a critical mass of women complains about the same symptoms, it’s probably time for the medical community to listen to what they’re saying and investigate those symptoms accordingly, rather than accuse those women of exaggerating their experiences.
At least, that’s the belief of Dr. Nap Hosang, an OB/GYN and chief medical officer at Cadence OTC, an emergency contraceptive provider.
“Women patients still feel they’re not being listened to, or that they’re not being listened to as they would like to be,” Hosang told The Post. “The responses they’re getting from their doctors aren’t addressing the issues that they brought to the conversation.”
If women on social media are sharing details of their experiences with birth control, he said, it’s in medical providers’ best interests to pay attention to what they’re saying and to try to rebuild trust with that vulnerable demographic.
Instead of blaming social media for propping up convenient (if not always accurate) information-sharing, medical providers need “to be trained in approaches to the conversations with women who are entering reproductive life and what they need to know about taking these medications.” And they should avoid denying that their reported side effects exist.
“I think the training of physicians does not emphasize sufficiently the tact and techniques for listening and responsibly responding to questions about birth control,” he explained. “It’s become a commodity. Like, ‘You want birth control? I’ll write a prescription.’”
The truth is that birth control — whether it’s the pill, an intrauterine device (IUD), a sponge or a condom — is never one size fits all. Doctors should be tailoring contraceptive recommendations to their patients’ individual needs, Hosang said. That could mean suggesting non-hormonal options if a patient is prone to migraines, for example.
The alternative is the nocebo effect — more women swearing off all kinds of birth control because of bad things they hear about a few specific types. A rise in unwanted pregnancies is just one possible outcome of that trajectory.
In the meantime, Hosang suggests we might be better off researching contraceptive alternatives with better efficacy than “natural” options like withdrawal (20% failure rate) and fertility tracking apps (up to a 25% failure rate by some estimates).
“Why have we not put more time and effort into the research to find a better working product?” Hosang wondered. “Frankly, for the last 40 years, there’s been no innovation in hormonal intervention, just repackaging it.”
If medical providers want their patients to trust the pills they prescribe, Hosang recommends taking a long look in the mirror.
“We should try to fix our shop first,” he said. “The nocebo effect has the power it has because we haven’t fixed our shop in the first place.”
