Yesterday, I saw a guy suggest that women who lose insurance coverage can go buy one of seven birth control brands offered by Walmart for $9—and that sounds like a broadly-applicable solution, but only if you don’t understand hormonal birth control. Most birth control pills have two hormones in them: one which convinces your body it’s producing a hormone it isn’t producing, and one which binds with a hormone in your bloodstream to mask it and convince your body it isn’t there. There are more than a dozen variations of each of these components, and hundreds of ways they could be combined.
How a given hormonal combination reacts with the body of an individual woman varies widely. The same pill will raise one woman’s sex drive and kill another’s. It’ll clear up one person’s acne and give another one acne. It’ll cause one to gain weight and one to lose it. It might be mood stabilizing, or cause severe depression. There are hormonal sliders the pill is moving, and you have no way to know in advance what this woman’s presets are, let alone how responsive her sliders will be to a set of chemicals she hasn’t tested personally.
Think of birth control pills as if they’re chili. There’s a whole bunch of different things called chili, and even if you know you want chili, a particular batch might have no ingredients in common with another batch. It might include elements you’re allergic to, or might be too spicy, or it might have none of the characteristics you want when you say “chili”. Beans v no beans, white v red, chicken v beef v vegetarian – the world of chili is vast.
Unlike with chili, you need a prescription for hormonal birth control, because although you’re probably safe if you’re on the same pill you’ve been taking for a while, you don’t really know how your body is going to react to a new one and it could react by forming blood clots that try to kill you. Testing a bunch of different kinds is strongly discouraged, and also impossible because your pharmicist wouldn’t give you a different kind of pill than the one prescribed to you. On top of that, the first month after you switch or start a pill variant is the most dangerous – is the time you’re most likely to have a life-threatening adverse reaction. When you think about switching types, you weigh that risk against the side effects you’re already experiencing.
(Why not opt out if it’s so dangerous, you might say. The answer is that pregnancy is even more dangerous. Sincerely, that is the reason the FDA thinks the risks are acceptable for female hormonal birth control but not male hormonal birth control.)
To make this less abstract, here are three forms of hormonal birth control I have used and how my specific body reacted to them:
Microgestin (norethisterone acetate and ethanyl estradiol) is great for me. I feel totally normal for the most part, with better skin and a slightly increased sex drive which is enough to be fun but not inconvenient.
Microgynon (levonorgestrel and ethanyl estradiol) is what I was prescribed when I moved to England, where Microgestin was not available. It makes me way more teary than my normal self. Not for the most part depressed, but more likely to burst into tears over something small. During two of the seven days of the month when I took spacer pills (the ones with no hormone that allow you to experience withdrawal bleeding, aka fake period) I felt delicate and bereft and wanted to be held by my partner – felt like I was mourning a very early miscarriage. This is a strange experience to get from a pill you take to ensure an egg will never be released and fertilized, and it felt simultaneously real and fake, the way “hangry” feels falser than angry.
Qlaira (dienogest and estradiol valerate) is what I was prescribed in Italy. The first month, I had terrible headaches. Those cleared up, but for the entire two years I was on this, I was emotionally flat and had no sex drive, and experienced constant dryness in parts of my body that shouldn’t have been dry. I didn’t get my libido back until more than a month after I stopped taking it.
None of this is a guide to what other women could expect. We can’t compare notes and say “I liked this one; you should try it” or “you have almond-shaped eyes, so clearly the best pill for you is lavender-colored.” However, you can see why maybe it could be a significant daily burden not to be able to take your preferred pill formulation. Of the three pills I listed above, Migrogynon is the only one with generic $9 Walmart equivalents. Otherwise, they offer progesterones I haven’t tried: norgestimate, norethisterone (not the same chemical as norethisterone acetate), and desogestrel.