The pill was the first drug to be created and prescribed for healthy people. Oral contraceptives became available in 1961 and within a decade were so ubiquitous as to gain the pet name of “the pill”. Fast-forward to the present: 100 million women will take a form of the pill today, right after brushing their teeth or before they go to bed. In fact, 80% of women will use oral contraceptives at some point during their lives. Many women now start taking the pill during their teens and continue taking it, every day, for several decades. The pill has become such a normalised, commonplace part of women’s daily routine that it’s easy to forget that the pill is actually a powerful medication. But all of us, at some point, will want to know: “How does the pill work?” The pill is made up of a synthetic estrogen and synthetic progesterone (known as progestin). These synthetic hormones are not the same as the hormones produced by the female body. The pill actually stops the production of those endogenous hormones via the brain. It suppresses the creation and fluctuation of hormones that make up the menstrual cycle and replaces that cycle with an artificial, flat stream of synthetic hormones. The body stops producing its own hormones and the pill acts as hormone replacement.
This process switches off the ovaries, preventing ovulation (the release of the egg from the ovary). The pill also prevents the production of fertile cervical fluid (essential for sperm to reach the egg). Plus, the lining of the uterus does not grow thicker (this uterine lining is what would usually, in an unmedicated cycle, become your period). This is the three-fold action by which the pill prevents pregnancy. Although women are only able to get pregnant on six days per menstrual cycle, the pill is taken every day to ensure infertility.
The usual language used for describing how the pill works is too often a mix of half-truths, platitudes, and a simple fudging of the facts. Understanding how the female body works when not on the pill can help us understand how the pill works. However, the female body and reproductive health have long been after-thoughts in science, as in our society. As a result, the pill has become both a product and a proponent of a sexist set-up, creating a gap in knowledge that gets filled with a host of medical myths.
For example, you may have heard that the pill “regulates” periods. The pill doesn’t manage the menstrual cycle, it replaces it, and therefore the pill does not “regulate” the menstrual cycle. When women take the pill, they do not experience a cycle or periods. When they take a break from the pill once a month or take the placebo/sugar pills and bleed, this is not menstruation. The bleed experienced on the pill is a “withdrawal bleed” (your body is withdrawing from the synthetic hormones) and very different from a physiological period.