Cassie got her first period when she was ten years old. From then on, she menstruated about once a year. By the time she was fourteen, she had a good sense that something might be wrong. She knew periods were supposed to happen regularly, and she often heard her friends complaining about their “time of the month.” Before she started high school, she visited a doctor for a standard physical exam. When he asked when she’d had her last period, she told him it had been so many months, she couldn’t even remember. He didn’t seem worried about it, but he did mention that she might consider the birth control pill. That information stuck in Cassie’s head.
“Once I heard that first doctor tell me that I might want to think about [the pill] I was like, ‘Wow, this could help me,’” Cassie said. “I didn’t think it could have any bad effects, I was looking at it as this great thing that could help me regulate my period. Everyone else was getting their period every month and I was like, ‘Why don’t I?’”
Cassie lived with her dad, and was hesitant to talk about birth control with him. Eventually, after thinking about it for a few months, she decided to broach the subject. Her dad’s first concern with the idea was that if Cassie started using birth control, it might contribute to her being more promiscuous than she would be otherwise. Cassie assured him this was not the case; she’d never been involved with a boy before, and wasn’t interested in anyone at the time. She explained to him that the pill has multiple uses, and to prove her point, pulled up a Google search about how the birth control pill can help regulate periods. In fact, it would not be unusual for Cassie to use the birth control pill for non-contraceptive purposes; according to the Guttmacher Institute, 8% of all teenage girls who are not sexually active take the birth control pill for health benefits other than preventing pregnancy. About 35% of teenage girls who take the pill do so solely for alternative health benefits, and 40% of teenage girls who take the pill do so to at least in part regulate their periods (Jones). Cassie's dad knew about her irregular menstrual cycle and agreed that the pill might be a good thing for her health. He also made the point that it would be a good idea for her to start the pill anyway, so that if she did get intimate with someone, she would already be protected.
Shortly after clearing it with her dad, Cassie went to see a gynecologist and told her she was interested in birth control to regulate her cycle. Within a half hour the doctor had prescribed a pill. They didn’t discuss there being different types of pills to choose from, nor did they talk about other solutions or possible underlying health conditions that could affect Cassie’s cycle.
“At the time, I was oblivious to anything else that could have helped me,” Cassie said.
After she started taking the pill, Cassie still did not menstruate monthly. She did, however, experience severe premenstrual symptoms each month – including nausea and vomiting, mood swings, food cravings, and weight gain. At a follow up appointment, she told her doctor that she didn’t like the way she’d felt since she started the pill. Her doctor said Cassie’s body would adapt eventually. A year later, Cassie still didn’t feel better and still didn’t get a monthly period, so her doctor prescribed a different pill. Even on the new pill, Cassie got her period every six to eight months at best. Cassie’s doctor told her it’s common for young girls to have irregular cycles and that she shouldn’t worry about it. Cassie didn’t mention her symptoms to her doctor again after that, and for the next three years, Cassie suffered the side effects of a pill that did not work for her body.
“There was like a cloud that would come over me every few weeks for no reason,” Cassie said. “I had zero energy. I didn’t want to eat anything, I didn’t want to do anything but lay down and sleep. My weight varied so much. And I would come out of it and it would feel like what I had just gone through didn’t happen to me, like I had observed somebody else in that situation. People [would] ask me why I was acting different I’d be like, ‘yeah, this is just something that happens, I don’t know why.’”
Before she’d started taking the pill, Cassie had been a “hyper” kid who loved spending time with her dad, her friends, and loved doing active things outdoors. But all of a sudden, she hardly even wanted to leave her bedroom. Sometimes she would stay in bed in the dark all day long, not even leaving to go into the kitchen for a snack. About two years after she started taking the pill, she remembers her dad making a comment to her about how much she’d changed. He didn’t draw a connection between her behavior and the pill, but he told her that he thought it was strange that she never wanted to see her friends, and that he was worried about her eating habits. Cassie didn’t want to talk to him about it.
“I felt like no one would understand because I didn’t understand it myself,” Cassie said. “There were things that I would go through in my head that I couldn’t explain, especially because I wasn’t getting a period. It made me feel like I was actually crazy, because if I was having hormone levels change from my period then it would make more sense, but that wasn’t happening which is kinda why I told myself I was crazy for a long time. It put me in a really low spot.”
Of course, Cassie wasn't actually crazy; she was most likely suffering from depression. According to psychologist Sarah Hill in her book This is your Brain on Birth Control, nearly every type of hormonal birth control has been linked to an increased risk of depression among women of all ages, and teenagers who use hormonal birth control are significantly more at risk of developing mental health issues; girls between the ages of 15-19 who take the pill are 20%-160% more likely to suffer from depression depending on the type of pill (Hill). Cassie had no idea her birth control could affect her mental health.
After Cassie’s dad talked to her about her behavior, she made a concerted effort to improve her lifestyle, hoping it would make her feel better emotionally. She made specific goals for herself: she would try to make her bed and eat breakfast every morning; she would try not to wear sweatpants every single day to school; she would take her dog for a walk every couple days; she would hang out with friends at least once a week; she would sit in a Starbucks and do her homework on the weekends. But absolutely nothing could make her feel better when she got in her "moods" each month, and her routine crumbled.
“It felt like my battery would just die, and I couldn’t do anything,” Cassie said. “Eventually, I realized, I couldn’t be this way for the rest of my life.”
After four years of this, Cassie decided to see a different doctor about what she was feeling. Her new doctor listened to Cassie’s concerns and quickly figured out that she is anemic – which could contribute to Cassie feeling low-energy. Then, she did a hormone test, and found that Cassie has Polycystic Ovary Syndrome (PCOS), which would be the reason Cassie rarely menstruates. With this information, her doctor prescribed Cassie a new pill. After just one week on this new pill, Cassie felt like a “completely different person.”
“I’m happy all day every day, and I don’t feel so anxious,” Cassie said. “I wake up and I’m ready to start my day rather than feeling like crap about myself, and I have been getting a regular period which is crazy, I’ve never had that and I appreciate it so much. I have so much energy now. My boyfriend, my friends, my coworkers, they’re all like, ‘Wow, you seem different.’”
Cassie is nineteen years old now, and though she’s been on birth control for five years, she’s been sexually active for less than one year. She now uses her birth control pill as treatment for PCOS and as contraception.
“I should have changed my doctor sooner because when I look back I’m like, ‘That really sucked,’” Cassie said. “It was [my doctor] that made me feel like what I was going through was normal and that whatever it was would pass, but it wasn’t passing and she wasn’t helping me. So eventually I figured out I needed to find something different because something was definitely wrong. And now I feel brand new.”
Hill, Sarah E. This Is Your Brain on Birth Control: The Surprising Science of Women, Hormones, and the Law of Unintended Consequences. Avery, 2019.
Jones, Rachel K. “Beyond Birth Control: The Overlooked Benefits Of Oral Contraceptive Pills.” Guttmacher Institute, Guttmacher Institute, Nov. 2011.
*Interview conducted September 26th, 2022 by phone.
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