For decades, birth control has been a cornerstone of reproductive autonomy, offering millions of women reliable contraception and relief from painful, disruptive menstrual symptoms. But despite its power, its widespread use has also revealed a deeper tension within women’s healthcare. While contraceptives can be highly beneficial, they are sometimes prescribed as quick solutions to complex problems — solutions that may overlook underlying conditions or minimize women’s experiences of pain. It’s a medication that is both incredibly helpful and, at times, a substitute for deeper care that women need.
In many medical contexts, women are disproportionately met with skepticism regarding the severity and legitimacy of their symptoms. Though the medical field has progressed away from labeling women’s symptoms as “hysteria,” subtler gender bias persists. Assumptions — explicit or implicit — that women are more emotional, sensitive, or prone to exaggeration can influence how medical professionals perceive and treat their pain. Women’s pain is often downplayed or dismissed, and potential underlying medical conditions are left uninvestigated.
The history of the pill reflects both medical innovation and these systemic gaps. When the first oral contraceptive was developed, it was a monumental innovation that promised women control over their bodies, symptoms, and futures. However, its early development was marked by practices now recognized as unethical. In 1956, researchers, in order to bypass United States regulations, conducted their first large–scale clinical trial in Puerto Rico, involving over 200 women living in public housing. None were told that they were participating in a clinical study for an experimental drug, nor were they informed of potential risks. 17% of participants reported experiencing nausea, dizziness, headaches, or stomach pain — side effects U.S. doctors largely dismissed as minor complaints.
Even today, research on women’s health remains disproportionately limited. “There’s not as much research as there should be,” says Dr. Noe King, a naturopathic physician practicing integrative gynecology in Oregon and Vermont. “To actually advocate for our conditions, there’s still a lot of work to be done.”
The first Food and Drug Administration-approved oral contraceptive arrived in 1960. Within two years of its initial distribution, 1.2 million American women were using the pill, highlighting the immediate need it met. Early formulations contained 100 to 175 micrograms of estrogen and 10 milligrams of progestin — far stronger than the 30 to 50 micrograms of estrogen and 0.3 to 1 milligrams of progestin in the modern pill, according to the American Medical Association Journal of Ethics.
Oral contraceptives use synthetic estrogen and progestin to mimic hormonal patterns and suppress ovulation. Combination pills that contain both estrogen and progestin are the most commonly used, although there are also progestin-only pills. Progestin thickens cervical mucus and thins the uterine lining, reducing the likelihood that a fertilized egg could implant. While this process is scientifically straightforward, it affects each individual differently, making informed guidance and ongoing conversations essential. “Every medication affects different people in different ways,” says Dr. Megan Fuerst, who specializes in family planning at Oregon Health & Science University. “[Birth control] is not a one-size-fits-all situation.”
While the pill may be the most familiar form of hormonal contraception, it is far from the only option. Depending on a patient’s goals, symptoms, and medical history, doctors may recommend a hormonal IUD, an implant, a patch, a ring, or progestin-only pills. Each method works differently and can affect the body in different ways. “It all depends on what somebody wants and what somebody’s goals are,” says Fuerst. She stresses that ongoing conversations about personal preference, symptoms, and medical history should guide decisions regarding birth control.
The pill affects everyone differently, and its long list of potential side effects can make it difficult for people to recognize the difference between normal reactions and genuine issues. Because of this, King encourages anyone interested in taking hormonal birth control to track their menstrual cycle. “I wish that everybody understood their cycle prior to [starting] birth control, because then we could navigate positive or negative effects better,” she says.
King emphasizes the importance of education and advocacy, expressing, “I’d love for there to be more advocacy, I’d love for there to be more research. I’d love for there primarily to be more education.” She believes that knowledge empowers patients, explaining, “If you are empowered with knowledge, then you can advocate for yourself.”
In Oregon, minors of any age can independently consent to birth control information and services without parental involvement. Many young women start the pill for noncontraceptive reasons, such as painful periods, acne, or irregular cycles. A 2011 study from the Guttmacher Institute found that 33% of teens use the pill solely for noncontraceptive purposes.
“When there’s something on a deeper level wrong, birth control can be a short-term fix for it,” says King. Conditions such as endometriosis and polycystic ovary syndrome (PCOS) can remain undetected for years if a birth control prescription is offered as the default solution rather than the starting point. The pill can be part of a treatment for these issues, but careful evaluation and ongoing monitoring are essential. Fuerst reinforces the importance of listening to the patient: “If you experience a side effect, I don’t care what the studies say — that’s you.” She emphasizes that, “Your birth control shouldn’t make your life worse, it should make your life better.”
The pill has transformed women’s lives, offering autonomy, symptom relief, and reproductive choice. Yet, the issues arising from it reflect a larger truth: medical care, especially concerning reproductive health, is most effective when women are listened to, well-informed, and empowered to make decisions that fit their own bodies and lives.
