On the Pill

the women come and go… (T.S. Eliot)

Tuesday. It says, as I pop the pale yellow pill through the foil. The passing days terrify me. Is this how I will measure out my life? With Dianette?

I am 18; placid and swollen with a heady dose of oestrogen, ecstasy and oxytocin.

I stare dumbly at the patronising pink cursive: Dianette. I am not, at this moment, particularly struck by the ludicrous name. I haven’t yet had to work my way through Celeste, Yasmin and her expensive, rarely-prescribed little sister Yaz. Contraception, I come to learn, has a register like a classroom of Barbies. Perky, plastic monikers coyly concealing the truth of the matter: denying sex like their labia-lacking counterparts. Nevertheless, staying at friends’ houses, I am always pleased not to have to spend every morning staring at the word Microgynon in brutal sans-serif.

Something I am struck by is ‘The Love Song of J. Alfred Prufrock’. I am extremely fascinated by the poignant and existentialist questions it raises about the complex notion of identity. As I said on my UCAS form yesterday (Monday).

I look in the mirror. It’s still cloudy with heat from my brother’s shower. He has left an indecorous streak of toothpaste, perhaps shaving foam – I cannot stand sharing a bathroom with my brother – across it. A yellow Post-it note written by my mother weeks ago in an attempt to moderate his adolescent habits (“IT IS EXTREMELY UNCIVILISED NOT TO USE A TOILET BRUSH!!!!”) hangs limply from one corner. I wonder if either of them have noticed the pack of pills.

As I brush my teeth, I wipe the mirror clear with the sleeve of my pajamas. There I am: my skin glowing in fake pregnancy; my breasts, though sadly also my thighs, hormonally plump. In the Sixties, my mother says to me, you could tell the girls who were on the pill (with its early, unsophisticated levels of oestrogen) just from their faces, their bloated countenances proclaiming their liberation.

The pill is the most wonderful of liberations for me. Not from pregnancy – all I want in the world at this time, for some socially dysfunctional yet biologically obvious reason, is to have a baby – but from myself. Since being prescribed it a few months ago by a GP unusually sympathetic to my physiological idiosyncrasies, who did not, as is more standard, brush me off with the one-size-fits-all Microgynon, I seem to have become a different and altogether preferable person. It’s not just that I have moved closer to a long hoped-for physical manifestation of myself – I no longer have spots, greasy hair or period pain, and I suddenly have breasts I am not ashamed of – but, more strangely, that I no longer seem to feel depressed.

The crippling anxiety that used to paralyse me on pavements as I walked home from school seems to have dissipated. This might well have something to do with the other exciting yellow-white pills I have been taking at the weekend. (Years later, very recently in fact, I learn about case studies in which severe depression is significantly reduced after a single, large dose of unadulterated 3,4-methylenedioxymethamphetamine: MDMA.) It might also have something to do with the surges of post-coital oxytocin flooding through my newly copulating body, tying me to my mate, as the transcendent oxytocin apparently does. But I doubt it. Because my boyfriend is painfully difficult, and, although I don’t know it yet, about to split up with me, for the second, heart-stabbing time. Whatever it is, I am happy. For the first time in a long, long time: happy.

Today, 12 years later, I can half remember that feeling. That dumb happiness. What it felt like to be very in love, and to have sex, when I was very young. That my mind could be obliterated. That it could go completely blank. I loved the feeling of escaping from everything: warm, stultified bliss. It was a little bit like taking pills. A happy, placid, pregnant sort of ecstasy. It is only much later that I realise I may have been escaping from myself.

‘One is not born, but rather becomes a woman’, as a man translated Simone de Beauvoir’s now clichéd words. It is not until well into my twenties, long after a highly expensive education at what was supposedly a bastion of the women’s education movement, that I come across them in the flesh. Existentialism, I had thought, was something men did. It is a boy, to his credit, who first reads me The Second Sex. It is also not until well into my twenties that I stop taking the pill. And that I start to notice an old self coming back: slighter around the hips, angrier around the middle of the month, and yet curiously awake.

When you take the pill, or rather, since you may well be a man, and will never have had to stuff oestrogen, progesterone or a cheeky cocktail of the two down your throat, when a woman takes the pill, several things may happen to her that are well known. She may become thinner, fatter, less or more hirsute; her skin may become suddenly awful or enviable; she may find herself buying bigger bras, smaller bras, crippling over in pain with heavier periods or – especially if she chooses to run packs together – having none at all. Also well known is the way in which her mood may be affected. Her monthly wrangles with pre-menstrual tension, pre-menstrual syndrome, lunacy, whatever you care to label it, may be amplified or dulled.

What is less well (but more recently and scientifically) known is that she may suddenly become repulsed by her husband. She may become unfathomably attracted to a man she has always distrusted who has an unusually long ring finger. She may become fiercely competitive at chess.

If she is a stripper, she may find her tips sky-diving. In 2007, scientists investigating the ‘lost’ human estrus, that is to say the commonly assumed notion that women, unlike dogs, should you care to make the comparison, do not go into heat, discovered that they did if they weren’t on the pill:

A mixed-model analysis of 296 work shifts (representing about 5300 lap dances) showed an interaction between cycle phase and hormonal contraception use. Normally cycling participants earned about US$335 per 5-h shift during estrus, US$260 per shift during the luteal phase, and US$185 per shift during menstruation. By contrast, participants using contraceptive pills showed no estrous earnings peak. These results constitute the first direct economic evidence for the existence and importance of estrus in contemporary human females, in a real-world work setting.

As Geoffrey Miller, Joshua M. Tybur, and Brent D. Jordan (the three wise men who carried out this provocative research) sagely observe: ‘These results have clear implications for human evolution, sexuality, and economics.’  

However we choose to respond to the conclusions (and troubling assumptions) of Messrs Miller, Tybur and Jordan, they are not alone. There is a frightening amount of evidence that taking the pill has serious implications for a women’s entire identity. Even when not on the pill, hormonal fluctuation alters a woman’s facial appearance, body odour, vocal pitch, libido and fertility: she is both differently attractive to and attracted to men at different times of the month. But on the pill, these alterations can be extreme. Studies in both animals and humans have shown that genes in the major histocompatibility complex (MHC) affect the way we smell, and the way we smell others: we prefer the odour of ‘MHC-dissimilar’ partners. Evolutionarily, apparently, this makes sense. It prevents in-breeding, and strengthens our offsprings’ immune systems.

On the pill, however, women prefer MHC-similar partners. (As I discover, trawling the net.) On the pill, women also prefer men with lower levels of testosterone – you can spot them by their stumpy ring fingers. The pill not only reduces women’s own testosterone levels  – diminishing their libido, and, potentially, competitiveness – but sways their choices in men: women are historically more attracted to men with higher testosterone levels. There has been much consternation, understandably, after a series of recent studies showed that women who had met, and often married, their unfortunate testosterone-light partners when on the pill, found them far less attractive and sexually exciting once they had stopped taking it. On the upside, the less testosterone a man has, the less likely he is, according to science, to cheat, and the more likely he is to be a sympathetic, supportive partner. Also, according to science, women on the pill generally have happier and longer relationships. Yet at the same time, they are more likely to stay in an unsatisfactory relationship: a woman taking oral contraception extends relationships by an average of two years. For a serial monogamist, this is worrying news.

Reading all this science it is easy to see through the gaps, not least in my crude understanding of it; to summon the legions of caveats and counter-arguments to attack its biological determinism; to despair at its simplistic view not just of gender and sexuality but of female intention: meet man, bed man, PIN MAN DOWN.

And yet.

I am in my late twenties. (I’m not sure of the exact day.) I am curiously awake. Slighter round the hips, sadder in the middle of the month, but more, somehow, myself. Less docile, it feels. Angrier. More full of fire. It makes sense to me that there is more testosterone coursing round my veins. Testosterone does not, I am sure, course around veins, but, as an androgen, it does, I am sure, have palpable effects on your body: on your libido, your weight, your brain, your skin.

I have always had trouble, at the best (and worst) of times, in knowing who I am. Classifications, diagnoses, forms that demand decisive filling in, have always left me pinned and wriggling. Anti-depressants add to the confusion, and so, probably, do Class As. But while I could be arrested, in theory, for possessing ecstasy, doctors have been dishing out daintily named oral contraceptives to me for years. The freedom of this has of course been a great thing. But so is the freedom to be oneself. And if I am ingesting potent levels of hormones, how should I begin to know who that is? And although gender, it seems, forms along a line and not two poles, and we are all at some infinitesimally varying point along it, how should we presume to know where we are?