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Reproductive Writes: Not Just Another Choice, Part 2: An Interview with Laura Wershler

Laura Wershler is Executive Director of Sexual Health Access Alberta. Recently she wrote a critical response for the re:Cycling blog to a study published in the British Medical Journal which reported that 'Women in the UK who have ever used oral contraceptives are less likely to die from any cause, including all cancers and heart disease, compared with never users.' She has previously served on the board for the Planned Parenthood Federation of Canada (now the Canadian Federation for Sexual Health) and is a self-described opponent of menstrual suppression through hormonal birth control and advocate of body literacy. In the second part of this interview she discusses the hows and whys of coming off the Pill.

Do you see an attitude in education and services that suggests the health of an individual woman is not as important as the benefits for the greater good - be that population control, or upholding sexual freedom?

Much of the thinking rests on an approach to menstruation and ovulation that states they are only related to reproduction. But that's not true - the cycle is so much more. I am adamantly pro-choice and I believe hormonal contraception has a place in women's reproductive lives. There's nothing wrong with considering these methods as part of how we manage fertility. My goal is solely to acknowledge that there are young women who want to choose not to use hormonal methods and that this is a valid choice, not only based on their experience but also on evidence that it holds health benefits.

Just as we have the right to choose hormonal methods, we need to have the right to not choose them. That's where sexual health clinics are falling down. If we are going to consider ourselves truly pro-choice, if we meet a woman who does not want to use hormonal methods and she has her reasons, presents them and says she doesn't want to be dissuaded then we should wholeheartedly understand what we need to provide to help young women make that choice. Otherwise, we just don't have informed choice and we are not honoring the patient. Let's not forget - she is not sick. She is looking to manage her fertility in a healthy way for her.

We don't acknowledge that being on the Pill can mean taking drugs from age 15 to 40, and that most women don't want to do that. We need to be filling in the gaps, the bridge periods. We are too focused on teenage and young adult woman and as such are adamantly committed to preventing them getting pregnant. The Pill isn't the perfect answer for all women but we keep acting like it is.

Do you see an effort to push women towards long-acting hormonal methods which are more 'effective' than the Pill in that they do not require the woman to remember to take a pill each day?

There is a real move towards Mirena. I know people who work in abortion clinics and they say they are seeing young women taking the Pill in ways they see as appropriate and still getting pregnant. The 'typical' rate of effectiveness of the Pill is definitely dropping - but there's no acknowledgement of that. Perfect use for the Fertility Awareness Method, when women are taught how to chart their fertility, has 99.6% effectiveness, but many people give the reason for not supporting this method as being that the typical use rate is around 85%. But this 'in practice' rate is happening with the Pill right now and no one is suggesting we don't use the Pill - instead there are the implants, injections.

Long-acting hormonal methods, I can't recommend them to anyone. I find them almost abusive. I think considering the side effects of Depo Provera on a 15 year-old girl (who I don't believe can be making an informed choice to take such a powerful drug) administering this method to teenagers is wrong. At the time when they are supposed to be exploring their sexuality, they are given a drug that takes the libido away and puts them into the hormonal profile of a menopausal woman. An unintended pregnancy is the only sign of health that we seem to care about. The irony here is that they want to give out the injection because they think young women can't take a pill every day, but now we know they need to take a calcium supplement when on the injection every day and if they're not going to remember the Pill, they're not going to remember the calcium supplement. It's a sledgehammer method.

If a woman chooses to come off the Pill after five years, a decade of use, what might she expect?

If hormonal birth control does not work out for a woman then she needs to have the sense of something to go back to. She needs to be connected to her body, know how it works, how her body feels. Many women don't know what is happening with their bodies when they come off the Pill - say, why they have acne, have developed ovarian cysts, or have irregular periods - so there's a sense that there is something wrong again and many of them end back up on the Pill. At some point if you want to be fertile you have to establish fertility, and I think because many women don't understand their bodies this can be a terrifying experience.

The Planned Parenthood site is providing excellent information on the Fertility Awareness Method, and it even suggests where you might go to learn the method, but the question is: Are Planned Parenthood clinics actually offering secular training in the method in their clinics? The other issue of concern is that there is no real acknowledgment of how dismissive sexual health care providers can be and often are when a woman asks about the method or looks for support to learn and use it effectively. So, in essence we are paying lip service to fertility awareness while not really doing anything concrete or proactive to remove the barriers that are keeping women from being able to learn and use the method. We are not advocating on women's behalf for access to information, support and services to use these methods effectively and confidently. In fact, mainstream sexual and reproductive health organizations are partly responsible for these barriers. Limited, if any, access to training, negative attitudes, and lack of knowledge about the methods are some of these barriers.

 There is little support out there for women coming off the Pill, even if they want to get pregnant. We don't show what happens in the progression towards fertility. We don't teach how they might chart their return to fertility, or change up their diet to redress the balance. Ignorance is not bliss, ignorance can be terrifying. Physicians and sexual health suppliers need to be more knowledgeable about what young women might experience coming off the Pill. We are leaving women high and dry in situations that cause a lot of concern, fear and anxiety, that could be done away with if we strove for all women to have body literacy.

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Comments

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Recently trying to conceive

Recently trying to conceive I've run across many of these women who, for the first time since they started menstruating, are not on the Pill. Many of them actually panic the first time they start to feel their long suppressed signs of fertility. A few didn't know how to cope with the normal symptoms of PMS at all! Personally I was on the pill for 2 months when I was 16 (4 years after menarche) to try to 'regulate' my periods. I absolutely hated it. I never stopped bleeding and it felt like someone else was always controlling my emotions. I didn't find out about Fertility Awareness until a few months ago when my husband and I wanted to start our family (got pregnant in my second full month of charting!) and I had found out my PCOS and irregular cycles may have been keeping us from conceiving.
Now that I know how Fertility Awareness works and how obvious the signs have been all along I trust using it for both trying to conceive and trying to avoid and I don't feel I will ever need to use hormones in my body ever again.

i feel discouraged after

i feel discouraged after reading this because i have 'polycystic ovary syndrome'. one of the side effects is noticeable dark facial hair (when i am on the pill my facial hair is not noticable). i have tried to go off the pill for two or three months at different times in the past but i find it difficult because the facial hair is very noticable when i am not on the pill..
any does anyone have suggestions or alternatives that i might pursue?

PCOS

Please don't be discouraged. The Centre for Menstrual Cycle and Ovulation Research at the University of British Columbia offers new approaches to treating PCOS, also called anovulatory androgen excess. Dr. Jerilynn Prior, an endocrinologist, has a different approach to treating this condition.

Please, everyone reading this blog, bookmark this site: www.cemcor.ubc.ca and share this link with your friends. You will find information for just about any question you might have that relates to menstrual cycle function. Make it your "go to" source for information, which you can then share with your doctor.

Here is a specific link for an article on treating PCOS. Good luck!

http://www.cemcor.ubc.ca/help_yourself/articles/challenge_pcos

THANK YOU!!!

THANK YOU!!!

Copper IUD?

I am wondering how Wershler (or anyone else here) feels about the non-hormonal IUD. As far as I can tell, it is highly effective, lasts for 12 years, brings minimal side effects, and contains no hormones. Are there drawbacks we aren't hearing about? Why wouldn't Wershler and other advocates like her promote this method?

I was wondering the same thing

I'm looking to go off the pill and would really like to use a copper IUD. Is there some reason Wershler and her group aren't pushing this option?

copper IUD

Many women do very well with the copper IUD and it is definitely making a comeback. I'm not sure about it lasting 12 years, but it is more affordable than the Mirena and comes with fewer potential side effects. Some women do experience more painful periods with this IUD so may have to consider another option.

In my experience talking to

In my experience talking to women, they have considered Mirena over the copper IUD because the Mirena has the capacity to stop your periods all together or make them extremely light, and because one major side effect of the copper IUD is that it can make your periods heavier and longer. Some women already have very heavy/long/crampy periods and don't want to risk it.

Also, I've had a couple women tell me that they actually trust hormones more. Which is very interesting to me because the copper IUD is (I believe) just as effective as Mirena. I'm not surprised that they trust the hormones in Mirena more though, since neither had used anything but hormonal contraceptives in the past and they don't know a whole lot about their natural cycles. Hormonal contraceptives are also very effective, so it's reasonable to feel super protected by them. On top of that, the in's and out's of how IUD's work is still a little mysterious, which could sway someone's decision. :P

Even though copper IUD's often make periods heavier and longer, it ultimately depends on the individual woman's body. Some women have no trouble at all, others only see a slight increase in flow or cramps.

I personally am working on getting a copper IUD (if my cervix will allow next time I try to have one inserted!) because I've hated hormonal contraceptives. I am extremely sensitive to hormonal changes apparently, because I get depressed, tired, sick, anxious, nauseated and horrible headaches when on HBC. A copper IUD won't change my cycle, and I don't have to think about it everyday, which sounds perfect.

I want to add as well that a

I want to add as well that a copper IUD has been VERY affordable for me. I live in Canada and I only have to pay for the IUD itself though. In Canada, we don't have Paragard, we have Nova-T and Flexi-T, both which last 5 years. The Flexi-T I was prescribed only cost me $61.00. That's very cost effective BC.

Another copper IUD fan here

I got a copper IUD (just a $10 copay with my insurance) about two years ago and I LOVE it. I did see a slight increase in flow but honestly, before I went on the pill in high school, my periods were much worse, so I can handle it.