The pill. Love it or hate it, chances are at some point you’ve used it. In its glory days it represented the liberation of women from the fear of unwanted pregnancies, allowing them to act freely and safely for the first time ever. But if you’re a millennial (born, roughly, between 1982 and 1996), it’s likely your attitude is more complex.

In fact, younger women are turning away from the pill in droves - an NHS study found that the number of women in contact with sexual and reproductive health services who used user-dependent contraception, including the pill, had dropped by more than 13 per cent between 2005 and 2015. It’s hardly surprising: a quick Google search chums up some alarming reports, from articles on possible links between the pill and cancer to claims that are outright bizarre, such as “contraceptive pills flushed down the toilet are turning fish transgender”.

As at so many points in history, if women want change, they’re not going to get help from the top

And that’s not even to mention the everyday side effects that many women reportedly experience: mood swings, bloating and weight gain top a long list. In an age where we’re all obsessed with health and wellbeing, young women simply don’t want to settle for so many symptoms. “I decided to go vegan a few years ago as I found myself increasingly aware of what I was putting in my body,” says Abbie, a 26-year-old radio presenter. “At the same time, I was still taking the pill and it started to feel incongruent with my new lifestyle. It was only apt that I started looking for an alternative method of contraception.” Small wonder so many women are rejecting the pill in an emerging cultural backlash against hormonal contraceptives in general to try to reclaim autonomy over their bodies.

The problem is, the pill hasn’t moved with the times. Since its arrival in Britain in 1961, there’s been a kind of “if it ain’t broke, don’t fix it” attitude. But there’s an argument to say that actually, it is broken; cracks that were initially masked by its own social significance are becoming harder to ignore the more ubiquitous it becomes. Combine this with the information revolution - where everyone with access to the internet becomes an overnight expert - and suddenly the cracks are getting wider and wider.

“I started taking Dianette [a combined pill, containing artificial versions of the female hormones oestrogen and progesterone] when I was 19, and was really naive about it. My breasts went from a B to a D cup almost overnight and emotionally I felt all over the place, but it was my first year of university so I put it down to other things,” Molly, 27, remembers. It’s a common experience: a woman feeling emotionally unbalanced, anxious and depressed, and yet assuming for too long that it’s due to everything but taking the pill. In response, some doctors seem all too keen to prescribe antidepressants without considering that the symptoms might be caused by something as simple to remedy as the patient’s contraception. “It was actually my best friend who had been through the same thing and told me to stop taking the pill immediately. I did, and started feeling much happier in a matter of weeks,” says Molly.

Her sentiments, and those of so many others, are supported by the science. Last year, the results of a study conducted by the University of Copenhagen of more than one million women over the course of 13 years confirmed a significant link between hormonal contraceptives and depression. Women taking combined oral contraceptives were 23 per cent more likely to be treated for it; those on the progestogen-only pill (known as the mini-pill) were 34 per cent more likely. Teens taking the combined pill were discovered to be at greatest risk, with an 80 per cent increased likelihood of being prescribed antidepressants. And yet governing bodies and health professionals are quick to lay blame at social media’s door for the atmospheric rise in mental-health issues, suggesting a “digital detox“ as a possible cure.

“It’s incredibly frustrating,” says Holly Grigg-Spall, author of the book Sweetening the Pill (also a forthcoming documentary). “Doctors make their own preconceived judgements on what form of contraception a woman should be on, rather than listening to the facts and the reality of her experience.

“The medical community thinks that the benefits of reducing the risk of unwanted pregnancies and the improved control over things like heavy bleeding outweigh the risk of potentially serious side effects and mental-health issues - but the reality is that there could be thousands of women who are experiencing depression, totally unnecessarily, as a result of their contraception. They deserve to be taken seriously.”

Of course, there are financial pressures; doctors are encouraged to prescribe the cheapest drugs first, which might not necessarily be the ones best suited to the individual in front of them. For example, one year’s treatment of the contraceptive pill Levest costs the NHS £7.80, while Eloine - a pill specially designed to alleviate severe pre-menstrual syndrome (PMS) and acne - costs £63.70.

Some pharmaceutical companies have made attempts to produce versions of the pill that more closely match our existing biochemistry. The multinational Bayer released one named Qlaira, and claims that the oestrogen component of this pill is bio-identical to the oestrogen in women’s bodies. However, it also contains a synthetic hormone called dienogest.

“The reality of modern medicine is that pharmaceutical companies have to have an economic incentive to research new products,” says Dr Jane Dickson, vice-president of the faculty of sexual and reproductive healthcare at the Royal College of Obstetricians and Gynaecologists. “Bio-identical hormones are far, far more expensive than synthetic versions and, unlike during the menopause, when only a small amount is needed to replace the body’s natural levels, contraception requires much higher doses to effectively put the reproductive organs to sleep.”

A grassroots movement, therefore, seemed inevitable; as at so many points in history, if women want change, they’re not going to get help from the top. One woman taking matters into her own hands is Dr Elina Berglund, founder of Natural Cycles - a revolutionary app that uses body temperature to help users try to prevent, or plan, pregnancy.

“Natural Cycles evolved from a personal decision to stop taking hormonal contraceptives,” she explains. “When I couldn’t find an adequate alternative I started researching and discovered that you can accurately predict ovulation through body temperature, and hence calculate when you are fertile and when you’re not.”

Using her knowledge of statistical analysis from her years as a particle physicist, Berglund created an algorithm - originally just for personal use. “I quickly realised the algorithm catered to a wider need from my female friends and colleagues. Together with my husband, who is also a physicist, we turned it into an app so more women and couples could benefit.”

The app, the first of its kind to be recognised as a medical contraceptive device, works by imputing the body’s basal temperature (the lowest and more stable temperature within a 24-hour period, which usually registers immediately after waking) into the app.”When you ovulate, the level of the hormone progesterone increases in your body, which warms it up by up to one third of a degree,” explains Berglund. In layman’s terms, your body temperature increases at ovulation and decreases at menstruation. The algorithm generates patterns in basal temperature into “green days”, when there is a very low risk of getting pregnant, and higher-risk “red days”. The statistics are promising. According to an independent study published in The European Journal of Contraception and Reproductive Health Care, the rate of “false” green days within the fertile window when used correctly was found to be less than 0.5 per cent. Just to put that in context, male condoms are 98 per cent effective, and the figure for the pill is greater than 99 per cent - making the app apparently as effective as the pill (if not more so).

Of course, data evidence is one thing, but the reality doesn’t always marry up. “It’s important to treat fertility apps for contraceptive purposes with caution,” warns Dr Dickson. “Natural methods won’t work for all women. Anyone who has an irregular cycle - maybe they’ve just had a baby, or they have polycystic ovaries or other hormonal imbalances such as diabetes - should be very careful

“Natural family planning can be as reliable as the pill. But only if it is used perfectly 100 per cent of the time - and that’s hard to do. Any slip-ups - you record the wrong temperature, or you just forget one morning —and the failure rate rises dramatically.”

Even so, there’s been widespread support from the medical community, according to Dr Berglund. “The NHS has been as supportive as it can be of a contraceptive method - I think it recognises that it’s important to listen to women who don’t want to use an invasive or hormonal form of contraception, and to offer them options.”

Natural Cycles is not the only new method that the NHS is supporting, as it has shifted its focus away from prescribing the pill and other user-dependent methods of contraception (where the effectiveness depends on the user to take it correctly) in favour of long-acting reversible contraceptive (LARCs) like IUDs and implants. According to the most recent NHS guidelines, “expert clinical opinion is that LARC methods may have a wider role in contraception and their increased uptake could help to reduce unintended pregnancy.”

Dr Dickson is an advocate, but says that the lack of general awareness is unfortunate. “There are so many amazing options being developed. There’s Jaydess, which is a much narrower, much thinner, three-year coil. It’s got a little bit of hormone in it so it does give you a lighter period, but because there’s so much less hormone, women hardly ever experience the side effects. The tiny bit of hormone stays within the uterus.” Kyleena, another low-hormone IUD, is set to launch in Britain in the near future.

“There’s also the NuvaRing,” Dr Dickson continues. “It’s a very flexible plastic ring that sits around the opening of the cervix and releases the lowest dose of progesterone and oestrogen that is available - literally half the dose of the pill. The user just has to swap it for a new one every three weeks.”

Despite these advances, the hurdle of artificial hormones remains too high for some. Molly, for one, still feels that an app is the best method, and is now using the fertility-tracker app Kindara, as well as condoms.

“After I came off the pill, I had the Mirena hormonal IUD. Initially, I felt fine but I got to a point where I felt mentally stagnant - almost like it flatlined my hormones. I then tried the copper coil, which is hormone free, but was experiencing very heavy and very painful periods, which would leave me feeling drained. The combined use of the app with condoms works for me, and my boyfriend is happy, too. I guess it’s a bit of a hippy thing to say but I just think that fighting nature and interrupting your natural cycle is dangerous.”

NFP REDISCOVERED

How was Natural Cycles born?

“Natural Cycles evolved from a personal decision to stop taking hormonal contraceptives,” says Berglund. “I couldn’t find an adequate alternative, so I started researching and discovered that you can accurately predict ovulation through body temperature, hence calculate when you’re fertile and when you’re not.”

“Using my knowledge of statistical mathematics from years as a particle physicist, I created an algorithm to predict my fertility, which I quickly realised catered to a wider need from my female friends and colleagues. Together with my husband, who is also a physicist, we turned the algorithym into an app so more women and couples could benefit.”

 “When you ovulate, the level of the hormone progesterone increases in your body, which warms it up by up to one third of a degree Celsius,” explains Berglund. “Body temperature increases at ovulation and decreases at menstruation.”

“By measuring your basal temperature – your lowest and most stable temperature within a twenty-four-hour period – you need to measure your temperature under the tongue as soon as you wake up in the morning. Really, it should be the first thing you do, before even standing up or having a drink.”

When you sign up for the Natural Cycles app, you can opt in to receive a basal thermometer, which is accurate to two decimal places – a necessary requirement when dealing with such minute temperature variations. “Since we’re looking for such a small shift in termperature, ideally you want to measure with as high precision as possible and an oral, basal thermometer offers that higher level of precision.”

Each user inputs the reading into the app and the algorithm calculates whether or not there is a risk of pregnancy. If there is a risk, the app will signal a red day, if no risk is calculated, the signal will be green.

“Every woman’s cycle is different, the algorithym gets to know you and your data. The first month you will get more red days until the algorithm has got to know you and then you will get more and more green days.” The average user should expect to see about one-third red, and two-thirds green.

Are there any side effects?

To put it simply: no. As a natural contraceptive method, it’s non hormonal and non intrusive.

How effective is it?

According to an independent study published in The European Journal of Contraception & Reproductive Health Care, the rate of false green days within the fertile window when used correctly was found to be less than 0.1 per cent - that’s more effective than male condoms (98 per cent effective) and as effective, if not more so, than the pill (>99 per cent effective). In fact, Natural Cycles has proved so effective, it is the first app to be classified as a certified contraceptive device.

“The most common source of unwanted pregnancy with Natural Cycles is when the user ignores that it’s a red day and takes the risk,” says Berglund. “At the end of the day, it’s up to the woman – as long as she’s aware of what she’s doing and has been given accurate information.”

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