How the Pill Changes Everything: Your Brain on Birth Control

by Sarah E. Hill

THE PILL

Changes your brain
Alters your stress response
Can increase your risk of depression
Affects your choice of mate selection

Hormonal birth control is taken by millions of women around the world every day. Yet until recently we knew very little about how the Pill affects the non-reproductive systems of the female body, because research on these other systems was conducted almost exclusively on men. In her trailblazing book, Dr Sarah Hill uses the latest science to reveal how the Pill is changing women and the world, for better and worse. She puts the power back in your hands to make smarter, more informed choices about your health and your hormones.

IT'S EVERYTHING YOUR DOCTOR NEVER TOLD YOU

Genres: Nonfiction, Health, Science, Feminism, Psychology, Self Help, Audiobook

320 pages, Kindle Edition

First published October 1, 2019

About the author

Sarah E. Hill, PhD, is an associate professor of psychology and a leading researcher in the dynamic and rapidly expanding field of evolutionary psychology.

Reviews

[Emily (Books with Emily Fox on Youtube) · Rating 2 out of 5]

While I appreciate that more research is being made on the topic of hormone, reproductive health and birth control (being let's be real, it's massively understudied). I had issues with the tone of this book.

At time it felt like "I'm not like other mom, I'm a cool mom". Sentences like "It’s SO not a good time". Not a big deal until... we get to the ones like this:

"probably because the word vulva is so ugly"

We're absolutely not doing that. We're grown ass adults and the author has a PhD. We're not going to continue perpetuating that crap.

You can hear it for yourself: https://youtu.be/_1AmEWgpw0E?t=761

I almost put the book down in the intro after she states that this book is for everyone "even feminists"... excuse you??

I want to read more on the topic but I can't really recommend it

[Sarah · Rating 2 out of 5]

I have mixed feelings about this book. I'm thrilled that the author wrote it - I think hormones and reproductive health and birth control are all massively understudied subjects, and ones that the public tends to massively misunderstand. It's nice to see this type of work laid out in fairly simple (if sometimes a bit condescending) language. Hill takes a feminist approach to her concerns about birth control, and her acknowledgement of the importance of the pill for many young folks who are trying not to get pregnant is a huge point in her favour. She notes that the pill has allowed financial, educational, and relationship freedom for many people who would otherwise not have it, and she's absolutely right. I think she's also absolutely right in her main stance: that taking the pill is a much more significant choice than most of us realize and that the powerful hormonal changes induced by the pill are not to be taken lightly.

But the devil's in the details. I have the same degrees and similar research training as Hill, and I've read most of the work she cites in the first half of the book. My understanding of that material, and of psychology research in general, makes me seriously question the way the author makes her case.

And she is, indeed, making a case. Many of my issues with this book stem from the fact that Hill is just too invested in her hypothesis to tell a balanced story. She starts the book by comparing cultural vs. evolutionary explanations for behaviour, suggesting that, "The 'women as a cultural construction' perspective describes women as passive receptacle [sic] of social roles imposed on us by men. The evolutionary biological perspective describes women as being the benefactors of millions of years of inherited wisdom from our female ancestors." Ugh, stop. Literally all we're talking about is what things influence behaviour, and we know from decades of research that the answer is almost certainly "both", so let's stop twisting words around to make one sound more appealing or politically correct.

Similarly, Hill will spend three pages talking about a study that found significant differences in women's behaviour based on their pill usage, and then throw in a one-line footnote saying that several other studies haven't found this effect at all. Um, what? Maybe tell us about those too?? As if to illustrate her perspective on this, late in the book, Hill tells us that "research has a high failure rate", and that experiments that don't find significant effects are worth "doodly-squat". Listen, academia certainly has a file-drawer problem, but this attitude of non-significant findings being viewed as "failure" is EXACTLY why that problem persists.

Hill also does a lot of speculating in this book, and some of it based on pretty shaky theoretical ground. She does at least acknowledge that it's all speculation, but still - it seems borderline irresponsible to publish a book intended for the less-educated masses to consume, establish yourself as an authority that they should trust, and then start wildly conjecturing about things you think might be true but which no one has any data to support.

And finally, Hill doesn't acknowledge until 70% of the way through that most of the science in this book is pseudo-experimental. After 179 pages, she finally notes that most studies on the pill do not involve random assignment, and therefore, we can't conclusively say that birth control "causes" much of anything. (Of course, carefully controlled studies and thoughtful research design can be the next best thing in establishing causality, but as far as I can tell most of these studies did not address 3rd variable problems in a satisfactory way). I cannot imagine why Hill would have waited so long to discuss this, when it is crucial to understanding the studies presented throughout the book.

Like I said: I actually agree with Hill's main point here. I think that behind all the conjecturing and cherry picking, there's some real cause for concern regarding the long-term and wide-ranging effects of birth control pills. So why hide your message behind all of that? Why spend all this time and energy twisting the message to sound more convincing when it was already pretty convincing in the first place?

(Also, other reviewers have noted that this book is heteronormative and cisnormative as hell, and they are not wrong. I'll leave it to folks more well-versed in that area to cover this, since this review is already long, but suffice it to say that there is a lot of gender essentialism going on and only a meek 1-page conciliatory note for people who "colour outside the lines" to counteract that.)

[Tilly · Rating 4 out of 5]

4 stars

I was both excited and nervous to read this book as being someone that suffers from endometriosis and is on a combined pill for treatment (and which massively helps me cope), I didn't want to be completely put off taking it! But I am a scientist at heart and so I wanted the information anyway, as we all should.
Dr Sarah Hill is a brilliant writer and the book is split up nicely for different areas the pill can and does affect. I like to think myself well read within everything gyaecological but I learnt a great deal which made the book thoroughly interesting. There is some vital information and advice for women both on the pill and thinking of taking the pill, so it is a must read. Dr Hill was also very careful not to give advice on what you as a reader should do, but gave you the necessary information to make up your own mind.
What I found was missing was information about the many illnesses and conditions that the pill may be used to treat of manage. It fully focused on the not getting pregnant aspect and handling PMS when in fact many women take it for other medical reasons. I also found that there was quite a bit of repetition which I could have done without.
Overall, the science and explanations were great but there were a few things missing for me. However a very good and incredibly important read for women.

Please note that I received this book in exchange for an honest review.

[Nashwa S · Rating 1 out of 5]

DNF @ 56%

I really wanted to like this book or rather, I was looking forward to reading it. I was looking for a book that would give me a neutral perspective - benefits and side effects of taking hormonal contraceptives. And what impact these pills have on anxiety in the long-run. But I couldn’t get through it, I tried it as an ebook and then wasted one valuable Audible credit on the audiobook :(

This book caters to one kind of relationship i.e. heteronormative (male/female) relationships. It hardly takes into consideration that trans people are usually prescribed hormonal contraceptives after a major sex-change operations, or that oral contraceptives are prescribed for people suffering from PCOS and other diseases.

Additionally, I didn’t believe everything in this book. I don’t believe in the notion that “you are your hormones” which essentially reduces fully grown human beings to bodily functions/parts. Just like I’m not my lungs, my heart or just my stomach - I’m not my hormones. Yes, hormonal contraceptives change things in your body but they don’t erase the essence of your being.

There were also some other wild speculations in this book - e.g the fact that women who are high fertility or in their ovulation phase are likely to cheat on their partners because they are attracted to traditionally good-looking men during those days ( WTF!) And I also don’t believe that ovulating women become femme fatales and attract every man in the vicinity (actual BS) as it is implied in the book. I didn’t believe that pill taking women give birth to less healthier babies. Other wild speculations included that women who are on birth control are attracted towards mediocre looking men while naturally cycling women are attracted to the Jason Momoa’s of the world. Gym bros, super muscular, square jaw and the like - those who have raging testosterone.

The writing really riled me up. The author is extremely condescending, makes inappropriate jokes as if her audience are a group of giggling 13-year-olds. If a book is meant for adults, then talking down to the target demographic really doesn’t make sense. Referring to men as “slightly less hairier than apes” is one example, “sperm germs” is another one.
The quirky footnotes were distracting and really started to piss me off, and the bad puns were just off-putting. Yes, we know “thrust” can be used in multiple ways. The fact that she said contraceptives give you hair in “embarrassing places” instead of explaining what she meant is another example.

I need a better book on the subject.

[Sophia · Rating 4 out of 5]

This kind of book is a must read for women on or planning to use birth control. It tells you all the changes that are not on that enormous information sheet that comes with the box but instead are far more likely: psychological side effects. It opens your eyes to all the things that may have changed in your life that you attributed to anything but the pill.
Having said that, there were a few things I didn’t like about the author’s communication style.

For one, she treats numbers as if they were toxic. There are some nice plots, but otherwise the reader has no way of knowing how large effect sizes are or how likely something is in the population. So when she says the pill decreases libido, by how much? How many women are actually on the pill? How many of those have ill effects? By not providing these numbers, she makes the phenomenon seem enormous, because when you say “women on the pill have a harder time discriminating odors” you imagine scent-blindness, not a 5-10% difference. I honestly don’t know what numbers are behind any of the studies she cites, but because of her writing style, I was ready to stop birth control right then and there, and a decision like that should not happen without numbers.
The other thing I didn’t like was her way of presenting still uncertain research with a lot of optimism and promoting theories in a similar way. She’ll make a strong statement, then walk back a little saying “not all research agrees” then undoes that by adding “but it’s something to keep an eye on!” If you’re a scientist talking to other scientists, the moment you declare you like a theory but it’s not universally accepted, the listeners will appreciate being informed of this new idea and evaluate it for themselves. When you do this with the general public, they look to you as an authority and would most likely just trust your expert opinion (unless they already have a reason to not agree with you). I think she should have held back on ideas that aren’t so solid.

Then she has a few ideas that I just think aren’t correct or at least not as big a factor as she thinks. Two examples of this: the idea that the introduction of the pill is the main driver for women’s increased college education; and the possibility that it is the reason for men’s decreased college education. In general, the author has a bit too much of a “nature” interpretation of behavior, attributing almost everything to evolution, hormones and genes, viewing all social phenomenon as a consequence of these. In reality, society can change arbitrarily, and if you only look at western research on western people, you really don’t have the data to affirm whether large scale changes are really due to a single factor like the use of birth control. In the case of explaining the increase in percentage of women in college, just like you can say the introduction of the pill increased women’s chances of higher education, obtaining higher education increased women’s awareness of the need for birth control. In developing countries, it’s not enough to just provide the pill, you need to also provide the education that allows women to want and benefit from the pill.
I’m not denying that the pill was a social game changer, and I really think there’s something to the idea of a lot of these changes being unintentional and unanticipated, but such statements require a lot more caution and a harder look at other societies.
A similarly bold idea is that men actually have decreased their interest in higher education because they no longer need to compete too hard for sex like in the bad old days where women had to be picky because they were essentially always choosing the father of their children. For one thing, from one of the few graphs she provides, she states that there is this decrease; I don’t see it. I see both genders increasing in the 60s and 70s, women exponentially and men logarithmically. The very fact that the percent of men obtaining college degrees increases makes it almost impossible to say that anything specific had a negative impact on their overall desire to study; you don’t have some clear “baseline” time period where all the men that wanted to study could study, until basically the present day! There are no grounds for saying men want to study less than before rather than they just want to study less than women.

So all in all, I think it’s a super relevant topic, the author is clearly an authority in the field, I just think the book promotes the effects of the pill being worse and larger than they may be.

[Shannen · Rating 1 out of 5]

I only read the intro and chapter 1 of this book, and that was enough for me. I expected it to be propaganda for or against birth control, but it turned out to be propaganda of a different kind. Apparently women (despite the note saying there are many ways to define a woman) are defined primarily by the size of their gametes and reproductive viability. Does your body make eggs? Then you are a woman! And the only type of woman worth discussing (if you're heterosexual).

There is a disclaimer for why the author chose to exclude lesbians and trans men and women: because if they use the pill it's not primarily for pregnancy prevention. She couldn't just say that the research primarily concerns birth control used for pregnancy prevention though (that I believe - why would we do research on "women's" health unless it was in the context of their ability to make babies?!); what I don't believe is that all of the studies looked at checked to make sure all their participants were cishet. The one that rang this alarm bell for me in particular is where they had actors of the opposite gender ask strangers on a college campus for a date/to go back to their apartment/to have sex with them (the author notes that "male" and "female" brains responded differently; but by her definition this is determined by the size of your gametes and I doubt they stopped and measured them on all study participants). I also don't understand why just the criteria of pregnancy prevention would exclude people of the LGBT+ community (just because someone's not cishet doesn't mean they can't get pregnant). I don't like that the author made a point of excluding these people from all the studies she looks at in a blanket statement at the beginning of the book.

As a side note to this I was annoyed by the exclusion of taking birth control for any reason other than pregnancy prevention. Sure, it's plausible that research done doesn't concern people outside this bubble (I think the author even noted it as a narrow group of study), but I wish that had been pointed out in the book summary. Lots of people take birth control for other reasons. The author encourages you to read on even if you don't fall into this "narrow" category, but I have other qualms with that (noted below). Alternatives to the pill aren't discussed if you're not using if for birth control because why would you be using it for anything else? Likewise based on the author's own assertion that most research concerns pregnancy prevention and other reviews, I don't expect the effects of birth control on people who need it for other reasons are discussed. That was my primary interest in picking up the book.

I was increasingly skeptical of how scientific her approach really was. This caused me to seek out end notes on my own (not mentioned in the text) and then try to piece together how they were cited in the text - usually by a * and not a number, as is the typical standard. Sometimes they were not noted at all (I found two consecutive references unmarked in the first chapter). Also I expected the * to lead to a foot note or note at the end of the section or chapter, not a citation at the end of the book (based on typical usage). She also consistently referred to biology and psychology as if they were interchangeable. This grated on my patience. Granted, the last book I finished was a thick biography where the author mentioned his sources in detail and the context and/or bias of the authors of his sources. Maybe I'm just spoiled, but this author's approach struck me as sloppy and unprofessional. The tone is also condescending; she constantly tells you that you don't know what you think you know and assumes what the reader believes. Aren't you lucky she's here to educate you? It's not like you picked up a nonfiction book on your own initiative to learn something new.

So my doubts about the text were piling up, despite the odd disclaimers about how even if you're not a cishet woman taking the pill to prevent pregnancy your experiences are still valid (which felt forced), when she rolled into another aside which really put the final nail in the coffin for me. After repeatedly hammering home that "women" are reproductively viable egg producers, she takes a moment to address how this shakes out under a feminist lens. She wants to reassure the reader that they are not defined by their uterus! Isn't it more feminist to think that you've inherited the biological wisdom of your female ancestors than to think you're so gullible that you're swayed by socio-cultural circumstances? Dissing sociology for a biology-is-destiny stance seems pretty brazen for a psychologist, whose field is closer to the former than the latter (ignoring her continued treatment of psychology and biology as the same subject). After asserting that she is indeed so feminist she really slams on her own definition of a "biological woman." Take pride in the fact that you are a woman!* People might get offended, but she's not saying that people should have babies just because they can. She's just saying that if you can't, you're not a woman. She tries to slip that in there with a lot of PC sounding bullshit that clearly wasn't written with any understanding of the people in the groups she's isolating, but she is basically saying if you can't carry an egg to term you are not a fucking woman.

*Assuming you produce eggs and are reproductively viable.

Infertile? Not a woman. No ovaries? Not a woman. Trans? Not a woman (she specifically cited trans men among her "these people don't take birth control for pregnancy prevention" group, just in case any non cishet person slipped through; granted many trans men probably meet her definition of a woman; I think of this as an "it hurt itself in its confusion" moment - trans men are in fact men). You can be a woman if you're a lesbian, but if you're not producing biological offspring to carry on your genes you are useless to her narrative. Bi/Pan/Ace? Do those people exist? Are they reproducing with people with the other size gametes? If not, irrelevant. She didn't exclude these people on purpose, it's just that scientists don't care about them. You matter! Just not to science. She's not a TERF, she just thinks women are primarily defined by their reproductive capabilities (but still a feminist!). Like women's psychology has evolved based on their production of biological offspring, because they've never cared for children that they didn't spit the egg out for I guess? (She specifically mentions the evolution of women and parental investment based on their biological offspring while ignoring/discounting any other influences.) All kinds of concerning exclusions here. All kinds. Anyway that really did it in for me. Fuck her for trying to shove her TERF ideals down other peoples' throats.

TLDR
I spotted this in the library and picked it up, and am so glad I didn't waste money (or that much time on it). The author tries to justify her grossly limited view of woman, her research may be well done but is poorly cited and interpreted, and she's condescending. I don't trust her to present unbiased science and conclusions to me; I suspect her data was cherry picked to suit her needs and her theories are written through an incredibly narrow lens based primarily on her own experiences and perceptions. There are probably a lot of interesting things to learn about the effects of birth control on the body, but I'm not going to learn it from this author.

Edit
As an edit to my already lengthy review - the more I think about this the more it bothers me. The author takes a deliberately exclusionist view of history - taking into account only the direct biological ancestors of people living today - and assumes that no LGBT+ people participated in this process and can therefore be excluded from her view of history. She went out of the way to emphasize the people excluded from her view of the world repeatedly and acted as though the science somehow justified this perspective - as if these people never existed and have no relevance to our psychology today.

[Valerie · Rating 5 out of 5]

A fantastic, must-read for all women on and off birth control. Not only is this book chock full of information about the pull, birth control in general, and the effects of it; it is also PACKED with information and facts about sex, hormones and women in general.

I won this book on a goodreads giveaway and it is my favorite won book thus far. Non-fiction books are not typically my style of reading, but a book like this practically begs to be read. I ate up every word, soaked up the information that seems to be kept from women, and more than doubled my knowledge on the science behind us women.

I highly recommend this book, not just to women on birth control, but to all of us women out there. Not only do you better understand your body, but you can glimpse into your own psyche, mind, actions and every day life.

Thanks Avery Books for this fantastic read, I look forward to reading more!

[Mehrsa · Rating 5 out of 5]

All I can say about this book is HOLY S***! I mean, TMI, but I have never been able to use the pill. I've tried over and over again with different versions and for different reasons (at first for the obvious reason of birth control, but then for other reasons that had nothing to do with birth control but for which the pill seemed to be the answer from my doctors). Every single version and every single time I used it, it made me either crazy, sort of depressed, too emotional, or just incredibly uncomfortable. So I stopped. I've used other methods of birth control instead. Reading this book was just so eye-opening for me. Because every time I've shared my experiences on the pill with friends, everyone seemed to think that the pill made them feel no different than not taking the pill. So I thought I was the crazy unlucky one. But apparently, there are others! And research that backs it up! Some of the research in this book is highly speculative and Hill is very careful in flagging those sections, but some of it seems like common sense. Why wouldn't your hormones determine your mood, sexuality, and a whole bunch of other things? And why wouldn't an artificial hormone disruptor make some of those drives work differently? This is not a book that is anti-pill. She is very careful to say that too and I appreciate it. Without effective birth control, none of us would have been able to do what we did. And ultimately, for many women, taking the pill is the right decision even given the tradeoffs. However, maybe if it's not for birth control, we shouldn't be prescribing the pill for teenage acne or peri-menopausal cramps or whatever else ails those with ovaries and the hormones that accompany them. She doesn't go into other forms of non-hormonal birth control like IUDs without hormones but there are certainly options. In any event, this book is mostly geared toward the young and how the pill my affect your mate preferences.

[Brittany (whatbritreads) · Rating 5 out of 5]

This book influenced me before I’d even read it. I stopped taking the pill after seeing approximately two TikTok videos about how this book was opening people’s eyes to the real effects of it. I put the book on my wishlist, stopped the pill, and then finally got around to reading it. And I’m so glad I did, because I loved it just as much as I thought I would. This book wasn’t the sole reason I quit the pill but it confirmed for me personally that I’d made the right choice for me and my body. And if you’re on the fence or curious, I think it can help you do that too.

Just to clarify, this isn’t an anti-pill book. Well it is, and it isn’t. What I really liked about it and admire the author for, is including a very balanced argument and presenting differing research so you have the facts before you. Sure, she’s mildly arguing for one side based on her personal experience and experience of people she knows and her patients have had, but her focus isn’t to convert you to one side or another. It’s to inform you, so you can make a better decision about what you’re putting in your body, and become more aware of when you should be wary. In fact, some of this presents a very good argument for taking the pill, and I agree with it as someone who took hormonal birth control for five years. It helped me too. But knowing the science behind the pill, and the research that has gone on around it, was fascinating.

This book had me stopping every few seconds to regurgitate information to my boyfriend constantly. I just found it all so fascinating, and I can’t believe some of this stuff isn’t more widespread knowledge outside of scientific communities. I really appreciated the layout of the information, the science is presented to you in bite size segments and if you're unfamiliar it’s super easy to follow along with. We take a gradual journey so but the time we’re discussing different types of hormonal pills and the effects on our brains and our bodies and everything in between, it all makes sense. And it’s mildly horrifying, and incredible.

It presented a very balanced, well researched little book and I loved it. It took a scientific approach and was really informative, but the author also let her guard down and shared personal anecdotes and more emotional pieces when it was necessary. I was completely engrossed the entire way through, and it has taught me so much in just a couple hundred pages, and really shifted my perspective on things. It was really eye opening, and I had a great time reading it. This will be one I recommend and talk about a lot more frequently.

[Autumn · Rating 1 out of 5]

This book was hugely disappointing. I should have looked at the author’s credentials as an evolutionary psychologist before reading, given that the entire frame of the book is built on biological determinism (e.g. “you are your hormones” and not much else) and the assumption that humans are driven almost entirely by sex-driven, reproductive-seeking behavior. Evolutionary psychology is essentially a theory and yet it is used to no abandon in this book to interpret data related to research on the pill.

The author’s heterosexism is on display throughout the text, as she consistently ignores queer people’s experiences, because they don’t fit in tidily to evolutionary theory. Her upholding of the gender binary through constant citing of sex differences research (including some pretty poorly-done studies on attraction to “feminine” vs “masculine” faces on and off the pill) are based on antiquated assumptions. Despite believing in a theory which allegedly explains all of human history, her sense of history is poor in that she seems to have thought women have had a significant say in their “mating” choices/marriages/etc. Not only is this fairly inaccurate for all women, it is especially true for certain populations based on race, class, social position, etc. Naturally she doesn’t touch on any of these aspects of identity.

The only redeeming parts of the book were where she explains the actual science of how hormones impact our body, as well as a chapter toward the end that discusses women’s historical exclusion from medical research. Unfortunately her book perpetuates the same exclusion of populations by focusing so narrowly on reproduction and heteronormative cultural narratives.

Lastly, and this is likely the publisher’s fault, but the censoring of curse words (e.g.: sh**) throughout is so obnoxious for a book that talks about labial secretions. If you’re going to write in a tone supposedly made for adults, own it.

[✨ jami ✨ · Rating 4 out of 5]

3.5*

Some chapters (especially those more toward the start) were SO good and some were a miss. The tone of the writing annoyed me at times. I also didn't like that a lot of the examples presented in this book were just assumptions made by the author - while I understand this is an under-researched area, I really didn't like that entire chapters were based around concepts that might maybe be real potentially if our assumptions are onto something.

That said, the chapters that were good were GOOD. The section about different generations of the pill and the impact of the pill on mental health and mood were great. It was just when it leant too heavily into speculation and evolutionary psychology I was put off. Overall, still worth the read for me.

[marta the book slayer · Rating 4 out of 5]

I really appreciated that this book left the reader with the choice to decide whether to remain on the pill or not. There was no hidden agenda from the author to persuade you to one side. Thus, she really tells both factual sides of the story, gives various personal examples, and research. I learned so much and female health is an area I have become increasingly interested in (no surprise as I am a woman so I should really learn as much as I can to live my healthiest life). Glad to have picked up this recommendation from the Healthier Together podcast.

For those looking for a reason to pick up this book, did you know that a women's cycle determines who she will be attracted to (basically it varies as a woman goes through her cycle every single month)... if you did know this and are curious to learn more I encourage you to read, if you had no idea, well then no worries I didn't either until I read this book!

[Jillian Doherty · Rating 5 out of 5]

This book should be in every counseling center - chocked full of factual affirmations, opening one's eyes with paradigm-shattering data.

This book provides an even-handed, science-based understanding of who women are, both on and off the pill. It will change the way that women think about their hormones and how they view themselves.

The truth about how the pill can affect women is hidden but crucial and only starting to be known. No researcher wants to be on record as the person who took down hormonal birth control, but every woman who is using it needs to know. The consequences can range from casual (mild mood swings) to devastating (suicide).

Galley borrowed from the publisher.

[Diana · Rating 2 out of 5]

The book was very informative and definitely gave me great insight on birth control and how it works (against) in your body. However, the author added so many “quirky” footnotes that constantly left a bad taste in my mouth. I felt like she was bragging about how intelligent she is the whole time, as well as making the readers know that she is “trying her best” to put everything in a simple way, so that even WE could understand. I liked the book, but the author made me uncomfortable. I’ve never been so off-put by the voice of the author in a book before!

[saranimals · Rating 3 out of 5]

Excessive use of footnotes significantly impeded the flow (pun intended) of reading

[Haley Baumeister · Rating 4 out of 5]

If a naturally cycling woman gets to experience the 4 "seasons" every month, those on hormonal contraception are forever in the fall & winter of their cycle (albeit in a synthetic form). Though not a perfect replica of the luteal phase, this comes with its own set of hormonal implications that effect things such as mood, energy, interests, sexual attraction and arousal, and overall zest (or lack there-of) for life in general.

The author does a decent job of explaining the natural cycle of women and how hormonal contraception does not *just* affect your ability to get pregnant. A woman's ability to get pregnant is a result of ovulation... which is a result of a set of hormonal cascades involving rising estrogen and the LH spike... which effect our mind and body.... which are part of the delicate makeup of our hormones that predictably fluctuate throughout the month..... which make us who we are.

In this book the author is focusing on the mind, and she does so with a heavy dose of evolutionary theory (although a lot of this can be attributed to, well, being designed as men and women). Using data gleaned from scientific studies, she covers FASCINATING data research on how women on the pill (vs. naturally-cycling women) are effected by mood changes, depression and anxiety, sexual attraction and arousal, the ways in which we choose partners/husbands, circumstances that lead to weight gain, motivation & brain fog, the suppression of cortisol's stress response, the oxytocin released (or not!!) when we see our partners/husbands or NEWBORNS.

I wish she would have gone further into how hormonal contraception is *still* pushed by providers for postpartum women already susceptible to crazy post-birth hormones, the baby blues, postpartum depression & anxiety, lack of sleep and new mom stress. It is WILD to me that I see so much talk about about postpartum depression and anxiety (rightly so!) without the caveat: "HEY, MAYBE IT'S BEING WORSENED BY THOSE ARTIFICIALLY MESSING WITH THEIR BODY'S DELICATE BALANCE DURING AN ALREADY DELICATE TIME."

One time on Twitter, I posed the question of whether women who had gone to the doctor for depression had been asked *at all* whether they were on hormonal contraception...... sounds like it's not a basic, routine question! That is also wild, since everyone I know of who has been on hormonal contraception has talked about having depression or being diagnosed with some sort of mood disorder. What a terrible oversight in the care of women, or getting to the root of problems for them.

It bums me out that so many women are suffering unnecessarily because of the easy prescription written for contraception (we're only fertile 6ish days a month).... for "iRrEgUlaR pErIoDs" as a teenager (probably a deeper cycle issue that's only being masked, not treated, and will have to be dealt with eventually... potentially when the woman wants to have children and it might be a time crunch to get to the actual fertility problem.)

I'm aware the author was focusing on the effects on the brain, so I'm glad she mentioned that medicine is so focused on the PHYSICAL safety of prescriptions and procedures, we often put up with the "other" effects as if they are an afterthought. But as her research shows, all those "other things" in our mind, which affect our lived experience.... ARE who we are. We can't just take the pill to target the one part of us that releases an egg in ovulation. Our hormonal makeup is a whole, interconnected package that effects everything.

She does touch on some physical side effects, too though. A glaring one she neglected to add is that hormonal contraceptives are classified as a Group 1 Carcinogen. The widespread embrace of the pill from the 60's onward has now led to studies on the connection between its use and breast cancer in women years afterwards...!

Anyways, she weaves in a lot of talk about how the pill has revolutionized women's participation in the workplace and furthering our education, control our family planning, etc. At times this started to grate on me, because goodness..... it's 2022 and we have more knowledge than ever about how women's bodies (and our natural cycles) work to allow us to be fertile only like 6 days a month! Taking the pill is not a given, and more women are learning this! The author touches on how charting/journaling your mood and physical signs could be beneficial on and off the pill. I wish she would have advocated more for charting in general. Some women still do not know the basics of how their female body works to affect their mind and body in predictable ways throughout the month, via the stages of their cycle. I would say it's far more empowering to have such knowledge and ownership of your body than.... suffer the consequences chronicled in the data of this book.

She certainly wanted it to be known that women should have more options, know them, and take personal ownership themselves (even as we wait for the world of medicine to catch up and stop pushing things on women that often do more harm than we're willing to admit in the name of "empowerment" or masking symptoms.)

Good resources for women include: FactsAboutFertility.org / NaturalWomanhood.org / NaProTechnology.com.

I also hope to get through many of these books eventually: https://www.goodreads.com/review/list... (In particular, "The Fifth Vital Sign").

It was a pleasant surprise that in the last third of the book, where she's ruminating on the social implications of easy access to contraception.... and the dating/sex market vs. the marriage market... she mentions the data-filled book "Cheap Sex" (https://www.goodreads.com/en/book/sho...) by sociologist Mark Regnerus. (My husband took his class at the University of Texas, Austin). We as a society think we can make sex (in hook-up culture, dating, in pornography, etc.) cheap, easy, and commitment-free.... and then are surprised that it's hard to find someone willing to put in the work and commitment the privileges of marriage require.

As for the portion on how data in medicine and scientific research skews male (because of women's natural cycles & their corresponding hormones "messing things up" and making the research more nuanced), I was reminded of the book "Invisible Women"(https://www.goodreads.com/book/show/4...) by Caroline Criado Pérez.

I could have done without her often-times immature and girl-bossy phrasing....... but all in all, a good primer for anyone not familiar with any of the effects of artificial hormonal contraception. I found the data from research studies some of the most valuable, eye-opening information this book had to offer.

[Hope · Rating 4 out of 5]

This book was so freaking interesting. It should be required reading for anyone on birth control - not to scare anyone - but because better information leads to better decision making. I learned a lot from this book that can explain some of my experiences on hormonal birth control, and that information will likely help me make good decisions if I ever decide to go back on it.

My one complaint about this book is that I thought the author generalized a little bit too much about women’s experiences of birth control. Access to birth control is not, and has never been, evenly spread across all populations of women, and I wish the author had considered that a little more. I also find it hard to believe that the current male-female achievement gap can be explained by the rise of birth control and men’s sexual motivations... but that’s maybe just me expecting too much from men!

[Laura Noggle · Rating 3 out of 5]

*Note: Despite the star rating, this book should still be read by anyone who's ever taken birth control for extended periods of time.*

I'm glad this topic is being talked about, but as the author states, more conclusive research is needed.

Yes, there are many unknowns when it comes to ingesting birth control, and much of this I think I've already gathered throughout my years. When I lived in Asia, I stopped taking birth control as I really didn't trust getting it in China where "controls" and "standards" are laughable at best.

After a brief return to it, I've been off birth control now for almost 5 years. I'm not sure if I was ever a different person on it, but intuitively, I lean more and more towards not messing around with man-made hormones. There are so many unestablished risks and possible long term effects.

The author did an admirable job, although it could have used a tighter edit with less repetition.

Conclusion: More research and stats are needed, but it doesn't hurt to err on the side of caution. Consider taking a break for a while and trying a new method while recording your own personal case study.

[Laura · Rating 1 out of 5]

BIG sigh
… where to begin (cursed quotes below)

I spent more time being irritated with the author rather than taking in the information I was being presented there. The little things that were actually interesting seem so irrelevant compared to the problematic things in the book. I can’t believe that a supposedly educated mature woman will seriously use condescending language when talking about the female body. I also can’t believe she feels the need to present herself like Regina George’s “cool mom” and mention that she’s more than just her “nerdy” hobbies (wtf?). I absolutely can not believe that she deliberately includes sexist jokes and censored remarks in a book about reproductive health and women’s bodies.


OH and most of the information is either based on random statistics (that later on is being contradicted) and/or mostly speculation. It is extremely disappointing to see a missed opportunity for a crucial topic that has been neglected for too long.

Here are some quotes that are just cursed

“During that time, I was able to graduate summa cum laude from college (nerd!) and go on to get a PhD from one of the most competitive psychology programs in the country (double nerd!)” 💀

“I happen to have both a uterus and an advanced degree.”

“Nobody was expecting women to out-perv men when it came to getting down to business with the pictures. But they totally did.”

“And if you’re a black lemur – a sexually dimorphic primate, with brown-furred females and black-furred males – they make your fur turn black. Which is totally embarrassing. Even for a lemur.” ???????

“Because sex no longer comes with the risk of pregnancy” 😃?

“Interestingly, research in humans suggests that human males (those slightly less hairy apes that we call men)” …grow up.

[L.R. Lam]

I found this really interesting. Learned about:

- how hormones work in AFAB bodies
- how birth control is made and the hormones synthesized
- that most research studies use male subjects, even male rats and even cells (!)
- a lot of the time this is due to the pressure for academics to publish often--takes longer to control for hormonal cycles etc.
- plus of course how birth control affects the body and mind, which is the bulk of the book
- the potential wider ramifications of birth control, e.g. the divorce rate

What I would have liked more of:
- birth control as medical treatment (for things like endometriosis, PCOS, etc)

I also appreciated the caveat at the start that most of the studies were done on white, straight, cisgender women and therefore was lacking in intersectionality.

Overall, super interesting. Really recommend to people both on and off birth control, because we're not really informed and knowledge is power.

[Sara]

Informative look into the contraceptive pill and it's effects on the brain, from choosing different partners, smell sensitivity and beyond. It was certainly food for thought for someone who is currently in the process of coming off its continued, long term use and how it's changed my personality in many respects over the past 15 years. I did find some of the information presented to be quite repetitive however, and I would have liked more case studies from other women and how they responded to the pill. Overall though, this achieved what it wanted to do, which is get information about the contraceptive pill out to a wider, non science based, audience. .

[Jaimie Krems · Rating 5 out of 5]

As an evolutionary social scientist---I'm professor of experimental psychology at a large research-focused university---I had very high expectations for this book. It exceeded those expectations.

Dr. Hill is an incredible author and her work is not only readable, but it's also plainly fun to read.

I will be assigning this book to students and recommending it to those interested in women's psychology and behavior, evolutionary medicine, hormones---and simply to all who are interested in better understanding the mysteries that still wait to be discovered about women's bodies and minds. (For the record, given what this book reveals about the impact of birth control on women, everyone should be interested in better understanding its effects on women.)

[Tasnim Rahman · Rating 1 out of 5]

I found it so frustrating that ‘Dr’ Sarah Hill kept regurgitating the onnnnly reason that females take the pill to avoid pregnancy pregnancy. I mean, let’s ignore all the women who take the pill for pre-menstrual syndrome (PMS), Premenstrual dysphoric disorder (PMDD), Polycystic Ovary Syndrome (PCOS), reducing acne, regulating periods, reducing risk of uterine cancer, managing endometriosis, treating alopecia and other reasons not mentioned. Yet, Dr. Hill’s obsession with sex, and pregnancy, is annoying to say the least.

The language used in this book is childish sometimes which takes away the integrity of the content. Dr. Hill also presents the argument that testosterone is reduced by the pill (what about PCOS then?) and I find it odd that she refers to testosterone as ‘T’, as though it’s a forbidden word.

Needless to say, her basis of stating females on the pill are less sexually inclined and active being based off from a study on female apes is a big disaster. Initially I thought her stance on women’s behavioural and psychological changes from being on the pill would be on cognitive impact and change but she relies heavily on evolutionary theories which just became a bunch of jargon for me.

Up next, the big D. Depression. Dr. Hill mentions that correlation does not mean causation; pills don’t cause depression and that there must be another variable. However Hill does not use this argument for the rest of her theories about sex-mating, stress response and so on. Depression and other mental health impacts are rarely mentioned. If anything she brushes over these until the very last chapter, in relation to suicide. Do I need to expand on how problematic this is? She attempts to back up this theory through evidencing an article which presents that the percentage of women likely to be diagnosed with depression 6 months after being put on the pill is 50% and percentage of women given antidepressants is 40% which is very high, though not a surprise to me. I still need to read up on this a little further.

So, a good thing about the book is that the graphs help to understand hormonal explanations, aiding visualising how an ideal hormonal journey would seem, on paper at least.

The last chapter explains why studies are male dominated and orientated. However this chapter would have been better placed in the beginning. It’s the only chapter that I could relate to. It would be helpful if she had included further research probes and who’s responsibility it is to change narratives and priority rather than just ‘society and science’. She is passive about the state of research and it’s concerning.

Finally Dr Hill, in the same chapter, talks about depression as an effect of the pill, but barely touches on this. An interesting conversation she introduces is the best age to go on the pill according to how our brains respond as teenagers and adults. I found this part of the book so much more beneficial and it would have been so useful to have a comparative study between several contraceptive methods to take her stance one step further rather than basing it on a theory that has not yet reached research panels. I’m going to do some more reading around this as the book could have been a lot more focused on the final chapter.

Do I need to give overall thoughts? It’s a waste of time for anyone looking to read into it. Look for journal articles instead, that’s where I’ll be looking next.

[Jasmin Abbott · Rating 3 out of 5]

Brilliant summary of current evidence about what being on the pill does to your body that is extremely needed - however I would want readers to bear in mind this is how one person explains their (well researched) interpretation since, as someone with a scientific background, there are many points in the book I would be more critical of the evidence and therefore the interpretation. Not all scientists think evolutionary biology/psychology is an explanation for everything, which the author does not touch upon. I gave the book three stars for this reason; that the author does not discuss other perspectives, which is a failing given the book is intended for consumption by people who may not have the tools to critique the evidence and opinions themselves. Some other points I thought could be improved on. Unfortunately the book talks about ‘the pill’ and doesn’t separate out evidence much for the combined pill and progesterone-only pill (probably because there isn’t enough evidence to begin with). The book is also entirely about “women” who take the pill for birth-control - whilst the author does caveats that the book is also for people taking the pill who don’t identify as women, I don’t think the language throughout the book reflects this. Finally the book constantly references making a choice about taking the pill for birth control and doesn’t talk about people who take the pill for medical reasons e.g. what should people with PCOS (a very common condition) do with this evidence?

I hope more similar literature and research into this field comes! The authors summary about why the field of research is so lacking is very good and I wish more people knew about this!!

[Divya Shanmugam · Rating 5 out of 5]

I really liked this book. It gave me questions I'd like to ask my doctor and this /very/ cool table that breaks down the types of progestins used in different birth control pills and side effects you could expect from them. I appreciate the author's inclusion of contradictory studies - it eased my skepticism towards lines about a study that studied X and showed Y. The only comment is that its written sort of colloquially, so I found myself skimming over some paragraphs.

I learned that the endometrium is one of the most hostile environments for an embryo to implant in ! This is meant to weed out the weak embryos and studies on mice have shown that embryos thrive easily (almost parasitically) in other tissues.

and then there's a story about a fish with three genders that I won't spoil!!

[Sam · Rating 4 out of 5]

This was a good read! Don’t be alarmed - this book isn’t full of fear mongering or negativity regarding birth control. It’s really not one sided at all. It’s scientific, and discusses how the pill affects all women in so many different ways, and that it’s the woman’s decision to take it. Women really need to be outspoken about our health, since we are rarely listened to, so I think this book would be great to read for all women.

[Mehtap exotiquetv · Rating 2 out of 5]

In diesem Buch werden unterschiedliche Nebenwirkungen der Pille besprochen. Diese Nebenwirkungen können laut Autorin folgende sein: Stimmungsschwankungen, Unlust zu Sex, Thrombosegefahr für die Pillen der dritten Generation, Unattraktivität gegenüber Männern, falsche Partnerwahl.

Dabei argumentiert die Autorin nicht immer sachlich und wissenschaftlich. Gerade bei der Partnerwahl berichtet sie von Anekdoten ihrer fremdgehenden Freundinnen, die beim Absetzen ihrer Pille bemerkt hätten, wie doof und unattraktiv doch ihr Partner sei.
Ziemlich absurde Argumentation, die nicht auf Daten basiert, sondern an subjektiven Empfindungen. Und Frauen, die die Pille nehmen würden, wären sexuell nicht attraktiv und Männer wollen kein Sex mit ihnen haben wollen.

Dann greift sie bei der Argumentation auf sexuelle Unlust auf Daten zurück (endlich), die dann auf unterschiedliche Generationen der Pille und ihre Bestandteile zurückzuführen ist. Denn nicht jede Pille hat dieselbe Zusammensetzung. Und nicht jede Frau reagiert pauschal gleich. Leider betont das die Autorin sehr selten und unterschwellig, dass diese Nebenwirkungen nicht alle Frauen zutrifft.

Ich hätte mir wirklich gewünscht, dass in diesem Buch sachlich die Vor- und Nachteile aufgelistet werden, was aber sehr kurz kommt. Die Anekdoten ihrer Freundinnen, die kontextlos die Pille erklären sollen, empfand ich dann doch sehr verwirrend.

Etwas enttäuscht war ich schon von den Inhalten, die auch sprachlich betrachtet sehr metaphorisch waren.

[Meghan · Rating 4 out of 5]

This book covers a TON of research in a very digestible way. Relatively unbiased, secular book that details the side effects of various types of hormonal birth control.
The voice of the novel is extremely casual and there is swearing so it won't be everyone's cup of tea.
It was both affirming and sad to hear that my own struggles with mental health while on the pill (to try to alleviate PCOS symptoms) are not unique. I'm thankful that Sarah Hill and other researchers are trying to make sure women have a full understanding of how these medications can affect all aspects of our lives so we can make informed medical decisions.

[Lindsay Nixon · Rating 5 out of 5]

HOLY F—— s—-!

READ THIS BOOK ASAP. Even if you aren’t in the pill or are in menopause. This is a mandatory read. It’s also the most comprehensive book on women’s health (mental, endocrine and reproductive) I’ve ever read and I read 13 books on periods alone last year.

This is also a must read for any feminist.

If you are a woman that has difficulty with happiness, depression, promotion/success, stress, feeling mute, weight management, feelings sexy, feeling content with your partner, motivation, energy levels, relationships, definitely do not miss this book!

[alyssa · Rating 4 out of 5]

super interesting book. she obviously had to dumb it down a bit, as it is for the lay-person and not the scientist, so sometimes the writing can be a little too informal to the point where it feels like immature (using words like fucking, bullshit, etc.), which i don’t love when i am reading a non-fiction novel. it makes it feel like it’s trying to be edgy and cool like chyeaaah bro hang loose!! like if you’re reading something educational, it should be treated like important information - you can simplify it without making a mockery of it

that aside, the content was super fascinating. it was laid out really clearly, following a really concise and logical roadmap. her points linked wonderfully. there was clearly a lot of research and planning that went into this book

my overall takeaway is: although birth control has undoubtably been beneficial for women, that shit is scary. SCARY!!! this book scared me straight i can’t lie. everyone’s experience with birth control is different, certainly, but mine aligned with a lot of the things she talked about. life felt more vibrant and magical, and less dull, once i stopped my birth control. i felt alive and awake again, and i didn’t even know or notice that i was asleep

hopefully, one day, women won’t have to sacrifice their mental and physical wellbeing in order to avoid a life altering, life changing, or even life threatening pregnancy. that’s the dream! hopefully we can have it all