Sarah E. Hill on Women’s Brains and the Birth Control Pill

Sarah E. Hill is a research psychologist who uses theoretical tools taken from evolutionary sciences to study psychology and health. Recently, she has turned her expertise to uncovering what we know and don’t know about the impact of the birth control pill on the brain. In her TEDxVienna talk, she lays out what science knows so far about the relationship between the two, hoping to empower women to make informed health choices.

Mrs. Hill, you’ve studied Anthropology in Milwaukee, and earned your PhD at the University of Texas at Austin. Would you tell our readers when exactly your interest in this particular topic of the birth control pill and its effects on the brain was sparked?

It started about…six years ago, when I went off the birth control pill. I felt different.

So, it was a personal background?

It was! So, my background – I’ve been working as a research psychologist for almost nineteen years, either as a PhD student or in research faculty at University, and I studied women and health, and especially women’s sexual decision making and relationship psychology… so, my background has always been {in} an area surrounding this issue, but I was never aware of the research showing the way that the birth control pill influences women’s relationship psychology and their brain. It was when I went off the birth control pill, that I had an epiphany – ‘the birth control pill influences women’s hormones, and we’ve known for decades of research that hormones influence their behavior, so of course the birth control pill must be influencing women’s behavior and the way that their brain works too!’. I feel like I had a blind spot. I always thought of the birth control pill in terms of preventing ovulation, I never thought about how pervasive hormones are in the body, and never connected the dots. So, I went into the research literature to see what people published on it, and I was surprised that there was quite a bit of research, but there were also a lot of research questions that still needed so be answered. What I wanted to do is get all of this information in one place together for women, so everybody could get the information I didn’t have.

That sounds incredible – so, you wanted to fill the gap that was missing to you personally and give it to the public?

Yes, a lot of it was just teaching women about the way that hormones influence the brain, because I had to get a PhD to learn that, and we shouldn’t have to get an advanced degree to learn about how our bodies work. I wanted to give that information to women, and I wanted to communicate in conversational language and make it accessible to anybody.

In your talk, you’ve mentioned your research on sex hormones and how they impact women’s behaviour, can you tell us more about how you conducted this study?

The research is a combination of what we’ve done in the research lab and what has been done by other people for decades now. When I first thought of the research question, I went to the databases for psychology and medical research to do key word searches. I downloaded every single paper that had been published, and experimentally looked cross-sectionally at how the pill influences women’s behavior and the structure of the brain – and I read them all! (laughs)
What we’re doing in our research labs now is filling some of the gaps. Just to give one example, there’s research that finds that women who are on the pill don’t express their preference for testosterone markers in men. So, what I was really interested in was whether it’s possible that pill-taking women’s perceptual acuity might be damaged. What we’re doing right now is testing the impact of the pill on women taking the pill versus on naturally cycling women, looking at actual levels of oestrogen within both groups of women, and seeing whether or not that predicts how quickly women are able to notice one face turning into another more masculine or feminine face – we use a facial morphing program for that – or acoustic signals where a voice gets morphed a little bit deeper. What we want to see is whether or not the pill is making women less sensitive to those differences.

Let’s talk about your book for a moment, which has been rated number one on Amazon’s hot new releases. Some of the pill’s side effects mentioned sounded quite shocking to me, for example, that the birth control pill ‘can form your very identity […] and going off the pill can change the sense of who you are’. How much of an impact do you think statements like these have for women who have to make this rather impactful decision regarding birth control on a psychological level?

Right, experientially – for me, and for a lot of women that I’ve talked to, especially if you’re on the pill for a long time, you start to get a sense of who you are, and how you experience the world, and when you go off it, it really starts to feel like waking up, and having to re-figure out the way that you respond to the world around you. In fact, after my talk, a young woman came in and talked to me, she told me she’s been on it [the pill] for a decade, and it took her two years to know who she is again [after stopping]. It took her this period of learning how she is responding to the environment. She found that she was not as career-motivated as she was when she was on it and now she’s more concerned about work-life-balance, and she feels more feminine, more in tune with that side of herself  – these are oestrogen effects! It’s not like our hormones turn us into a radically different person, you don’t wake up one day going ‘oh my gosh, who is this?’. Instead, it tilts the handle a little bit. It may shift you from solely being career-focused to wanting more balance, because you’re more in tune with your femininity – those are some of the oestrogenic qualities. Sometimes I’ve heard women who went off the pill say they’re starting to think about babies, and fearing to set the women’s movement back fifty years by these thoughts (laughs) – But some of these things are nudged towards the female prototype by the sex hormone oestrogen.

In your book title, you use the term ‘law of unintended consequences’, could you explain this to our readers?

Absolutely! The thing about ‘law of unintended consequences’ is, whenever you have an interdependent system, whether it is the hormones in the body or individual women within society, you can’t make a small change. Any change that you make from point A is going to influence point B, point C, etc.

A ripple-effect?

Like a ripple-effect! Hormones influence so many different systems in the body, and women’s sex hormones influence almost everything, because almost every system in our body requires a work-around for pregnancy. The immune system, the digestive system, all of these different systems that we have require the body to do something different when a woman is pregnant. What that tells us is that these are systems that are sensitive to sex-hormones, so when you change sex-hormones, it changes all of them. When you’re changing women, they are in relationships with other people, who are again in a relationship, and so on. You’re changing the world. In one of the chapters in the book, I talk about the fact that women taking the pill has influenced men’s behavior and how that might influence us globally, for example, in the types of jobs that are created. So, in interdependent systems there are no such things as small changes, there are always going to be unintended consequences, for better and for worse.

So, this does have an effect on the public in a greater understanding, would you say that the scientific understanding of this rather vital topic is already breaking into public realm or is it still counted as ‘taboo’ – especially when it comes to women’s sexuality and reproductive rights?

I think there’s not enough out there. There’s not enough discussion about it, for some of the reasons I talked about in my talk. The idea of having thoughtful conversations about the birth control pill in a critical light where we evaluate the trade-offs and think about the question ‘is this always a good idea?’ has been a taboo even among feminists. There is this idea of ‘don’t question the pill, otherwise that freedom is taken away from us’, or ‘we shouldn’t talk about sex-hormones and their effects on the brain, or they’re going to take away our right to vote’. So, that’s one side of taboos that makes it tricky. Then there’s the opposite side, it’s a sort of bipartisan issue, because on the other side you have people who don’t want us to talk about women’s sexuality and the idea that if we have the birth control we’re going to do all sorts of reckless things. It’s a hard topic to have thoughtful conversations about, because you can get all sorts of reactions to it. The second part of the issue is that there is not enough research. We need more science, more thoughtful science to move forward and address some of these unanswered questions. Only very recently, less than twenty years ago, people have started to ask, ‘what happens to the brain on the birth control pill?’, and even now there’s not enough research on it, because everybody, even medical doctors and neuroscientists – people who understand the way the body works – sometimes have this magical thinking about the mind being something other than a product of the brain. We have this idea that who we are is an essence of this soul that exists outside the production of the physical body, but that’s not how it works. Our mind is a product of our brain, and part of the way it works is through hormones. So, I think that we had some magical thinking going on, and I think it’s time that we get rid of this magical thinking, and recognize how our brains use our hormones to create this experience of being ‘us’, and push for research to understand ‘who does a woman become on the birth control pill?’.

You’ve mentioned that the pill was described as ‘a force in the lives of women’, who are now scared to criticize it, yet we still have to start this conversation. What would you suggest that needs to be done in order to inform the affected audience?

I think it really is a matter of education, education, education… Women need to learn how their bodies and brains work, and how the body uses hormones and how that influences who they are. In the absence of the pill, they need to understand what the domains of influence are, in terms of how the pill might affect them psychologically, and then start to have thoughtful conversations about it. We need to take away these taboos. Women need to talk to their friends, their mothers, their daughters, their doctors. They need to talk about the experiences they’re having on the birth control pill, and push to find something that works for them. Sometimes it means finding a different pill, sometimes it means getting rid of the pill altogether.

So, it can also be used as a form of female empowerment?

Absolutely. I think education is empowering, and if we work together to find good options, we will be able to do it.

Talking about the future, as it’s our ten years’ anniversary of TEDXVienna, where do you see yourself in ten years? Perhaps at TEDXVienna 2029?

That sounds amazing, I’d love that! Mark me down! (laughs) I think I’m going to continue bringing science out to the public. This was my first book, and I really enjoyed writing it. It’s incredible to be able to take the thing I love as research and make it available to everybody. I can see my career continuing with doing a lot of research, and doing things that brings this research to people, so that everybody is able to learn about the things that I’ve learnt in my research lab.

Thank you!

Photo: Gavin Gough

Sarah E. Hill’s debut release ‘This Is Your Brain on Birth Control: The surprising science of women, hormones, and the law of unintended consequences’ is now available for purchase.
Make sure to watch her TEDx Talk from the About Time conference!

Leen De Marez

Leen is a speech therapy student from Vienna who holds a degree in English language and linguistics. She firmly believes in social change, extraterrestrials, and the use of the Oxford comma.

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