Women’s health means more than eating well, exercising and having a heating pad for that time of the month. It includes contraception and sexuality. Both are very complicated and often politicized. In 2021, we still see governments around the world making decisions about women’s reproductive health. We wanted to do a deeper dive into both contraception and women’s sexual health to provide women with the information that they need to make informed decisions.
We spoke with Dr. Julie Thorne to get an expert opinion. Dr. Thorne is the current family planning lead for Women’s College Hospital and Mt Sinai Hospital. She spent 2018-2020 working in Eldoret, Kenya with the AMPATH Consortium (www.ampathkenya.org) and her time there has given her an important perspective on global women’s health, health systems, and innovative ways of thinking about care delivery. Dr. Thorne’s fellowship was in the CARE program at Queen’s University. She is most passionate about contraception for family planning and for menstrual management, as well as safe and accessible abortion care. She gave us her insight into both topics.
How have contraception choices changed over the years?
Women nowadays are not just limited to the pill which was the case when female contraception first became available. The doses of estrogen and progesterone at that point were quite high which was problematic. We now have options that include the pill, the patch and the vaginal ring. There are methods that combine estrogen and progesterone and progesterone alone. We have methods that don’t have hormones in them. We have long-acting options that can three years, five years, seven years and ten years. There are also short-acting methods that you have to use every time as well.
Contraception is not only a method for preventing unplanned pregnancies, but can help women with their menstrual health. Tell us about how they help, when you prescribe them and how women can decide which method is best for them?
I think that the element of choice is important for the patient and remembering that one size doesn’t fit all. Just because one method doesn’t work, doesn’t mean that another method won’t work. One place to go for information is to speak to your healthcare provider about what you are looking for. Also, look at other places that have reliable information for self-education. I refer people to websites including sexandu.ca and birthcontrolforme.ca which explain the options. There are also self-guided questionnaires on them so that you can think about how your menstrual cycle is, what you are looking for, when you might want to plan for your next baby if you want to have kids at all and what your lifestyle is like. Some people take the pill every day because they have other medical conditions and some people can’t remember to take a pill every day so they may want something that they can set and forget.
A lot of women will experience problematic symptoms with their menstruation that we consider outside of the realm of normal. These symptoms may include heavy bleeding, excessive pain, even less common side effects like migraines or on rare occasions, seizures. We can manage these side effects through manipulation with hormonal contraceptives. A hormonal IUC (intrauterine contraception also known as an IUD), for example, can greatly reduce your menstrual flow. Methods that suppress ovulation (the release of an egg with your monthly cycle) can manage cyclic symptoms. These methods include the shot (hormonal injection), the hormonal contraceptive pills or the implant.
Things that contain estrogen can help a lot with things like problematic hair growth or acne. Then there is the idea that women want control. Sometimes menstruation is a bit of a nuisance and there has been a trend in wondering if we even need to menstruate if we aren’t trying to get pregnant. Can we suppress menstruation so that we don’t need to worry about bleeding every month and have it interfere with our daily activities? We need to learn how to empower ourselves when it comes to learning about contraceptive functions and how they might fit into your life by navigating to websites like birthcontrolforme.ca and sexandu.ca – they are good places to start.
Why aren’t certain contraceptives available in Canada if they have approval in the USA or in Europe?
Everything that we offer to people in medicine has to be approved by Health Canada. That is important. A lot of women focus on natural medicine and natural methods. They don’t realize that when they try to medicate themselves with supplements, that a lot of them are not regulated. All of our medications are regulated. They need Health Canada approval in order to come to market. Our regulations require us to study them in a population that reflects our own which means that trials need to be conducted in Canada. The randomized control trials that look at efficacy and safety of a drug are very expensive and have already been conducted in other countries. Not all drug companies will want to invest in another country, especially in Canada where we have a smaller population. There just isn’t a lot of incentive for them.
There also has to be market demand. If it isn’t there, then a drug company doesn’t have the motivation to bring it in. There is also the issue of accessibility. It is part of the duty of the Canadian government to make contraceptives accessible, but not all options are available to all people and this is an issue that I feel passionately about. It depends on whether they have private insurance or if women have to pay for them out of pocket.
What new contraceptives will be coming out?
In Canada, the newest contraception that not everybody may be aware of is the implant. We are expecting a new pill on the market that has a different estrogen in it. That’s really hot off the press and not available yet. There is some fascinating technology and multi-drug tools that are undergoing research. They prevent pregnancy and STIs (sexually transmitted infections) through a contraceptive ring. We are also looking at different shapes of the IUC, but this is still in the research and development phase. The standard IUC is a T-frame and they are excellent and there are also hormonal IUCs. There are some updates that are researchers are working on in other countries that haven’t worked their way into Canada.
Women’s health, and our reproductive health in particular, is always a hot topic and often gets politicized. Why are we still talking about this in 2021?
This is a topic that I feel passionately about. We have this incredible social consciousness and this incredible connectivity around the globe. Here and internationally, women continue to be denied opportunities and there continues to be efforts to control or suppress their sexuality. This focuses on their reproductive health and also suppresses their efforts on the path to success in reaching their own goals. Religion and politics are often hard to separate and women’s sexual health can be politicized for the sake of votes. I think until we have gender equality, this is always going to be a hot topic.
It would be great to see a focus on accessibility for mental health services for women. We need better accessibility to providers of pelvic physiotherapists. Contraception and women’s sexual health including menstruation and their sex lives needs to be mobilized and properly represented rather than being treated as taboo. We have seen the expansion of contraceptive options, but we need better advocacy. It must be made a priority with the people who sit at the Health Canada offices.
Women need options, and it’s our responsibility to make them available to them, both for quality of life and supporting a healthy society. We need universal contraceptive private coverage which is part of the international, sustainable development goals which we aren’t even close to meeting. There are arguments in this that expand beyond just our own autonomy in choosing contraceptives. It saves the government money to have accessible options that include contraceptives like the IUC and I’m not sure why they don’t take a broader lens on that. Thank goodness we have women out there who are making some noise.
Read Part 2 of our interview with Dr. Thorne to learn more about women’s sexual health.