The Pill.

Today we have a post that’s a little bit different, and if I’m honest, it’s an absolute belter.  Katie , who has a huge passion for science, and who writes the brilliant blog A Is For Aspirin has written about the Pill, explaining in an accessible and hilarious way about exactly how it works.  I know I won’t be the only one who has taken the Pill without thinking much about what’s behind it, and how exactly it affects my body.  I want AOW to be able to answer the questions we don’t ask, and I want to start a conversation which leads us to understanding our bodies better.  I found this fascinating, and I think you will, too. 

Over to you, Katie:  


I’m a big believer that everybody has a hidden (or not so hidden) soapbox subject. If you get them started on it, you know about it, because three hours later you’re still listening to them, and still attempting to avoid Matrix-style their ever more expansive hand gestures. Well my personal soapbox subject is biochemistry, and in particular how little people generally understand about the way their amazing bodies work and, even more in particular, the ways that drugs affect the body and how they work on a molecular level. Honestly, I am a HOOT at dinner parties.

The incredibly lovely AOW ladies have allowed me to guest post here to give a little introduction to the world of how drugs work by explaining how the pill works. Because I bet that 99% of you have taken it, in some form or another, and I imagine that, like me until recently, many of you don’t really know how it works (if you do know, hang around anyway, there’ll probably be cake. There usually is).

So, the pill. The pill is full of synthetic hormones, the specific ones depend on which pill you’re taking but generally the combined pill has one progesterone-like ingredient and one oestrogen. In general hormones are the messenger system of the body, they dart around the place attaching themselves to cells and relaying instructions to make them do things, or stop doing things, or do more of a specific thing. In my head, hormones have loudspeakers and clipboards and are called efficient-sounding names like Barbara and Robert. The whole of your reproductive cycle is a delicately balanced system of hormones, all shouting instructions at cells at exactly the right moment, culminating in the production of an egg, ready to be fertilised.

Anthromorphised hormones called Barbara. That’s right.

In addition to progesterone and oestrogen, there are a few other key hormones involved. Together, they form Team Reproduction. Some of them even have capes to match their clipboards. They are gonadotropin-releasing hormone (GnRH), follicle stimulating hormone (FSH) and luteinising hormone (LH).

The instigator in the process in GnRH, it is produced by the hypothalamus in the brain, and on production it races off to the anterior pituitary gland, there to shout at cells until they start producing FSH.  FSH, once produced by the pituitary gland, flies down to the ovaries and tells them that it’s time to start prepping the egg, which they do by growing follicles, one of which will become an egg when it grows up. Although it would probably rather be a ballerina, it doesn’t get that option. The ovaries, alongside their egg-prepping, start to release oestrogen, which scoots back up to the brain to tell the pituitary gland to slow down on the FSH production. At the same time, another deputation of oestrogen hormones are busy encouraging the hypothalamus to produce even more GnRH. Because by this time the hypothalamus probably needs some moral support or something.

This oestrogen cheerleading squad results in a sudden increase in GnRH production from the hypothalamus, which tells the pituitary gland to stop messing around with FSH and produce a mega-load of LH. Pretty soon an squad of LH molecules has amassed, and once this cheerleading squad is ready it marches upon the ovaries chanting “IT’S GO TIME”. And the ovaries release the egg. The role of progesterone in this reproductive party is to stop/start the production of GnRH in the first place. Crucially, when the body is pregnant, progesterone stops it from making eggs, on account of at this point it doesn’t need more eggs, it needs to focus on more important things, like growing a baby.

Because this is how we all look when we take the pill, right?

The hormones in the pill effectively work by convincing the body that it’s already pregnant by stopping the hypothalamus from releasing GnRH. They’re like undercover stealth hormones, hacking the system. Since the body thinks it’s already made an egg, it doesn’t feel the need to make another one, and thus you don’t get pregnant.  So that’s how it works. And the reason you have to try and take it at the same time every day is how carefully and delicately balanced the hormonal system is, big changes in hormone levels can send things a bit wonky. Regularity is a buzzword in the world of hormones.

This is all so far so good, but I’m sure I am not the only woman here to have experienced side effects from the pill. Nausea. Headaches. Acne. Decreased libido. Mood swings. Depression. Weight gain. Not a list of joy.

As a woman who has experienced all the above effects, except acne, I can tesitfy to wanting very much to understand what’s going on (read: hysterically flushing my pills down the toilet whilst sobbing “why are you doing this to me?”) Unfortunately this is one of the areas of science where the answer is… we don’t exactly know. There’s a lot of data out there on the fact that the pill does cause side effects, there’s a lot less on HOW it actually causes them it. In general though, your hormones are carefully controlled and balanced at every stage of the cycle, any shift or imbalance causes symptoms. Changing your levels of oestrogen and progesterone changes your cycle, and hormone changes = side effects. Quite why these side effects include a quite insanely desperate need for cake, no-one knows.

Totally how I would like to be able to react to hormonal symptoms. Wig and all.

So that’s the pill. And despite the fact that the side effects aren’t fully understood, I think it’s WORTH knowing how it works, and what it does. It’s worth knowing how your body functions and how pharmaceuticals cleverly trick and manipulate it, to prevent pregnancy, or stop a headache, or lower blood pressure. First because it’s your body, and you owe it to know what you do to it. But second because it is just so AWESOME. And I mean that in the entirely literal sense that it regularly inspires awe in me. Because your body is incredible, and the human race is possibly even more incredible to have worked out so much of how it works, and how we can help it along. To me, this, my soapbox subject, is mind-blowing. I hope you agree, just a tiny bit.

Categories: Health, Your Favourite Posts
62 interesting thoughts on this


  1. Posted April 18, 2012 at 7:18 am | Permalink

    Fab post Katie! Coming off the pill, and learning how my body works (how come we never noticed ovulation pains and fertile cervical mucous at 18?) Was liberating -especially after suffering at the hands of Cilest which made me a mad woman. But I am grateful for the pill – without it, who knows what life would be like?

    • Carly
      Posted April 18, 2012 at 7:26 am | Permalink

      Ovulation pains?! Do tell!

      • Posted April 18, 2012 at 11:31 am | Permalink

        Yup – not everyone gets them, but it’s like a dragging pain around the time of ovulation x

    • Posted April 18, 2012 at 10:08 am | Permalink

      Completely agree, the pill can make us totally loopy, but it’s a hugely empowering and liberating thing for us to have access to as women. It’s even more empowering if we understand how it works, it lets us be the ones in control.

      Plus, even without the pill, hormones can make us act batshit bonkers at times!

      K x

  2. Carly
    Posted April 18, 2012 at 7:25 am | Permalink

    Wow, I feel so intelligent after reading this!
    Katie, you have done what my Science teachers never did – made it relevant, interesting AND funny! I just love the comment about wanting to be a ballerina.

    I do find it fascinating and I also liked your blog post about how cold and flu remedies work. I think it’s good to know what you’re putting inside yourself when you take medicine.

    I’m starting to imagine a Katie’s corner on AOW, complete with picture of you in specs and a lab coat answering all our random science questions!


    • Posted April 18, 2012 at 7:39 am | Permalink

      PLEASE can we have Katie’s Corner!

      I loved this post. I was a zombie for 10 years on the pill but couldn’t hack the pain without pharmaceutical assistance (endometriosis) so now I’m on nuvaring which i really like. I think the pill (and especially microgynon which made me want to jump in front of a train) are too easily dished our as the first option when for a lot of us there are far better alternatives.

      • Zan
        Posted April 18, 2012 at 8:57 am | Permalink

        Vote No. 3 for Katie’s Science Corner! :)

      • Steff
        Posted April 18, 2012 at 10:39 am | Permalink

        Totally agree Amy, on both counts!

    • Posted April 18, 2012 at 11:35 am | Permalink

      Not kidding, I am wearing specs and a lab coat RIGHT NOW. I love you all (I apologise if that’s weird), and you are all inspiring me to blog better and more!

      Amy, you are so right, every woman has different hormone levels and reacts differently, it’s not an area where one-pill-fits-all is ever going to be an option. I understand why Doctors have a first-line pill, but I think most doctors could be better educated about women’s health and how the pill works. However, if they’re not going to be, we can!

      K x

  3. Sandra C
    Posted April 18, 2012 at 7:38 am | Permalink

    I really enjoyed that!! I knew how it worked, but you made it interesting and understandable. I’ve just subscribed to your blog. I love interesting science things. Thank you!! x

    • Posted April 18, 2012 at 11:36 am | Permalink

      This made me do a little dance! Yay! I promise to blog more often now you are reading :-)

      K x

  4. Posted April 18, 2012 at 7:40 am | Permalink

    Look you lot you’ve got to remember I’m an impressionable idiot- I’m going to be thinking about Barbara and ballerina eggs everytime I get my period now!!! Thanks a lot.

    The cake thing makes complete sense though- when you are pregnant you do cry and want cake so your body is reacting the same because you’ve tricked it!?

  5. Posted April 18, 2012 at 7:42 am | Permalink

    I second the motion for Katie’s Corner

  6. Posted April 18, 2012 at 8:10 am | Permalink

    This is fantastic, you’ve already told me in five minutes of reading what my doctor hasn’t be able to explain to me ever, in spite of my barrage of questions. Post on PCOS now please, I need more!


    • Zan
      Posted April 18, 2012 at 9:07 am | Permalink

      Oh yes, ANYTHING on PCOS would be good. I’ve been on the pill for a loooooooong time (around 16 years I think) and the two times I had a break, I pretty much had 1 period in the space of a year. Which is one of the reasons I’m so grateful for the pill, stops me worrying because either a) total lack of periods or b) in lots of pain due to evil long, painful periods that last for weeks!

      I was eventually diagnosed with PCOS in my mid-20′s but lord knows I can’t work out exactly what that is, everything I read is different! I do know that it makes it v difficult to maintain my weight, makes my teenage acne flair up and my hair grows at twice it’s normal speed. My pill (Yasmin, a godsend) stops the symptoms and allows me to not balloon at the sight of cake. But there will come a stage when I’ll need/want to come off the pill. I suspect it may be soon as I’m coming up to an age when apparently my medical records at the GP set off some sort of ‘red flag’ for being on the Pill (my last visit to the GP involved tutting…!). I feel I need to have some understanding of the condition to know how to deal with it without the pill.

      • Posted April 18, 2012 at 9:51 am | Permalink

        Zan this is exactly my story too! Even down to the Yasmin!


        • Zan
          Posted April 18, 2012 at 10:34 am | Permalink

          Oh yey! Not yey that you suffer too obviously (wouldn’t wish it on anyone) but yey that someone else understands! I do often feel like that part of my body just doesn’t like me :(

          • Posted April 18, 2012 at 1:25 pm | Permalink

            I’ll look into PCOS for you ladies, and report back with cake! I know someone else who has it aswell and they were utterly miserable before it was diagnosed. It’s more common than people realise, I think.

            K x

            • Posted April 18, 2012 at 9:23 pm | Permalink

              Amazing!! Particularly interested in the subtleties between having PCO (having the follicles on your ovaries) and PCOS (which I THINK is all the horrid side effects) – there is a big difference but the doctor couldn’t articulate it for me in any way that I could grasp.


  7. Mahj
    Posted April 18, 2012 at 8:25 am | Permalink

    Erm wow Katie. Pls can you be my health guru from now on?!
    Im currently very happy with my pill (Femodene) l, but it was trial and error getting there. I tried Dianette which made my skin look a beaut (I suffer from evil acne) but made me quite crackers.
    Coincidentally I was thinking this morning about taking a break from my pill as I don’t like being on it for prolonged periods of time, so this is quite timely.


  8. Posted April 18, 2012 at 9:00 am | Permalink

    Yay for science on AOW! I have tried numerous pills, luckily I never get major side effects with any of them but they never really do the good things they promise (except stopping those pesky babies!) ie Dianette is meant to work wonders for bad skin – not for me :(

  9. Posted April 18, 2012 at 9:00 am | Permalink

    I want an efficient sounding name like Barbara. And a cape (velvet…?)

    This is pure brilliance, you’re welcome at my dinner parties any time.

    I think my soapbox subject is anything to do with benefits and the tax system. My current topic du jour is what difference free childcare for working mothers would make to this country. Good grief, we’d be a right pair at that dinner party.

    Ps. More cool science bits please.

    • Posted April 18, 2012 at 1:23 pm | Permalink

      I definitely want to be seated near you at a dinner party Lucy. I bet we’d be the life and soul.

      K x

  10. Posted April 18, 2012 at 9:05 am | Permalink

    Best use of the word Awesome ever.
    Our bodies are awesome, and I love love love hearing about what they do, because as you rightly said they are AWESOME.
    Being preggers currently leaves me no room to comment, but I hated taking the pill, albeit I was happy with the non-preggers results when needed, but I am hoping not to have to go back on it once baby no2 arrives.
    Katie, is it the same kind of hormone reactions that delay the start of ovulation when you are breastfeeding? (again, I know this differs wildy from women to women)

    • Posted April 18, 2012 at 1:27 pm | Permalink

      I’d have to look into it a bit more, but it’s a hormonal thing that delays ovulation so it’ll certainly be along the same lines I imagine!

      K x

  11. Posted April 18, 2012 at 9:31 am | Permalink

    Really really interesting post!
    I’ve been taking the pill for ten years but i’ve never once thought about how it actually works.

  12. Posted April 18, 2012 at 9:44 am | Permalink

    I knew you’d all love this!

    Penny hit the nail on the head, Katie…it’s like I get it now, after years of just taking it because it was a quick fix way of not getting pregnant.

    My pulmonary embolism last summer was put down to using the Pill. I’d been on it six years. I don’t believe the doctors and think they have said it was the Pill for an easy answer. I’ve been off it since last July and my skin is absolutely shocking but I feel much, much more in tune with my body.

    • Posted April 18, 2012 at 9:53 am | Permalink

      Have you been to the doctor’s about your skin Anna? I was having a nightmare with mine but I went back and they gave me some stuff that’s cleared it up almost completely. Takes about 4 weeks to work but it’s been a GODSEND.


      • Posted April 18, 2012 at 10:13 am | Permalink

        Pensky, does it mean I’ll be on antibiotics or whatever they are from the doctor forever?

        • Posted April 18, 2012 at 10:41 am | Permalink

          I don’t know! It’s just a spot cream, I think *confused face* I used it every day for about 6 weeks, and now I just use it when I have a flare-up, which is getting less and less often.


          • Posted April 18, 2012 at 11:20 am | Permalink

            I’ve had a zillion creams that didn’t work. Have now been referred to dermatologist and have been taking antibiotics for 6 months now – luckily the ones you can have a drink on! Also have a shampoo as apparently your scalp can affect your skin, and another cream.
            None have worked miracles but the trial continues…

          • Posted April 18, 2012 at 12:06 pm | Permalink

            Duac and Fucadin creams have both worked well for me.

            • Posted April 18, 2012 at 1:16 pm | Permalink

              Duac is the one I use! Will definitely check out that soap…


          • Posted April 18, 2012 at 12:11 pm | Permalink

            Also a really cheap soap has helped me loads – its black sea mud mask soap (i think), no brand name just some cheesy packaging with a photo on. Get it from boots or holland & barrett for about three pounds.

        • Posted April 18, 2012 at 9:24 pm | Permalink

          I took roaccutane Anna..drastic potential side effects but incredible results in a matter of months, it’s basically a grotesque amount of vitamin A. I rationalised that I was just getting my vitamins. No booze whilst you’re on it though…not sure you are ready for that just yet, you white wine spritzer girl you!

    • Posted April 18, 2012 at 9:53 am | Permalink

      In my expereince the pill is the scape goat / answer Doctors seem to throw at us to make us go away or be quiet. (obv not all Doctors, just the ones I seem to have encountered)
      Not anymore I fear…

      • Zan
        Posted April 18, 2012 at 10:42 am | Permalink

        Oh yes… like you say not all GPs but I’ve lost count of the amount of times I’ve gone to doctors with something totally unrelated only to be asked ‘have you thought about changing your pill?’ like it would help. It’s taken me years to find one that works for me, so the answer is always going to be ‘no, unless it’s life-threatening for me to continue to take it’!

        That said, I do have a friend who can’t take the pill due to blood clotting issues (identified early enough that she didn’t even get 6 months into taking it), so it can be a genuine issue. But I still think blaming the pill can is used as a bit of a ‘catch-all’ answer.

  13. Posted April 18, 2012 at 10:04 am | Permalink

    Reading these comments has made me grin all over my face like the Joker, but just slightly less insane. You are all unbelievably brilliant.

    I’m more than happy to answer any science questions I know the answers to (and to try and find the answers to the ones I don’t). Answers may come with additional cake and, often, bouncing.

    K x

  14. Esme
    Posted April 18, 2012 at 10:08 am | Permalink

    Well done Katie! Great post. I completely agree that the pill tends to be the option women are offered and it takes us to ask for something different. I’m a migraine sufferer and despite the fact the pill is linked to migraines, I was on it for years. Finally I suggested getting a coil and the doctor was like ‘that’s a good idea!’ Er, thanks…

  15. Laura C
    Posted April 18, 2012 at 10:09 am | Permalink

    Another vote over here for Katie’s corner!

    You are all going to flinch at my Pill history – from the age of 15/16 I was on microgynon, but my memory is useless and I didn’t trust it so always backed up in the bedroom dept. I thought that this was just a waste so had the implant (Implanon) put in, and immediately turned into a crazy lady. The doctor wouldn’t take it out and put me on the mini pill which didn’t help at all, and made my acne worse. Finally, I am now on Dianette with the implant STILL in, because they wont take it out. My skin in still horrendous, and prescription creams don’t help. Yay for double dose of hormones…not.

    Actually at the end of my tether, want to pitch it all into the nearest skip and cut out my implant myself.

    I’m due a doctors appointment next week, I feel a massive AOW inspired rant coming on!


  16. Samantha Pancheri
    Posted April 18, 2012 at 10:12 am | Permalink

    Love it! And totally backing the call for Katie’s Science Corner!

  17. Jessie
    Posted April 18, 2012 at 10:52 am | Permalink

    This is brilliant! I actually love being on the pill (Yasmin for me for yonks now), to the point that I’m really scared about coming off it. I was put on it for ovulation pains – oh yes – I know all about those – when I was in my first year of uni and I have to say I am only just realising that that means the Pill and I are coming up to our 10 year anniversary – there may be cake! For me it just makes everything better, my moods, my skin, my weight – everything is just so stable, and I love stability!
    But ultimately, I would really like to give having a baby my best shot so I have to take the chance with the hormone roulette for the ‘greater good’ (!) and it’s something I’m thinking about SO much at the moment. So thank you Katie – a brilliantly well timed post.
    Isn’t being a woman so cool, crazy & confusing all at the same time!

  18. Posted April 18, 2012 at 11:25 am | Permalink

    Wow I think this is the first time I’ve ever sat and thought about how the pill actually works – to be honest I actually found it a little bit scary. Yes I LOVE the control that the pill gives you not only over your contraception but also over your periods (knowing when they are going to come is such a luxury!) but tricking my body into thinking it’s pregnant? That kind of freaked the hell out of me.

    I’ve actually been off the pill since last summer. We’d been travelling in Asia for five months and were taking a hideous amount of tablets each day plus we’d had a shite load of jabs before going and I just felt like I needed to get rid of all the crap in my system, including the pill. It’s quite ironic that I won’t take headache tablets etc unless I literally can’t stand the pain, but was chucking down my pill each morning without a second thought. The doctor prescribed it, I took it and that was that.

    I feel 100% better for not taking it (even with period pains!), but I do miss knowing exactly when I’ll have a period – and the less said about the romance killers aka condoms the better. Perhaps if/when I go back on it I need a new brand?

    Thanks for the insight though Katie – lots to think about!


  19. Posted April 18, 2012 at 11:32 am | Permalink

    Katie, could you write an easy to understand piece on the biochemical doodahs involved in depression and anxiety do you think?

    • Posted April 18, 2012 at 1:29 pm | Permalink

      Yes, definitely! I’ve started researching/writing one on anxiety attacks already, great minds! Depression is a bit trickier but I’ll definitely do what I can :-)

      K x

  20. Posted April 18, 2012 at 1:15 pm | Permalink

    Great post Katie!

    I have a thing for science as well ( and a degree in it too) and now as a medical student I experience the wow moments almost every day when I’m studying how the human body works and how awesome it is. A couple of things I would add to this post would be information on how the hormones prepare the uterus lining for the fertilized egg to implant and why it’s essential to take your mini pill ( progesterone only) strictly on time.

    Also I’m voting for a sciency corner on AOW as well! Or maybe a podcast about science and medical matters relevant for women.

  21. Katie
    Posted April 18, 2012 at 2:36 pm | Permalink

    Amazingly, I actually researched the pill before I went on it. I never found anything as comprehensive as this post though.

    It was the tender boobs that I hated. Came off the pill about four years ago.

    Thank you Katielase.


    • Katie
      Posted April 18, 2012 at 2:43 pm | Permalink

      P.S. I wasn’t sure whether to say anything, but since we’ve been married we have been combining Natural Birth Control (FAM Method), and condoms (for the fertile days). I really like discovering what is going on with my body.

  22. Julie Westmoreland
    Posted April 18, 2012 at 2:38 pm | Permalink

    Brilliant Katie well done my lovely xx

  23. Posted April 18, 2012 at 3:48 pm | Permalink

    Surely I’m not the only one wondering if ‘Barbara’ is Anna K’s middle name?!

    Great post, Katie. Can’t wait to read more from you!

  24. katy
    Posted April 18, 2012 at 7:35 pm | Permalink

    Aaaah! I love cool science posts!!!
    Can I play?? Can I play in the science corner?

    I could write about cool sciency stuff too! like like like – the bee wiggle dance (you will never look at a bee in the same way again!)

    Loved this post – very well written and important that we know exactly what we take before the take it!

    • Posted April 18, 2012 at 10:42 pm | Permalink

      I MUST know what the bee wiggle dance is. Please?

      K x

  25. Posted April 18, 2012 at 8:53 pm | Permalink

    Great post! I have a pill-related bugbear. I keep on seeing (what I believe to be) the myth that we need to have periods, and I think that needs to be dispelled! I even read a blog post recently that stated that we needed to shed our womb’s lining part of our body’s detox process. Can you imagine if the place where embryos develop were some kind of toxin-loaded waste product? Hmm… Not the healthiest start.

    I’d love it if someone who can speak fluent scientist and layperson would explain that. Unless I’m totally wrong, in which case I need to really reconsider my contraceptive options.

    Also, a note to the team – could you make it possible to subscribe to comments by email?

  26. mysparethoughts
    Posted April 19, 2012 at 8:31 am | Permalink

    So much good stuff here in the post and the comments.
    Acne – I was put on the pill (dianette) at 14 so I trigger all sorts of red flags. Eventually had a course of roaccutane which worked wonders at the time but my acne has since flared up again.
    Headaches – I suffer from crippling headaches with each period and sometimes at ovulation and sometimes for the heck of it
    I’ve tried combined pill, mini pill and the jab for a while. Currently going fake hormone free to see if my body will go it alone. Quite scary having not had a natural period in 16 years. So far acne is back with vengeance and I’ve gained at least a stone in weight.
    Speaking from my own experience I found the nurses and doctors a
    t family planning clinics much more helpful than at the GP surgery as it is the main focus of their job.

  27. Posted April 19, 2012 at 7:40 pm | Permalink

    Great post – more of these please! I’m been on the pill for years and i have to say i’m a bit scared to come off it in the next year or so. Looking forward to finding what my body is really like though… :-)
    Rachie xo

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