This interview was originally published through Audible Sessions.
Note: Text has been edited and does not match audio exactly.
Holly Newson: I'm Holly Newson. Welcome to Audible Sessions, a place where we delve into the books, careers and lives of authors and creators. If you're going to listen to one interview this week, one podcast, I think you have done so well to pick this one with Kate Muir. I learned so much about contraception, hormones and health from Kate and her book, Everything You Need to Know About the Pill. Just those moments where you go, "How did I not know that?"
So, coming up, we have what you need to know about fertility awareness apps and your data, how different the different pills really are, the pervasive myths about the pill that need busting, the women who lost their lives in pill trials, where we're at with male contraception, and so much more. Let's dive in. You write that abortion rates are going up and that pill usage is going down. So, does that show that women are waking up to how bad the pill really is, that they're willing to take this risk, or is there something else going on there?
Kate Muir: I think there's a whole bunch of things happening at once, and I call it the pill quake, which is just sort of an earthquake in contraception. One thing is that women have discovered the side effects and that social media and conversation has reinforced that. We also made a big documentary where we did a big poll on the side effects, and 36 percent of women had come off the pill because of mental health problems, low mood, anxiety, depression, generally feeling odd.
So, there's that and then there's what's going on is the sort of TikTok consulting room, so people are kind of going to TikTok, they trust TikTok for telling them the best retinol cream for their face, they trust certain influencers. And if those influencers say, "It's time to try Natural Cycles. Why don't you give up having synthetic hormones in your body? This is why you won't get pregnant probably."
And then women have just been misinformed and I think gaslit about these symptoms. Also, I think we want to know more, and that's why I've written this book, really, is that I just didn't know enough. I think the combination of all those things is sending women into having abortions, and that's absolutely fine, but it's not a great form of contraception. And the abortion pill is available, and 80 percent of abortions are with the abortion pill in the UK. But that's not what we want to go about doing. We want a better form of contraception for women and for men.
HN: You mentioned TikTok there and the Natural Cycles, so let's start with TikTok. Why do you think that the information-sharing there is so broad? And how much would you say is actually useful versus how much is misinformation?
KM: As far as I know from studies, it looks like one in five are absolutely wrong.
HN: Okay.
KM: So, people saying, "The pill will make you infertile. You must come off it." There's all that sort of stuff going on, and obviously on TikTok – and I've gone on TikTok myself doing pill scandal recently – you've got 30 seconds or 20 seconds to explain a complex medical situation, which is really subtle and different for every individual. And the very idea that you say, “Fantastic. Natural Cycles is marvelous,” it just doesn't explain it enough.
And even when they do explain it, and there's a sort of legal thing that these influencers have to say, that they give them a script, Natural Cycles give them a script to say, and it's like, “This is 98 percent effective with proper and correct use. It's 93 percent effective in normal use.” And you're going, "Well, that's a 7 percent failure rate." So, that would be a bit of a worry for me, if I wasn't feeling relaxed about getting pregnant.
So, it's very difficult for, I think, particularly younger women who are using TikTok as Google, really, to find out the truth about their lives, and they find out really good stuff in other areas of TikTok. You can really decorate a room really well from TikTok. There's great stuff there. But this is not really the place for it and we somehow have to get the truth and the science into TikTok. I don't know how we're going to do that, but hopefully this book will begin a big movement of women actually knowing the truth about contraception and understanding it, and maybe being able to talk about it more.
HN: You mentioned Natural Cycles there. There's one part in the book where you talk about data sharing. So, what do people need to know about fertility-awareness apps and their data?
KM: Well, some of them are very safe. I think Clue, in particular, because it's European-based, has got quite strict laws around what it does with its data, and indeed uses some of its anonymised data for good, to analyse what's happening to women and for science. Flo got into a lot of trouble for sharing the data a few years ago, and I think it's all a bit of a risk. Certainly in America, women are terrified if they're Googling something around abortion or trying to find out something that the authorities could be following what they're doing, if they were trying to get an abortion pill out of state or something like that. It really is a risk.
So, I think you've got to be careful how much you give away. I found going into Flo myself, I went in and had a go at playing it being a younger version of myself, and they really wanted all my data and access to everything on my phone. And I kind of wondered jokingly whether they'd be tracking your periods and you would suddenly get advertisements on your phone for huge piles of ice cream just at the moment. Or large packets of biscuits just before your period, or they try to sell you weepy romantic movies just before your period. I mean, who knows, but you've got to suspect the worst, I think.
I also think at the same time, I think also these apps are fantastic because I love the idea of a school girl, age 12, being able to go on for the first time when she gets her period and start tracking it on her phone and know when her period is going to come and know when she might be a bit moody or whatever. And we never had those tools and I think it makes people feel safer. It really would be brilliant if we could educate the youngest women, because we did a big poll and 64 percent of pill users go on it at school. And I just think, "Oh, my God, what did I know at school?" Nothing. What do they know about the different kinds of pill and things like that? Just, we are really not being looked after.
HN: And with the different types of pill, how different are the different pills?
KM: Really different. I didn't know this either. Some of them are androgenic, so they come from testosterone. They're a testosterone-like synthetic progestin in the pill. And then some of them are estrogenic, so that's more female hormone. And obviously the estrogenic pills, and they would be things like Yasmin, which have got drospirenone in them, and those estrogenic pills tend to kind of lower your acne, tend to also sometimes give you larger breasts, things like that. You never know what each pill will do to people. And then the androgenic pills are like the basic ones like the Rigevidon, Microgynon and Levest. They've been around for years and years some of them. And you might get a little bit spottier on them and it might make you feel slightly different.
But one of the worries with some of these pills that really interested me was that the pills, because they lower your hormones, they lower your levels of free testosterone, and testosterone is a female hormone too, which we shout a lot about in the book. And the lower your levels of what's called “sex hormone binding globulin” – now we should all know those words. They are very, very important to us as women and our partners. They really, really matter. And when sex hormone binding globulin goes down, your testosterone is handcuffed, basically. It's not getting around your body, and 21 percent of women say they have lowered libido on the pill and on other forms of hormonal contraception. And I think that that is not a conversation – that a fifth of us are finding our sex lives are a bit crap on the pill, why isn't that a big conversation? Why are we told, "Oh, don't worry. It's not very important”?
You look in the textbooks and it literally hardly mentions it, because I've read all the contraception textbooks and whatever. It's like footnote number 12. It's literally not part of the conversation. And we go on the pill for why? Mostly, well, to have sex. And yet it's not helping us. It's not helping a fifth of us. I really wonder that no one has looked at this from above in an almost philosophical, political kind of way as well as a medical way and gone, "Oh, my God, what bits of the truth are there that we have not been told?" And that's what I felt the whole way through the book. I would just unearth something and go, "Oh, my God, I have to tell everyone this."
HN: With libido, obviously, there are a lot of women who experience that decline. Are there some women on some pills that experience an increase?
KM: Yeah. I think just being on the pill can really, really help you feel confident, I suppose, and then there's no condom in the situation so that can be great. There are some pills that seem to have a progestin in them that doesn't affect your sex hormone binding globulin. So, quite a lot of women find that's great, and there's one called NOMAC, and drospirenone. These are names that of course nobody knows. But some of them are better than others and it's definitely worth trying a couple to see which one works for you.
There's also a new generation of pills that has come out and they are made with natural estrogen because, and I suppose I should make this clear, that the pills do not have natural hormones in them. Pills have synthetic hormones and it's ethanol, estradiol and progestin, that's what you get in the average combined pill. But in the newer generation of pills, which are called Zoely, Drovelis and Qlaira, they have natural estrogen in them, which is a body-identical copy of your own hormone. And they're quite hard to get, certainly here in Britain on the NHS, because they're more expensive. And we don't want to give them out.
But very interestingly there's been quite a few studies, particularly in Australia, of women with PMDD and PMS. And it seems to be that the natural estrogen is better for mood. It keeps your hormones nice and steady, which you want, and the natural estrogen, about 65 percent of people said it had made them less depressed and less sort of rundown before their period. So, there's also the stuff that pills can be good. How can we use them? What are the best pills? Which are the ones that will help us with our mood at the same time or will help with libido?
We've just not got that information clearly enough. So, that is what I'm trying to explain. I even put a list in the book of “Here are the androgenic pills, and here are the estrogenic pills.” And at least you can begin there and look up what you've got and go to your doctor and go, "I think I need another kind of pill. This is not the person I am. This pill has changed me and I want to be more natural, more like the previous person I was." I think that's sort of really important, just what hormones are doing in your head as well as your body.
HN: Yeah, definitely. When I read that, that there were pills with body-identical estrogens and that everything else that I'd had previously was synthetic, my mind was blown a little bit. And you've written a lot about the menopause as well, you say that you yourself take body-identical estrogen and body identical progestogen. So where are we at in terms of getting a fully kind of body-identical hormone contraceptive pill?
KM: Not there yet. And why not, is my question. So, I interviewed one of the scientists at Theramex. It's actually quite a good sort of women-led pharma company, and they said we cannot yet make the progesterone effective enough, but we can make the body-identical estrogen. And the progestin is the not great thing about the pill. The progestin is the thing to be worrying about in terms of breast cancer and things like that. The progestin seems to be the thing that affects mood more than anything else. So, it is really worth waiting for that to change.
And I had this chance, weird chance, to look at the pill through menopause glasses and hormone glasses because at the time I hit menopause, the body-identical HRT hormone replacement therapy became available, and it is fantastic because it is a copy of your own hormones. So, the only thing that's happening is you're topping your hormones back to your kind of 40-year-old level, and you feel great. And, of course, you have the same hormones every day, including a little bit of testosterone in my case, because that's also a female hormone. And so you wake up and you're like, "I used to be a clapped-up banger. My hormones were all over the shop, kept breaking down. I am now a Tesla."
I'm completely calm every day and I know what I'm going to do and I'm going to get on with it. I was thinking, "Why can't younger women on the pill have what I have?” And it's cheap as chips. Natural hormones, you can't patent them. They're a product of nature. So, it's fantastic if we could get that for younger women. And obviously there are all the new things happening in contraception, but not fast enough.
HN: Yeah, and of course a lot of women aren't taking the pill for contraception. We mentioned that young girls, teenagers, are starting on the pill, and that can be for really heavy periods, acne, those sorts of reasons. So, with taking the pill at that age, do we know what that does to a developing brain?
KM: We are just learning what is happening to the brain on the pill or indeed on any hormonal contraception, be it the implant or patch or whatever, or injection. And they have scanned people's brains on the pill and off the pill, the same person so you can tell how the brain has changed. And there is a huge kind of brain bank in California that is scanning women's brains to bring us a huge amount of data on this. So, it's only started. But what we can see is on some, and they're really small studies, but I think they're interesting so I've just put them out there and people can decide what they think. But the androgenic pills, which are more male in a certain way, tend to make you more kind of spatially aware. But the estrogenic pills tend to make more women better at recognizing faces and the sort of emotional female side. So, they emphasise to a tiny degree the masculine or feminine sort of sides of our brain, in those traditional kind of terms.
And the other interesting thing was there was a study out of Denmark that looked at the serotonin in the brain, the happy hormone in the brain, and basically women who had gone on the pill had about 10 percent less. It was functioning 10 percent lower, their serotonin, which is fine if you're feeling okay, but what if you're a little bit depressed and that just kicks you over the edge into another place?
So, I'm really kind of worried about what happens to teenagers in this whole story. I think particularly what happens to teenage brains when instead of giving them an estrogen creative high every month as they would get being on their natural cycle and you get that kind of amazing oomph in the middle of the month, you suddenly just get this flatline and the hormones are just lower than they would be or you're not ovulating at all. And so they're in a kind of not quite menopause but a little mini menopause. With little low hormones when they're very young. And it's all right, but nobody has cared enough to ask what this means. And that's what we have to do now is go and say, "What is this doing to the teenage brain?"
The other thing we know about the teenage brain very clearly is there's been a huge study done in the UK Biobank, which is basically patients’ records. It's records from a while ago these, so most women were on the combined pill at that point. But what it showed was you were around 73 percent more likely to get depression in the two years after being on the combined pill than not. And that isn't necessarily a disaster and you end up in mental hospital or anything, but there definitely was a change in the women who went on the pill. And the small studies that you get, the kind of official studies which are 20 women on the pill, 20 women on nothing at all or a placebo, we study their levels of depression, but they immediately exclude anyone who is a bit depressed already, has difficult periods already. They exclude all the outliers. And it is the outliers who suffer on the pill.
I think one of the things in this book, everybody goes, “But 90 percent of people do great on the pill, or do great on the coil, or do great on this,” and yet the 10 percent might be you. And the 10 percent were my daughter, Molly. She got quite depressed on the pill. There was other things in her life going on, but when she came off the pill, she felt so much better. We didn't spot it at home in lockdown. We just thought it was lockdown. And then she really cheered up when her pill prescription ran out. I felt so stupid as a mom not being able to see that while I was writing a book about hormones and the menopause, right? I didn't see my own daughter and she didn't see herself. And then we both started investigating what was going on with the pill and mental health, and we looked into these big Swedish and Scandinavian studies, which are really superb, as to what is going on with depression and changes with the pill.
HN: I remember my second year of university, I was on the pill for irregular and heavy periods and I was inconsolable for the whole year. I remember there were times where there'd be social events and housemates would have to persuade me to leave the house. Came off the pill third year, felt great.
KM: Wow.
HN: Like, honestly, second year of uni, my main memory is like, I had to say to my boyfriend, I knew in myself I was inconsolable and I had to say to him, "There's nothing you can say that's going to make me feel better." And it's just crazy how you can lose so much time. And what I think is interesting is health professionals recommend three months to try a pill, then if that's not working try another pill. And it only takes trying four pills to have lost a year if all four happen to not work for you. So, what do you think of that advice and that kind of time frame?
KM: I'm not a doctor, so I'm looking at this from a much wider sort of scientific point of view. But I would say you know much more quickly than that what the pill is doing to you. Hormones, they turn over in a couple of days in your body, so you often know if things are going wrong. And I would certainly not suffer through. One of the things in the book, I interviewed a woman who'd had an implant in the book and was really struggling with symptoms and bleeding with the implant in her arm for months and months and months, and they kept sending her back. And it wasn't until her mom went in with her that they agreed to take the implant out, because they thought, “Irresponsible person might get pregnant. Don't take implant out.” I really think if someone wants to voice what's going on, then they should immediately get attention and help and be allowed to change.
And, of course, no one can get appointments with their GP and it's all a real struggle. But I think even just for women to be more self-aware and think, "I don't have to suffer. I don't have to suffer for another month." And my great thing, which I've said to a lot of people, even like you that I've just met talking to them, I've said, "What about taking a pill holiday for a month and see what happens? You can use a condom a few times. It will be fine." And they take a pill holiday and they go, "Oh, my God. So that was what that was doing to me." It's not going to do any harm to come off it and then go back on it. It's not going to kill you. And it's really worth knowing who the you is, and not the kind of synthetic hormonal you. Like the story you've just told, I mean, just everywhere I go someone tells me.
HN: I can imagine this happens to you a lot.
KM: I go in a bus queue and someone tells me their story. And they're all different, and they're all really moving because they're bits of people's lives that have been taken away. And we think, “Well, we're just doing this so we can have sex.” Why are we putting something in our bodies that is this bad and causes this amount of suffering? Why do we put up with it? But on the other hand, the pill can be great and help you with polycystic ovarian syndrome. It can help with endometriosis and, indeed, if you've got terrible periods maybe it's for you or maybe the coil is for you. We do have it as a brilliant option. I don't want to cause a panic. I want to be responsible, but I also think people have been too on the side of shutting up and keeping calm and carrying on.
HN: We know that there's racism within health care. So much of this does come down to having to advocate so much for yourself, and whether you're listened to and believed. So, do Black women have a worse experience of the side effects and the big risks on the pill?
KM: Well, there's a history of the injection, the Depo-Provera injection, being really, really heavily used on certain populations. It's the hormonal injection. When I was looking into what it was doing in America in some studies, I would find that 80 percent or 70 percent of the users in that study would be Black and it was very much inject people and send them off for a good few months and they're not going to cause any trouble. So, that is really worrying, that you might be getting the worst option because of the racism of your med and the assumptions of your medical professional.
I was talking to Neelam Heera-Shergill, who runs a group called Sisters in Birmingham here. She was talking about Asian, South Asian women in her community being really embarrassed to go into their doctor who knows their whole family and not wanting to be seen to be having the pill. If they wanted the pill for heavy periods or acne or whatever it was, it was seen as a sexual thing by their community. That was a real kind of internal problem for people in the community, that the pill was seen as “you are promiscuous,” and in fact you want it for something else. It's fair enough also if you're promiscuous too. But the idea that there was this shame around it when people needed it in a medically necessary way. So, there's that.
But I think the bit of research that sent me absolutely screaming off the wall in the whole book was actually the history. Oh, my God, and we're talking about Black women and indeed it was some Black women and then Puerto Rican women who were given the first doses of the pill back in 1956. And 256 women in Puerto Rico in the slums, basically, are given this pill, which is 10 times the level of hormones of the pills we now have. So, it's a killer pill. It's a sledgehammer. And three of those women die. We don't know why they died because they died of "unknown causes." And these are young women who suddenly disappeared. And then a quarter of women on this trial leave because of nausea, dizziness and headaches, which are often the precursors to strokes, right? And we are giving this hormone at this level and we know at much, much lower levels it caused clots and strokes in women. But guess what, the survivors were the only people counted when they took the study to the Food and Drug Administration in America and said, "None of these women have got pregnant. Isn't it marvelous?" And that was what happened. And so basically the people who suffered were left by the wayside. You think about these Puerto Rican women, they died for us to have sex, literally.
It is really a disturbing piece of history that we haven't thought enough about. Those early women were gaslit. They weren't told anything about the risks and side effects of what they were getting, and nobody knew. And then we continue to be gaslit now about our symptoms and what happens around this. It has so liberated us and let us be in education and be in jobs, and it has done this amazing thing for women and continues to do it around the world where people are just still struggling to get to that level of equality. But the time has come to ask questions, I think.
HN: Do you think there still isn't really informed consent as to what we're putting in our bodies?
KM: Yes. I think we have no idea. I think you ask the average woman, they would not be able to name correctly the hormones in their pill. And we found that 29 percent didn't know the name of their pill in the poll. And if you don't know if you're on a combined pill or a progesterone-only pill, I mean, you really don't know what's going on.
I've done a chapter on the coil. Oh, my God, I think women really don't know what's going to hit them with the coil, and they're really not told enough, often, by the people fitting the coil, about the pain, about their rights to have a local anesthetic, about what happens afterwards. Because they say, "You may get some cramps or bleeding afterwards for a month." And you talk to people and they go, "Well, it was three months and it was agony. I was down there on the floor and rolling around.” And they've maybe kept on with the coil and they've sorted it out. But I think if they'd known more about what is going to happen and they'd known the truth of what was going to happen, well, they might have consented, they might not have. But is that informed consent when you're not fully told of the sort of risks of what it's really going to feel like?
I just think honesty in all this is the best policy, because if we're not honest, if professional people and medical professionals are not telling the full version of the truth, then people will go for the other truth on TikTok or from their friends. And they really need to improve what they're doing in the medical profession and be more open and be better informed. A lot of doctors just don't know the different forms of the pill. They wouldn't necessarily know about those new pills and what they can do. And this is really important, you know?
HN: How do we balance the fact that some of that truth that we're not getting at the moment is quite scary?
KM: That's a really good question, and it's a question I don't quite know how to handle, in a sense. I think we have to give people a really decent list of alternatives. But I do think we have to give them some of the scary truth. And often they won't believe it anyway. I'm not sure, to be honest with you. I just think we need to have the information out there and kind of see what happens, because there's this pill quake going on. There's a sort of revolution going on. I would just rather people knew the truth. I think we can't be treated like children anymore on the pill. I think we deserve full knowledge even if it's difficult knowledge. And I think also the new contraceptive methods will take us out of this period of chaos. But I think we are in the period of chaos right now.
HN: Yeah. And there's one bit of misinformation about the pill which I think I had retained. So, tell me what the pope has to do with the idea that we have to have a withdrawal bleed, that we have to have a break from our pill packet and have a bleed?
KM: I love this bit. I mean, it's so annoying when you think about – in fact, I wrote in the book about my worst period. I mean, everybody has their most embarrassing period and mine was at university when I was a member of the kind of students representative council. I had to go and sit on the university senate with all these old professors in gowns. And I'd elected to wear a white skirt that day and a black leather jacket. And as I got up from this big meeting with all these stuffy academics, I'd been representing the students, the old guy next to me poked me and he said, "I think you've got a stain on your skirt, dear." And I looked around I had this huge red saucer on the back of my white skirt. Just the worst feeling. And then I had to walk down the sort of ceremonial stairs from the academic hall with the big red ring on my skirt, which I had to turn around and put my bag in front of and then run to the toilet. I was just so ashamed. We've all had one of those on a white sofa or something like that, haven't we?
But when I thought about that and then I went back to the history of the pill and we found out that Dr. John Rock, who was basically one of the inventors of the pill, was a Catholic and was very keen that the pope should consider it to be part of the rhythm method, which was allowed by the Catholic Church. And he thought if it looked natural and if women had a week's break off the pill every month, then it would look rather similar to the rhythm method. But they knew already that you didn't need a break at all and it didn't cause you to explode or anything like that. The only reason you would bleed is because the hormones weren't there and you would bleed because the hormones were withdrawn. But actually, you can go on without having a period at all for 15 years if you want.
And the other thing I learned in the book was that the best withdrawal period is not a week, it's like four days or two days, because if you want to have a bleed, which some people do, then a really short one is fantastic because it doesn't get your ovulation coming up again. And if you forget your pill on day eight after you've had a seven-day break, chance you could get pregnant then because you're running into kind of the fertile period. Whereas if you've only got a four or a two-day break, it's much better.
So, the textbooks were sort of advocating years ago 84 days on, four days off. Doctors, no idea, had they? We did not get that information. And then we did this poll for the Pill Revolution documentary I made for Channel 4 and we discovered that 48 percent of women on the combined pill thought they had to take a break. So, half of us were taking a break and having that big red stain on their white skirt and having a miserable time if they didn't want to have periods. And nobody has told us that, but we knew in 1960, before that even. We've known for over 60 years that it is perfectly okay not to have a period and we have just been using truckloads of Tampax for years and years. And I think that's, wow. Wow. What a disservice to women. It's just astonishing, isn't it?
HN: Yeah, it's crazy to think. I remember there was one girl in my sixth form who, I don't know how every other girl seemed to know this, but she was taking her pill packets back-to-back. The ones where they say to take a break. And I do remember everyone being like, "But that can't be safe, can it?" When it was obviously fine and she obviously had the information that none of the rest of us did.
KM: Yeah. And I wonder if periods are going to be, I mean, it's great there's period power. But periods are also going to be a bit of a thing of the past because lots of people on the coil don't have periods. Lots of people are taking things back-to-back. If they're a bother, it really is brilliant that we can avoid them and that we have the tools to do this. It's just making sure we have the right tools and not the wrong ones, you know?
HN: What affect do the cuts to health services and accessibility of sexual health and contraception have on who can get what and where?
KM: Well, this is really interesting. I mean, people are not getting enough time to discuss this with their doctors. And one of the things that's happening is they've hugely cut the budgets to sexual health clinics. So there are some places in Britain where you'll wait a year to get a coil, which is just terrible. And there's other difficulties, which is that you can get the pill over the counter in a pharmacy now and that's been a change this year, which is great for people going back to get their pill again and again. Some of the good pharmacies, like I interviewed Superdrug, and they go, "We'll give someone 15 minutes in a proper consultation room. We'll go through all the stuff with them. We're training our pharmacists up." But if you're in a pharmacy that has no time and no money and they don't really want that consultation, they can fill in the form very fast and you could be in and out in five minutes or two minutes, or whatever it is.
It's a risk that people won't have time to look after you. I think the cuts mean that we are not getting what we require. I really think we should bring this into schools. I was talking to my stepson and he was taught how to make aspirin in his A-level chemistry. And I was like, "That's really good. What did they tell you about the contraceptive pill in A-level chemistry and what's in it?" And he said, "Nothing." And I thought, "Wow, what do we use as much as aspirin?" I was just kind of astonished that we're not teaching anyone this really essential information about what they're putting in their bodies.
HN: Where are we at with male forms of contraception?
KM: Well, this is fun. I feel they're getting really good stuff, like the progestin they are getting is a new progestin called Nestorone, which is much better – and looks better for things like libido, guess what? – than the ones we've been using. And we may get that one ourselves, too, in a vaginal ring. But anyway, the Nestorone is in a trial called the NST trial, which is Nestorone, progesterone and testosterone together in a gel. And men rub it on their shoulders morning and night, little blob of gel just looks like hair gel.
HN: Any particular reason it's the shoulders?
KM: You can rub it anywhere. I think that's just where they tested it.
HN: Got it, got it.
KM: It brings your sperm count down from millions to zero. No, almost zero, and the testosterone basically keeps your free testosterone going. So, in the male pill, they've thought through the idea about libido in a way that for the female pill they have not. So, they're compensating for the low testosterone created by the progestin in the testicles, but they're making sure your free testosterone around your body is still going kind of gangbusters. And it's been really successful. They've tried it in South Africa, America. Here, they've been doing trials in Edinburgh and Manchester. And men seem to be absolutely fine. The results are not out. But really low side effects, if none. And also men love taking responsibility in a couple for that. If their girlfriend has been struggling on the coil or something like that, it really is nice to say, "Right. Well, I'll take that burden and I'll remember to put the gel on every day." You got to trust one another, though, for that.
But the other forms of male contraception, the big one coming out is the temporary gel vasectomy, which is in America called either ADAM or Plan A, because the morning-after pill is called Plan B in America. So, anyway Plan A is to inject into your vas deferens a little blob of Vasalgel, which is a bit like superglue. And it basically puts a little sieve in your tubes that stops the sperm coming through. And then two years later, say, when you decide you want to have a baby or whatever, you get another injection which is a bit like bicarbonate of soda and it just melts away the little sieve that's in your tubes and then a week later you are back to normal and you will be fertile.
It's done really well in big trials in India and they've done rather well on a lot of happy monkeys in America, and who have done a lot of sex. And then it's about to be tried on people in America. So that looks like quite a good option and it gives the man control, but it's also temporary. Everything is quite convenient about that. And so there's good stuff like that. One of my favourites is called the Coso, and it's a little bath for your testicles. It looks like sort of two mugs joined together. It looks like something made by Apple or something. And you put your testicles in this little bath, like little jacuzzi, and you switch it on, and warms them up. I don't know, don't quite know what it does to them for a while. But when they come out, they're infertile for about a few months and it sort of discombobulates the sperm.
So, if people want to do that, they can do that. But it's non-hormonal. It's reversible. It's a lot of the options we never had. We’ve not been given the same option. And we say, "Oh, wide choice, patch, coil." But it's the same progestin in it, which has the same risks. And that's really important to understand. We have a wide choice, but it's made of the same things.
In Sweden, I interviewed this lovely guy and he had a girlfriend who had a terrible time with contraception and decided to invent something new, and he's invented a cervical gel that you rub on five minutes before you have sex, on your cervix, and it basically rebuffs all sperm. And it's been very successful in sheep. They've tested it in sheep and with randy rams, and the process has been tested, and they are now about to test that in humans in America. But that would be great, five minutes before you have sex. You got to have five minutes’ foreplay, everybody. And you can put the gel on your cervix. Brilliant. So simple. And it looks to be very successful. So, there are all these options, but why did they take so long to arrive? Why wasn't all this male contraception of any interest till suddenly now?
HN: So, what are the timelines like here? Because I'm guessing most of that's not on the market.
KM: No. None of that is on the market. I think the fastest thing will be the Plan B Vasalgel, if that comes through. And that might be two years in the future. I think the testosterone gel for your shoulder will be maybe five years. It's taken a long, long time. And also in those studies of men previously, because we've successfully had pills that made men infertile, but previously, the side effects in men were considered to be very, very important because you couldn't compare them to the risk of pregnancy because, in women, the side effects were compared against a massive risk of pregnancy, and you can die in pregnancy. All sorts of things could happen. So, it was more evenly balanced, whereas the side effects in men are just a problem and they are counted in a kind of different scientific way. So, there's an attempt to change that and get it to be considered a joint responsibility. So, you can consider the fact that a man feels a little bit headachy one day, but that compares to him not getting pregnant as a sort of family. And that's slightly different, but no, science has not caught up with life yet.
HN: Yeah. And we started by talking about the fact that abortion rates had gone up. Why do you think it's really important that we talk much more openly about abortions?
KM: Well, because of what's happening in America for a start, which is things like Florida there's going to be a ban at six weeks on abortion. You read these stories in America and you want to cry. It's just horrendous what's happening to women, in terms of everything. But I just think abortion, you can look at the most extreme cases and say, "Oh, my God, a 12-year-old has been raped." But even in the most ordinary cases, abortion should be part of our health care. I feel that really strongly. I've had two abortions myself. I've got three children as well and that worked out within my life to be the right thing for me. I had abortions because contraception failed me and I wasn't on hormonal contraception, I was on then a diaphragm, which was just rubbish eventually after a while.
It just seems so wrong that we don't talk about it. And I love the story of France in the 1960s, when over 300 really famous women, including kind of actresses like Catherine Deneuve and Simone de Beauvoir, all came out and said, "We have had illegal abortions and we are all going to talk about them. We need to change abortion law in France." And then a couple of years later, it did change. I feel that obviously an abortion, it's painful, it's difficult, it's complicated, it's different for everybody. And for some people, it's a huge trauma and for other people it's sort of a contraception gone wrong thing. It really, really varies and you've got to be massively sensitive to that.
But I feel that, I'm interviewing all these people, I have to be honest about what happened to me in this book, and I will be totally honest about my own abortions. I think if every single person who feels strong enough to say that, says that, then we'll all feel less crap about it and we'll all feel more confident, and we'll all understand how it works and what it feels like and what the abortion pill feels like. That's not discussed enough and we need to know what is going to happen to us, and that it happens to a third of women, so it's not weird, it's not surprising, it's part of our health care.
HN: I didn't realise that in Wales and Scotland, I was aware in Northern Ireland, that it's very different from England and that people end up having to come to England for abortion.
KM: After 12 weeks there isn't a surgical abortion in Scotland and you have to come down to – you have to pay to come down to a hospital somewhere in England and there are big queues, so you're put back a few weeks. So, I mean, really, we should have that as a service throughout the land. Things have got better because 80 percent of abortions are done now by the pill and it will be even more, and that is good. And it's really pretty safe and uncomfortable at home, and I indeed describe a home abortion. Maya Oppenheim told me about her home abortion with the pill and it was really hard going, but she's really glad she did it. We should know that. We should know what it feels like and be really, really honest. So, I hope that will cause an openness in conversation too.
HN: And you've created this book. What was it like to create the audiobook?
KM: Oh, terrible. I found it very hard to say medroxyprogesterone acetate.
HN: Fair enough. [laughs]
KM: There were lots of words, obviously, in this book and that this almost reflects that women don't have the vocabulary, that we don't have the vocabulary to name medroxyprogesterone acetate, which is the big hormone in the Depo-Provera injection, which is not very good and not a very safe hormone. And there were just a lot of words that I had a little struggle with. On the other hand, I got so angry and I got very emotional talking about the things when I was recording the book because you write it and it's all statistics and footnotes, and making sure everything is correct. And then when you read it, you kind of feel it. So, that was really good. Actually, when I was reading the bits about my own abortions, I found that quite difficult in a way that writing about them hadn't been.
HN: Why do you think that was?
KM: I just think it's, you know, you're going public at that point, I think.
HN: Yeah. And do you feel okay with that?
KM: Yeah. Yeah, I do.
HN: Well, Kate, it's been such a pleasure to chat about this book. I kept stopping. I have so many screenshots on my phone of this PDF. I cannot even tell you. I can't wait for everyone to listen to it and read it. It's really fantastic.
KM: Oh, thank you. And thank you for telling your story too.
HN: Thanks for listening to Audible Sessions. If you enjoyed this and want to hear more, search Audible Sessions on the Audible website or on the app. Everything You Need to Know About the Pill, written and narrated by Kate Muir, published by Simon & Schuster, is available to listen to on Audible now.
