Dr. Sarah Hill is an American psychologist, professor, researcher and author of How the Pill Changes Everything. Published in October 2019, the book has been a worldwide success and since then, Hill has been featured in many publications, has given a Ted Talk and been on various podcasts and radio shows.
It is arguably the first book written about the hormonal effects of the pill that is easily accessible to the public. When I googled “birth control book”, it was the first one to pop up. It explains how females function compared to males, how our sex hormones make us who are, how the pill alters our sex hormones, what we haven’t been told about the pill, what research still needs to be done and why this research hasn’t been done sooner. This book is a birth control pill revelation.
Here, Hill tells The Lowdown about how she came to write her debut novel and tells us about her successes since. This is why we should stan*.
Sex hormones and us
As a researcher and psychologist, Hill has spent the last 15 years looking into human behaviours (specifically females) and how our hormones can change who we are. But it wasn’t until she completely came off the birth control pill that she started to research more into sex hormones and their effect on the body.
Before we go further, I should explain (well, it’s really Hill who explains it in her book) that our sex hormones affect who we are, how we feel, who we love and how we view the world. When we take the birth control pill, our sex hormones are altered. It’s impossible to take a hormonal tablet that would only target one specific area of the body, so of course it’s going to change our thoughts and feelings.
Hill first went onto the pill when she was 17 and was in a relationship. She says she didn’t have any major problems with it and stayed on it non-stop until she was ready to have children. After having and breastfeeding her two children, Hill went back onto the pill, but was only on it for a short while as her husband had a vasectomy in 2016/17.
“I felt like I woke up”
Hill says that after coming off the pill, her whole outlook changed. “About three months in, I felt like I woke up,” she says. It wasn’t a sudden change but instead, she started to feel more. Hill began to go to the gym again, she noticed attractive men at the gym, she listened to music more and wanted to have sex with her husband more too.
Despite her spending a lot of her career researching hormones, Hill felt her changed behaviour was odd. “I thought ‘this is odd’ and so I went to the research literature to see if there might be some sort of explanation for how I was feeling.” After delving deep into the world of academic journals and papers, Hill found that there is information out there, but it’s only really accessible to academics or those who might understand the possible confusing language.
Upon discovering that the information she was looking for was out there, Hill admits she felt both surprised and embarrassed. Surprised that there in fact was so much research, but also embarrassed as the pill having an effect on our behaviours wasn’t something she, as a psychologist and researcher, had ever thought about. This realization made her think, she says. If she, a researcher and doctor in this field didn’t know about this, then how could your Joe public possibly know?
To ensure she hadn’t missed any possible books that may have been published without her knowing, Hill took to Amazon (other book retailers are available) to see if there had been books written for the public – but it was slim pickings. Fuelled now with a need to share her new-found knowledge with the rest of the world, she came up with the idea to write her own book. She says confidentially to me, “I felt like I had a responsibility to present this information to women. If I don’t know about this, then nobody else will either.”
Hill says it took her roughly two and a half to three years to write her debut novel. This included extensive research and in-depth interviews, submitting the book proposal and then writing it. She used past research but also researched as she wrote, ensuring she was using the most up to date data and findings.
Something I found that really stood out in this book was that Hill was on it. The questions I would have reading one section were often answered in the following paragraphs. It’s also the first book I’ve read that’s explained what is happening to our brains and the effects from that on our bodies and minds, in a way that I understand.
The book touches on many areas, way too many to discuss in one article. For example, it costs researchers a hell of a lot more to gather data on females than males. This is because females have cycles and so it can be tricky to gather consistent information – it is therefore more time consuming (this type of expense is the same for female rats!). Did you also know (I didn’t until I read this book) that it has only recently been made necessary for some organisations to include females in their trials? “If your research is getting funded by the National Institute of Health (NIH), then you have to include ‘some’ women in your studies,” Hill says. The NIH funds some researchers in America and so these rules don’t even apply to all research labs. Frustratingly, Hill adds that when you look at studies being conducted that now include females, a lot of them aren’t being done in a way that is actually going to make predictions because they’ve only used ‘some women’.
No pill bashing here
One thing Hill continuously clarifies throughout her book is that she is in no way pill bashing. It’s not about putting women off the pill, she knows it can be extremely beneficial to some females – hell, she got her PhD while on it and so certainly isn’t against. “The pill has been a really pivotal invention in terms of allowing women to become financially independent and things like that,” she explains.
“It’s not that I want women to say the pill is bad or evil because I don’t think that’s true. But it just entails some trade-offs a lot of women are making without knowing it,” Hill adds. But with the pill, Hill says, there seem to be different attitudes compared to other hormonal pills. Science and society don’t seem to treat the pill as a big deal and women are repeatedly given it as a way of preventing pregnancy, dealing with period cramps, moods or acne. This isn’t necessarily the same for other hormonal tablets.
“The pill entails some trade-offs a lot of women make without knowing it”
Take anabolic steroids, for example. Male athletes take these to improve their fitness performance. In her book, Hill explains that these steroids stimulate hormone receptors and can affect a male’s body and brain in a negative way. Interestingly, these steroids have been made illegal to buy, unless prescribed by a professional, because of the mental health risks they pose (not just because it would be cheating). It’s kind of ironic that at the same time, males are being advised to not take steroids (that contain hormones), while females are being given a pill that does. “With steroid use that are illegal, the idea is that the health risks that are involved don’t outweigh the rewards,” Hill says, “but with women and birth control pill, the understanding is that ‘yeah there’s health risks but the rewards outweigh the risks'”.
Hill wants to ask (and wants people to ask it themselves), who’s making these decisions? Who is deciding that it’s ok for females to repeatedly take hormonal pills, but that it’s dangerous for males to? It’s not that these shouldn’t be available, Hill says, but we’re not told about the range of risks and so we are at the mercy of our doctors or lawmakers. Of course, for some, benefits of the contraceptive pill would outweigh the negative. “It really surprises me the lack of gravity that a lot of doctors are experiencing when they’re putting really young girls on the pill for acne.” She likens taking the pill to something as simple as taking aspirin; people don’t think it’s that big of a deal. “It’s just about having the information out there so we are able to make the best decision for us.”
How the Pill Changes Everything has certainly made an impact. Hill explains she has received “mostly positive” responses from her book. She says women in America can be rather protective over the pill and so she was worried she may receive backlash, even though her aim was never to bash the pill. “I get emails daily from women who tell me that they never had an explanation for how they were feeling. They were led to believe they were crazy, only to have their suspicions verified by the information in the book.” She adds, “That’s been an absolutely incredible experience”.
In addition, since publication, Hill has received several emails from fellow academics or undergraduates looking to conduct similar research asking for advice. Not only that, but she has also been contacted by people from other professions asking how they can help.
Despite this book giving us so much more information than we have had already, Hill says this is just the beginning.
Hill and her lab are currently conducting data analysis on existing data sets looking into contraception and mood-related side effects. “Mental health is an important thing to look into, especially given the increased risk in suicides [for example] in adolescent women [taking the pill]” – mental health is also something Hill discusses in her book.
“Science belongs to the people”
She is also working hard to ramp up science communication as she says there is a “huge disconnect” between science and the public. “Science in a lot of ways is a National Park – it’s information that belongs to the people but the people don’t get it.” It’s not that it’s not out there, she adds, but that nobody wants to read research journals. “Even academics don’t want to read them,” she says. “There’s so much information relevant to people living in the world that lives in these research journals that aren’t being told about.” Therefore, she and her lab partners are working on something to ensure this information gets out there.
Adding more to her plate, Hill is also working on a ‘Women’s wellness business’. Here, she intends to create a programme where females can send in samples (of bodily fluids and whatnot) to her lab and they will be able to give them information about their hormones. This way, females will be able to map their hormones and develop a personal understanding of what’s going on in their bodies and how they’re feeling psychologically.
On top of that, Hill is a mother of two, wife, friend, professor, a witty writer and arguably (I’m sure you will agree) a birth control pioneer. Humbly, she says her book is only the beginning. There’s still so much more to learn about the birth control pill and we’re unfortunately still at a stage where females have to be their own guinea pigs in testing what works for them. At least this is a start.
Get your copy of How the Pill Changes Everything here.
To stan: To be a huge fan of or express extreme support for something or someone.