Medical experts are becoming increasingly concerned about searches for “birth control” on TikTok or Instagram unleashing a cascade of misleading videos vilifying hormonal contraception – young women blaming weight gain on the pill, and complaints about depression and anxiety, among other things.
Additionally, they say, a growing school of social media influencers is recommending “natural” alternatives, for instance like timing sex to menstrual cycles – a less effective birth-control method that doctors warn could result in unwanted pregnancies.
Physicians say the explosion of online birth-control misinformation is targeting vulnerable groups, people in their teens and early 20s who are more likely to believe what they see on their phones because of algorithms feeding them a stream of videos reinforcing messages often divorced from scientific evidence.
While doctors say hormonal contraception that includes birth-control pills and intrauterine devices (IUDs) is safe and effective, they worry the profession’s long-standing lack of transparency about some of the serious but rare side effects has left many patients seeking information from unqualified online communities.
The Washington Post reports that the backlash to birth control comes at a time of rampant misinformation about basic health tenets amid poor digital literacy and political debate over reproductive rights, where frequently, far-right conservatives argue that broad acceptance of birth control has altered traditional gender roles and weakened the family.
Physicians and researchers say minimal data are available about the scale of this new phenomenon, but anecdotally, more patients are verbalising misconceptions about birth control fuelled by influencers and conservative commentators.
“People are claiming to be experts on birth control …saying things the science does not bear out,” said Michael Belmonte, an OB/GYN and family planning expert with the American College of Obstetricians and Gynaecologists (ACOG). “I am seeing those direct failures of this misinformation.”
Patients believe what they see on social media about the dangers of hormonal birth control and the effectiveness of tracking periods to prevent pregnancy, he added.
“Doctors stand a better chance of dispelling misinformation when they listen to patients’ concerns, some of whom are more worried about the side effects of birth control than the effectiveness doctors have long been trained to emphasise.”
He has adopted ACOG’s recommendation that physicians candidly discuss common side effects like nausea, headaches, breast tenderness and bleeding between periods; many of these resolve on their own or can be mitigated by switching forms of birth control.
Why misinformation is on the rise
For influencers seeking fame and fortune on the internet, negative content draws more clicks, allowing them to reach a wider audience to sell their products and services.
Nicole Bendayan, with more than 1m combined followers on Instagram and TikTok for her holistic-health coaching business, posted that she stopped using hormonal birth control because she was concerned about weight gain, low libido and intermittent bleeding, which she had assumed were side effects.
Her post about becoming a “cycle-syncing nutritionist” who teaches women how to live “in tune” with their menstrual cycles has drawn 10.5m views.
The 29-year-old is not a licensed medical specialist.
“I had a lot of really bad symptoms (and) saw different doctors. They all dismissed me. Even when I asked if it had anything to do with birth control, they all said no,” she told The Washington Post. She had used a vaginal ring for eight years and an IUD for two; she said when she went off birth control, her symptoms vanished.
Bendayan has told her followers that birth control may deplete magnesium, vitamins B, C and E, and zinc levels. She charges hundreds of dollars for a three-month virtual programme that includes analyses of blood panels for what she calls hormonal imbalances.
When asked about the science behind why her symptoms resolved after getting off birth control, Bendayan said she did her own research and found studies backing up what she was feeling. She doesn’t claim to be a doctor, but says she wants to help others.
“I make it clear in a disclaimer that I’m not a medical professional and would happily work with their healthcare team,” said Bendayan, who lives in Spain. “I’m an educator.”
Hormones
In recent years, an entire industry has popped up around regulating hormones that experts say is often a cash grab; there is no proven science that the hormone-balancing regimes pushed by some social media influencers – such as Bendayan – work.
Social media companies struggle to combat misinformation as they balance free-speech protections. Meta, the parent company of Facebook and Instagram, says it works hard to protect online communities.
“Our policies are designed to give people a voice, while keeping people safe on our apps,” said Meta spokesperson Ryan Daniels.
TikTok recently removed at least five videos linking birth control to mental health issues and other health problems after The Post asked how the company prevents the spread of misinformation. One of the videos removed was of Bendayan saying certain forms of birth control could make users more susceptible to sexually transmitted infections, which experts say the evidence does not support.
Brett Cooper, a media commentator, argued in a viral TikTok clip that birth control can affect fertility, cause weight gain, and even alter to whom people might be attracted. It racked up more than 219 000 “likes” before TikTok removed it after The Post’s inquiry.
Medical experts say there is no evidence birth control affects fertility long term.
In a 2017-2019 federal survey, the latest available, 14% of women aged 15 to 49 said they were currently using oral contraceptive pills, and 10% said they were using long-acting reversible contraceptives like an IUD.
In a survey of women aged 15 to 44 who had had sex, the percentage who reported ever having used the pill dropped from 82% to 79% between 2002 and 2015, while the percentage for those ever having used an IUD more than doubled, to 15%.
Side effects of birth control
All forms of medication, including hormonal birth control, can have side effects. Some are rare, but serious: birth-control pills that contain oestrogen can lead to blood clots and strokes. IUDs can perforate the uterine wall.
The US Food and Drug Administration says the risk of developing blood clots from using birth-control pills – three to nine women out of 10 000 who are on the pill – remains lower than the risk of developing blood clots in pregnancy and in the postpartum period.
Doctors note that Opill, the over-the-counter pill that will soon be available in stores and online in the US, contains only progestin, meaning it does not have the blood clot risk of oestrogen-containing pills.
The algorithms behind TikTok, YouTube and Instagram are designed to surface content similar to what viewers have already watched, which experts say leads viewers to believe that more people suffer complications than in reality.
Jenny Wu, an OB/GYN resident at Duke University, said her Gen Z patients were turning away from IUDs at higher rates than her millennial patients, and were referencing TikTok posts about the pain of IUD insertion. So she analysed the 100 most popular TikTok videos about IUDs and found that a surprisingly high proportion, almost 40%, were negative.
“It’s changed how I practice,” she said. She now routinely offers patients various pain management options including anti-inflammatory drugs, a lidocaine injection into the cervix, or anti-anxiety medication.
See more from MedicalBrief archives:
New York health advisory lists social media an environmental toxin
First over-the-counter birth control pill approved in US
Breast cancer risk increased by some birth control pills
Contraception with fewer hormones still effective – Philippines modelling study