Debates about the ethical dimension of the Pill are like smoke-filled 19th-century battlefields “where ignorant armies clash by night”. Inquiry is enveloped by dense clouds of competing studies, ideology-fuelled rage, commercial interests, and social indoctrination.

It’s rare to find an overview of the issues which frames it as an anthropological problem, rather than as solely a medical, social or ideological issue. Fortunately, a recent article in the journal Frontiers in Medicine by three Spanish authors, a pharmacist, a doctor and a bioethicist, tackles this controversial issue head-on.

Their starting point is that hormone-based contraceptives are artificial. This is fundamental to appreciating its effects on women – and all of society. They conclude that an evaluation of the impact of the Pill upon women has to be holistic. It needs to take into account all dimensions of a woman’s life – not just whether or not the Pill leads to cancer or heart failure.

Dr Micaela Menarguez, one of the authors of this stunning article, answered some questions from Mercator about their findings. She is a pharmacist at the Catholic University of Murcia (UCAM).

The Pill protects women’s autonomy by giving them control of their fertility. What could possibly be wrong with that?

When considering women’s autonomy and their fertility, some questions have often been ignored. On the one hand, the Pill affects physical and women's mental health; there are many studies already published which show this question.

On the other hand, the Pill decreases libido, sexual desire in women, and affects their sexual life. If we consider all these questions, we need to find other solutions for fertility control and regulation.

At this moment, Natural Family Planning, which involves women in the knowledge of their own cycle, seems to be the best solution. It also provides women with the opportunity to know when they are fertile and when they are infertile and helps them to make considered decisions about their sexual life, without associated health problems.

It is also important to note that fertility control is not the only element in women's autonomy. Most women want complete and honest information about the effects of the Pill on their health. This would give them full autonomy in their relationships and their lifestyle.

How does the Pill affect women’s mental health?

In many ways, starting with mood swings. Recent studies have shown that there is a correlation between women using the Pill and mental illnesses like depression, anxiety, suicidality and even attempted suicide.

This happens because there are neuronal receptors in the brain for the kind of hormones that the Pill contains in its formulation. They may involve areas involved in regulating emotions, affecting the synthesis of neurotransmitters, and potentially leading to their deregulation.

How does it affect women’s romantic life?

The Pill affects both women’s emotions and sexual desire. In both cases, women lose, because they become more unstable, become moodier, and enjoy sex less.

And, of course, it also affects relationships between men and women. The exogenous estradiol in the Pill seems to make women evaluate their partners less positively. On the other hand, increased levels of progesterone after ovulation in women who are not under the Pill make them perceive their partner in a more positive way.

The link between the Pill and various forms of cancer is highly controversial. What’s your opinion?

On one hand, studies have proved that cancers related to hormones probably become worse with the Pill, because it is hormone-based. Studies that argue that the Pill protects women from some cancers have a lot of methodological problems (e.g. selection of population). What we do know is that pregnancy and delivery protect women from breast, ovarian and endometrium cancer.

Your paper highlights the fact that there are many gaps in what doctors know about the effects of the Pill. Where are the biggest gaps, do you think?

Doctors simply don't know how dangerous the Pill is. Most of them really don’t. For example, its effects on mental health, its effects upon libido, its effects on the cardiovascular system, the risks of certain cancers and so on.

It is crucial for them to keep up to date on recent research, with a critical analysis of their findings and the methodology to provide optimal advice to their patients.