3 years of being on birth control

A detailed personal case study has gone viral on the rationalist forum LessWrong, where user AnnaJo chronicled her three-year journey experimenting with hormonal birth control to manage severe menstrual pain that disrupted her academic life. The post, titled "3 years of being on birth control," methodically documents her trials with four different progestins—starting with segesterone acetate in Annovera, then drospirenone in Yasmin—and their profound side effects, including significant depression and loss of motivation.

AnnaJo's core hypothesis centers on Sex Hormone Binding Globulin (SHBG), a protein that binds to sex hormones like testosterone. She notes that combination birth control pills increase SHBG, which reduces free testosterone, and that anti-androgenic (fourth-generation) progestins raise SHBG more than others. Her personal data suggests her tolerance for different contraceptives may be correlated with her SHBG response, proposing it as a potential predictive biomarker for side effects. This n=1 experiment highlights the complex trade-offs in hormonal treatment and the lack of personalized tools in women's healthcare.

The post resonates for its data-driven, self-experimentation approach applied to a common but poorly understood health issue. It underscores the gap between clinical drug categories and individual biochemistry, suggesting that tracking specific hormones like SHBG could help others navigate contraceptive choices with fewer debilitating side effects.