Alice Pelton, frustrated by a lack of knowledge about birth control, developed The Lowdown, a contraception review platform and resource maintained by women, for women.
ALICE PELTON WAS 16 YEARS OLD WHEN SHE TOOK THE PILL FOR THE FIRST TIME.
She, like many teenagers, was terrified of becoming pregnant, so taking a course of the combination hormonal contraceptive pill, as advised by her doctor, seemed like the next obvious step. Pelton’s emotions was all over the place in the months that followed. “I’d have these uncontrollable outbursts and cry over the most insignificant things,” she remembers. “There were heated debates with befuddled ex-boyfriends and family members… I’d also have these extremely deep lows, where it seemed like there was a piece of gauze in my head, preventing the serotonin from properly flowing around it, and everything was really flat.
“Pelton admits that her reactions were irrational, that her “emotions were out of control.” However, given the stereotypes that surround teenagers, none of it seemed particularly unusual at the time. After a break-up, she stopped taking the pill and noticed a significant difference. She felt more levelled and at ease. Her equilibrium slipped once again when she started a new relationship and went back on the pill. “It was as if it was night and day.” “I experienced crazy mood swings and would cry over the most insignificant things… it only took a few days for my mother to turn to me and say, ‘You’ve really changed,'” she adds. “That’s when I realized how much of an influence these hormones had been having on my emotions for years.”
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Pelton tried a variety of contraceptive pills, as well as other hormonal contraceptives like the IUD (intrauterine contraceptive coil), but each had its own set of unwanted side effects. It appeared to be a never-ending game of trial and error. Over dinner one night, she discussed it with her boyfriend, and an idea began to form. What if there was a method for women to support one another, to share and compare their stories? She stated, “I can’t believe we don’t examine our contraceptives like we do everything else. “Contraception, she realized, could be tackled in the same way that any other data challenge could be – but what she saw online was a jumble of unorganized data. She couldn’t even find a place that listed all of the different pill brands.
Conversations were taking place on sites like Mumsnet and Reddit, confirming that she wasn’t alone in her search for the appropriate contraception, but the conversations were frequently disconnected and confused. Pelton, a product manager by trade, drew inspiration from an odd source: Fantasy Football game apps, which she had previously worked to develop. “A lot of sport is data-rich, and Fantasy Football is all about making decisions about the players on your teams and attempting to convey a lot of information on a little screen – stats, assists, points, and so on,” she explains.
She founded The Lowdown, a contraception review website and online community with over 80,000 participants, in 2019. The Lowdown’s website provides contraception guidance as well as impartial contraceptive reviews submitted by site visitors – there are currently over 4,500 published testimonials – all of which can be compared and contrasted using filters such as user age, pill brand, and time spent using it. It’s like a “Tripadvisor for contraception,” according to Pelton. Telemedicine GP visits and an online pharmacy are also available through The Lowdown. Despite the fact that the platform covers all contraceptives, including non-hormonal choices, the pill is the subject of the bulk of evaluations (65%), with the combination pill accounting for 42% of the total.
Mood changes, weight gain, and despair are common side effects cited in reviews. Users on this site, however, are more pragmatic than on other product review sites, which tend to attract feedback from customers who have had a particularly excellent or bad experience. “It’s just my experience,” a frequent sentiment goes. “Other ladies might find it works for them.” The overall message is clear: despite the pill’s significant societal influence, not to mention its massive global market, the product is simply not up to par for many people. The pill, which has been around for sixty years, could use an update, and Pelton believes that a more user-centric approach is what’s needed.
THE CONTRACEPTIVE PILL HAS REVOLUTIONIZED WOMEN’S HEALTH AND FAMILY PLANNING SINCE IT FIRST APPEARED IN THE UK IN 1961
(at first exclusively on prescription to married women), and is frequently touted as the single most important contributor to gender equality to date. The combined pill is the most often prescribed contraceptive around the world1, with over three million women in the UK receiving either the combined pill or the progesterone-only pill each year. 2 “We know that when compared to alternative hormonal contraceptive treatments, women prefer the combination pill,” says the researcher. Diana Mansour, a consultant gynaecologist and senior vice-chair of the Royal College of Obstetricians and Gynaecologists’ Faculty of Sexual and Reproductive Healthcare, agrees.
She believes the pill’s appeal stems from its ease of use. “It’s simple because it’s in their hands,” she explains. “Women can know when to expect their period or avoid it entirely — it’s a lot more suited to our lifestyle. “Contraceptive pills, like any other therapeutic medicine, have a wide range of potential adverse effects. In a normal pill pack’s patient guidance leaflet, irregular or unpredictable menstrual bleeding, headaches, acne, weight gain, sadness, anxiety, and other mood changes are only a few of the more prevalent side effects. A study of women in Europe and the United States found that 20-30% of them were unsatisfied with their contraception, with adverse effects being the most common cause for discontinuation.
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Since the pill’s invention, women have endured its undesirable and unpredictable side effects – such are the risks we are ready to accept to avert an unwanted pregnancy. However, as information becomes more widely available, some people are resisting. Sarah Hill, a social psychologist located in Texas, expresses her dissatisfaction vocally. “Women frequently say something like, ‘I really like my new birth control.’ Now I’ve gained 25 pounds, no longer have sex, and my hair is coming out as a result of it. But aside from that, it’s fantastic!’ she exclaims.
“The parameters are so low because a lot of it is so awful,” says the narrator. How the Pill Changes Everything: How the Pill Changes Everything is a book on this sentiment. Your Mind as a Birth Control Device. Hill, like Pelton, felt motivated to dig into the pill’s purported adverse effects after experiencing her own revelation after being off it for a long time. The irony, she observes, is that she studied and researched hormones for the 12-13 years she was on the pill – “yet I’d never imagined until then that the hormones would be altering my brain in any way.”
WHY, IN THIS DAY AND AGE OF RAPID MEDICAL DEVELOPMENT, HAVE RESEARCHERS FAILED TO CREATE A BETTER PILL FOR EVERYONE?
It’s not as simple as it appears. “A lot of the research on the adverse effects of contraception is unclear, and that’s because it’s fundamentally difficult to do,” says Mel Davis-Hall, clinical editor of the British Medical Journal and co-medical director of The Lowdown. Changes in sex desire and mood, for example, are notoriously difficult to assess due to their “inherently complex nature,” she explains. “Women are living their lives and experiencing ups and downs as a result of a variety of external variables, so you won’t receive conclusive answers. “The Lowdown has disadvantages in this area: no matter how detailed users’ assessments are, their experiences are primarily subjective, making the data impossible to quantify for scientific studies.
Pelton, on the other hand, refutes this, citing NHS Track and Trace’s massive data collection effort for the distribution of Covid-19. “There’s a snobbishness about what we’re doing with The Lowdown – the complaints will always be that it’s based on self-reported, skewed data.” But wait a minute, aren’t we doing the same thing with Covid-19? Hasn’t that demonstrated that millions of people can self-report and discuss side effects and be heard? “How is contraception any different?” you might wonder. The fact that there is “a scarcity of current data about what women’s periods are like regularly,” according to Pelton, makes comparing contraception data even more challenging. “I believe there is a fundamentally sexist attitude toward women who self-report pain, difficulties, or periods. Women are being overlooked because there is a perception that we are less trustworthy. It’s a load of nonsense.”
Pelton expects that the Lowdown will be able to contribute to contraceptive research, particularly when it comes to side effects, and potentially assist drive the creation of new options, in addition to allowing women to share their experiences and make more educated choices. Pelton was introduced to Frederik Petursson Madsen, the CEO of Cirqle Biomedical, by The Lowdown because he, too, wanted to do something radical: genuinely asking women what they wanted from a contraceptive product. He explains, “The aim was basically to understand what constitutes the ultimate contraceptive and trying to discover the technology to achieve that.”
“Innovation, in my opinion, has been predominantly driven from the research side by scientists in labs, rather than from the user perspective, for the previous few decades. “When his fiancée decided to stop taking the pill owing to undesired side effects, Petursson Madsen began thinking alternative contraception solutions. He feels that the absence of contraceptive design innovation is due to a degree of ignorance among big investors, the majority of whom are men. He admits, “I wasn’t really conscious of the problem.” “It didn’t take long for me to realise that I, too, would prefer not to utilise chemical contraception.” It just felt incorrect, like something that might be bettered. There aren’t many other sectors where you have a product that is so vital to society but the current standard of care is so outmoded.”
FOR THE TIME BEING,
he pill is still widely used as one of the few safe choices for women. As a result, it’s critical that users have access to the greatest prescription and related information available. The Lowdown has already expressed interest in assisting in this area. Visitors to the internet can look up a specific contraceptive brand or method, read about its ingredients and adverse effects, and learn how to use it. They can also take out a brief questionnaire to receive recommendations for additional contraceptive brands that may be suitable for them depending on their previous experiences. They can get a private, 20-minute video consultation with medical experts for £37 if they want to. “When you consider that a typical GP session lasts up to ten minutes to cover several concerns as well as administrative responsibilities, it’s not long enough,” says Yarlett, who oversees the telemedicine section.
In 2020, online pharmacy dispensing surged by 45 percent, partly as a result of Covid-19, which made in-person GP appointments more difficult. Pelton claims that The Lowdown has experienced a significant increase in pill sales, although customers cite stock concerns as one of the main reasons for going private – a problem that existed prior to the pandemic. “It’s very normal for a lady to have used one brand for many years, move to a different region or town, and then discover they can’t get it,” she explains. Manufacturers and distributors can also face supply concerns; when we chat in summer 2021, she explains that women are hopping from pharmacy to drugstore looking for the progestogen-only pill Noriday, which is currently out of stock.
Pelton and her colleagues anticipate that in the future, more data-rich, tailored medical treatment will be available, combining NHS services with online resources. “Giving women better access to information and data before and after their appointment is a big part of how we can help the NHS,” Yarlett adds. She’s also working on an algorithm as part of her work with The Lowdown, which she thinks will assist women better understand their symptoms as part of a bigger consultation package. “The idea is that a woman can input her contraceptive method as well as any negative effects or symptoms she may be experiencing,” she explains. “From there, she’ll be referred to either visit a GP or healthcare professional for additional investigations – with an explanation of which investigations we’re performing and why – or she’ll be given guidance on how she may manage this side effect herself.” Changing how she takes the pill, advocating a change in oestrogen dosage or progestogen type, or attempting an alternate form of contraception are all possibilities.
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Yarlett hopes that by doing so, women will gain a better understanding of their own bodies and a greater sense of control over their contraception and health. She goes on to say that an algorithm like this may be classified as a medical device and controlled by the MHRA, which The Lowdown is investigating. “I believe that having women access to this knowledge and cognitive process will raise contraceptive user satisfaction and improve overall health outcomes,” she says. Another option is to share data from The Lowdown with consenting patients’ GPs in order to save time during NHS sessions and construct more complete patient profiles to aid diagnosis. “We’re all trying to achieve the same goal here, which is to assist women in making their own decisions, feeling well-informed, and correctly using contraception.”
NHS England approached The Lowdown in 2021 to chat to women and answer some common questions about receiving the vaccine while pregnant; the company was approached by NHS England in 2021 to talk to women and answer some frequent questions about obtaining the vaccine while pregnant. “That was excellent to achieve,” Pelton adds, “and a tremendous evidence that we’re not only gaining trust with women, but also with the NHS.” “It helps that we already have a really involved community of women who trust us, and we’re able to communicate with them in a manner that NHS communications professionals – who need a lot of sign-offs for everything – aren’t able to. “Pharmaceutical businesses have begun contacting The Lowdown directly for market research to improve their products, and the company gave data from 2,000 survey replies in June in response to the UK government’s need for evidence on reproductive health. 10
Pelton is now running the company out of a co-working facility in Brixton, central London, with a permanent office in Waterloo on the way. “The Lowdown has started to produce a tiny but consistent profit from its telemedicine service, and has received funding from health tech investors Calm/Storm VC and Nina Capital, as well as a number of independent tech entrepreneurs, this year. The funds will be used to refurbish the online platform in preparation for a relaunch in the fall, as well as work on extending The Lowdown abroad. If there’s one thing the Covid-19 pandemic has taught us, it’s that women’s health – and the symptoms they describe – should be taken more seriously. “I’ll say it until I’m blue in the face to everyone: listen to what women have to say,” she says. “Self-reported reviews are the best we have in the absence of actual gold standard clinical research.”