Pre-Menstrual Dysphoric Disorder (PMDD) and Birth Control, A Dangerous Combination

From “Taking Charge of Your Fertility” by Toni Weschler

From my previous posts you have learned that I don’t oppose all forms of birth control, but that I urge caution about hormonal birth control.

I have two reasons for this: the first is the fact that hormonal birth control can be an abortificant. The second is much more personal, hormonal birth control can really create havoc on your body and mind.

Shortly before we were married, my wife went to her gynecologist for a routine check and pre-wedding screening (not like she needed it but whatever). While there, the doctor told her she should start taking birth control a couple of months before the wedding. “You don’t want to be inconvenienced by a baby.” she told her. Being young and naive my soon to be wife acquiesced and started taking what the doctor prescribed.

The side effects began her first week on the pill. At first it was a near constant nausea which kept her in bed most of the time. Next, a nearly insatiable libido disappeared. Then came the depression and anxiety. She reported these to the doctor and was assured they weren’t side-effects, she was probably just nervous about the wedding.

Reluctantly, the doctor switched her pills for the patch. Her nausea abated slightly, but the rest of the symptoms remained in full force.

By the time the wedding came, she had very little interest in sex. There were a few nights on the honeymoon where she cried for hours because she couldn’t understand what was happening to her. She didn’t want me anymore. What sort of switch happened that would cause her to suddenly stop her interest in me?

Upon our return, my new wife reported these problems to the doctor only to be told that she was probably just regretting her decision to get married so young. “Depression is not a side effect of birth control.” Nonetheless, her doctor agreed to change the medication again, this time to the Nuva Ring.

While the ring was better for nausea, the depression worsened dramatically. There were nights I would wake up next to a sweating, rocking, tearful woman. Sex was nearly impossible. She contemplated suicide.

All the while, the doctor insisted it was in her head.

I don’t remember exactly what clicked in my mind, but one morning I told her to quit the birth control. While the side-effects weren’t spelled out on the packaging, it was too suspicious to me that they would coincide with her first dosages. She quit taking them, much to her doctor’s chagrin.

Within a month her mood was vastly better. Her nausea disappeared. There were still incredible mental and emotional scars that made sex difficult, but her appetite for it returned in force. Two months after quitting (three months after the wedding), she was pregnant.

After our first daughter was born we ignorantly decided to try the BC again. Breastfeeding was a hellish nightmare (thanks to a lack of lactation consultants) and parenting did not seem like something we wanted to do more of at that point.

Side effects came right back full force. She was told “oh, those aren’t side effects” yet again.

Funny how they disappeared shortly after she stopped taking the pill for the second time.

The labels did vaguely mention that you could have suicidal thoughts as a side-effect. But it was listed as an almost unheard of side effect. Our only guess is that women who do not suffer from Pre-Menstrual Dysphoric Disorder (PMDD) rarely have those side effects. Or that doctors simply don’t care.

She was never screened for PMDD, we didn’t know she had it until almost ten years later. But the diagnosis made everything make sense. Any fluctuation in hormones brings about emotional and mental changes in her. Birth control, pregnancy, and breastfeeding each had their own effects, whether nausea or severe depression or decreased libido. Like clockwork she gets severe depression about ten days before her period and starts feeling better immediately upon menstruation. Then she is healthy for a week or so after, before plunging back down again.

Most doctors don’t even know what PMDD is, it’s just not on their radar. They are convinced that BC simply doesn’t have any emotional side effects. They barely listened to her about the nausea.

It’s almost like they have an agenda to push. Hence the “you don’t want to be inconvenienced by a baby” comment.

Needless to say, hormonal birth control is definitely not for us. Since this happened to us we have talked to dozens of women who had similar experiences, even ones without PMDD.

If you decide to use it and you experience similar side effects, don’t let the doctor tell you that you are crazy or that you should just switch until you find one that works. Get your hormones checked and talk to a doctor about the possibility of PMDD. It took a general practitioner about ten minutes to make the diagnosis and prescribe medication and other therapies. Now she is healthier emotionally than she has ever been.

It’s not worth living in misery when there are other ways to go about preventing pregnancy.

Killing the Seed: How Hormonal Birth Control Violates the Sixth Commandment

In my previous post I talked about how I don’t believe sperm by itself is a “seed” and therefore I don’t believe that birth control methods which block sperm are immoral in and of themselves. Today I’d like to talk about how a fertilized egg is a seed.

If we continue the analogy of conception being like sowing seeds in a garden, the fertilized egg is what is “planted” in the uterus. The fertilized egg (zygote), unlike a sperm, has a very real potential of growing into an adult.

Most “pro-choice” people will argue that life does not begin until some magic moment such as the first breath or even later. But logic concludes that two living cells do not come together to form a non-living blob of tissue. The sperm is alive, the egg is alive, therefore the fertilized egg is alive as well. Not only is it alive, it contains its own unique strand of DNA. It is not identical to its mother or its father. Nor is it a mutation like cancer. Thus the zygote is a living person and under the requirements of the Sixth commandment, should be protected as such.

Unlike sperm, the fertilized egg is not just a potential life, it is a life. And without the next step of implantation that life will end. Blocking the zygote from implantation ends that life.

Most birth control pills and the IUD work primarily through preventing ovulation or fertilization, but in the rare instance that these mechanisms fail they also have the effect of making the uterine walls inhospitable to implantation by the fertilized egg.

In recent times, politically charged “science” has called into question whether this is actually one of the mechanisms of hormonal birth control. We actually know very little about how the pill works, we know it prevents ovulation, we know it prevents sperm from reaching egg, and we know it thins the uterine lining or changes the chemical environment of the uterus. Given the third one it makes sense to err on the side of caution and assume that it also prevents implantation of the “seed”.

And even if we consider it a slim possibility that the egg will be released, then fertilized and then make it to the uterus, this slim possibility that one will be responsible for the death of another human being should be enough to persuade us to avoid these methods.

Many will argue that if we reach my conclusion we will also have to assume that natural miscarriages are sinful too. What makes the elective abortion different from the natural miscarriage?

This should be obvious, one is willful, the other is not. A woman who naturally miscarries cannot be help morally culpable for the death of her child, she was most likely not in control of the situation that led to the miscarriage.

Stay tuned next week for an analysis of side effects…

*I realized after I was almost done writing this that one could conclude that I am calling all users of hormonal birth control sinners. Please be assured that you are not a part of this category if you are abstaining from sex and taking birth control for reasons other than contraception.

A Few Explanations

Lest I be accused of misrepresentation, I do want to clarify a few things about Onanism.

Onanists do understand that Onan was deliberately disobeying God. They do not simply conclude that the spilling itself was the whole of Onan’s transgressions.

The implications of what they believe are quite staggering. While most don’t believe there are any reasons to prevent pregnancy, there are some who will allow it. However, because of their interpretation of these verses, they often assert the only moral way to prevent pregnancy is complete abstinence, even in marriage. I know a man who has gone twelve years without intercourse because he refused his wife’s request to have a vasectomy. He considers it his cross to bear. It’s almost like a badge of honor to him. I think it’s a shame. I think it is atrocious that he has allowed his wife to withhold from him (sin) for this long without approaching her as a brother in Christ or as a Godly husband concerned with his wife’s soul.

They also don’t go officially by the name “Onanist”, I just coined the term to describe those who hold to this particular application of the Onan story. So don’t go pointing a finger and yelling “Onanist!” at them. They probably wouldn’t understand anyway.

Don’t be this guy…

Every Sperm is Sacred: Onanism and Birth Control

Every Sperm is Sacred… Wait, that’s the Catholics… Source

You may want to send your kids into the next room for the next couple of posts, I’m going to talk about sex. In particular about birth control. Is birth control a sin? Is it wise? Can it harm you?

Personally, we do not use hormonal birth control, but ours is less a conscience issue and more of a personal experience issue. I’ll discuss later in this series, but first I want to address a common objection to birth control often thrown around in Reformed circles: The story of Onan.

And Judah took a wife for Er his firstborn, and her name was Tamar. But Er, Judah’s firstborn, was wicked in the sight of the Lord, and the Lord put him to death. Then Judah said to Onan, “Go in to your brother’s wife and perform the duty of a brother-in-law to her, and raise up offspring for your brother.” But Onan knew that the offspring would not be his. So whenever he went in to his brother’s wife he would waste the semen on the ground, so as not to give offspring to his brother. And what he did was wicked in the sight of the Lord, and He put him to death also.
Genesis 38:6-10

According to the Onanists, the mere spilling of a man’s semen outside of a woman’s body is a sinful thing. The birth control methods of coitus interruptus (stopping before orgasm), pulling out, or even vasectomy are ruled out as violating the principle found in the story of Onan.

Just reading the story of Onan is not enough to find these principles. One has to dig into commentaries and discussions written centuries ago.

Before one questions my Reformed credentials, old commentaries are helpful when studying the essentials of our faith. They are helpful for learning Godliness and how to live a Holy life. But, sometimes even the men of the past show their fallibility.

“….the third [murder], in that there is a seminal vital virtue, which perishes if the seed be spilled; and by doing this to hinder the begetting of a living child, is the first degree of murder that can be committed, and the next unto it is the marring of conception, when it is made…” -Westminster Annotations and Commentary on the Whole Bible (1657), Genesis 38:9.

“Most Hebrew and Christian commentators conclude [from the grammar] that the sin of Er was of the same type as the sin of Onan, which they call effeminacy. Augustine in book 22, Against Faust Chap. 84, concluded that this Er had sinned in this offense severely because that sin impedes conception and destroys the foetus in its own seed….” – Lutheran minister Johann Gerhard (1582-1637)

“The rabbis interpreted Onan’s transgression as birth control through coitus interruptus. In an illustrative euphemism, the Jewish commentator Rashi calls this “threshing within, winnowing without.””

Given the terminology used by the commentators I think it is safe to assume that the interpretation of past generations was based on a belief that the man’s sperm was a fully formed seed. In fact, the KJV translates verse 9 as:

And Onan knew that the seed should not be his; and it came to pass, when he went in unto his brother’s wife, that he spilled it on the ground, lest that he should give seed to his brother.

This seed was planted into a woman’s body, much like planting a vegetable seed in a garden. To spill the seed was murder as the spiller was denying the living seed the opportunity to sprout and grow.

The 6th commandment requires us to protect life. Even potential life should be protected. If we assume that a man’s emission is a fully formed seed it is reasonable to conclude that wasting this emission is in fact ending a potential life.

In order to answer the question “do spermicidal or barrier birth control methods violate the 6th commandment?” we have to answer this question: “is sperm in and of itself ‘potential life?’”

My answer to this is “no”.

Semen is not a seed, sperm is not a seed. Without an egg present there is no chance that the sperm will survive. Unless the sperm fertilizes an egg it will die. Yes, the sperm is a living cell, but it does not carry by itself the potential for new human life.

Unless a woman is ovulating there is no potential for that sperm to grow into a life as it will never contact an egg. It will simply swim around inside the woman for a few hours or days and eventually die.

If we had to ensure sperm survived sex (the logical conclusion of Onanists), we would limit sexual union to only the time in which a woman is ovulating. Any sex outside of that time of fertility would be denying that “seed” a real opportunity to grow into life. You would be robbing that sperm the opportunity to meet and fertilize an egg.

We are commanded to give our spouse their conjugal rights, surely our spouse wants this fulfillment outside of the ovulation period, are we therefore being commanded to commit murder every time we do it any other time?

God would not command us to violate His own commandments. He knew that eventually we would know the science behind ovulation and understand the cycle of fertility. He allowed us to discover these things. The logical conclusion of the Onanists would have us use this knowledge to limit intercourse to those fertile times, otherwise we are “wasting” our “seed” just as Onan did.

Whether or not you believe barrier methods of birth control are sinful or not is not an indication of your salvation. This is a matter of conscience and I don’t hold it against anyone if they come to the conclusion that they personally cannot use barriers, coitus interuptus, or vasectomies in good conscience.

But for the reasons above, I don’t consider them sinful.

Stick around for the next post when I discuss why I believe hormonal birth control is sinful.

CRAS: Nudity

If you’re not familiar with my term “CRAS” go here for an explanation.

Clothing demonstrates to others our character. What we do or do not wear projects our character to the world. As Christians we should strive to project Godly character with what we wear. We do not want to give a false impression of God’s people to the world. We should be humble but also project joy. We should dress according to occasion. Somber times (and corporate worship) call for somber dress and somber face. Joyful times, such as weddings, call for more joyous dress.

But what about nudity? In my quest to become more Biblical in my thinking and less influenced by culture, this topic has come to mind any time a discussion of “modesty” comes across my newsfeed.

What we wear can demonstrate to others our openness or reservedness. Nudity is to be fully open and exposed. Which is why people generally do not like it. People do not like to be vulnerable. Sins and scars can be hidden with clothing. 

While nudity equalizes us and removes classes, every habit is demonstrated on the body. Abuse from self and from others is displayed. Such things are shameful and the desire to cover them is great.

Is simple nudity sinful? Some say lust and sexuality make nudity sinful. Some say the dress requirements given to the Old Testament temple priests prove nudity is sinful. However, I conclude that simple nudity is not a sinful state. Would God have created Adam and Eve in a sinful state? In spite of the unclothed state of man, God declared Creation “Very Good”.

Some say that certain passages in Leviticus 18 and 20 define nudity as sinful. However, it is clear from the context that “Uncovering the nakedness” is a condemnation of sexual immorality. Literal readings would mean we cannot change our children or bathe an elderly parent. We could not care for others in any way that might require exposing their bodies.

These passages do not condemn simple nudity, they condemn sexual acts among relatives or between non-married people. There is also a condemnation of rape found in these passages. “Exposing the nakedness” in this case is an aggressive act of embarrassment and objectification. In the story of Ham, the bible does not condemn Noah’s nudity, just Ham’s exposure of it. Noah cursed Ham’s son Canaan for drawing attention to his compromised situation.

Some say we should always wear clothing because it is symbolic of Christ’s covering of our sins. This was certainly true of the clothing God created for Adam and Eve. Is there reason to believe God’s clothing of Adam and Eve to be prescriptive to us? When He provided their skin coverings God could have outright declared nakedness to be sinful. However, He simply provided coverings to them as an act of mercy and as a protection to the new harshness of the fallen world. Nudity seems therefore to be acceptable morally in some if not many and most situations.

Some say that the command to “clothe the naked” implies that nudity is sinful. However, if we take this approach to other commands to care for others we would have to assume the state of poverty is sinful, being hungry is sinful, being imprisoned is sinful, being a stranger is sinful, being thirsty is sinful, and being sick is sinful.  All of these states of being would be preposterous to declare sin, so why declare nudity sinful?

We clothe the naked as a protection against the elements and to make the person socially acceptable to the culture they reside in. We do not clothe them because we are making a statement that the body is inherently sinful. Because of this I do not think it’s a requirement that we should clothe cultures where nudity is normal. Indigenous people getting dressed after being converted show us less that nudity is sinful than that the culture that brought them the gospel is “superior” and they are showing respect and admiration for it. Many missionaries did not concern themselves with forcing clothing on the natives, even where they noted the nudity in their journals. The gospel was first and foremost on their minds. We should be more concerned with spreading the Gospel than in making sure people are clothed according to our cultural standards.

Some say that nudity is only appropriate in certain circumstances. They argue that nudity in the garden was only between spouses. I have a few problems with this position. The proponents of this must be reading into scripture an assumption that Adam and Eve would realize the sinfulness of exposing themselves to others outside of their marriage once they started procreation. This is patently absurd. God gave one rule in the Garden and it wasn’t “cover up when  you start having kids.” 

I suppose I cannot say they are accusing God of creating Adam and Eve in a state of sin, since these folks say nudity in marriage is not sinful, but the command to take dominion and procreate was given before clothing. This to me demonstrates that nudity would have been the state of man even after procreation. Had man not fallen, he would still be naked to this day. The only reason he might have gotten dressed was for protection from the elements outside the Garden. But that is speculation as well, and I’ve already condemned the speculations of others so I’ll move on.

While it may sound special and spiritual to claim that the sight of one’s body should be reserved for one’s spouse (and I do not condemn those who feel this way), I do not believe it is a Biblical mandate. If it was inherently sinful to expose ourselves to others besides our spouse, one would be sinning by showering and changing in a public locker room or by exposing ourself to the nurses and doctors at the hospital. There are no exceptions for sin. If we cannot find Scriptural support that says seeing or exposing our nudity is sin outside of marriage, there are certainly no verses excepting doctors, nurses, or old men at the gym.

We should reserve sex for our spouse, but the body is not itself sex. The body is a sin-scarred image of God, not inherently sinful in itself, but marred by one’s spiritual condition.

Does this mean we should all strip off and preach the Gospel in the nude (as Isiah did)? No. We should be offending others with the Gospel itself, not in our appearance. We should adhere to the dress norms of the culture we are reaching.

Does this mean we should have naked church services? One place perhaps that we could be safely naked would be church. But, clothing is symbolic, it does demonstrate a level of humility before our God that we should cover ourselves in His presence. Unless Scripture tells us to remove our clothing (like God telling Moses to remove his shoes) we should wear clothes to church. 1 Timothy 2:9-10 demonstrate that what one wears in church is important to demonstrate our holiness to the world around us. Again, we should be offending the pagans around us with the Gospel, not with our dress, if certain parts of the body offend the culture around us, we would be right to cover them up for the sake of our witness.

So when should we be naked? I do not think that’s the right question, it is not a matter of “should” it is simply a matter of “is it wrong, can I condemn someone as a sinner for doing it?” We cannot Biblically condemn nudity as a sin, but we should be careful in how we approach it. We should not violate our conscience or the conscience of those around us. We should not offend our culture with our bodies, but with the Gospel alone. We should be careful not to project a false image of ourselves, clothed or naked.

Can we go naked here, there, and everywhere? I don’t see why not. “Should” we? It depends.

Be careful what you wear or do not wear, it says a lot about you to the world around you.

Avoiding the CRAS

​“GRAS” is a government label which stands for “Generally Recognized As Safe”. Many things are labeled as GRAS but are only safe to a certain point, or are not safe at all. But the government is too lax to change the label, so the products or compounds continue in public use.

I propose we create a label for things that are commonly called sin that really are not sin. “CRAS” would be a good acronym for these things. Things “Commonly Regarded As Sin” include drinking, dancing, long hair on men, short hair on women, nudity, being drunk, use of birth control, saying certain words, anger, telling untruths to evil people, women wearing pants, men wearing anything but pants, and on and on.

Some of these things are sin after a certain threshold is met, or under certain circumstances, or when done by certain people. But the church and church culture at large is too lax to discriminate and to stop labeling these things as sin. So people continue to fight them even though they’ve never truly examined why they are so opposed and the people that engage in them are still labeled sinners.

I won’t argue that ALL people can do ALL CRAS things. Each of us have our own struggles with various sins. For some of us alcohol is a stumbling block, for others it’s nudity in art or temptations to lose our temper sinfully. Anything can be sin to depraved people, honestly. 

A few of those things I list probably surprise a few of you. Either you regard them as sin at any level and think I’m being antinomian in saying they are not, or you have never heard them called sin. All of the things listed above I have read and heard called sin. Some of them have been the topic of heated Facebook debate, with me usually on the minority side.

Each of us need to listen to our conscience and follow what it says we should and should not do. But we need to be careful not to bind the consciences of others over things that we cannot call sin scripturally. We should be gracious to those who can handle the things we can’t and stop calling them out for adiaphora.

When pointed out that there are people in scripture clearly doing the very thing they are calling sin without consequence or even at the command of God, CRAS defenders will commonly resort to saying there are exceptions. Samson’s long hair, Isaiah’s nudity, and David’s (almost naked) dancing are often explained away as exceptions to the Rule. God somehow suspended His holiness and granted permission (and command) to violate the law. 

Perhaps I am too black and white, but when there is an exception, a rule is no longer a rule, especially when it comes to sin.

People also like to change the meanings of words in scripture and say Jesus made and drank non-alcoholic wine, Isaiah was wearing underwear, or Samson’s hair wasn’t really THAT long. When pointed out that some things are relative, like hair length, they’ll say something like “well, you know what long is.” This applies to women’s dress as well with “It’s obvious when the skirt is too short” or “When too much skin is showing” or “Low cut is low cut.” 

Alcohol is also a fun topic. Some say any level of alcohol consumption is evil. Some say it’s a sin to be drunk period. But what is “drunk”? At what point does being drunk become “addicted to much wine”? How many drinks equals “drunkenness and carousing”? “Drunk” is a relative term. Do we think the wedding guests were stone sober when Jesus made the best wine in large quantities so the party could continue?  I have pointed out to some anti-drinking folks that the wine in Jesus’s day was made extra potent so that it could be mixed with water to kill microbes so the “best” wine was really the strongest. I was told that Jesus only drank heavily dilute wine. Heavily diluted wine seems to defeat the antimicrobial point of the wine in the first place.

Sinful things clearly listed in scripture as sinful are always sinful without exception. Murder, lying, theft, adultery, idolatry, incest, homosexual acts, immoderate use of food or drink, these are all obvious things listed as sin in scripture. But with CRAS things folks often have to jump through hoops to prove a sin where there may or may not be sin. Where scripture speaks, speak, where scripture does not speak, do not put words into its mouth.
The other side of “sin is sin” is “not sin can sometimes be sin.” Things not listed in scripture as sin can be sinful in certain circumstances to certain individuals. This is where the CRAS stuff falls. If it becomes idolatrous or harmful to one’s self or others it becomes sinful. If by doing it one would be violating other law (i.e. causing a brother to stumble or making a false witness of themselves) or one’s conscience (one feels x is sin, but does it anyway) then they are sinning. 

We should not take our Christian liberty to be an “anything goes” type of freedom. Those who have no problem with CRAS things should refrain from them if they are with a weaker brother or sister who cannot handle those things or around non-believers who would be turned off to the Gospel if they witness participation in such things. 

If our conscience tells us not to do something, even if scripture may not back it up, we should not do it. But we should also make sure our conscience is not left in ignorance. We need to educate ourselves so that we do not fall into the CRAS traps described above.

The bottom line with all of these things is: stop calling people sinners who may not actually be sinners. Be careful when labeling things as sins when there is little or no scripture to back you up. Don’t think that just because your conscience feels pricked by a certain thing that it is sinful for everyone. Maybe it is sinful for you because of a weakness in your character or just a spiritual struggle you’re not able to overcome. Don’t heap guilt on others just because you can’t control yourself. And don’t think that just because you are able to do them that you should do them with reckless abandon and ignore the consciences of others.