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Content Warning: This discusses matters of suicide.
“Wait and see how it goes,” a doctor told Haley H.* when she first sought out birth control to deal with painful periods and brought up her own history of depression and family history of suicidality that she worried might affect her reaction to birth control (which can have side effects of mood swings, depression, and suicidal thoughts). “I have severe period cramps, to the point where I’m out of commission for the first day of my period each month. But I would rather deal with one day a month being in that much pain than exacerbating my depression issues,” Haley told ELLE. “That was not something worth doing trial and error with.”
Still, she had no choice but to experiment with multiple forms of birth control, first via an online birth control service’s chat consultation, which guided her to choose a hormonal birth ring that caused uncomfortable mood swings, followed by a physician-prescribed progestin-only minipill (a type of birth control pill that doesn't contain estrogen and comes in a pack with three weeks of the same color pills and just one week of placebo pills) that made her period six weeks late and completely unpredictable. After the second attempt at contraception, she decided she needed to get more information about her body’s reaction to birth control.
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Elizabeth Ruzzo, PhD, geneticist and founder of adyn, a Seattle-based femtech startup that’s pioneering a hormonal birth control test, had a similar experience: She was put on birth control and another medication simultaneously and experienced crippling depression and suicidal thoughts that stopped almost immediately once she went off the birth control. In total, it was an eight-year journey of going on and off birth control methods and battling depression along the way. Finally, she decided to create something that could give people more agency over their own birth control decision and give them info about their own genetics and hormonal biology.
Countless people find themselves in the same situation after starting a new birth control method. About 63 percentof people have reported stopping the hormonal birth control pill due to experiencing side effects, which can range from sore breasts and spotting to blood clots and strokes.
Enter the adyn birth control test, a new at-home hormone test that can inform you of genetic risks for things like blood clots and depression, and then assess what type of birth control—something the average person takes for 30 years of their reproductive lives—might be the right choice for your body based on your biology and your reproductive goals. The kit retails at $369, and measures your genetics and baseline hormone levels, even if you’re already on hormonal birth control.
Then, a medical provider from adyn (either a doctor or nurse practitioner who has extensive experience prescribing birth control) will have a private telehealth consultation with you, studying your genetic risk test results and taking into account everything else you report about your health, from anxiety to acne, before guiding you toward birth control options that might minimize your side effects.
The average birth control consultation is only 13 minutes, Ruzzo notes. That’s why adyn’s contraceptive counseling appointments are at least twice that length, starting at 25 minutes, and the practitioners take more time to walk through the patient’s prior history with birth control, genetic medical history, and what the patient actually wants out of their contraception.
Following that initial consultation, the number one reason people switch birth control is because of side effects. 30 percent of people have tried 5 or more methods of birth control before finding the right one (if they ever do), according to the CDC.
Adyn doesn’t promise you your birth control perfect match, but it aims to do everything it can to weed out what’s not right for your body and eliminate so much of that uncertainty. ELLE spoke with Ruzzo to get more information on this boundary-breaking test that aims to take at least some of the errors out of the trial and error of birth control.
There are other at-home hormone tests out there, more specifically geared toward fertility and general wellness, like Modern Fertility, Mira, and Everlywell, but none specifically for hormonal birth control. How is this revolutionary in the hormonal health space?
Ruzzo: We are the only product on the market that combines personal hormones, genetic, and self-reported medical information to help you make the best decision for your body. Our goal is not to just give people the test and handle the results and force people to interpret them on their own. The results include explanations of what’s being tested and why, and then customers also have a virtual care visit with a provider who has been trained to help them understand the results of the test.
Plus, it’s an absolutely terrifying time politically—everything that’s happening opens the door for birth control being both more important and unfortunately being the next thing under attack.
What can adyn tell you about your biology that you might not already know?
Ruzzo: It’s important to note that the number one reason that individuals switch birth control methods is side effects—ranging from annoyances like acne to life-threatening side effects like blood clots and severe depression. The majority of people do trial and error and try four or more methods of birth control, and the side effects vary based on your body and the birth control formulation. Adyn is looking at places where we can partially predict based on your DNA and hormonal profile how to minimize the risk of experiencing unpleasant birth control side effects.
We started with the most dangerous risks, like blood clots and depression, but are able to also report on which birth control methods can help with things like acne and heavy, painful periods—both in people who experience these conditions naturally or as a result of hormonal birth control. We’re collecting comprehensive information upfront, including past experiences with birth control and side effects, what people are looking for in a hormonal birth control, and any other risks. For example, doctors frequently don’t ask about a history with migraines with aura, a known risk factor for blood clot-induced strokes, which could be exacerbated by hormonal birth control pills.
We’re then incorporating all that information into the virtual care visits for your provider to really have the full picture before making any birth control recommendations. Keep in mind that your information is safe with us: Our infrastructure has been built from the ground up with HIPAA-compliant data protections in place, using encryptions, and data access is secured behind multi-factor authentication, having you periodically rotate passwords to prevent data attacks.
How does adyn take other environmental factors (besides genetics) for mental health conditions into consideration?
Ruzzo: We ask about family history when it’s available because it can be really helpful, but we actually had an amazing early user offer that they were adopted and didn’t have that information. We didn’t have that option available, so we updated our survey to include adoption on it. In addition to the way we’ve developed the genetic risk factor assessment, we acknowledge that depression is a complex disease and your environment can impact it. So, if we tell you that you don’t have an increased genetic risk for depression but your parent just died, you might be experiencing depression anyway.
Part of it is understanding and reporting your own history with specific birth control. So maybe you don’t have a family history of mental illness, but maybe you had suicidal ideation or anxiety about a specific birth control option before. We’re not going to recommend that same option again, because we have that information in front of us in a way that other healthcare providers just don't have the time to think through.
What’s the point of testing your baseline hormones if you’re going to be taking medication that suppresses your hormones anyway?
Ruzzo: Your hormones change not just throughout the month but throughout the course of your life. The most important thing to understand is that we standardize the day that you measure. Everyone collects the finger prick of blood on day three of your cycle so it’s standardized to expected reference ranges. The way hormonal birth works is that it suppresses the endogenous levels of hormones (those produced naturally by your endocrine system), so with the test we can read into how much different people’s hormones are suppressed, even when they’re on the same drug. To what extent are you able to suppress those endogenous hormones, and how much might that level of suppression play into how your body is interacting with the hormones your body is encountering through birth control?
For example, we look at androgen levels, like testosterone; when those are higher (often in people who have conditions like Polycystic Ovary Syndrome, or PCOS), we want to help people avoid progestins, one of the key hormones in many methods of hormonal birth control, that mimic those androgens and can worsen some side effects. In people who have acne or excessive hair growth, it’s often that they have elevated androgen levels, something certain forms of hormonal birth control may help regulate.
Can you share how specific the test results get in terms of birth control recommendations?
Ruzzo: We provide information on all the highly effective methods: the pill, patch, ring, shot, implant, and hormonal and copper IUD. They’re all listed in a way that you can compare them side by side when you read your results. It’s not usually a recommendation for or against a certain brand, but instead for or against a method or formulation. So for example, if you suffer from acne—there are some pill formulations or compounds you may want to avoid. In other cases, it could be a more all-encompassing suggestion, like the combination pill, that could help with a specific issue you’re having and why that is. Basically, depending on test results and customer preferences, we provide additional information and personalized context to help the customer make an informed choice.
Who might be the appropriate person to try adyn, and who is this not for?
Ruzzo: It’s really for anyone seeking birth control, looking to change their birth control, or anyone just plain curious about their own biology and understanding their hormone levels. You can take our test if you’re currently on birth control. Our report takes that into consideration and adjusts your recommendations. This is the type of product I wish had existed when I tried birth control, and what led me to leave academia to start this company.
Currently, the birth control test is only available for people ages 18 and up. Our target audience is aged 18 to 49—we can operate all across the U.S. except in New York, New Jersey, and Rhode Island (which don’t allow a third party, such as adyn, to accept lab invoices and pass the cost on to customers, but we are working on serving birth control users in these states ASAP).
What was the process like of getting this to market, and how did you test this on specific demographic groups?
Ruzzo: There are nearly 200 birth options for providers to choose from. The providers really have no scientific way to choose from these options, which leads to birth control being prescribed in a pretty inconsistent and rushed way. Adyn collects structured data on individual medical history and reproductive goals, and then we incorporate biological risk data on top of that, to generate personalized recommendations. Each element of our tests and the resulting recommendations are based on data from established organizations such as the CDC and/or existing peer-reviewed studies.
However, especially when it came to genetic studies, those are unfortunately primarily based on individuals of European ancestry. So this is a huge issue in genetic research. What we are hoping to do is predict the collective experience of all of our birth control users, especially those who have been historically excluded from this research, so that we can make new discoveries that are going to help fill in some of these medical research gaps.
And on that note, how are you working to make this more accessible to more people?
Ruzzo: We worked to ensure that we were accessible to HSAs and FSAs before the launch. We’re also working really zealously, to get insurance coverage—which is a slow process. But this is feasible for the birth control test, unlike many other home tests, because of the actual medical actionability. I fully understand that $369 is out of reach for many people we want to serve. Right now, generating that level of high-quality data is expensive and critical for our mission. We’re also training professionals to make sure they’re able to interpret and walk patients through the data. We hope that as we grow, we can definitely lower the price point with scale. We'll be doing things like implementing “buy now pay later” to help people who want to spread the purchase price out over time.
In the meantime, we are actively pursuing creating a nonprofit and clinical partnership that will further increase access. We’re seeking nonprofit partners who would like to donate the birth control test to their communities in need of highly effective birth control methods. We're also developing a health equity ambassador program that will partner with mission-aligned students from Historically Black Colleges and Universities, Hispanic Serving Institutions, Tribal Colleges and Universities, and Asian American and Pacific Islander Serving Institutions. These students won’t be required to use or sell adyn’s test or opt into our research program, but will create content that shares accurate scientific and sexual health education in a peer-to-peer leadership program on campus. Adyn will then contribute to these students’ tuition funds and provide professional mentorship in STEM.
*Last name is redacted for medical privacy purposes.
The interview was edited and condensed for clarity.
