Maybe it’s just me (and who I follow on social media), but it sure seems like everyone is talking about their experiences going off of birth control recently (honestly, that’s what prompted me to start this month-long discussion about our hormones). And what’s REALLY strange to me is that women seem to be giving a disclaimer prior to talking about their experience with birth control by saying, “maybe this is TMI” and treating it like a taboo topic. In my line of work, I am totally comfortable talking with my patients and clients not only about birth control, but also about their cycles. It continues to surprise me that most women that I work with have very little understanding of their cycle and how hormonal birth control can affect things. I often wonder if the lack of understanding surrounding this topic is what keeps women from feeling like they can talk freely about it. Ladies, let’s educate ourselves so that we are comfortable starting a discussion about our cycles!
Let me start by recounting my own personal journey with birth control, which began when my primary care doctor was quick to prescribe oral contraceptive pills (OCP) at my yearly physical when I was 16 years old in response to my complaints of menstrual cramps (mind you, I had my period for less than a year, but I digress). Perhaps this is actually is TMI, but I wasn’t anywhere close to being sexually active at that age! Regardless, I stayed on the pill until I was 29 years old – and my doctors NEVER questioned it, even though my mother was diagnosed with breast cancer (a hormone-receptive cancer) at a young age! I guess I assumed that long-term birth control use was the norm for young women, and that it had to be “safe” since all of my doctors were so quick to refill my prescription year after year. In total, I was feeding my body a synthetic hormone for 13 years!
When I started to learn more about my body and really considered the implications of being on birth control long-term, I decided to seek out another alternative. I went to my OB/GYN armed with my newfound knowledge and holistic values, requesting a copper IUD to limit my exposure to synthetic hormones. But my doctor shot me down. She told me that the copper IUD leads to heavy bleeding and cramping, she told me I’d simply hate it and expected to see me back in a few months requesting its removal. Instead, she talked me into a Mirena – also an IUD, but one that used a different hormone (progestin). She assured me there would be no negative side effects and that I’d love it. And I did love it – for a while. I never had a cycle (which, in retrospect is clearly NOT a good thing) and I hardly knew it was there. At this point in my life, I was eating strict paleo (read: no hormones in anything I ate) and was using a very expensive water filter to further limit my exposure to hormones in my tap water. However, I began developing the worst acne of my life – we’re talking cystic, painful stuff that left scars on my face. My provider assured me that that Mirena had nothing to do with this (keep reading to find out why this happens!) and suggested that we add an OCP back into the mix. However, I ultimately had it removed. I wanted to start from the ground up to find hormonal balance naturally and “reset,” so to speak. Within the next 3 months I started to notice improved performance in the gym and began putting muscle on more quickly. What I did not anticipate was that the effects of my birth control use were long-lasting. It took me THREE YEARS to get a regular cycle back. And, I’m still fighting the good fight to address my vitamin and mineral deficiencies, which were exacerbated by long-term birth control use. And what about my acne? I’m happy to say that it is much improved.
So before we talk about what birth control does to your body, go back and read my blog that explains the basic female hormones and what happens during a cycle: https://dramyosborne.com/blog/2019/10/01/female-hormones-what-happens-during-your-period/
Birth control is comprised of synthetic steroid drugs – ethinylestradiol is a synthetic estrogen and drospirenone and levonorgestrel are progestins progesterone-like steroids). Ethinylestradiol and progestins progesterone both prevent release of leutenizing hormone and follicle stimulating hormone, which help to prevent pregnancy by preventing ovulation. Since you didn’t ovulate, you also wouldn’t form a corpus luteum, so there would be no luteal phase and no progesterone would be created. What this means for you is that you stop making progesterone when you’re taking progestins. So, when you don’t have that progesterone creation, your uterine lining doesn’t thicken (which is also a means by which to prevent pregnancy). When you take your week of placebo pills, you will shed the lining that you do have and experience a “bleed,” not a menstrual cycle. These bleeds are often much lighter than your normal cycle, since progestin prevents thickening of the uterine wall.
Let me be clear – hormonal birth control does not “regulate” your hormones; it shuts them down and replaces them with synthetic ones. So, sure, your “bleeds” are likely regular, but this is NOT your menses and you therefore do NOT have “regular” cycles. Back when birth control was created in the 1950’s (a far more conservative time), it was not as socially acceptable to prescribe birth control to prevent pregnancy, so it was marked as a way to “regulate” things like “female problems.” And it seems that this concept stuck, because we still think that birth control “regulates” our cycle.
And now, here is a little break down of the common types of birth control and how they work.
- The traditional oral contraceptive pill (OCP) is a combination of synthetic estrogen (ethinylestradiol) with a progestin (e.g. levonorgestrel). So, what happens if you take the pill? Well, essentially you don’t ovulate, and you won’t form the thick uterine lining needed for implantation.
- The mini pill only contains a lower dose of progestin (it does not contain a synthetic estrogen); this works to thin the uterine lining, rather than by suppressing ovulation, although this does inadvertently happen when you’re taking the mini pill.
- NuvaRing also works to suppress ovulation by administering ethinylestradiol and etonogestrel (a progestin). But the risk of blood clots is higher, because the drugs get into your blood immediately, as they do not have to pass through your GI tract (and therefore do not get processed by the liver).
- Similarly, patches work to deliver hormones (typically ethinylestradiol and the progrestin norelgestromin) directly into the blood. These increase your risk for blood clots, just like the NuvaRing.
- Implants contain just progestin, so again, they work to thin the uterine lining. They are often associated with weight gain and breakthrough bleeding.
- Injections contain a high dose of progestin, which will suppress your body’s ability to make both estrogen and progesterone. This subsequent deficiency in natural hormones can lead to bone loss and weight gain. There is also some literature that suggests an increased risk for breast cancer.
- Hormonal IUD (Mirena and Skyla) release small amounts of progestin into the uterus to thin the uterine lining. There is still a risk of anovulation, but it is lower than the other forms of hormonal birth control. The Mirena often stops bleeding in women, but may not necessarily suppress your ovulation hormones, so it may be the best bet if you’re adamant about taking hormonal birth control.
Now, I am NOT saying that you should not use birth control. But, it is imperative that we understand the effects of what we’re taking. It’s even more important that we take the necessary precautions to counteract the effects of birth control.
There are quite a few risks and adverse effects associated with taking birth control. I’ve detailed a few of them below:
- Progestins can have a big effect on our androgens (e.g. testosterone), thereby resulting in hair loss, acne and decreased muscle synthesis. Some progestins have this effect while you’re taking them, while other progestins may suppress your androgens while taking them. However, when you go off of these androgen-suppressing progestins you have a rebound effect of androgens and end up experiencing these symptoms anyways. Decreased testosterone can result in loss of libido, vaginal dryness, atrophy/painful intercourse (I see this A LOT as a pelvic PT) and delayed conception once you come off.
- High dose estrogen birth control has been shown to increase your risk of breast cancer up to three times, but this risk can return to normal one year after stopping the pill. It is relevant to note that the research DOES show a reduced risk of uterine, colorectal and ovarian cancers when using OCP. But, there are other natural ways to reduce your cancer risks without taking OCP.
- All hormonal birth control increases your risk for blood clots, although for OCP the risk is small. As discussed before, the NuvaRing has the highest risk. It’s important to note that smoking increases this risk A LOT.
- Literature has shown a link between hormonal birth control and mood disorders, namely depression.
- Loss of sex drive is another VERY common adverse effect of birth control. This happens because it suppresses your testosterone (you need this for your libido!). It can also contribute to painful sex to decrease in natural vaginal lubrication.
- Hair loss could occur after taking a progestin with a high androgen index because they act like testosterone in your body (e.g. medroxyprogesterone acetate, levonorgestrel, norgestrel and etonogestrel). Androgens can cause hair loss by shrinking your hair follicles; however, this is reversible (thank god!).
- Changes in body composition are also common with use of hormonal birth control for a couple of reasons: One, the pill can affect insulin and increase sugar cravings. Secondly, pills with synthetic estrogen lead to increased fat deposits through the hips and can actually worsen cellulite.
- Obviously, when we introduce synthetic hormones to our bodies, there are effects on the other hormone systems. Birth control can affect thyroid hormones and inuslin function, but this topic warrants its own post.
- Taking hormonal birth control can alter your natural bacteria in both your gut and your vagina, which can lead to GI issues and yeast infections!
- As if this weren’t enough, hormonal birth control leads to nutrient deficiencies, especially B vitamins, zinc, selenium, and magnesium.
Whew, that was a lot. Now listen, I understand that it may not be feasible for everyone to come off of hormonal birth control. But, if you have been or are on hormonal birth control, I encourage you to adopt the following lifestyle modifications to promote general health:
- Make sure you’re getting adequate nutrients – magnesium, vitamin D, selenium, zinc and B vitamins are of utmost importance.
- Limit your inflammation – the easiest ways we can do this is to limit consumption of inflammatory foods (gluten, dairy, sugar and processed food), decrease alcohol intake, get more sleep and manage stress.
- Maintain healthy gut microflora – taking a probiotic and/or eating fermented foods is helpful, but avoidance of alcohol and sugar is equally as important, as is stress management and sleep.
- Take glutathione – this supplement not only has a strong anti-inflammatory effect, but also helps to support detoxification.
- Avoid exposure to environmental toxins – the biggest things to avoid are plastics containing BPA and pesticides. I will discuss endocrine and environmental disruptors in greater depth in a later post.
Now let’s look at what happens when we come off the pill. There can be some initial rebound effects that women have to work through (I know I did!). One major issue was acne! Synthetic estrogen and progestins work to control acne by reducing sebum production. Your body responds to this by increasing its sebum production, and this upregulated sebum production persists once you go off of birth control. So now you have overactive skin oil production. Cool. Irregular periods are very common when coming off of the pill. Some women also develop PCOS after coming off of the pill. I’d also like to mention, that I had completely forgotten what menstrual cramps felt like. Not that anything was abnormal, this was just an adjustment!
Again, my point in this was not to dissuade you from using birth control. However, if you’re someone that has been on hormonal birth control for an extended period of time, I do encourage you to consider an alternate form (e.g. a copper IUD, condoms or even fertility tracking via basal body temperature or evaluating your cervical fluid). Because what I can tell you is that long-term hormonal birth control use can really contribute to and perpetuate other health issues, like insulin resistance, thyroid issues, SIBO, intestinal permeability and pelvic pain. Regardless of whether or not you are using birth control, I hope that this helps to give you some insight into how birth control works so that you can be armed with the knowledge you need to make decisions related to your health!