I will confess that before my naturopathy days, I was on the oral contraceptive pill (OCP) for many years (close to two decades on and off). I didn’t have any noticeable side effects (that I linked to the OCP) and it was convenient to have a withdrawal bleed when it suited me. I really didn’t give it a second thought. And aside from my GP checking my blood pressure every year, I’m not sure there were any real assessments of my health and certainly no discussion of the risks, consequences or alternatives.
Then I did my naturopathy degree! And I began to learn about how the body works, the role of hormones and much more. Knowing what I know now, I’m pretty sure the pill would not have been an automatic choice.
I believe that for anyone thinking of going on the pill or already on the pill, it is important to understand the pros and cons fully and the risks as they might apply to you, in the context of your health needs…regardless of whether you are using the pill for birth control or other reasons. There are alternatives and it may be smart to consider them before taking synthetic steroids (i.e. all forms of hormonal birth control).
What to consider about oral contraceptives
Some people call oral contraceptives “chemical castration” as they effectively shut down your ovarian function. As a result you stop producing oestradiol, progesterone and some DHEA and your ovaries can shrink to the size of a post-menopausal woman (although they can recover to normal size once you cease hormonal birth control).
We need our hormones, not just for reproduction, but also for healthy brain, bone, muscles and metabolism. They are involved in the release of neurotransmitters such as serotonin and dopamine. They also influence our thyroid and adrenal functions.
The form of oestrogen used in the OCP is ethyinyl oestradiol which is different in chemical structure to your own oestrogen. As a consequence, it has different effects in the body. Your own natural oestrogen plays a role in insulin signalling (and therefore your metabolism and regulation of blood sugar) whereas the synthetic form decreases your insulin sensitivity.
Depending on the form of contraception (i.e. which pill or other hormonal contraception), your progesterone is replaced with one of the synthetic forms of progestin. The most widely used of these is levonorgestrel. As you probably know, progesterone is the pro-gestation hormone in that it helps to hold a pregnancy. It is also a calming hormone involved in the release of GABA. GABA is an inhibitory neurotransmitter, the lack of which results in increased anxiety. In contrast, levonorgestrel is the same chemical used in the morning after pill to prevent a pregnancy taking hold. It has no calming effect and has been shown to result in increased anxiety.
Many of the synthetic progestins are derived from testosterone and can have similar effects to testosterone in the body. They are considered to have a high androgen index and their side effects include acne, weight gain and hair loss. In fact, hair loss often results from hormonal birth control. The American Hair Loss Association states that hair loss will be more common if you have a family history of hair loss, so that is worth considering if hair loss is an issue for you.
Even though there is hormonal birth control which has a low androgen index, they are not without their side effects which include suppression of adrenal function, risk of fatal blood clots, depression, anxiety and loss of libido.
Hair loss will often get worse when you stop hormonal birth control. The synthetic steroid hormones cause shrinkage of the hair follicles which may take a long time to recover (if at all).
Some women on the pill report increased anxiety. It is thought that this may be due to the loss of the calming hormone, progesterone and is possibly also associated with changes in parts of the brain which are involved in regulation of emotions.
All hormonal birth control (whether the OCP or some other form) do not use natural forms of your hormones.
Even if you don’t suffer from any of the above side effects (which are often the reason women come off birth control or at least switch to a different type), there are other consequences of hormonal birth control. These include but are not limited to:
- alteration of the microbiome of the digestive tract and the vagina
- reduced bone density
- nutritional deficiencies and imbalances (particular relating to zinc and copper)
- recurrent bladder infections and thrush
What are the alternatives to the oral contraceptive pill?
If you aren’t keen to use hormonal birth control, there are some alternatives which aren’t harmful in any way, have a high (but not 100%) prevention rate when practised correctly and which allow your normal ovulatory and hormonal pattern to continue:
- fertility awareness – using temperature and symptoms to identify your fertile window (we teach this as part of our preconception care program)
- condoms (preferably without spermicide which tends to increase risk of bladder infections)
- femcap with contragel (a cervical cap with a non-toxic gel)
- withdrawal, particularly when combined with methods for tracking ovulation
Another method to consider is the copper IUD. It is not without risks but the more recent ones are much safer than the earliest versions. They can result in heavy periods and pain for some women, so may not be suitable for women who already have painful, heavy periods. They are best inserted by a doctor skilled in this area. They have the advantage of allowing normal ovulation. Once inserted you don’t need to do anything. They are suitable for any age and they result in a rapid return to fertility once removed.
A further option is the intrauterine Mirena. Its active ingredient is still levonorgestrel but as it works at a mostly local level the blood levels of this synthetic hormone are significantly lower (although some women will still experience the side effects mentioned above). It doesn’t block your normal levels of oestradiol so it doesn’t completely shut down your ovarian function although it will be reduced and you may not ovulate every cycle (in some cases up to 85% of cycles may be annovulatory in the first year). Menstrual periods will be much lighter with the Mirena and therefore it can be a good option for perimenopausal or other women who experience heavy periods.
So, what should you do?
If you are considering using some form of hormonal birth control I encourage you to research the side effects, risk and benefits of the particular form you are considering. We can help you with that.
Also, consider the reason why you might use these drugs and devices. Is it for contraception and if so, would other methods be safer and better for you in the long run?
If your reasons for hormonal birth control are other reasons such as acne, heavy periods, period pain or some other symptom I would encourage you to seek help to address the underlying causes of those symptoms. They are signs that something is out of balance and often when we work on bringing your body back into balance, your symptoms resolve and hormonal intervention is not required.
If you are already on the OCP and you would like to come off it, I recommend you work with your naturopath. You need to have alternative means of contraception in place and we also need to understand what your real periods were like before you went on the OCP as this will dictate a treatment plan for stopping. If, prior to the OCP your periods were irregular or if you had heavy periods/pain, PCOS or acne we will commence treatment in advance of stopping the OCP. Often it is these issues which reappear when a woman stops the OCP that leave her feeling like she has no option but to go back on the pill. But there are alternatives.