Millions of women take birth control pills (BCP) for contraception and/or to treat an underlying hormone imbalance. BCPs block ovulation and thicken your cervical mucus so that sperm have a reduced chance of meeting up with a fertilized egg. But are they a good idea? That depends.
As a gynecologist practicing functional medicine, I have a skewed perspective when it comes to the Pill. I’ve seen many women over the years suffering with side effects from BCPs. From vaginal dryness to lost libido, from micronutrient deficiency to breast cancer, and from infertility and early menopause to worsening mood problems, I’ve seen it all.
There’s even a term for the former Pill-taking refugee, called “post birth control syndrome,” a constellation of signs and symptoms that together define a syndrome, not a disease. I wish more women were forewarned, and received full informed consent before picking up their monthly packets at the pharmacy. I would even call oral contraceptives the biggest hormone problem for women, and yet it’s iatrogenic – prescribed by clinicians and considered by most to be relatively risk-free, at least that’s what the pharmaceutical companies would like you to believe. They say BCPs are safer than being pregnant, but that’s not the right comparison when it comes to a woman’s quality of life, mood, confidence, agency, libido, and lubrication.
BCPs contain synthetic versions of estrogen and progesterone, the two main female hormones. Over time, the dose of synthetic estrogen in BCPs has declined, more synthetic progestins have been included, and regimens beyond the 21 day active/7 day placebo have been developed and marketed. Along with these changes, BCPs have gone far beyond pregnancy prevention. As you probably know, BCPs are prescribed, mostly off label, for acne, hirsutism, painful periods (dysmenorrhea, including endometriosis), irregular menstruation, heavy periods (menorrhagia), reduction in risk of ovarian and endometrial cancers, and improvement in premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD).
How BCPs Work
The hormones in BCPs prevent ovulation, while thickening the lining of the cervix to prevent sperm from reaching any eggs that might have been released, and thinning the uterine lining to make it harder for a fertilized egg to implant. The pill “tricks” the female body into not having a normal monthly cycle, which prevents unwanted pregnancy in the range of 99.6 percent for error-free users and 91 percent in typical users.1 “How effective are birth control methods?” Centers for Disease Control and Prevention, accessed April 4, 2016, ...continue In scientific terms, BCPs inhibit ovulation by suppressing your production of luteinizing hormone (LH).2Sonalkar, S., et al. “Contraception”, Endotext November 11, 2014, accessed April 4, 2016, http://www.ncbi.nlm.nih.gov/pubmed/25905371
Allow me to be clear: There are proven benefits to taking BCPs based on epidemiologic studies. In fact, taking a BCP is associated with a reduced risk of ovarian, endometrial, and thyroid cancers.3Wu, L., et al. “Linear reduction in thyroid cancer risk by oral contraceptive use: a dose–response meta-analysis of prospective cohort ...continue Specifically, five years of birth control pill use is associated with a 90 percent reduction in ovarian cancer after the five years.
Certain medical conditions are contraindications to taking estrogen-containing contraception: hypertension, migraine, breast cancer, risk of blood clot or deep venous thromboembolism (VTE) or pulmonary embolism; history of cerebral vascular accident; coronary artery or ischemic heart disease; personal history of estrogen-dependent cancer including known or history of breast cancer; in smoker, age greater than 35 years. The association between estrogen use and venous thromboembolism was identified more than 20 years ago, and risk increases as estrogen dose increases and also depends of the type of progestin used.
- BCPs dramatically decrease your testosterone levels, and may cause low sex drive, vaginal dryness, and painful intercourse. BCPs reduce acne and hirsuitism by lowering your testosterone levels, but sometimes you can get too much of a drop, thereby creating new symptoms. Studies show that free (or biologically available) testosterone levels drop on average by 61 percent in women on BCPs.4Zimmerman, Y., et al. “The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and ...continue While the mechanism isn’t completely understood, it’s thought that BCPs increase sex hormone binding globulin fourfold, which acts like a sponge that soaks up testosterone. As a result, approximately 25 percent of women on BCPs have decreased lubrication, vaginal dryness, and lack of arousal. Furthermore, 5 percent of women have painful sexual relations.Two things trouble me about these results: First, many women don’t realize the problems are a side effect of BCPs, so they don’t seek help. Second, when you stop the BCP, you don’t necessarily go back to normal. In fact, up to one year later, your hormone levels may still be out of whack.5Panzer, C., et al. “Impact of oral contraceptives on sex hormone‐binding globulin and androgen levels: A retrospective study in women with ...continue
- BCPs can decrease certain nutrients in the body. BCPs have been shown to lower levels of several nutrients, including vitamins B1, B2, B5, B6, B9 (folate), B12, vitamins C and E, copper, magnesium, selenium, and zinc.6Seelig, M. S. “Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual ...continue The mechanisms by which oral contraceptives deplete these nutrients aren’t completely known, but the important takeaway is that you may need to replenish these micronutrients to keep your neuroendocrine system working as an ally and your body functioning well.
- BCPs may make you clot. BCPs are associated with an increased risk of blood clots (deep vein thrombosis and pulmonary embolus) of up to threefold (greater if drosperinone used).
- BCPs don’t help PMS, and may make it worse. Exceptions are for the BCPs containing drosperinone, a synthetic progestin, but these are also linked to greater risk of blood clots of six or seven-fold.
- BCPs can lower your thyroid hormones. BCPs increase thyroglobulin, a protein that binds thyroid hormone. If you are on thyroid medication, you may need to adjust your dose.
- Delayed conception. For women who stop the BCP to become pregnant, return to normal ovulation may be delayed. Other contraceptives, such as the copper IUD, have no delay in fertility.
- May cause weight gain, bloating, and fluid retention.
- May increase the risk of breast cancer. We know that synthetic progestins in menopausal hormone replacement therapy do increase the risk of breast cancer, and therefore the same may be true of the synthetic progestins in BCPs. At the same time, the data is mixed, and it seems that if there is any higher risk, it’s modest.
If You Stay on the Pill, Do This
For some women, the BCP is the easiest or most convenient choice, and above all else, I support a woman’s right to choose. I prefer non-hormonal forms of contraception like the copper intrauterine device (IUD), cervical caps, diaphragms, and condoms, but I understand they are not always possible, affordable, or appropriately effective.
If you choose to stay on the Pill despite my precautions, take note of any symptoms of hormone imbalance, which you can learn more about in my first book, The Hormone Cure.
Use Nutrition to Counter Depletions
Focus on eating a balanced, varied diet that includes selections from all food groups in order to ensure that you replenish or prevent micronutrient gaps. If you’d like to increase your dietary intake of these vitamins and minerals that decline on BCPs, I recommend the following:
Foods rich in B vitamins include poultry, dark leafy greens, milk and milk products, eggs, and seafood.
For vitamin C, include dark leafy greens, citrus fruits, and berries.
Foods rich in vitamin E include dark leafy greens, nuts, seeds, and extracted oils.
Foods rich in zinc include oysters, seafood, meat and poultry, beans, and nuts.
Foods rich in selenium include Brazil nuts, tuna and halibut, beef and poultry, eggs, and spinach.
Foods high in magnesium include dark leafy greens, nuts and seeds, yogurt, black beans, and dark chocolate.
In my opinion, women on the Pill should take a supplement containing B complex vitamins (B2, B6 and B12), together with methylated folate, vitamins E and C as well as the minerals magnesium, zinc, and selenium. Take methylated folate because most women in the United States have impaired methylation via the MTHFR gene and need the more bioavailable form – you can also eat dark green leafy vegetables to get more folate. Look for supplements that contain “5-methyltetrahydrofolate” (5-MTHF). Avoid products that say “folic acid” on the label – you want folate, not folic acid.
If you take BCPs, add in foods rich in the vitamins and minerals that tend to drop with Pill consumption, and consider taking a vitamin B complex and the other supplements mentioned earlier. If you have PMS and want a birth control pill, choose one containing drosperinone as long as you do not have an increased risk of blood clots. While BCPs may reduce your risk of ovarian, endometrial, and thyroid cancer, they may modestly increase your risk of breast cancer, so take care to adjust based on family history and individual risk. My best advice is to avoid BCPs if you can and choose instead a non-hormonal IUD, cervical cap, diaphragm, and/or condoms.
Above all, be aware of your choices, and if you choose to use the Pill, be very mindful of any changes that may be occurring with your physical or mental health. If you feel like something’s just not right, contact your gynecologist immediately.
Sara Gottfried, MD is the author of the new book, Younger: A Breakthrough Program to Reset Your Genes, Reverse Aging, and Turn Back the Clock 10 Years. She’s the two-time New York Times bestselling author of The Hormone Cure and The Hormone Reset Diet. After graduating from Harvard Medical School and MIT, Dr. Gottfried completed her residency at the University of California at San Francisco. She is a board-certified gynecologist who teaches natural hormone balancing in her novel online programs so that women can lose weight, detoxify, and slow down aging. Dr. Gottfried lives in Berkeley, CA with her husband and two daughters.
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|1.||↑||“How effective are birth control methods?” Centers for Disease Control and Prevention, accessed April 4, 2016, http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm.|
|2.||↑||Sonalkar, S., et al. “Contraception”, Endotext November 11, 2014, accessed April 4, 2016, http://www.ncbi.nlm.nih.gov/pubmed/25905371|
|3.||↑||Wu, L., et al. “Linear reduction in thyroid cancer risk by oral contraceptive use: a dose–response meta-analysis of prospective cohort studies.” Human Reproduction (2015): dev160; La Vecchia, C. “Ovarian cancer: epidemiology and risk factors.” European Journal of Cancer Prevention: The Official Journal of the European Cancer Prevention Organisation (ECP) (2016); Caserta, D., et al. “Combined oral contraceptives: health benefits beyond contraception.” Panminerva Medica 56, no. 3 (2014): 233-244.|
|4.||↑||Zimmerman, Y., et al. “The effect of combined oral contraception on testosterone levels in healthy women: a systematic review and meta-analysis.” Human Reproduction Update 20, no. 1 (2014): 76-105.|
|5.||↑||Panzer, C., et al. “Impact of oral contraceptives on sex hormone‐binding globulin and androgen levels: A retrospective study in women with sexual dysfunction.” The Journal of Sexual Medicine 3, no. 1 (2006): 104-113.|
|6.||↑||Seelig, M. S. “Interrelationship of magnesium and estrogen in cardiovascular and bone disorders, eclampsia, migraine and premenstrual syndrome.” Journal of the American College of Nutrition 12, no. 4 (1993): 442-458; Palmery, M., et al. “Oral contraceptives and changes in nutritional requirements.” European Review for Medical and Pharmacological Sciences 17, no. 13 (2013): 1804-13; Thorp, V. J. “Effect of oral contraceptive agents on vitamin and mineral requirements.” Journal of the American Dietetic Association 76, no. 6 (1980): 581-584.|