The birth control pill is being misused by modern medicine. Did you know this? As women in our sexual partnerships, we are typically saddled with the conundrum of how to prevent pregnancy. In our modern world there is still not a viable contraception option that will take some of the responsibility (and physiologic burden) off of the woman… yet. When women come into my office and are on the birth control pill (or “OCP”, the oral contraceptive pill) I simultaneously sigh in exasperation and also feel my heart going out to this woman: I know your struggle. We have no easy options!
With that said, I still feel very strongly about women not choosing OCP’s as their form of contraception, but even more so that women do not start the Pill as a tool for managing other symptoms. Here is where we start to see it being applied ignorantly and inappropriately. When an MD puts a woman on the Pill to address symptoms of heavy bleeding, acne, mood swings, etc. it really gets my goat! I feel strongly that if women knew all of the reasons I land on this side of the debate, they, too, would shift their thinking. So, I am here to share with you my passionate case for why NOT to take OCP’s.
First, let’s just get an understanding of what a menstrual cycle is about. As my colleague, Dr. Julia Christensen, ND said “the menstrual cycle, also known as the moon cycle, exists as the result of an orchestrated symphony involving many hormone pathways from the brain to the ovaries.” Beautifully stated. Women’s bodies are quite complex. The pituitary gland (in the brain) communicates with the ovaries constantly, but the waves of hormones vary, depending on where you are in your cycle. From the day you bleed (day 1) until the day you ovulate (roughly day 14), your body is in an estrogen dominant state. This estrogen dominant state stimulates a lovely thickening of the uterine wall to provide a nice home for a fertilized egg to implant should fertilization occur.
When you ovulate, your ovaries are stimulated to release an egg by the hormone luteinizing hormone (LH), which is released from the pituitary gland and triggers the shift in the ovary to send that egg on down the fallopian tube. As that egg makes it’s way, your ovaries shift gears and release progesterone. Now, from day 14 to day 28 (or so) your body will be in a progesterone dominant state. This is the hormone that will be supportive of early pregnancy, so the first few weeks after an egg has been fertilized. If no fertilization occurs, the egg will not implant (which causes a whole new cascade of hormones) and the body will peak at a high level of progesterone on day 21 of your cycle, and then it will begin to fall. The reason you bleed around day 28 is because that rich thickening of tissue that developed during the estrogenic portion of your cycle, and was nourished by the presence of progesterone during the second half, is suddenly deprived of hormonal stimulation when the progesterone levels fall. The bleed is due to progesterone withdrawal.
Got all of that? Good. Now, for The Pill:
To start, if you are on OCP’s to “regulate” your cycle, be not fooled! They are not actually regulating your cycle. The Pill does not regulate your menstrual cycle.
The Pill is inducing a state much like pregnancy, which means that you are not ovulating. This means that this whole “symphony” of hormonal conversation between your brain and your glands is not happening. This means, therefore, that you are not actually cycling. Your body is not in its normal, natural state.
So what about if you are on the OCP to help with acne, mood swings, PMS, endometriosis, PCOS, or any other symptom? The Pill is not addressing the cause of any of these issues. In fact, the Pill is masking the underlying cause of these issues, and disturbingly, might be making all of these worse. Each of these symptoms indicates that some other aspect of your physiology is off. The possibilities range from adrenal dysregulation, liver congestion, gastro-intestinal imbalances, nutrient malabsorption, stress responses, and more.
Here are more interesting facts about OCP’s:
· They disrupt the healthy balance of gut bacteria and can contribute to intestinal permeability and inflammation. We need healthy gut bacteria to have a healthy immune system, to break down food and properly absorb nutrients, to metabolize hormones (Estrogen & testosterone, as well as thyroid hormones), and to maintain a healthy metabolism. [1]
· The combination of the Pill inducing an estrogen dominant state and the disruption of the gut bacteria (which leads to an ineffective clearance of excess estrogens) leads to an overall estrogen dominant state of being for a prolonged period of time, which can lead to symptoms such as ovarian cysts, fibrocystic breasts, heavy bleeding (especially once the Pill is discontinued), mood swings, and weight gain.
· Thyroid hormone binding globulin is increased on the Pill, which means that your body experiences a hypothyroid state. This can lead to weight gain, moodiness, lack of energy, hair loss, dry skin, and several other symptoms. [2],[3]
· Sex hormone binding globulin is also increased, which binds up sex hormones and makes the body unable to use them. This includes testosterone, which is essential for your sense of drive in the world, for mood and interest in life, healthy muscle mass, and for libido.
· From a nutrient standpoint, OCP’s interfere with many of the essential ingredients for a healthy body. Levels of B6 (required for healthy neurotransmitters and a balanced mood), magnesium, zinc, phosphorus, calcium, and selenium. [4] It can also increase iron and copper, which can cause agitation and anxiety-like symptoms.
So, at the end of the day, now you can see the mess that I see when a patient sits down and tells me she has been on the Pill. As I noted, I understand how difficult it can be to choose a method of contraception. However, when the Pill is used to treat any other symptom the body is presenting, it is just sloppy medicine, in my opinion. Not only does it fail to address what is really being communicated by the body, it is very likely exacerbating the root of the issue and many, many more physiologic functions beyond that.
For help in getting off the Pill and repairing your gut, hormone balance, metabolism, thyroid function, fertility, and anything else that may have gotten out of whack, find a licensed Naturopathic Doctor, licensed acupuncturist/ Chinese herbalist, or functional medicine doctor. And remember to ask any prescribing doctor whether the medication they are giving you is helping your body to heal, or if it is just a band-aid to cover up symptoms. Ultimately, it is your choice as to whether or not symptom management is your end-goal, but I encourage people to really understand what they are putting into their bodies and why. As a doctor my job is to educate you about what your symptom picture means and help you to understand what your options are for returning to a balanced state. If I have not done that, then I have not done my job.
[1] https://www.ncbi.nlm.nih.gov/pubmed/26658991
[2] https://www.ncbi.nlm.nih.gov/pubmed/1219185
[3] https://www.ncbi.nlm.nih.gov/pubmed/12521654
[4] https://www.ncbi.nlm.nih.gov/pubmed/22224344
