authored by Justin Janoska
Chances are if you walk into your doctor’s office and complain about one of a multitude of symptoms like insomnia, heavy or painful periods, acne, etc. you leave with a prescription for oral contraceptives (OC) – whether that’s the estrogen and progestin combo or progestin only pill.
Birth control seems to be the go-to universal drug for resolution of most female’s collective complaints because it “regulates” the menstrual cycle – when in fact, it doesn’t. Rarely do women nowadays live without at least one nagging symptom, like bloating or PMS, and are left with the impression that they’re broken and unwell unless administered a pharmaceutical drug to “correct” the dysfunction.
It’s almost like saying: “you’re a woman, so naturally you must be sick.”
Not only does this insinuate ignominy to the gender, but leaves an inedible psychological imprint of hopelessness and despondency with no light at the end of the tunnel.
This closely parallels with the conventional medicine model of using medication to dampen symptoms of various diseases and conditions when it merely masks the underlying causes.
Ultimately, the problem doesn’t get resolved, and oral contraceptives are no exception.
But aside from erasing the plaguing symptoms, the decision to accept an oral contraceptive clearly stems from the appealing motifs of independence and liberation.
That’s another way of saying: “Well, sorry I’m not getting preggers.”
Shockingly though, at least 58% of women who take the pill are prescribed it for reasons unrelated to preventing pregnancy.
Despite your rationale for being on the pill, the medical community has a vital responsibility to provide informed consent about the pill – awareness of the risks verses the benefits, the side effects of the drug, and safer alternatives. Failure to communicate this information is largely due to the monetary incentive behind prescription and/or lack of knowledge about the risks.
And it’s a massive oversight.
If you learned about evidence from a recent 2015 study on oral contraceptives and its ability to predispose oral contraceptive users to first-ever ischemic strokes, would you still take it?
But there’s very little chance of your doctor ever telling you warnings like this.
Fear-mongering tactics are commonly used as well to cajole you to accept birth control in order to avoid pregnancy or your debilitating symptoms. And when you pair that with the freedom it offers, it’s nearly impossible to refuse.
And I get it.
But there’s mounting evidence piling up signifying the dire pitfalls of arguably the most perilous drug on the market.
So, since your doctor wont share this information about the risks and side effects of oral contraceptives, I’ll be the substitute teacher.
The Psychological and Physiological Impact
There’s certainly a laundry list of mood altering effects that come with oral contraception use and this has been documented in the scientific literature, even as far back as 1987. In one of the first ever conducted observational studies examining the side effects of OC in 46,000 women over a span of 25 years, a 30% rise in depression was found.
For instance, depression is a major side effect of the estrogen and progestin combination contraceptive, which commonly results in termination of its use. It may explain why 65% of women discontinue the pill after their first year using it. After only 6 months of use, one study noted a 33% discontinuation rate and 47% after 12 months, with 87% of the explanation being due to the intense emotional side effects, exacerbation of PMS, and decline in libido.
Oral contraceptive use has also been noted to significantly elevate various neurotic symptoms and induce greater negative side effects during menstrual cycles – which is purported to be a psychosomatic issue.
Ironically, evidence suggests that females who have a history of severe PMS and psychiatric disorders would not be good candidates for oral contraceptives as it compounds the adverse mood changes. Conversely, in those who have no history of disorders, pills containing more progesterone relative to estrogen are associated with undesirable mood alterations. On the flip side, oral contraception and intrauterine device (IUD) use among women diagnosed with depression and bipolar didn’t exhibit any exacerbations of negative mood symptoms.
The emotional changes seen in OC use has nebulous, yet conflicting evidence in the psychological and pharmacological etiology, which can be rooted in common methodological issues and flawed diagnostic criteria.
Some evidence from multiple randomized controlled trials deduce that the mental changes with OC use have a psychological origin since they are seen in placebo administered subjects and don’t differ from synthetic hormone use.
To quote from one study: “…it is not the pharmacodynamics that primarily impact the individual’s psyche and subsequent emotions and behavior, but rather the belief that one is contracepting is causing such a phenomenon.”
Despite the tangled web of antagonistic evidence, there are known specific biological phenomena with synthetic hormones that may justify the existence for these psychological corollaries, thereby compounding the perplexity surrounding its etiology.
Oxidative Stress and Inflammation
By virtue of the fact that oral contraceptives predispose females to augmented inflammation is enough of a reason to dismiss their use, irrespective of the psychological mood changes.
Despite the high variability in dosages and duration of OC use, cohort studies conducted as far back as 1976 and 1981 encompassing women to the tune of 17,000 in each have demonstrated the validity of serious, life-threatening epidemiological events. For instance, a 20% rise in all-cause mortality risk was seen in 20% of OC users.
In a more recent case study of evaluating 9 female Muslims, OC administration for at least 1 month during Ramadan revealed a high risk of thrombosis or blood clotting. Combined estrogen and progestin oral contraceptive use and its correlation with myocardial infarction and thrombotic events in obese women was evaluated in a systemic review of 11 population studies.
Among the mixed results of increased incidence, it appears that combined drug use does elevate the risk for cerebral venous thrombosis. And that there’s a proportional increase in venous thromboembolism events the higher the body mass index (BMI) is.
Birth control raises the risk for thromboembolisms, gallstones, hypertension, and atherogenesis (arterial plaque build up), which predispose one for myocardial infarction (heart attack), especially in higher dose estrogen. Through the mechanism of decreasing the glycoprotein antithrombin III (a natural blood thinner), there is an obtrusive increase in blood coagulation and clotting.
In general, OC has shown varying results on cancer. OC has a protective effect for cervical and ovarian cancer, yet there is an elevated risk for cervical cancer in women who have a history of cervical carcinoma.
An important take-way from the research on oral contraceptives is that those with genetic susceptibilities to thrombotic events and blood clots need to be incredibly circumspect with OC use. Certain SNPs or polymorphisms have been correlated with thrombosis and should be strongly considered when making judicious decisions.
Either way, an influx of free radical synthesis and subsequent oxidative stress is a concern and the cornerstone for such pathologies.
Lipid peroxidation measured through malondialdehyde (MDA), is a vital biomarker used to check the status of oxidative stress or the degree of cell membrane damage. In one study that assessed 120 females, low-dose OC use caused a significant rise in MDA compared to the placebo group. However, the 3rd group which was treated with OC and vitamin C and E found a reduction in MDA and increase in antioxidant enzymes, which suggests that these vitamins would be conducive to the OC user.
Not to mention, oxidative stress and inflammation could be a major contributor to the cognitive and mental changes seen with OC use since we are becoming more aware that conventional medicine has had it all wrong with hypothesizing the cause of depression. It’s actually an inflammatory problem, that no anti-depressant truly resolves.
An equally central piece to the psychological changes seen with oral contraceptives is that they contribute to dysbiosis or imbalances in the gut ecology. The microbiota has a copious amount of indispensable responsibilities like orchestrating biochemical reactions – neurotransmitter (serotonin) and hormone (thyroid) synthesis and regulation.
Therefore, aberrancies in the gut bacteria and yeast ratio can definitely become an unheeded factor when it comes to cognitive and mood disturbances, as well as magnify inflammation induced by an overgrowth of pathogenic microbes.
Any way you look at it, in a society where there’s no paucity of toxicant exposures and total body burden accrues on a daily basis, the increased risk of deleterious oxidative stress is enough justification to either reconsider, limit or cease OC use because at some point it is not a long-term solution or sustainable approach to resolve debilitating symptoms.
Hypothyroidism Masked By Depression
Other biological occurrences related to combined OC use is hypothyroidism – which ironically can be mimic depression. Synthetic hormones raise a carry protein called sex hormone binding globulin (SHBG) which binds to sex hormones like estrogen and thyroid hormones. Hence, too much estrogen can reduce the bioavailability of thyroid hormone to perform its much needed tasks.
In other words, without free thyroid hormones in circulation, you experience subclinical hypothyroidism which manifests as severe fatigue, constipation, dry skin, brain fog, frail and brittle hair and nails, and of course, depression.
Every cell in the body has a receptor for thyroid hormone and without sufficient levels, physiological processes simply cannot occur, including the ability to lose weight. The higher estrogen levels in the body predispose women to store more fat in the arms and legs due to the increase in alpha-adrenergic receptors – these basically make you burn fat slower. Moreover, estrogen dominant states can make the brain more sensitive to the hunger inducing hormone ghrelin, galvanizing you to eat more satiating foods.
When this factored in with the notion that environmental and plant estrogens are notoriously prevalent in our society, it can compound the effort to lose fat even further. Therefore, this is an avenue to explore if fat loss has been an uphill battle.
Given the fact that a majority of pharmaceutical grade medications deplete at least one nutrient from the body, the one drug that’s infamous for draining the multiple (if not, the most) nutrients from the body is none other than… birth control – whether that’s oral contraceptives or intrauterine devices.
To spell it out, zinc, selenium and tyrosine, vitamin B2, vitamin B6, folate, tryptophan, CoQ10, vitamin C, vitamin E, zinc, selenium, phosphorus, and magnesium are significantly exhausted.
The depleting action of OC on B6, tryptophan and tyrosine can exacerbate negative emotional changes by reducing neurotransmitters serotonin and dopamine synthesis. As one study denotes, 80% of OC users had abnormalities in tryptophan metabolism, which ultimately disrupts the synthesis of serotonin.
Conversely, zinc and selenium are major building blocks for thyroid hormone production, where zinc is essential for thyroid receptor sensitivity.
CoQ10 is one of the most crucial anti-aging nutrients and antioxidants in the body by protecting the mitochondria in the cells from oxidative stress and inflammation, and literally assisting in producing 95% of your ATP energy production. But unfortunately, levels drop past the age of 25.
Based on the established evidence that a plethora of nutrient deficiencies are at play here with OC use, it would be more than sensible to replenish and invest in a high-quality multivitamin, B-complex, and vitamin C and E supplement to restore antioxidant levels, and reduce oxidative stress.
Alternative Methods: Intrauterine Devices, Implants, And Nothing At All
Intrauterine devices (IUD) and contraceptive implants, like Nexplanon (etonogestrel) have gained popularity as alternative forms of birth control. However, the safety among them has been questioned and evaluated in the literature multiple times. According to a massive retrospective study that vetted 90,000 women in age groups of 15-19, 20-24, and 25-44 taking IUDs for 7 years, the discontinuation rate for the levonorgestrel-releasing IUDs (LNG) was quite similar among all groups at 10-12%.
LNGs were deemed less problematic than its copper counterpart as discontinuation rates were higher with the copper IUD likely due to the adverse side effects studied (i.e. dysmenorrhea, excessive menstruation, irregularity, amenorrhea, etc). Nevertheless, all symptoms were all low – roughly <6% in all groups for both LNG and copper IUDs.
Because LNG releases only 20 mcg per day into the body, the hormonal side effects are less dramatic than of oral contraceptives; however, the mood changes and decreased sex drive are congruent with OC. Again while IUDs may a viable, long-term contraceptive option for women and “resolve” complications with menstrual cycles, the psychological side effects are the greatest concern from my perspective.
Alas, the evidence on discontinuation for this reason is insufficient. Instead, there has been reports of a 24% discontinuation rate after 1 year of LNG use and 33% after 2 years due to side effects of painful menstruation, irregularity, weight gain and PMS related symptoms.
The copper IUD has been studied for its safety and side effects where one study concludes that there is a higher incidence of dysmenorrhea and menorrhagia, which parallels with other research. Purportedly, neurological mood changes or libido have not been associated with its use.
In one study that compared reversible contraceptives (IUDs and implants) with oral contraceptives to assess continuation rates in 4,700 women over a 3-year period, the results make it pretty evident. Reversible contraceptives are more sustainable long-term, where 70% of users remained on levonorgestrel and copper IUDs after 3 years. When juxtaposed with oral contraceptive users, there was an alarming 69% discontinuation rate after the study ended.
The explanation for cessation of LNG use and copper IUD use stems from bleeding changes; 19% and 25%, respectively. The reported reasons for why oral contraceptive users discontinued its use is related to indefinable side effects, and logistical reasons – or in other words, failing to take the pill. Therefore, it’s difficult to conclude if OC had mood altering implications.
Oral contraceptive use though is unsurprisingly seen at the bottom of the list in terms tolerability compared with long-lasting reversible contraception.
The most salient point made with this study is that the statistics make it clear with regard to birth control use – there is a discernible, yet consistent increase in discontinuation rate with each subsequent year regardless of which intervention is used.
Rationalizations for discontinuation of IUDs or subdermal implants are consistent with other research which indicate that bleeding issues (59%), cramping (15%) and mood changes (11%) were the major reasons for the implant, whereas bleeding and cramping accounted for 13% of users on the Levonorgestrel IUD. In general, there was a 22% discontinuation rate after 1 year of use of either intervention.
So, what can be extracted, from the evidence?
The advantages to long-lasting IUDs relate to long-term pregnancy prevention and potentially mitigating the heavy bleeding periods.
However, they would NOT be advisable for women who have high copper blood levels (i.e. copper IUD), STDs, uterus structural abnormalities, infections in the pelvis, and cervical, endometrial or breast cancer.
The copper IUD might be the one IUD to avoid the most because of the risk of higher than needed copper levels, which can lead to toxicity and create an excess of dopamine and serotonin. When factored in with other environmental exposures (i.e. water pipes, cookware, dental fillings, food, etc.), excess copper exposure is possible. Therefore, checking your copper status when considering going this route with be a sound idea.
But… let’s not forget an underrated, yet equally as effective as oral contraceptives method, and guess what…
it requires nothing, but your brain.
Fertility Awareness Method (FAM)
It seems rather intuitive, but strangely enough it’s not well known or considered much. This approach simply entails understanding your own unique biochemistry. Not every menstrual cycle is the same with all woman, or even the same every month for even one woman.
FAM is about listening attentively to the symptoms of hormonal changes and honing in on when you’re fertile, and when you aren’t so prudent decisions can be made about sexual tendencies.
Most females aren’t aware that you can’t just spontaneously decide when you feel like getting pregnant. You have to discover your own individualistic menstrual pattern and work with it to your advantage.
Unless you’re fertile a woman can’t pregnant, and that only occurs during the “fertility zone.” Because sperm can survive in the vagina for 5 days prior to ovulation, and fertilize an egg up to 24 hours after one is injected from the ovaries, there really is only about a 6-day window of opportunity. After that 24th hour mark, the egg disintegrates.
So, abstaining from unprotected intercourse 5 days before your ovulatory period and 1 day after ovulation – if pregnancy is not the goal – is obligatory, but… in order to exploit this innate hormonal process, you have to learn your body’s signals.
In fact, there are a few FAM methods that can be utilized to detect fertility signals.
Here are some you can employ:
- Body temperature/Symptothermal Method: During different phases of the menstrual cycle, the body temperature fluctuates. Around the time of ovulation and in the subsequent luteal phase, the temperature rises and stays high relative to the beginning of the cycle. Consistently taking your body temperature every morning when you wake up can help guide you to mapping out your fertility zone.
Is it effective? Yes, very much actually.
One study found pregnancy in 0.6 per 100 women over 13 cycles when abstaining from intercourse during the fertile period. That’s a 99% effectiveness rate, which is more or less identical to oral contraceptives.
- Cervical mucus: When used in conjunction with the symptothermal method, this is another invaluable indication of fertility. While women have different mucus appearances and textures, generally the raw egg white/stringy looking and watery/dripping fluid type of mucus is secreted during ovulation. This method according to the literature is greatly effective also, independent of other FAM approaches. Self-examination can be achieved by reaching towards the cervix or observing after using the restroom.
As the authors state: “the quality of the vaginal discharge correlates well with the cycle-specific probability of pregnancy in fertile couples.”
- Cycle Pattern: Not every female has a “typical” 28-day cycle, but can range from 21-36 days. Jotting down the times of when you start and end a cycle, along with the body temperature and mucus changes in between can help you figure out your personal pattern.
The iCycleBeads app is a highly useful tool to help do this. It involves inputting your start and end cycle period dates, while also being notified when your zone of fertility is. When used perfectly as instructed, it appears to have a rate of 95% effectiveness.
Again though, be mindful of the fact that the day of ovulation may not commence on the same date every month.
Menstrual cycles are an inherent and integral reproductive process that reflects overall health status, yet somehow has vanished for many women and is treated like it’s a nuisance to have. It’s a dismal reality that deserves recognition because throwing drugs into the mix only to abolish the heavy bleeding, the cramps, the acne… only dismantles the convoluted hormonal and biochemical necessities of life.
Unprotected sex is one of the main motives to begin oral contraceptives, but is ironically paradoxical because manipulating and altering hormones so one can feel liberated with her sexuality comes with the side effects of low sex drive and depression. And when PMS symptoms are absent, you’re effectively skewing personalities to the point where it’s nearly oblivious to the woman instead of tackling the stressors that are instigating the PMS-inducing hormonal imbalances.
Given the multiple and varying psychological and physiological side effects attached to birth control – oral contraceptives, patches, IUDs, implants, etc. an informed decision must be made on your behalf about whether or not it’s right for you. Your doctor may cajole you to follow down the pharmaceutical road without making the professional decision to advise you on the aforementioned negative baggage that commonly comes with it.
But understand this one thing… You always have a choice.
The final call comes from you and you only.
There are circumstances where oral contraceptives are contraindicated like for some women with a history of neuropsychiatric illnesses, intense PMS, and genetic polymorphisms. And some women would not be good candidates for IUDs, even though it appears to be a much more bearable option with fewer side effects compared to OC.
There are pros and cons to each intervention. Birth control confers a tacit, liberating, worry-free sensation for many; that’s a coherent, crystal-clear rationalization, and this resonates loudly with many young females. But the fertility awareness methods are equally as effective, yet just require a more circumspect and less haphazard sexual behavior at certain times of the month.
Either way, if a tangible tool like birth control is decided upon, that is a decision I respect.
The purpose here is to inform you about the dangers and disservice oral contraceptives can cause.
Birth control’s ability to restore hormonal imbalances in the body is tenuous and largely ineffective. From a functional medicine perspective, the root cause of the imbalance still remains and the drug is merely putting a Band-Aid on a reoccurring “injury.”
Whether the decision is to finally address the underlying dysfunction with its ensuing symptoms or conceive; sooner or later, weaning off birth control is the ultimate goal for women. Artificially regulating your endocrine system just compounds and disrupts your body’s innate ability to reach equilibrium, and function the way it was intended to do.
When you decide to make that decision is absolutely up to you, just as is your decision to start birth control.