The Good and Bad of Oral Contraception
Birth Control Pills
Whether for preventing pregnancies or regulating menstruation, many women have been “on the pill.” Birth Control Pills, or Oral Contraceptive Pills (OCPs), are one of several options for contraception. Women also have the option of injectables such as Depo-Provera, implants like IUDs, and vaginal rings. The pill still remains the most popular choice.
All OCPs contain progestin, a synthetic form of progesterone. Progestin helps to block ovulation, inhibit sperm from entering the uterus and prevent implantation of a fertilized egg. Each of these actions will reduce the chance of getting pregnant while on the pill. Some OCPs contain estrogen which can increase the efficacy of the progestin while reducing risk of irregular bleeding.
There are three types of oral contraceptives – Combined Estrogen-Progestin, Progestin Only, and Emergency contraception. The majority of OCPs on the market are combined estrogen-progestin pills. The combo pills can either provide the same amount of estrogen and progestin throughout the entire cycle, or contain the same level of estrogen with incremental increases in progestin. Both of these options trick the body into stopping ovulation. Progestin Only pills provide the contraceptive effects without estrogen. This pill is usually given to women with conditions too risky to use estrogen. Lastly, Emergency contraception is high doses of synthetic hormones that may prevent implantation of a fertilized egg if taken within 5 days of fertilization.
Side Effects
One thing to remember when choosing how you balance your hormones or prevent pregnancy is that the convenience of oral contraception does come with a cost. Common side effects include mood swings, depression, loss of sex drive, weight gain, bone deterioration, migraines, high cholesterol, high blood pressure, and increased risk of heart disease, strokes and cancer.
Weight Gain may occur due to progestin’s effects on androgens like testosterone. Progestin increases the androgenic effect in the body leading to increased appetite and fluid retention. Additionally, synthetic estrogens may increase insulin resistance which can lead to weight gain.
Bone deterioration is also a risk when using the pill or Depo-Provera. Results from a large study indicated that incidence of fractures were much higher with pill users than non-pill users. Furthermore, the increased loss of bone mineral density from the pill may not be reversible.
Migraines have also been implicated in studies related to OCP use. Research shows estrogen containing oral contraceptives may increase both migraine and non-migraine headaches.
Stroke is a serious side effect of OCPs. One effect of synthetic estrogen is increased risk of blood clots. This risk is the reason why women with blood clotting problems should avoid the combined hormone OCP.
Cancer of the liver, cervix and breast are all risks of taking OCPs, especially for several years. Risk of cervical cancer doubles when OCPs are taken 10 years or more. Risk of breast cancer increases with just 4 or 5 years of OCP use.
All hormones need to be processed by the liver to safely be excreted from the body. This includes synthetic hormones in oral contraceptives. So a healthy liver is important to reduce side effects as well as handle the constant influx of synthetic hormones. However, chronic stress on the liver from metabolizing these synthetic hormones increases risk of liver disease and liver cancer.
The Pill’s Effect on Fertility
Women often take OCPs to prevent pregnancy. However, it is not always an easy road back to fertility when they are ready to conceive. This is because a hormonal shift to a normal cycle cannot reverse overnight. Studies have found it may take over a year to conceive after stopping OCPs. The longer a woman is on OCPs, the longer it may take to conceive. This effect is not only due to hormonal imbalances; nutrient deficiencies from using OCPs can also contribute to fertility problems.
Nutrient Imbalance
Oral contraceptive pills do not only affect your hormone levels, they are also depleting your body of several nutrients.
Vitamin A – Studies have shown that beta-carotene levels, a precursor for vitamin A, can decrease in women using OCPs. Vitamin A deficiency can lead to eye problems, dry and scaly skin, teeth and gum issues, heavy menstrual bleeding, decreased immune function and increased risk of cancer.
Vitamin B6 – This B vitamin is used by the liver to process estrogen and metabolizes differently when a woman is pregnant. OCPs trick the body into thinking its pregnant which depletes B6. This can lead to nausea, lethargy, anxiety, depression, fatigue and insomnia.
Thiamine and Riboflavin – Deficiencies of Vitamins B1 (thiamine) and B2 (riboflavin) are both possible with OCP use. This can lead to mouth and gum infections, eye irritation, skin problems, dizziness, depression, irritability, insomnia, fatigue, weakness and constipation.
Folic Acid and Vitamin B12 – Levels of these two B vitamins are greatly reduced in OCP users. This can lead to anemia as well as increased risk of neural tube defects and spina bifida when pregnancy does occur.
Vitamin C – OCPs increase the breakdown of vitamin C. A deficiency in vitamin C can cause bruising, bleeding gums, heavy menstrual bleeding, and compromised immunity.
Magnesium – OCPs can interfere with the absorption of magnesium leading to PMS, lumpy breasts, muscle cramps and anxiety.
Zinc – This mineral is also depleted by OCPs. This can lead to diabetes, skin infections, and lowered fertility.
Copper and Iron – These two minerals can actually increase with OCP use. High iron levels can increase inflammation in the body while high copper levels can lead to immune dysfunction, insomnia, mood swings and depression.
Benefits v. Cost
Oral contraceptive pills do provide many benefits beyond reducing risk of pregnancy. OCPs have been used for conditions such as iron deficient anemia, heavy bleeding during menstruation, ovarian cysts, polycystic ovarian syndrome, endometriosis and abnormal male pattern hair growth. Additionally, OCPs may protect from uterine and ovarian cancers. The best thing to do is weigh the benefits of birth control pills with their side effects before making a decision about using them.
Supplementation
If you decide to take OCPs, adding certain supplements to your regimen can reduce nutrient imbalances and side effects.
B Complex – B6 is required for proper liver metabolism of hormones, including those in OCPs. B1, B2, and B12 are depleted by OCPs.
Methylated folate – Folic acid is commonly deficient in OCP users. Methylated folate is a more bioavailable form than folic acid.
Magnesium – This mineral is important for hundreds of functions in the body, including estrogen metabolism. OCPs may interfere with the body’s ability to absorb and utilize magnesium.
Beta-carotene – This carotenoid is a precursor to vitamin A, an important antioxidant and anti-cancer nutrient.
Zinc – This mineral also becomes depleted with OCP use.
Vitamin C – Depletion of zinc can also create an imbalance between zinc and copper, increasing the body’s need for vitamin C.
Milk Thistle – This Cholagogue herb helps to support the liver’s job of metabolizing hormones.
Probiotics – OCPs can create an imbalance in the vaginal ecosystem. Probiotics can help rebalance the microbiota.
Whole food sources of these nutrients are just as important. Consuming a whole foods diet rich in organic fruits and vegetables, free-range lean meats, wild caught fish, cold-pressed and unrefined oils, and legumes will provide many of the nutrients needed to enhance and maintain your health when using “the Pill.”
Resources:
The Pill, Jane Bennett & Alexandra Pope
Women’s Encyclopedia of Natural Medicine, Tori Hudson, ND
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