Birth control pills

Are you using any form of hormonal birth control? Contemplating which form is best for you? There are many types such as the pill, IUDs, depo-provera injections, and the NuvaRing.  Some can inhibit ovulation and therefore stop you from getting your period while others may induce a period but keep it very light.  Here is some key information you should know about hormonal birth control because nowadays women are not just opting for birth control to prevent a pregnancy but also so that they don’t have to deal with heavy, painful and horrendous periods.  It would suck to be at work or school and leak through your underwear or be in so much pain that you pass out or throw up.  In today’s society, we also cannot afford to be taking sick days off every month to deal with our period.

I’m going to let you in on a little secret …. Pain, cramps, clots, heavy bleeding can be a sign of inflammation, insulin resistance, adrenal dysregulation, estrogen dominance, or something else.  Dietary and lifestyle modifications, especially with the addition of key nutritional supplements or herbs to support the body and maybe a little bit of acupuncture can help eliminate menstrual symptoms, balance your hormones and maybe bring on periods that show up with minimal disruption to your daily routine.  Interested to know what works for you and try to avoid using the pill for “regulating your period”? Book a FREE 15-minute naturopathic discovery call and let’s discuss how I can help you.

If you really want to use birth control, keep on reading for some non-hormonal options. If you are on the oral contraceptive pill, you will want to keep reading to know which vital nutrients the pill depletes from your body. If you have been feeling worse since being on the pill, I’ve outlined some of the very common adverse effects the pill causes below as well.

Blood Clots & Pulmonary Embolisms

The most severe adverse outcome of hormonal birth control, especially combination oral contraceptive pills, is the development of blood clots which can manifest in leg cramps, leg or calf pain. These blood clots can get dislodged and travel into the lungs resulting in a pulmonary embolism creating difficulty breathing, coughing up blood and other respiratory symptoms. They can also travel to the brain.

A systematic review was performed to analyze the risk of venous thrombosis (VT) (includes deep vein thrombosis, cerebral thrombosis, and pulmonary embolism) from various hormonal birth control preparations and found that oral combination birth control pills increased the risk of VT by 4-48.6 compared to oral contraception with progestin only which increased the risk by 2.79–4.07 [1]. Other forms of hormonal birth control did have a risk of VT but lower than the oral contraceptive pill. They found that the NuvaRing and the patch had an increased risk of VT of 6.5 and 7.9, respectively. Progestin implants and the depo shot had a lower risk and the progestin-only IUDs did not increase risk [1]. This highlights that most of the risk of VT comes from the estrogen with the exception of the oral combo pills, Yaz and Yasmin that yield a very high risk of blood clots because of the specific progestin they used – Drospirenone- plus the estrogen in the pill.

The reason why NuvaRing and patch, which supply a continuous flow of estrogen and progestin, had a lower risk than Yaz and Yasmin is that they don’t use the same progestin, drospirenone.

If you are already in an estrogen excess state or prone to migraines, your medical doctor may discourage you from using any oral combination birth control which is because of the estrogen and recommend the mini-pill which is only progestin. You will see below that the mini-pill has its own problems.

Is the Oral Birth Control Pill Really Regulating Your Periods?

Uterus

It feels wonderful – you get your period every month and know exactly when you will get it. It comes and goes and you aren’t stuck in bed. This isn’t your REAL period.  When you are on the pill, you don’t ovulate. The bleeding you experience is a withdrawal bleed and occurs following a period of 7 days of sugar pills or not taking any pills so the hormones you ingested for 3 weeks drop from the body.

The estrogen and progestin in the pill suppress your own body’s ability to make FSH and LH stopping follicle development and ovulation. This reduces your own estrogen and progesterone production – two hormones which have many benefits on our body other than just reproduction. This can often leave one in a state of estrogen dominance and if you want to conceive, it can take a few months for your ovaries to re-gain function, regulate your hormones and get your REAL period back.

There are many supplements and herbs to help with hormone regulation once you come off the pill to get your period back and minimize the estrogen dominant signs and symptoms while detoxifying the synthetic estrogens from your body. My recommendation if you are currently on the pill and trying to conceive, plan to come off the pill at least 3 months before trying to conceive and work with a naturopathic doctor to support your hormone balance including ensuring you have optimal progesterone to reduce the risk of an early miscarriage.

What can Estrogen Dominance Look Like?

  • Bloating
  • Constipation/loose stools
  • Breast tenderness
  • Anxiety
  • Low mood
  • Low motivation
  • Spotting before your period when you come off the pill if your progesterone is low
  • Acne
  • Heavy flow
  • Insomnia
  • Weight gain around the hips
  • Mood changes before your period

Doesn’t The Pill Have Progesterone to Mitigate the Estrogen Dominance?

Progesterone

Unfortunately, progestin does not equal progesterone that our body makes and doesn’t have the same physiological benefits.  Progestin in the birth control is there to help thicken the cervical mucus so sperm has a difficult time entering the uterus and fertilizing an egg if you did happen to ovulate. In combination with estradiol, the progestin suppresses ovulation. The NuvaRing and patch can also suppress ovulation. You may still ovulate on the mini-pill which is why they recommend taking it at the same time every day to try and suppress ovulation. It isn’t uncommon to still ovulate and have a light period while on the IUDs since these are local administration of progestin and clinically in my practice, I’ve seen more women have a light period with the Kyleena (low-dose progestin) versus not having any period on the Mirena IUD.

Anytime ovulation doesn’t happen, this sets you up for estrogen dominance because most of our progesterone is made from the corpus luteum (follicle remnant after ovulation).  Only a very small amount of progesterone comes from our adrenal glands.

Low Mood and Depression on Birth Control?

Some women report feeling horrible – more anxious, sad, weepy and depressed on birth control.  This could be a drop in estrogen and estrogen does help make serotonin.  Another reason is because progestin increases an enzyme known as MAO (monoamine oxidase) [2].  This enzyme breaks down serotonin, dopamine, adrenaline.  This could create feelings of being depressed, low motivation, and have more anxiety.  The effects can be worse if you are on progestin-only birth control.

Progestin induced depression

Nutrient Depletion

Nutrient depletion

This applies more to those who are on the pill or the NuvaRing or the Patch which can increase your susceptibility to candida/yeast overgrowth, adrenal stress and cortisol dysregulation, and deplete certain nutrients like B12, folate, B6, magnesium, zinc, selenium, vitamin C, and vitamin B2 [3]. All of these nutrients are vital to glutathione – our master antioxidant that helps eliminate excess estrogen.

It’s important to ask your healthcare professional for the best formula to replenish these nutrients on and off your chosen form of birth control method.  I like to recommend a supplement with active forms of the nutrients for better bioavailability.

Non-Hormonal Forms of Birth Control

  1. Male and Female Condoms
  2. A diaphragm – a reusable silicone cup that is inserted vaginally and covers the cervix so sperm cannot enter the uterus
  3. Copper IUD – this increases prostaglandins and white blood cells but it can create heavier periods and more inflammation and may not be recommended for people with uterine conditions like fibroids
  4. BBT tracking – Tracking your morning oral temperature on waking to know when ovulation occurs. A jump in temperature of 0.6-1 degree indicates ovulation is about to occur.
  5. Cervical mucus tracking: Paying attention to your cervical mucus is a great indicator to know you are about to ovulate when you start noticing that sticky / slippery discharge. You really have a fertile window for only 5-6 days
  6. Natural Options: If you are looking at the pill for having better periods, there are lots of natural options to balance your hormones and stop having painful periods.

Book a naturopathic consultation to discover how you can regulate and have better periods naturally and/or we can also discuss some of these other non-hormone options of birth control.  Already on the birth control pill and inspired to get off it, let’s set you up for success so you don’t have horrendous periods after that, are able to conceive and replete all those nutrients that are depleted.

Reference:

[1] Keenan, L., Kerr, T., Duane, M., & Van Gundy, K. Systematic Review of Hormonal Contraception and Risk of Venous Thrombosis. The Linacre quarterly. 2018;85(4): 470–477.  PMID: 32431379

[2] Wise J. Hormonal contraception use among teenagers linked to depression.  BMJ. 2016;354:i5289

[3] Mytavin.com to determine nutrients depleted on Nuva Ring and oral contraceptives.

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