Birth Control: The Good, The Bad and The Downright Ugly 2.0

As a Naturopathic Doctor who focuses on women’s health, one of the most common questions I’m asked is “So, is birth control really that bad for me?” The answer, like most medical questions, is….It depends.

Birth control is a very controversial topic, especially amongst health care professionals. I have seen the birth control pill, also referred to as the oral contraceptive pill (OCP), be demonized by some health professionals.  This essentially scares women into believing their only option is to forgo any form of hormonal birth control. However, I find this very disheartening. A woman should never feel ashamed about her reproductive rights or feel guilty for using the OCP.

The choice of whether to use the OCP is a personal one. There is no one right answer or a clear pathway for anyone. There is evidence both for and against the OCP, thus helping women feel empowered to make an informed decision.

Most important, it gives women a choice to decide when they are ready to have children. When used properly, the OCP can be 99.9% effective at preventing pregnancies. This is a game changer for women who are not yet ready to be become pregnant, be a mom and raise a child. We are fortunate to have this choice in Canada. 

The Good

Decreased Risk of Endometrial and Ovarian cancer

The use of the OCP is linked to a decreased risk of endometrial and ovarian cancer. The OCP causes your uterine lining to shed every month, reducing the incidence of endometrial hyperplasia. It also reduces your risk of ovarian cancer, although the exact mechanism is not known. These protective effects appear to last for 15 years after stopping the pill, before diminishing back to the baseline risk.1

Symptom Management

The OCP can be the solution for many common ailments. It can help manage flow, reduce pain and cramping, produce a steady cycle length, and lead to clearer skin. In addition, it may also help stabilize mood and fix hormone-related headaches (see more on this below). For some women, this can be life-changing. If someone is completely debilitated by their symptoms, the OCP can be a highly effective method for management. Although it does not address the actual root cause of your symptoms, it is an option to consider. Keep in mind this is symptom ‘management’ not curative. When you get your period on the OCP, it is not a true period, simply a withdrawal bleed due to the progesterone in the pill. This prevents endometrial hyperplasia (build-up of the uterine lining), which can be a risk factor for cancer. I once had a patient tell me “it’s so great, the OCP completely regulated my cycle” not realizing it was an artificial cycle with an unnatural withdrawal bleed. Therefore if you had irregular periods before starting the OCP, you will very likely have irregular periods when you come off the OCP. Your issue has not been resolved.  Even though it is simply a band-aid solution, it could be the right answer in some cases.

The Bad

Unwanted New Symptoms 

You may experience a variety of unpleasant new symptoms. While the OCP can help manage migraines and mood swings in some women, it may exacerbate or induce them in others.Estrogen has a direct impact on serotonin (the happy hormone) levels in our body. This can lead to symptoms of depression after starting the OCP. It can also worsen migraines, as the sharp decline in estrogen after finishing a cycle can trigger an attack.3

Nutrient Depletion

I am constantly amazed and concerned that most medical doctors don’t talk to their patients about nutrient depletion. It is well documented that the OCP depletes several important nutrients, most notably Vitamin B6. It also depletes Vitamins B2, B12, C, folate, magnesium and zinc.  These are all extremely important for optimum health.4  I always recommend working with a Naturopathic Doctor who recognizes these nutrient depletions and has the expertise to supplement appropriately.

Folate → spinach, Brussels sprouts, broccoli, eggs, beets

Magnesium → dark chocolate, almonds, avocado, black beans

Vitamin B2 → almonds, eggs, spinach, grass-fed beef, spinach, asparagus, mushrooms

Vitamin B6 → chicken, turkey, grass-fed beef, avocado, sunflower seeds, sesame seeds

Vitamin B12 → clams, wild-caught salmon, turkey, mackerel, nutritional yeast, eggs, sardines

Vitamin C → red pepper, kale, orange, strawberries, broccoli, guava

Zinc → oysters, pumpkin seeds, chickpeas, cashews, spinach

The Ugly

Increased Risk of Breast and Cervical Cancer

The most concerning issue with birth control use is the increased risk of breast cancer, especially estrogen-positive.  Women between the ages of 22-49 who have used the pill for more than 5 years have a modest increase in the risk for breast cancer. However, the risk declines back to the baseline level 10 years after stopping birth control.5 There is also an increased risk of cervical cancer with use beyond 5 years, but this risk also declines to the same level as non-users ten years after ceasing use.6

True or false? Dispelling Common Myths

Does the OCP cause me to gain weight?

This is unlikely, especially when using combined oral contraceptive pills that contain both estrogen and progesterone. A large Cochrane Review looked at 49 separate trials and concluded that there is insufficient evidence proving that the OCP causes weight gain. There was also no difference between studies in the number of women who choose to discontinue the OCP due to weight gain. Another Cochrane Review examined the incidence of weight gain for progestin (synthetic progesterone) only containing pills. The average weight gain was less than 4.4 pounds and was more likely to occur after taking the pill for 2+ years. Another caveat is that there is a tendency to gain weight as we age due to a more sedentary lifestyle, poor eating habits, higher amounts of stress and less time for exercise. Think of the person you were five years and who you are now. Most people I know (and I can say this for myself) find it more difficult to find time for exercise and healthy eating as life gets busy and stressful with work, kids, finances etc. In these cases, focusing on lifestyle changes and finding permanent solutions for steady weight loss are more important.

Does the OCP affect my future fertility?

Contrary to popular belief, evidence-based medicine tells a different story.

Although some studies have shown delayed time to conception post-OCP use, this appears to be transient and short-lived. A Comprehensive Review of the literature indicates that  72% to 94% of former OCP users experience conception within 12 months of stopping the pill; in other words, most people get pregnant within one year after coming off the OCP. This statistic is very similar to women on the progestin-only contraceptives (75-95%), as well as the IUD (71-92%), condoms (91%) and natural family planning (92%).

Studies have found that it may take longer to conceive after discontinuing hormonal contraception in comparison to the discontinued use of non-hormonal contraception, such as the diaphragm. However, over time the differences between the groups decreased. In addition, while it may take longer for women who were on the OCP to conceive in comparison to the women on the IUD, in subsequent months the differences between groups decreased dramatically. Other studies have found that OCP users had very similar conception rates to women who used the progestin IUD as well as the copper IUD.

Women who have trouble conceiving after the use of OCP, most likely had absent periods or anovulatory cycles before they went on the pill.  It masked this issue and therefore was not apparent to them until they discontinued use and tried to conceive. Furthermore, if you are using the OCP to prevent pregnancy this also means you are delaying trying to conceive (TTC). By the time we are 30, we have depleted approximately 90% of our ovarian reserve. In general, women are delaying conception, which can increase the risk of infertility. As an ND who practices integrative fertility care, this is so much I can do to support egg quality and overall fertility. I work with couples to optimize their health through nutrition, acupuncture, supplements and IV therapy to help them achieve their goal of having a healthy baby.

Is post-birth control syndrome real?

Not how we think of it. Not too long ago there was conflicting information about whether or Post-Birth Control Syndrome (PBCS) was a condition. The debate got heated as you can read about in this National Post article. In my opinion, PBCS is real but not in the way it’s been portrayed to the public. I see a lot of people who struggle with acne, irregular periods, weight gain, hair growth, painful cramping, heavy periods (the list goes on) after they come off the OCP. However, this does not mean that the OCP caused these symptoms, it is most likely that the pill was suppressing these issues because it was supplying a steady state of hormones to the body. This was exactly that case for me when I tried coming off birth control. I was originally put on the OCP in high school for amenorrhea (absent periods), and no surprise when I went off the OCP I still had absent periods. This was not caused by the OCP, but the underlying PCOS, which was never diagnosed properly in the first place. Now that you’ve removed those synthetic hormones, all these hormonal imbalances reappear. So if you went on the OCP for acne, you will likely have acne when you come off, and it will likely be worse. That’s why working with an ND to help transition off the pill can mitigate these unwanted symptoms and provide a smoother road back to hormone balance. For more on this topic, I highly recommend listening to Dr. Aviva Romm’s podcast on Post-Pill Reset. It is, without doubt, the best podcast I have listened to on this topic, and I love her no-nonsense approach to health care. 

What are other birth control options I should consider other than the OCP?

Thankfully we have many options when it comes to birth control, including naturally fertility awareness method (FAM). How to choose an option really depends on your circumstances and something you should discuss with your medical team. The FDA and Planned Parenthood offer a great overview of different options on their websites.

A great book for learning more about FAM is “Taking Charge of your Fertility” by Toni Weschler. I have read it multiple times and frequently recommend it to patients who are interested in natural family planning. 

What Should I Do?

As you can see, the decision to start, stop or continue birth control is complex and personal. I strongly believe in educating my patients on their different birth control options and coming up with a solution for works for them. It is important to get the facts, understand the risks and benefits, and ultimately make the best decision for you. If you are unsure which method of birth control is right for you, let’s talk and find a solution that fits your lifestyle, family history and personal health. Still got more questions? I love this comprehensive guide written by the incredible team at MOM LOVES BEST

Thank you

A special thank you to Maddie Battle, my current clinical intern at Higher Health and student at the Institute of Holistic Nutrition. She helped write the updated edition of this blog, which required extensive research and I could not have done it without her. You can follow her on Instagram @maddiebattle.

References

  1. Vessey, M. P., & Painter, R. (1995). Endometrial and ovarian cancer and oral contraceptives-findings in a large cohort study. British journal of cancer, 71(6), 1340.
  2. De Leo, V., Scolaro, V., Musacchio, M. C., Di Sabatino, A., Morgante, G., & Cianci, A. (2011). Combined oral contraceptives in women with menstrual migraine without aura. Fertility and sterility, 96(4), 917-920.
  3. Brandes, J. L. (2006). The influence of estrogen on migraine: a systematic review. Jama, 295(15), 1824-1830.
  4. Wynn, V. (1975). Vitamins and oral contraceptive use. The Lancet, 305(7906), 561-564.
  5. Beaber, E. F., Buist, D. S., Barlow, W. E., Malone, K. E., Reed, S. D., & Li, C. I. (2014). Recent oral contraceptive use by formulation and breast cancer risk among women 20 to 49 years of age. Cancer research, 74(15), 4078-4089.
  6. International Collaboration of Epidemiological Studies of Cervical Cancer. (2007). Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16 573 women with cervical cancer and 35 509 women without cervical cancer from 24 epidemiological studies. The Lancet, 370(9599), 1609-1621.

 

2019-09-19T17:14:49-05:00