WHAT WE NEED TO KNOW ABOUT THE PILL

It is argued that the oral contraceptive pill empowers women and gives them control of their fertility. On the one hand—you’d think yes, indeed. On the other, absolutely not! Though toted as ‘one of the seven wonders of the modern world’ and also considered to be one of the best inventions that historians will reflect back on as something that characterised the 20th century—will it be for good, or otherwise? Let’s explore and understand the impact of using the contraceptive pill and what most of us have not been told or know about this medication. When I speak to the ‘pill’ I am referring to the combined oral contraceptive pill that contains both synthetic oestrogens and progestins. There are many hormonal birth control methods, which are going to be somewhat similar. A future blog may go through individual kinds and their pros/cons if you’d perhaps find that beneficial. For now, we will focus here.

First, let’s bust a myth that the pill can ‘regulate’ a cycle. It can do absolutely no such thing. You want to know why? The menstrual cycle is a beautiful rhythm of hypothalamic hormones talking to the ovaries, the ovaries responding with folliculogenesis (development of the follicle and egg), specific hormone triggers to ovulate, the continued development of the endometrium and then post-ovulatory exposure to progesterone from the corpus luteum (gland that used to be the follicle) to support implantation, then feedback that conception hasn’t occurred, decline of hormones, and restarting of the whole process again.

The pill literally cuts off that communication from the brain to the ovaries, so that beautiful hormonal rhythm is thwarted. The body responds to the synthetic hormones of the pill in such a way that it thinks it is pregnant, then when the active pills cease (sugar pills start) there is a withdrawal bleed (which is not a period) from the rapid decline/withdrawal in hormones.

So, in summary, one does not ovulate nor have a proper menstrual period on the pill. What does this mean for our health?

Well, as I explain to my women in clinic, teenagers and their parents, we need ovulation to occur and the exposure to our body’s own natural oestrogen especially, to bank health for our later years. Teenagers might not care about that yet, but in menopause we will. Oestrogen is important for our brain, our heart, and our bones. Then, progesterone is a lovely one for our mood, our skin, our metabolism and thyroid function, and our immune system regulation. Both oestrogen and progesterone have roles in the brain, which could be why women on the pill have a 71% greater chance of depression in the first 2 years of use.

From a nutrient perspective, we see the pill reducing levels of some of our really important nutrients:

- B vitamins important for energy and mood 

- vitamin C as an antioxidant and immune system support

- vitamin E also responsible for antioxidant roles in the body

- zinc important for the immune system, skin and thyroid function

- magnesium important for electrolyte balance, nervous system and blood pressure regulation

- selenium imperative in fertility, thyroid function and autoimmune conditions

Our microbiome, which developments in research continue to shout from the rooftops the importance of the gut in all facets of health, is also impacted by the pill. We see reduction in intestinal barrier integrity and increased permeability (what you might know as ‘leaky gut’), as well as reductions in diversity and richness. The pill has been associated with increased risk of developing inflammatory bowel disease, like Crohn’s, as well.

More scary is the fact that in 2005, the World Health Organisation changed the pill from being classified as ‘possibly carcinogenic’ to having sufficient evidence to label the pill as a group 1 carcinogen. This means it is ‘carcinogenic’, and has the potential to cause cancer in humans. Wild. Whilst the pill might be protective against uterine and ovarian cancer, other cancers such as breast cancer and cervical cancer risk is increased with 5+ years use.

Also, the longer one is on the pill, progression toward ovarian atrophy occurs, which is literally the shrinking of the ovaries. This can reverse upon ceasing the pill, but sometimes this can take months and months for ovaries to be responsive to the brain’s messages again. The clitoris also shrinks, leading to decreased arousal levels and time to orgasm increasing. Sex can become more painful for some. And, research reports sexual activity declines for those on the pill with the reduction in libido (likely due to decreased testosterone and/or the increase of sex hormone binding globulin).

Okay, so this all sounds gloom and doom and I am sure some of you are reading this feeling that contraception is really important to you. I hear you and can appreciate that. So, understanding that there are going to be some nutrient deficiencies and an impact on gut health means you can do your best to buffer those effects. I am not here to shun anyone who chooses to be on the pill and some mothers of teens I do have this conversation with—letting them know there are other ways to avoid pregnancy, from the Fertility Awareness Method and condoms. Condoms also protect against all kinds of sexually transmitted infections, but also bacteria and viruses we might not be aware of (and do not show up on usual STI screens). But if the choice is to be on the pill in these younger years, aiming for reduced time on the pill is probably a good idea. When one is in a position to have greater awareness of their menstrual cycle, it could be a time to adopt alternate methods to the pill (i.e. once in a committed relationship). Ideally, the shortest time we can be on the pill, the better for our health.

For other women, the pill is what reduces pain in endometriosis, clears skin for acne sufferers, and spares iron for those with anaemia—and to you, I recommend delving into the why behind those presenting conditions and what might be able to be done to remedy at the root. This is a large area of my work as a naturopath (endometriosis, acne, and anaemia support). 

My advice? Carefully consider all contraceptive options, and know the risk/benefit. This is being empowered in our fertility. Discovering other ways of remedying issues if you are indeed not really needing it for contraceptive use is wise. Also, just because it is readily prescribed does not mean it is completely safe. As with all medications, there are going to be downsides to taking them. It’s about understanding what the down sides are and making an informed choice that is important to me, and the message I am wishing to convey here. Knowledge is power, and you get to choose.