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The pill is a fantastic tool but let's take a deeper dive into how it might be affecting our bodies and explore some hormone free alternatives.
Summary:
In this post, we will discuss how the birth control pill and other hormonal contraceptives work to prevent pregnancy, the role synthetic hormones play in our health, hormone-free alternatives, and ways to use nutrition to support the body if taking the pill or for post-pill recovery.
FREEDOM!
Since the 1950s, when the pill was first introduced, hormonal birth control has benefited women immensely. It has provided reliable control governance over our fertility, provided regularity, and
given more women the opportunity to work outside the home. Meanwhile, numerous other hormonal contraceptives have come on the market from the NuvaRing, to the Depo Provera shot to hormonal implants. While these all have a slightly different application, the impact of the synthetic hormones has similar effects on the body.
I strongly believe women should have access to many birth control options and be able to choose the best option for their body. To best manage our health and well-being, let's take a quick look to understand how these hormonal influences are affecting our body, mind and
lifestyle in addition to exploring some safer alternatives.
The Pill in a nutshell
As we learned in Getting to Know Your Cycle, our hormones intentionally rise and fall in symphony with each other. In the first half of our cycle (the follicular phase), progesterone is low as estrogen rises. In the second half (the luteal phase), estrogen drops, and progesterone rises.
This very intentional and cyclic event, primes our reproductive system to generate, mature, and release a viable egg. However, most birth control pills deliver a consistent dose of estrogen and progestin (which is more akin to testosterone than our natural progesterone) throughout the 3-week hormone phase. Unfortunately, this in no way mimics the natural rise and fall of our innate cycle.
A placebo pill is taken during the fourth week. When taking the placebo, a uterine bleed is triggered. This, however, is simply from not having the steady input of synthetic hormones, which triggers the uterus to shed the lining and a “period” arrives. This steady plateau of estrogen and progestin maintains a series of hormonal cascades in a static state during the three-week window. The hormonal composition of the pill can affect people differently and lead to inflammation, high blood sugar and insulin resistance (Brighten). A healthy "real period" is the culmination of a series of hormonal events. This start with a direct line of communication between the brain and the ovaries, includes ovulation and therefore the production of progesterone. A pill bleed is simply a bleed, with no "brain-ovary" communication.
Two types of pills:
The combination pill contains estrogen and progestin. This pill is more effective and has less breakthrough bleeding. The combo pill works by thickening cervical mucus, suppressing ovulation, altering tubal motility, and thinning the uterine lining which creates an uninhabitable environment for a fertilized egg. For some people, weight gain, anxiety and depression can be experiences on the combo pill.
The progestin only pill is also known as the mini pill, and it is taken when women do not tolerate the synthetic estrogen well or are breast feeding. It has shown to only be effective in about 60% of women. (Brighten)
Ovarian hormones, estrogen and progesterone, have many effects beyond reproduction. Our mood, bones, thyroid, muscles, heart, and metabolism all rely on a healthy functioning cycle to thrive during and beyond our reproductive years.
Although modern-day birth control has provided benefits and autonomy over the menstrual cycle, there are some very real adverse impacts from synthetic hormones. This unnatural hormone pattern delivered by the pill overrides the pituitary gland in the brain, preventing the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), two of the primary hormones that facilitate the communication between the brain and the ovaries.
The lack of FSH and LH is what prevents ovulation from taking place. Due to the consistent levels of synthetic estrogen and progestin, our body kicks in a negative feedback loop telling our brain we have plenty of the ovarian hormones (estrogen and progesterone) and our brain suppresses the signal that would tell the body to make additional FSH and LH and ultimately estrogen and progesterone.
Now, we have lost our natural “brain-ovary” line of communication and no longer have sex hormones of our own. In addition, because we do not ovulate on the pill, we do not make the wonderful and absolutely necessary progesterone. The pill does not regulate hormones as some individuals might say, rather, it turns them off.
Ovarian hormones, estrogen and progesterone, have many effects beyond reproduction. Our mood, bones, thyroid, muscles, heart, and metabolism all rely on a healthy functioning cycle to thrive during and beyond our reproductive years. For example, progesterone improves brain health and cognition, where progestin has been linked to depression and anxiety. (Skovlund CW)
Some of the many roles estrogen and progesterone play in the body:
In the chart above, you will notice estrogen and progesterone play very important roles in the female body. They work in harmony to support a healthy cycle. When dysfunction occurs, there is an the increased risk of disease especially with estrogen dominance. They need to be in balance individually and work in harmony for the body to function optimally.
A word on the Pill and Estrogen Metabolism
The pill has also been shown to alter estrogen metabolism in the liver. The liver needs reliable sources of B vitamins and magnesium (which are depleted while on the pill) to properly get rid of used estrogens. While on the pill, used estrogens are shuttled towards a more problematic exit pathways known as 4 hydroxy estrogen pathway which is associated with inflammation, PMS symptoms and cancer.
Nutrient support while on the pill or post pill recovery:
The pill depletes key nutrients for a healthy menstrual cycle. A few of these include vitamin B6, magnesium and zinc.
B6 has been shown to help prevent or alleviate PMS symptoms and is beneficial in the formation of the corpus luteum (the source of progesterone production once the egg has left the follicle).
Wild caught fish, grass-fed beef, beef liver, pastured chicken, sweet potatoes, spinach and banana are all reliable sources of B6.
Magnesium – this is such an important mineral in controlling insulin production which is connected to testosterone levels and the health of the ovaries. This also heavily influences adrenal health which is the foundation for balancing hormones. Magnesium can also help reduce sugar cravings (brighten) which can be challenging with unbalanced hormones. Phase II detoxification, in the liver, also relies on magnesium as we covered in the previous post all about detoxification. (see blog post re liver detox)
Reliable sources include kelp, fish, spinach, almonds, molasses, mineral water, dark chocolate, shrimp, avocado, and buckwheat. However, our food supply is not as rich in magnesium as it once was so supplementation is probably necessary (bisglycinate 300-600mg a day. (Brighten)
Zinc – this is an essential trace element for female hormonal health. Adequate levels are needed for the the release of FSH from the pituitary gland in the brain, the development of the follicle (Maares M), and it is helpful in reducing menstrual pain (Garner TB). In addition, we are not capable of storing zinc (Garner TB) so we must consume adequate amounts in our daily diet to replenish what is lost due to daily demands.
Food sources include pumpkin seeds, red meat, chicken, and shellfish. One tricky thing about zinc is that once your body stores are low, you need zinc in your cells to absorb zinc from your diet. A zinc lozenge is your best bet at this point as it will absorb into the blood stream from the mouth tissue and not be dependent upon the zinc in your gut for assimilation from your diet.
Safer hormone-free alternatives (always consult your doctor first)
Hormone-Free IUD Paragard – this small T-shaped device is inserted into the uterus and can be left in for up to 10 years. Paragard uses one active ingredient, copper, which is wrapped around the device. Copper creates a local in inflammatory reaction that is "toxic" to sperm and eggs and therefor prevents pregnancy. It is over 99% effective. You do need to be aware of the possibility of copper overload and possibly have copper levels tested. AND the extra good news: You will still ovulate and have a monthly cycle which if you remember from Living in Harmony with Your Hormones – is a vital sign of health! For more information check out Paragard for yourself.
FAM – Fertility Awareness Method - in short, you track your cycle and plan intercourse around the 6-ish days you are fertile each month. This is a very effective method, but you do have to be diligent about getting to know your body, your cycle and tracking the events of your cycle. Your fertile days are the 5 days before you ovulate because that is how long sperm survives in the uterus and one day after ovulation because that is how long an unfertilized egg survives. If used correctly, the FAM is as effective as the pill. (Briden)
Male or Female Condoms – Condoms are a barrier method of birth control and are easy and inexpensive to use. They can be used without toxic spermicide and protect against STDs. If used “correctly”, there is a 2% failure rate and if used “typically” there is an 18% failure rate for the male condom. So, make sure you have the right size and know how to properly keep it in place. The female condom has a “correct use” failure rate of 5% and a “typical use” failure rate of 28%.
Other safer options include a diaphragm without spermicide, cervical cap without spermicide and the withdrawal or pull-out method.
If you decide you want a hormonal option, I feel the hormonal IUD Mirena (aka Skyla and Liletta) is the best option. Still not my favorite due to the influences of synthetic progestin but it acts to thicken cervical mucus, thins the lining of the uterus and only partially suppresses ovulation. The only reason I choose this as the least of all evils, in the hormonal contraceptive world, is that there is a chance ovulation still occurs where on the pill, ovulation is completely suppressed. Ovulation is the key step in producing our own progesterone.
Be sure to do your own extensive research and consult your physician to find out what is best for YOU! Only YOU know what is best for YOUR body.
References
Skovlund CW, Mørch LS, Kessing LV, Lidegaard Ø. Association of Hormonal Contraception With Depression. JAMA Psychiatry. 2016;73(11):1154–1162. doi:10.1001/jamapsychiatry.2016.2387
Garner TB, Hester JM, Carothers A, Diaz FJ. Role of zinc in female reproduction. Biol Reprod. 2021;104(5):976-994. doi:10.1093/biolre/ioab023 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8599883/
Maares M, Haase H. A Guide to Human Zinc Absorption: General Overview and Recent Advances of In Vitro Intestinal Models. Nutrients. 2020;12(3):762. Published 2020 Mar 13. doi:10.3390/nu12030762 absorptionhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146416/#!po=46.0000
Brighten J. Beyond The Pill HarperCollins Publisher 2019
Briden L. The Period Repair Manual 2nd ed revised. Greenpeak publishing; 2018