Everything You Need To Know About The Oral Contraceptive Pill – Benefits & Risks
What Is “The Pill”?
Birth control pills are oral contraceptives, hormone pills, taken by mouth. They are often referred to as simply “the pill”, which tells you how common they are! Most oral contraceptives include a combination of synthetic hormones which mimic estrogen and progesterone (aka progestins) in the body. There are different types of combo pills, which use different combinations of hormones and doses:
Bi- or Tri-“phasic” (e.g. Tricyclen, Linessa, Synphasic) which contain increasing amounts of progestin over the cycle. A relatively new category that contain an “anti-androgenic” type of progestin called drospirenone (e.g. Yasmin, Yaz). These are often used for acne or other symptoms of hormone imbalance, e.g. excessive hair growth (aka hirsutism). More on this later!
Different ‘cycles’ than the typical 21 days on, 7 days off. For example, a 24/4 regimen and an extended use 84/7 regimen (i.e. one period every three months)
There are also progestin-only pills, also known as the minipill, although they are less commonly used.
Why Do People Take Them?
Obviously, they are most commonly taken as a method of birth control. The introduction of the birth control pill in the 1960s provided women control over reproduction. It empowered women to prevent unwanted pregnancies as they pursued further education and careers. (There was even a hit song in 1975, “The Pill” by Loretta Lynn!)
As a contraceptive method, they are preferred by a lot of women because they are:
– Highly effective – typical failure rate is 90 of 1000 women during 1 year of use. For perfect use (which is taken EVERY day at the same time with no missed pills), the failure rate is 3 of 1000 use during 1 year.
– Reversible (i.e. you can stop them at any time)
– Do not interfere with sex
Aside from contraception, many women are prescribed the pill for other reasons, including:
– Dysmenorrhea (painful periods)
– Regulating “abnormal” menstrual cycles (bleeding too much or too little)
– PMS & premenstrual dysphoric disorder (a very severe form of PMS)
– Heavy menstrual cycles and hot flashes in the perimenopausal period
– Birth control pills do work for most women to reduce these symptoms.
The question is – why are these symptoms happening in the first place? What is the underlying cause of irregular cycles, uncontrollable emotions or acne flare-ups? Finding out why these symptoms are happening in the first place and addressing the root cause is often more desirable than masking these symptoms with a pill!
How Does It Work?
The birth control pill prevents pregnancy through several mechanisms, but the main one is through stopping ovulation. If no egg is released, there is nothing to be fertilized by sperm and the woman cannot get pregnant. The synthetic estrogen and progestin in birth control pills stabilize a woman’s natural hormone levels and prevent estrogen from peaking mid-cycle. Without the bump in estrogen, the pituitary gland does not release other hormones follicle stimulating hormone (FSH) and luteinizing hormone (LH) which normally cause the ovaries to release mature eggs.
The synthetic estrogen in the pill works to:
– Stop the pituitary gland from producing FSH & LH to prevent ovulation
– Support the uterine lining (endometrium) to prevent breakthrough bleeding mid-cycle
The progestin in the pill works to:
– Stop the pituitary gland from producing LH to prevent egg release
– Make the uterine lining inhospitable to a fertilized egg
– Partially limit the sperm’s ability to fertilize the egg
– Thicken the cervical mucus to hinder sperm movement
Below is a diagram of a normal female cycle, who is not on an oral contraceptive. If you are taking the birth control pill, the ovarian hormone levels would be flat (no “hills”), there would be no LH and FSH spike, and no ovulation. The week of placebo pills or off the pill, would cause a decrease of estrogen and progestin (since you are no longer taking them) which stimulates the start of your period where your body to sheds the uterine lining.
What Are The Risks And Benefits?
There are both risks AND benefits with taking the pill, whatever you are using it for. Here is a list of some of them.
– Masking underlying symptoms or a diagnosis
– They cause nutrient deficiencies (e.g. CoQ10; vitamins: B6, B12, B1, B2, B3, C, E & folic acid, and minerals magnesium, selenium & zinc)
– Increased risk of blood clots
– Increased risk of heart attack & stroke (biggest concern high dose pills, age >35, smoking, other CV risk factors or disease)
– Increased risk of breast cancer
– Increased risk of cervical cancer
– It can cause low libido by reducing your body’s level of testosterone
– Migraine headache
– Depression & low mood
– Melasma (hyperpigmentation of the skin)
– Vaginal yeast infections
– Disruption of the microbiome
– May increase or precipitate the following
– High blood pressure, diabetes, high cholesterol
– Raynaud’s syndrome
– Gallbladder, liver, pancreas disorders
– “Side effects” of the pill: breakthrough bleeding, breast tenderness, nausea (this is normal for the 1st 3 months on the pill, after 3-6 months this should go away) & acne (even though it can be used to treat acne, it can worsen initially sometimes)
– Simple to use and highly effective method of contraception
– Decreased risk of endometrial cancer (the benefit is greatest with long term use, more than 5 years; but persists after you stop it!)
– Decreased risk of ovarian cancer (benefit within 1 year of use; persists after stopping)
– Decreased risk of
– Ovarian cysts
– Colorectal cancer
– Osteoporosis (increases your bone density)
– Ectopic pregnancy
– Improves menstrual symptoms and regularity
– Improves acne & growth of excessive body hair (although this may be ‘masking’ an underlying issue – see risks!)
What You Need To Know If You Are On The Pill…
We know that the birth control pill depletes your body of certain nutrients. In fact, some of the risks or possible side effects have been associated with nutrient depletions.
Here are a couple of examples:
– Depression & low mood. Vitamin B6 helps to convert tryptophan to serotonin in the body. While on the pill, you have a 80% deficiency relative to those who are not on the pill, and 20% frank deficiency.
– Cervical cancer. We know the important vitamin folic acid as important for preventing birth defects in babies, and it is one of the key components in prenatal vitamins. Folic acid is not just important for babies! You may have guessed where this is going… the pill also depletes your body of folic acid, hence increases risk of cervical cancer. Studies have actually show that higher doses of folic acid can reverse cervical dysplasia (abnormal cells found on your cervix during a pap smear). Side note: this should only be done with the guidance of a healthcare professional, as too high folic acid can be dangerous too!
So, if you decide the pill is right for you, ensure you are replacing those nutrients. Ideally, take magnesium and a B complex (look specifically B6, B12 & folic acid, or it’s activated form L-methylfolate aka 5-MTHF). At the bare minimum, take a good quality multivitamin (ideally a “prenatal” or women’s formula from a reputable supplement company).
What If You Are On The Pill And Want To Get Off?
I was in the same position a few years ago. Although I can’t say it was a smooth transition after being on the pill for almost 20 years (Yep!), I am glad I did it. I know my body better and am empowered to understand other options for contraception without simply resorting to popping a pill every day. Working with a Naturopathic Doctor can help ensure you are replacing the nutrients you need, identify non-hormonal methods of contraception, and get to the root cause of what symptoms you may be “treating” with the pill.
Should you be on the pill? There is no right or wrong answer! It is a simple, effective method of contraception and there are other benefits such as decreasing your risk of endometrial cancer. However, there are real risks that you should be aware of. If you smoke, have a strong family history of breast cancer and are using the pill for contraception, talk to your healthcare professional (pharmacist, naturopathic doctor or family physician) about other effective birth control options that are less risky for you. If you do take it, make sure to support your body with the nutrients you need to keep your body healthy!
Written by Stacey D’Angelo RPh. Stacey is the Co-founder and Pharmacist here at Wellth! Stacey graduated from the University of Waterloo School of Pharmacy in 2012. She is certified as Diabetes Educator (CDE), and in Sexual Health from the Academy from Anti-Aging Medicine (A4M). In addition, she has also pursued additional training in pain and palliative care, hormone therapy, and specialty compounding.
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