How do you make an informed decision about 'The Pill'

The Oral Contraceptive Pill (OCP) is touted as being one of the great inventions of the 20th century, and it’s true in that it has led to huge social changes due to women having better control over their fertility; or so it seemed when it became available during the 1960’s. It is now one of the most prescribed drugs in developed countries and is increasingly being used for much more than contraception.

So, if you or your teenage daughter have been prescribed the OCP do you know what it is and how it works? Are you also aware of the effect that it has on many key nutrients and how that can impact your health?

The OCP includes many different configurations but it is most frequently a combination of synthetic oestrogen and progestin (a form of progesterone). There are other forms of contraceptives used including Intrauterine Devices (IUD) however these are not included in this article. 'The Pill' is sold under a variety of commercial names including Yaz, Diane, Levalin, Yasmin and Evelyn. Most contain between 20 micrograms (mcg) and 30 mcg of synthetic oestrogen and varying doses of synthetic progesterone in different forms. Pills that contain higher doses of oestrogen have been discouraged as they carry an increased risk of blood clots.

The Pill works as a contraceptive by disrupting the normal hormonal fluctuations in a woman’s menstrual cycle and specifically by preventing ovulation. The menstrual cycle is regulated by feedback loops of specific hormones including Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH), Oestrogen and Progesterone. The Synthetic hormones in the OCP prevent the levels of FSH to increase enough to trigger a surge of LH required for ovulation. As you can see from the diagram below, it is a sophisticated symphony of hormones, and when you introduce synthetic hormones found in the OCP, this will essentially flat line the cycle.

Although you may have a bleed when you take the OCP, this is not a period. A normal period occurs when levels of endogenous (made by your body) oestrogen and progesterone decline, following ovulation that doesn't result in pregnancy, and it is a sign that your ovaries are functioning well. When you take the pill, a bleed occurs if you stop taking the pills containing the steroid hormones leading to lower levels of drug. It is often lighter because the endometrium or lining of the uterus is thinner. A lot of women are now advised by their doctor that it is fine to continually take the synthetic hormone and avoid having any bleed at all. The rationale for this:

· Less iron deficient anaemia

· Smooths out the cycle and lessens symptoms of PMS

Although the hormones in the OCP are designed to mimic your natural ones, they are chemically different, and this means that their effects are also different. Many women report increased anxiety, weight gain and even worsening acne after taking the OCP. There are also several nutrients that are displaced by OCP use. These include folate, vitamins B2, B6, B12 and vitamin C. These nutrients are vital for multiple body functions including healthy nervous system function, cardiovascular function as well healthy cell production and growth. Vitamin C is essential for adrenal function as well as being a major antioxidant required to neutralise toxins. It is also a vital component of collagen that is an ingredient in skin, bone, cartilage and tendons. Fat soluble vitamin E is also a powerful antioxidant in the body that becomes depleted with OCP use. It is important for cardiovascular health including maintaining the health of blood vessels and preventing blood clots.

Minerals such as zinc and selenium are vital for healthy thyroid hormone production. Selenium is also another powerful antioxidant needed in the body. Deficiencies in these nutrients can lead to thyroid dysfunction and problems with normal metabolic processes as well as infertility. Magnesium is another important mineral that may become depleted with OCP use and lead to increased symptoms such as muscle spasms. It is also a vital cofactor in glucose metabolism as well as the regulation of normal blood pressure.

The Pill is associated with increased cortisol production and this can result in changes in metabolism and blood glucose levels.

Many young women are first prescribed the OCP to treat acne or regulate their periods. It can be effective in the short term because it creates an artificial 'cycle that results in much lighter, shorter bleeds. Sebum production is greatly reduced due to lower levels of testosterone, mostly due to increased production of a binding protein called sex hormone binding globulin (SHBG) that binds testosterone making it inactive and not able to stimulate oil production and inflammation associated with acne. The menstrual cycle can take years to regulate and, unfortunately, when the OCP is prescribed in the early years this cannot occur and period problems such as heavy bleeding and acne often return if it is stopped. The Pill does not address the underlying causes of these issues which often include problems with hormone processing and excretion. Diet and lifestyle factors also play a vital role with processed foods that are high in sugar and saturated fats as well as food intolerances often implicated.

Another important consideration associated with OCP use, particularly when it is commenced in early adolescence to treat acne or to regulate the menstrual cycle and continued for contraception, is the long-term exposure to oestrogen. The body has ways of regulating the amount of oestrogen in circulation, but they can become overloaded leading to an oestrogen dominance and increased risk of conditions such as certain hormone dependent cancers, uterine fibroids that are benign growths and can lead to problems with fertility, as well as heavy menstrual bleeding and iron deficiency in perimenopausal women.

The Oral Contraceptive Pill may end up being the choice that you make for your contraceptive needs or to manage heavy bleeding or acne, and there are things you can do to support your body to reduce some of the side effects I've mentioned. The important thing is that you make an informed decision by understanding its effects and potential risks to your health.

If you would like more information about how you can support your hormonal health, reduce the impact of nutrient deficiencies from OCP use or other options available to treat hormone dysregulation such as heavy, painful periods, irregular cycles or acne, please make an appointment for a naturopathic consultation with Larissa Jane Naturopathy. Bookings can be made on my website larissajanenaturopathy.com.