Side Effects of Birth Control — Facts vs Myths
If you start looking, you’ll find conflicting opinions about birth control everywhere. Some corners of the internet will tell you that hormonal birth control (“HBC”) is “bad” and you shouldn’t be putting synthetic hormones in your body. Or maybe your doctor has told you that it will fix your acne. Or that there aren’t any serious side effects. Still others will tell you not to use it for moral or religious reasons. Maybe you’ve actually read the insert that comes with the pill package and seen that it’s associated with side effects like blood clots. But, like, what’s the REAL DEAL? If some of those above things are true, why? How does the the pill — or any form of hormonal birth control — affect your body and is there anything you can do about it?
Today we are busting myths and getting the bottom of REAL FACTS about hormonal birth control (specifically, the pill). Like I said in my previous post about why I quit the pill, I realize that HBC can be a contentious topic. This post is about real facts — there will be no fear mongering, and I’m not going to tell you what you should or shouldn’t do. That’s for you to decide, I’m just here to educate.
Speaking of education, we’re only touching the tip of the iceberg here — I mean, people go to years of school for this stuff (and I’m not one of them). I did my best to keep this as short as possible, believe it or not. ?I’ve included resources throughout and at the end of the post for you to continue learning!
How the pill works
(Need a refresher on all the birth control options out there? See this comprehensive list.)
We’re gonna get a little technical here, but I think it’s first and foremost important to know how this pack of little pills works in your body.
There are two types of birth control pills: the combination pill, and progestin only pill. Combination pills contain synthetic estrogen and progesterone (called progestin), and are slightly more effective which is why they’re more common. Generally when someone refers to “the pill” they’re probably talking about the combination pill, and that’s what we’ll be discussing.
The main way the pill prevents pregnancy is by stopping ovulation. Ovulation normally happens when the natural rise and fall of estrogen and progesterone signal to the brain to produce two very important hormones: follicle stimulating hormone (FSH) and luteinizing hormone (LH), which get your ovaries ready for ovulation and tell them to release an egg, respectively. When you take the pill every day, this constant level of synthetic hormones interrupts the normal communication between the ovaries and the brain, which interprets that there are more than enough hormones already. The brain doesn’t make FSH or LH, and your body doesn’t prepare for or release an egg.
The pill also thickens cervical mucus so that even if there were an egg, sperm couldn’t travel to the uterus to fertilize it, and thins the uterine lining so that even if there were an egg and it got fertilized, it’s less likely that it could implant in the wall of the uterine. (1, 2)
Fascinating right? (I think so at least! ?) Once you get past all the technical stuff, it’s pretty straightforward: no egg, no fertilization, no implantation, no baby. Seems like they thought of everything! So what’s the big deal, and where to all these stories of side effects come from? To understand a little better, let’s dive into some facts and myths.
The pill is “bad”
This is false.
Let’s start off with a polarizing statement, shall we? The pill — or any type of hormonal birth control — is not inherently “good” or “bad,” no matter your personal views. On the one hand, the advent of the pill in the 60s played a large part in the increasing women’s wages (3) and college enrollment and completion rates (4) in the US, which have surely been great things for women. On the other hand, the pill can cause some unwanted side effects which we’ll be talking about. The outcomes and the reasons are what matters, and that is for you to decide for yourself at any given time. For example, I don’t regret at all taking the pill for the last five-ish years (although I wish I had a little more knowledge at the time of my decision), but I and my circumstances changed and decided that a different form of birth control was better for me. Welcome to being human!
The pill causes moodiness
This can be true
This is a big one that gets talked about anecdotally a lot (it’s likely that you or someone you know has complained of this) — common symptoms seem to be lack of motivation and energy, frequent crying, and flattened mood. Now, mood disorders like depression and anxiety are extremely complicated (with or without birth control involved), and a whole host of factors like genetics, situation, diet, relationships, and more are all connected to whether or not a person experiences symptoms. However, you should know and believe that there is ABSOLUTELY a connection between birth control and depression. If anyone (especially a medical professional) disregards your mood symptoms or makes you feel like it’s “all in your head” you should seek out another opinion.
This is an area that really needs more research, but early studies have been promising in showing how this might work. A large study in 2016 found that users of HBC were more likely to be diagnosed with depression and prescribed an antidepressant for the first time (as in, these women had never had depression before taking HBC). (5, 6)
The going theory as to why birth control can cause depression gets real science-y real quick, but basically the pill affects melatonin (brain chemical that affects sleep) and serotonin (brain chemical that affects feelings of wellbeing and happiness) production, and increases inflammation — which encourages the body to produce chemicals that are harmful to your brain. (7, 8)
Now, this isn’t saying that if you start taking the pill you’ll get depressed. But it’s something to be aware of, and keep an eye on if you are on HBC — especially if you have family or personal history of depression or anxiety since you’re already more likely to develop a mood disorder.
The pill depletes your body of vitamins
This is true
Honestly this is one that sounded like some wellness BS to me at first ?, but turns out it’s absolutely true. Studies generally agree that the pill depletes your body of folic acid, vitamins B2, B6, B12, vitamin C, and the minerals magnesium, selenium and zinc. (9, 10)
Going into what each vitamin or mineral does in your body would take way too long, but I’ll highlight on a few:
- B vitamins are involved in tons of essential body functions, including your thyroid and immune function, and detoxification (liver function).
- Vitamin B6 specifically is involved in producing serotonin (remember from above that this brain chemical is responsible for feelings of happiness and wellbeing), as well as helping your immune system operate properly. (11)
- Vitamin B12 is associated with energy and mood levels. (12)
- Magnesium is one of the most important minerals for your body, and is involved in hundreds (!) of body processes. Studies have found connections between magnesium and sleep, thyroid function, heart health, insulin sensitivity, and even mental health. (13)
Hopefully that gives you an idea as to why these vitamins and minerals are important, and why some of these other side effects (like depression) could occur with extended birth control use. If you are taking birth control, it would be a good idea to supplement some of these vitamins. A good prenatal should actually cover you, or you could take a b-complex and magnesium.
You need to detox from the pill
The truth in this statement is that if you’re on the pill you need to support your body’s detox process. The word “detox” gets thrown around in lots of ways that are misleading, so let’s first define what detoxification is in the body.
First up, your body has its own natural detoxification process. Put simply, detoxification is the removal of harmful substances from a living organism. (14) In our case, our body is removing harmful, unwanted, or unused substances — which mainly happens via the liver.
One of those unwanted or unused substances that our liver needs to get rid of are hormones that the body doesn’t need anymore, including the synthetic hormones in the pill. If these hormones aren’t being eliminated properly, they go back into circulation in your body, causing hormone imbalance (and a whole host of potential side effects). And for estrogen detoxification specifically, your liver needs B vitamins and magnesium — yep, a few of the nutrients that the pill depletes. This makes it more likely that you get excess estrogen in your system if you take the pill long term.
Additionally, if you decide to go off the pill, you’ll need to support your liver and body in getting rid of the synthetic hormones.
You can support your liver by eating enough fiber (increase slowly if it’s low!). Liver supporting foods include cruciferous veggies (broccoli, cauliflower, brussels sprouts), beets, dark leafy greens like collard or kale, carrots, avocado, sweet potatoes, and berries. Dandelion tea is also great for supporting liver detox!
The pill messes with your gut health
This is true
This one is absolutely true and something I was shocked to learn, given my history of gut health issues to begin with. If you’re reading this blog then you probably already know this but I’ll say it again: gut health affects SO MUCH of your overall health, including mood, metabolism, skin, and immune system. So if you have an out of balance gut, it could affect so many areas of your life.
The pill “messes” with your gut health in a few major ways:
- Changes your microbiome. “Microbiome” refers to the trillions of bacteria, yeast, and organisms that live in your gut (fun fact: this can be up to 4lbs of your body weight!). These organisms break down food compounds, create vitamins and amino acids, and are the front line of your immune system. (16) Initial studies have shown that taking the pill long term may affect the normal healthy balance in your gut, making it easier for harmful bacteria and yeast to grow. (17)
- Affects estrogen metabolism. The microbiome plays an important role in regulating how much estrogen is circulating in your body, and an imbalance can lead to either too much or too little estrogen (which can both cause issues). (18)
- Increases risk for inflammatory bowel disease like Chron’s. Studies have shown that using birth control increases your risk of developing inflammatory diseases like Chron’s and ulcerative colitis (19), and that the longer you use HBC, the higher the risk is (20). The reason for this is still unknown, but it’s likely that long term HBC use increases inflammation and imbalance in the gut, which can trigger something like Chron’s if you also have a predisposition for it.
The pill will fix your acne or heavy & painful periods
This is false
The pill may make some symptoms (like acne, extreme PMS, or painful cramps) “go away” but make no mistake: it’s not fixing anything. It’s just masking those symptoms, and not changing any of the root causes as to why you may be getting hormonal acne or heavy periods. The pill does this by changing your body’s processes (for instance, the pill lowers testosterone, which in turn lowers oil production in the face. Less oil = less pimples). I’ll repeat again that this doesn’t make the pill or any form of hormonal birth control “bad,” and you don’t need to feel ashamed for using or wanting to use the pill to cope with any symptoms you’re having. My purpose here is to educate you, and I want you to know what’s really going on. You deserve to have birth control if you want, and you deserve to be able to get to the root cause of whatever symptoms you may be experiencing too.
I will also say that just because studies have found a connection between the pill and some of the above side effects doesn’t mean you will develop say, Chron’s if you start the pill! BUT if you have a personal or family history of mood disorders, gut disorders, or autoimmune conditions, it’s something you should be aware of and keep an eye on if you’re taking HBC.
Phew! That was a long one, but I really hope it was helpful! Just like when I started the low FODMAP diet, I’m finding that the reputable information out there is just SO DENSE and not really accessible — my hope here is to start talking about this in a way that more people can understand. To that end, if there’s anything in here that didn’t make sense, that surprised you, or that you’d like to learn more about, let me know! I’m here to help us all learn. ?
Lastly, if you just read all that and are thinking “holy heck! what am I supposed to do now?!” don’t worry — I’ve got you covered. See my resources below for a few protocols, and stay tuned for my next post which will cover what I’ve been doing! Oh and stay messy! ?
I’m sure you noticed that I linked my sources above like a crazy person, so clicking on any one of those will give you more info specific to that topic. I’ll also list some resources that have been super helpful to me, and that I’d recommend looking into if you’re on or considering birth control.
- Planned Parenthood has a very comprehensive guide to all the birth control options available.
- Beyond the Pill by Dr. Jolene Brighten. This book gets a little dramatic for my tastes (she jumps to conclusions at times that left me thinking “Wait, what? How did we get here Jolene?!”), but it’s full of tons of information regardless (and I used it a bunch while writing this post). Highly recommend.
- Dr. Brighten’s blog and Instagram are also great, free resources for overall hormone health.
- Avivia Romm’s hormone reset is also a great resource, as is her entire blog, Instagram, and podcast. I love her level-headed perspective.
- Laurie Christine King’s Instagram and blog are full of resources on women’s and hormone health.
- Lauren Hurst is my herbalist and acupuncturist and who I’ve been going to since I quit taking the pill. Her protocol is a mix of Dr. Brighten’s and Avivia Romm’s above. Highly recommend if you’re in the Austin area!
- Dr. Tassone is my OBGYN and is widely regarded as the hormone expert in the Austin area.
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