Recently there’s been a tweet re-circulating talking about how we have a generation of women who were put on birth control from the age of 14 years old for acne and irregular periods who are now dealing with PCOS, hormonal imbalances, depression and infertility. I’ve been getting a lot of questions about this and it’s an important conversation, so I thought I’d address these questions on the blog.
Let’s start with the mechanism of how oral birth control works…
By delivering a low dose of hormones, the pill suppresses communication between the pituitary and ovaries to prevent ovulation from occuring.
What is oral birth control made from?
Most oral birth control is a combination of synthetic estrogen and progestins, but there are progestin only options as well.
Does oral birth control or hormonal birth control cause infertility?
The research so far shows that low dose oral hormonal birth control likely does not cause infertility. A 2018 review showed that in women who discontinued oral hormonal birth control, the pregnancy rate was 87% within 12 months of discontinuation. What about those other 13%?
Well, we need more research, that’s for sure…but for anyone who’s been sitting in a puddle of guilt wondering if using birth control for 10 years caused their infertility, I want to relieve you here and now of that guilt.
What’s the problem with prescribing birth control for irregular periods and acne?
The problem is that hormonal birth control may be masking a more serious condition, like polycystic ovarian syndrome (PCOS), and while it may alleviate some of the uncomfortable signs and symptoms like acne, hirsutism and irregular periods, it does not address the root of the problem (inflammation, nutrient deficiencies, insulin resistance).
The bigger problem to me as a provider, is not that the pill doesn’t address the root of the problem…it’s that people are not getting informed consent or complete work ups.
As a teenager who had irregular periods and cystic acne, I wasn’t offered any testing or information from the FOUR providers I sought answers from over a three year period of time (pediatrician, dermatologist, primary care provider, OBGYN). I was offered birth control by 3 of out 4 providers and finally at 18 years old said, “sure, why not.” (In case you’re wondering, the remaining provider offered antibiotics and accutane).
I wasn’t told “Oh by the way, when you stop this birth control, all these issues will come right back again!” Had I known that, I might have continued looking for other treatment options. Or maybe not. I don’t know because I wasn’t given proper informed consent. I wasn’t told anything about any potential downsides of hormonal birth control, like depression, low libido or blood clots.
For someone who may have PCOS or endometriosis, two leading causes of infertility, it’s important to start having the conversations about how to address these holistically as soon as possible to preserve fertility and support overall health.
Hormonal birth control may be a very reasonable part of a treatment plan for these conditions, but women feel duped when they find out they weren’t given all the information or told their lifelong painful periods might be endometriosis and there might have been more they could be doing beyond the pill.
When we learn 10 years later that the issues we had at 19 that led us to starting birth control might be the very same issues causing our infertility, we feel resentful of the system and people who ignored our questions and pleas for help.
We resent ourselves for choosing the easy option that was handed to us to clear up our acne (even though there wasn’t a better option presented to us at the time) and because infertility is just fucking painful, we want something to blame, and it would be nice to be able to blame the birth control and not our own bodies. At least that’s my take
Are there options other than hormonal birth control to address irregular periods, PCOS and endometriosis?
The short answer is YES. But maybe it’s not as easy as yes/no…
Ideally I’d prefer to know what someone’s diagnosis and underlying triggers are before jumping to the pill as a treatment option. Once we start the pill, we’re limited in what hormones we can test because the pill is suppressing ovarian output of hormones. So when people come to me while taking the pill and request hormone testing, we have to first educate them on what we can reasonably test for…this applies to situations like PCOS and irregular cycles (cycles shorter than 25 days, longer than 35 days).
For suspected endometriosis, there isn’t any one blood test that can confirm this diagnosis which is one reason it can take an entire decade to diagnose endometriosis. Imaging is getting more sensitive, but the gold standard for diagnosis and treatment is laparoscopic surgery.
If financial resources were unlimited, I’d have everyone with PCOS, irregular periods, endometriosis and infertility seeing an OBGYN, naturopathic physician, acupuncturist, nutritionist and maybe a pelvic floor physical therapist. We desperately need an integrative team to improve fertility and health outcomes in these complex situations.
However, we live in the real world and have to take into account someone’s resources, insurance coverage, time, access to specialists and integrative medicine…hormonal birth control is often an inexpensive option that improves quality of life. But we deserve to know that other options exist and that lifestyle and diet can go a long way towards supporting these issues.
Once someone decides it’s time to start trying to get pregnant, obviously birth control is the first thing to go…so what then?
How long before trying to conceive should someone stop the pill?
I recommend my patients stop the pill about one year before trying to conceive. This gives us adequate time to:
- See how their hormonal function returns and if cycles are regular
- Run preconception tests to determine hormone, thyroid and nutrient status
- Address any nutrient deficiencies related to the pill
- Learn how to use the fertility awareness method
- Support their adrenal, gut health and liver health prior to conception
Are there non hormonal options for birth control?
Yes! The most commonly used non hormonal birth control options used in my patients are condoms and the copper IUD (Paraguard). Diaphragms, cervical caps and Phexxi are other non- hormonal options. I’ve been getting more questions about Phexxi lately. I have been keeping up on the studies, although I have not had a patient yet who has used it. For those wondering WTH it is, it’s basically a gel that lowers vaginal pH and decreases sperm motility. I don’t love the idea of something that affects vaginal pH, especially for people with a history of UTI, yeast infections or bacterial vaginosis, but I am glad to see other non hormonal options coming out on the market. Now if only male birth control were a research priority…but that’s a post for a different day….
Far and away my favorite option for non hormonal “birth control” is using the Fertility Awareness Method (FAM), especially for people hoping to conceive within the next year.
See our posts on ovulation prediction, confirmation and cycle tracking apps to learn more about FAM
***Be sure to have a discussion with your provider about the risks and benefits of your contraception options
Is there a way to offset the issues that can come up when stopping the pill (acne, oily hair, weight changes)?
The best place to start here is to have a conversation with a provider who is knowledgeable about these issues and who can take your complete health history into account. Prior to stopping the pill, there are some supportive measures I’ve found helpful in practice, but this varies from person to person. Starting a good quality Magnesium, B complex and liver support at least one month prior to stopping the pill has been helpful for many of my patients who previously had rebound acne and oily skin or hair.
A great resource here is the book Beyond the Pill, by Jolene Brighten, NMD. Even though this book is full of helpful tools, it’s still recommended to speak with your provider before starting any supplements or making major lifestyle changes.
PHEW…That was a bit longer than most of my blog posts, but again, this is a really important conversation as the hormonal birth control pill is one of the most commonly prescribed drugs in the world!
If you found this post helpful, be sure to let us know and share with someone who may need it.
If you’re ready for holistic support on your fertility journey, apply to work with Dr. Katie Rose HERE
*This post is for educational purposes only. Please talk to your doctor before making any dietary, supplement or exercise changes.