Should I Be Taking Birth Control Pills

One of the more common concerns I have as a gynecologist is when patients come to see me who are on hormonal birth control for reasons other than preventing a pregnancy.

Younger women might have been prescribed birth control pills to deal with acne or to address painful periods. Perimenopausal women may have been given a prescription to deal with mood swings or anxiety, regulate periods, and resolve disruptive PMS symptoms.

Women who are no longer concerned with pregnancy (maybe they had their tubes tied or their partner had a vasectomy), may still be on the pill for any number of non-contraceptive related reasons.

Even women in their fifties may still be “on the pill” as well. Some had been taking birth control to help “normalize” the crazy hormonal swings during the transition times of perimenopause and menopause. Some would tell me that they’d been on oral contraceptives “since they could remember.” They were often unsure whether they should still be on them or not.

In many cases, once I successfully weaned women off of the pill, other underlying health issues responsible for their original symptoms, such as endometriosis, estrogen dominance, food sensitivities, PCOS, and even autoimmune diseases, were finally able to surface and be treated. These treatments, not being prescribed birth control pills, usually resolved the original as well as any ongoing symptoms.

This is an important topic for all women! In the majority of cases, there are other ways—much healthier alternatives—to address these types of symptoms without the potential negative side effects and health risks associated with shutting down a woman’s uterus.

Oral contraception suppresses a perfectly normal and healthy physiologic process, shutting down a woman’s natural hormone production which is vital for much more than having a period each month. Shutting down this natural production can affect our brain, breast, and immune health, as well as put us at greater risk for health issues such as osteoporosis and cardiovascular disease.

Birth control pills have been linked to a wide range of mental health issues including teenage anxiety and postpartum depression, as well as painful sex and low libido. Oral contraceptives have been associated with increased risks for various types of cancer (cervical and breast cancer), thyroid, and gut disorders, as well.

Being on birth control can even impact the male partner a woman chooses (I’ll share what the research has found, it is quite fascinating)!

So let’s talk about the pros and cons of oral contraceptives, why they are prescribed so often (for the wrong reasons), and what alternatives exist.

In this article, I will discuss,

• How do oral contraceptives work?

• Why are they so over-prescribed?

• Why oral contraceptives are not the best option for many women

• When do oral contraceptives make sense?

• Alternatives to birth control pills

• Lifestyle changes that can really make a difference

Oral contraceptives are prescription medications that have different short-term effects for any given woman depending on her age and hormone status, genetics, symptoms, lifestyle, and underlying health. They also have longer-term health implications.

Yet many conventional doctors prescribe the pill as a “one size fits all” solution for “all things affecting women at all ages and stages” (well beyond use as a contraceptive). Many doctors simply do not discuss the potential risks of its use with their patients.

So let’s talk a bit about what oral contraceptives are and how they work. Then we’ll discuss what the research tells us about their risk.

Birth control pills are synthetic versions of our actual hormones. They are chemicals produced in labs and patented by manufacturers. They are not the same in structure or in how they affect different aspects of health throughout the body (including the brain, breast, heart, and bone). I often refer to them as disruptors for this reason.

Rather than the natural ups and downs that our own hormones experience throughout our cycle, the synthetic hormones in oral contraceptive prescriptions are artificially maintained at a constant, singular level with no natural ebb and flow. This in itself can lead to problems such as overwhelming the liver’s ability to adequately detox estrogen. It does not support our body’s natural hormonal rhythms or how we were designed, and has implications on other hormone activity throughout our bodies including cortisol.

Different types of hormonal birth control (such as intrauterine devices/IUDs, injections, skin patches, vaginal rings, and subdermal implants) work in slightly different ways but all work to effectively stop fertilization.

Birth control pills accomplish this in three ways:

There are two types of oral birth control:

Combination pills containing both estrogen and progestin (the synthetic steroid for progesterone). This is the most commonly prescribed type of oral contraceptive. There are different types of progestin in various brands along with the synthetic steroid for estrogen, ethinyl estradiol. Different brands have varying dosages available for a doctor to prescribe. Birth control pills used to have much higher estrogen levels but today contain much less (20-50 mg typically).

Progestin-only pills are taken by some women who can’t take estrogen due to health risks or who are breastfeeding.

There are multiple generations of oral birth control (containing varying dosages and different synthetic ingredients) so comparing data from studies to assess a given woman’s particular health risks can be challenging.

I think the important thing is that every woman be aware of the information contained in this article so she can further discuss her own unique situation with her doctor in order to make an informed decision.

Because of their widespread use, this article will focus mainly on combination pills. The bulk of research has been done relating to this type of oral contraceptive.  

Why Are Contraceptives So Overly Prescribed?

Birth control pills were initially designed for shorter-term use (versus ongoing use over many decades), and to be used as a contraceptive for healthy young women who didn’t want to get pregnant (or who wanted to space out pregnancies).

But over the past decades, it has become a standard of care prescription for all things relating to a woman’s fluctuating hormones, and that’s where the problem lies.

If you think about when women are prescribed birth control these days (other than as a contraceptive), it’s most often during “life cycle transition phases” when a woman’s hormones are fluctuating and causing negative symptoms:

• A young girl transitioning into puberty perhaps with painful periods

• A young woman dealing with PMS symptoms (irregular periods, breakthrough bleeding, and anxiety or insomnia), polycystic ovary syndrome (PCOS), or acne

• A young woman experiencing a natural decline in her reproductive hormones in her thirties (entering perimenopause and experiencing menstrual irregularities and heavy bleeding, vaginal atrophy symptoms, declines in libido, and more)

• A woman transitioning into menopause (did someone say hot flashes?)

These are key times that women are prescribed or left on birth control longer-term, often in an effort to “normalize” a wide variety of physical and mental symptoms.

Early in my OB/GYN practice I routinely saw women, really in all of the above scenarios, who had been prescribed the pill to simply shut everything down. Some had also been prescribed Prozac or an SSI for their anxiety, irritability, and depression symptoms. But in many cases, neither the pill nor the Prozac would address all their issues, especially things like ovarian cysts, fibroids, menstrual cramping, or pain. So then the standard of care was typically an endometrial ablation or a hysterectomy (and while we’re taking out the uterus let’s remove those ovaries, too!). And this could be a woman as young as in her late 30s.

As I became more educated in integrative practices I quickly learned that shutting down a woman’s uterus was simply masking many underlying problems and that these problems were still there—and often much progressed—when a woman finally came off the pill. Once I focused on treating these underlying problems, rather than continuing a patient on a contraceptive prescription, I dramatically reduced my patients’ need for surgery and other procedures, and they became symptom-free in many cases.

Why Oral Contraceptives are Not the Best Option for Many Women

When we look at the benefits versus risks of shutting down our natural hormone production we’ll see why this isn’t a good thing in most cases.

Here are the main issues with using oral contraceptives:

1| Oral contraceptives can mask other serious hormone-related health conditions

2| Coming off the pill can be problematic

3| Chemically induced menopause has significant effects throughout the body (not just the uterus)

4| There are better and safer options available to treat root causes (and prevent pregnancy)

Women who are put on the pill to deal with hormone imbalances and period-related symptoms are often later found to have serious hormone-related health conditions such as endometriosis, PCOS, and autoimmune diseases such as Hashimoto’s (thyroid autoimmune condition).

Unfortunately, the pill’s effects can leave these underlying conditions undiagnosed and untreated until such time as a woman comes off birth control or worse, has had her uterus or perhaps even her ovaries removed due to progressive symptoms. Even without a hysterectomy, should she then want to get pregnant, it can sometimes be more difficult or even impossible (such as can happen with an inflammatory condition such as endometriosis).

Along with masking these types of hormone-based conditions, Nicole talked about how the pill can mask something as simple to correct as food sensitivities. Many women don’t realize that food sensitivities can often be the root cause of painful periods and that the pain can often be addressed by eliminating common inflammatory foods (versus taking prescription medication to shut down the uterus!). She has found that dairy is a common culprit resulting in painful periods. Dairy has been a huge sensitivity for me through most of my life. Some oral contraceptives even contain reactive fillers such as lactose.

Along with addressing any food sensitivities, Nicole has found that having a woman get a handle on her blood sugar control can dramatically improve period pain and PMS symptoms. Gut issues (leaky gut due to an inflammatory diet, stress, toxins, and infections) can also be at the root cause of period pain and heavy bleeding. She has found that many women with endometriosis may not even have specific period-related symptoms, but often have gut-related symptoms. There are many ways to improve gut health; for example, simply getting off antacids if you use them or helping your digestive system with some systemic enzymes, prebiotics, and probiotics. I’ve linked in a podcast that discusses how to have a healthier gut. If a doctor merely throws birth control pills at a woman having these symptoms, she may not discover she has endometriosis or other underlying conditions until she is off the pill and trying (unsuccessfully) to conceive. The gut issues also won’t go away and will like worsen over time, causing other issues.

Another example of this masking effect is the fairly common condition of estrogen dominance. A woman may be put on oral contraceptives to deal with heavy periods, but sometimes her heavy periods can be due to her having estrogen dominance (ED). With declining levels of estrogen and progesterone, the ratio of estrogen to progesterone can get out of whack resulting in ED in many women. Poor estrogen detox due to a congested liver and exposure to endocrine disruptors in our foods, environment, and personal care products can also help lead to ED.

And guess what? ED expresses itself as PMS with heavier periods, acne, and other negative hormonal symptoms including anxiety, mood swings, irritability, sleep disruptions, hot flashes, skin conditions, and so much more. It can also be a root cause for fibroids and ovarian cysts (sometimes resulting in an unnecessary hysterectomy).

Instead of being prescribed oral birth control, what should be dealt with in this case is supporting estrogen detox, and I would probably add in some natural progesterone to bump up its level, perhaps even prescription-based progesterone if needed. There are many things you can do to help support the body’s natural hormone levels in most cases, such as reducing stress, using adrenal adaptogens such as maca, and staying alkaline by eating the right diet. Note that being on the pill, in turn, can create the condition of ED as well.

Along with checking out the linked articles and podcasts you might also be interested in listening to Dr. Liz Lipski and I talk about estrogen-balancing foods and how to have a healthier gut microbiome in this podcast (“How to Eat Your Way to a Healthier Menopause”).

Oral contraceptives can also mask (and worsen) problems associated with unhealthy levels of our own naturally produced hormones such as seen with low levels of testosterone in women. Low levels of testosterone may present as irregular menstrual cycles, low libido, or any number of neurological symptoms including depression, irritability, anxiety, and even poor cognitive function. Your doctor can easily test your testosterone levels (learn more about healthy levels here ). In my practice, I routinely prescribed bio-identical testosterone to women for these types of symptoms with great results. No uterus shutdown is required!

On the flip side, a woman taking the pill (which lowers testosterone levels) can have these same types of side effects (I’ll talk a bit more about this below). Low testosterone levels also increase some longer-term health risks such as obesity, osteoporosis, muscle wasting, heart disease, and even depression.

There are a number of ways to naturally increase testosterone levels including taking key nutrients and supporting the adrenals. You can learn more in the linked article.

Sadly, birth control pills have become a standard of care for acne, which in the bulk of cases is actually way overkill and also doesn’t really make sense when you understand what birth control pills are doing to a woman’s skin. Birth control pills do suppress skin oil, but only while a woman is taking the pills. Once off the pills women often experience ongoing problems (because the root cause hasn’t been addressed, right?). Additionally, based on what I and my peers have seen clinically when women do eventually get off of birth control, the skin issues can rebound at a much worse level than before.

Better to treat the root causes of acne which are masked by the use of the pill. These include food sensitivities (dairy, sugar, processed foods, etc.), stress, and nutrient deficiencies, especially those related to immune health such as zinc and selenium (reduced when on the pill), and gut issues.

One of my podcast experts, Dr. Lara Briden, has actually found histamine intolerance to often be at the root of skin and rash issues along with causing other PMS symptoms, headaches, and nasal congestion. Too much estrogen, too little progesterone, or a vitamin B6 deficiency can be culprits here.

I would usually suggest addressing these root causes by eliminating reactive foods such as dairy, increasing zinc, eating probiotic-rich foods, and following a Keto-Green® diet and lifestyle to best support the gut. Also, maybe adding some progesterone, either a bio-identical progesterone prescription or my bio-identical progesterone cream, Balance (previously called Pura Balance PPR Cream).

Note that acne and skin conditions can also be symptoms of PCOS. The link to the podcast will share more on this connection and what you can do about it.

And these are just a few examples!

I hope you see how birth control pills can mask so many underlying health issues, which is why they really should only be prescribed for the purpose they were originally designed for: shorter-term contraceptive use in younger, healthy women—when other options aren’t viable.

Now let’s talk about the second reason the pill isn’t the best solution.

When a woman is on the pill she is getting constant levels of synthetic hormones versus the more natural hormone rhythm associated with ovulation (where estrogen and progesterone ebb and flow). The brain tries to balance this out and deals with it by shutting down the production of natural hormones. This shut-off can be difficult to reverse in some women and there can be additional symptoms seen post-pill.

In another fascinating interview with Dr. Jolene Brighten, “The Truth About A Healthy Life Beyond the Pill,” we discussed post-birth control syndrome, side effects that can often pop up or continue after a woman stops using the pill. In particular in her practice she routinely sees,

• Heavy and painful periods

• Missing periods (post-pill amenorrhea)

• Acne and skin conditions (even when women didn’t have these issues prior to going on the pill)

• Anxiety and mood swings

• Fatigue

• Gut symptoms

• Loss of libido

I have utilized many of the natural treatments mentioned previously (adrenal adaptogens and stress reduction, supporting optimal detox and liver health, an anti-inflammatory and nutrient-rich diet that also helps with insulin control, etc.) to address these types of symptoms post-pill. There are almost always other underlying issues that start to surface, so those then need to be addressed. You can learn more about how to more gently wean yourself off of the pill at many of the linked podcasts and blogs referenced in this article, or visit my podcast guests’ helpful websites. Finding a good functional doctor is a great idea as there are a variety of natural herbs that can also be helpful.

While there is conflicting data on whether the pill impacts a woman’s success at a later pregnancy some literature points to several impacts that may occur. Estrogen level and the duration of use seem to be key to varying fertility statistics. As with most things a woman’s genetic predispositions, lifestyle, and underlying health would also come into play, of course. (1)

Some research has found that being on birth control pills affects a woman’s ovarian reserve (the finite number of eggs a woman has in her ovaries) which could affect her fertility. In one study, users of hormonal contraception had 42.2 percent lower ovarian volume than non-users. (2)

In one review involving 48 studies, most showed that during oral contraceptive use, there is a reduction in serum concentrations of LH, FSH, and estrogen, as well as a reduction in ovarian volume, endometrial thickness, and the number and size of antral follicles (a good indicator of the number of eggs a woman still has and visible with an ultrasound). The concern I usually have is the length of time a woman shuts everything down, it is so often well over a decade. (3)

Women may experience nutrient deficiencies while on the pill which can continue even when they stop using it. We know that the makeup and integrity of the gut microbiome is affected by synthetic hormones which can contribute to leaky gut and the malabsorption of key nutrients.

Some nutrient deficiencies that are commonly seen with oral birth control usage are Vitamins B2, B6, B12 (especially important for vegetarians who may already be at risk), vitamin C and E, folate (this is particularly important if a woman still wants to conceive as it is vital for fetal development), and the minerals calcium (improves PMS symptoms, but watch out for dairy sensitivities), magnesium, zinc, and selenium (vital for thyroid health). (4-5) Many of these nutrients are also important for bone health which may be adversely impacted while on the pill (more on this in a moment).

There is also some interesting research that associates oral contraceptive use with mineral deficiencies and an increased risk for obesity! In particular deficiencies in zinc, iron, calcium, vitamins A, B, and D, and antioxidants have been associated with obesity. Perhaps this is a contributing factor as to why so many women gain weight when on the pill. (6)

Addressing these types of common nutrient deficiencies is very easy to do.

Along with masking underlying health issues, birth control pills can have other serious effects throughout the body, so let’s talk about that next.   

You don’t really see birth control ever advertised as “chemically induced menopause” by contraceptive manufacturers as that doesn’t sound like a thing most women might want to inflict on their bodies, right? But that is what it is, and research continues to find oral contraceptive use is associated with many significant effects throughout the body. I’ll talk about a few of these in this section.

Vaginal tissue and libido impacts – and how the pill may even influence the partner we choose!

Oral contraceptives can make women more susceptible to thinning vaginal tissue and painful sex, as well as negatively impacting libido.

This is particularly seen in younger women. Remember, being on the pill is chemically induced menopause. So symptoms such as dry and thin vaginal tissue, and pain during sex, make complete sense.

Research has found that sex hormone-binding globulin (SHBG) increases with oral contraceptive use. This in turn is associated with lower testosterone levels. In fact, significantly reduced testosterone levels.

A guest on one of my podcasts (“How To Take Control of Your Reproductive Health”), Lisa Hendrickson-Jack (who is the podcast host at Fertility Friday), said that the increase in sex hormone binding globulin (SHBG) that occurs when a woman is taking oral contraceptives binds to testosterone, resulting in up to 60 percent lower testosterone than a woman who is not on the pill.

This lower level of testosterone can cause a lack of libido and negative effects on sexual well-being and overall mood. Our vulva tissue is particularly sensitive to testosterone decline. Libido and sexual well-being impacts are a major reason women stop birth control pills within the first six months of their use. (7)

Along with messing with our libido, oral contraceptives have actually been found to influence the partner we choose! I discussed this fascinating topic in a podcast (“This is Your Brain on Birth Control”) with Sarah E. Hill. In the podcast Sarah, a psychologist who specializes in women’s health and use of birth control pills, talks about how the pill has been found to affect this.

You should listen to the podcast for more details, but here is one study on how the pill affects your mate selection. The bottom line is that when women are ovulating and their estrogen levels are high they tend to emphasize “sexy” qualities such as a man’s masculinity and appearance, swagger, voice…the chiseled jaw and muscles, that sort of thing. But when on the pill, since that keeps a woman’s own natural levels of estrogen very low, that they are more likely to choose a male partner based on other characteristics (than the sexy, testosterone-based attributes just mentioned) versus their sex appeal and sexiness. (8) 

Sarah said that in the research, women who chose their partner when on the pill were less likely to get divorced than women who chose their partners while naturally ovulating/cycling. That’s kind of refreshing! The sad thing, though, was that in those on the pill who did get divorced in 8 of 10 cases, they initiated it. The theory is that when they go off the pill, and they may have natural estrogen again, perhaps they are reprioritizing the sex appeal and sexiness attributes once more.

Sarah talks about other aspects of the brain, cortisol, and how being on the pill can blunt our stress response (which while sounding like a good thing really is not) during the podcast. So interesting. I’ll talk a bit more about the pill’s effect on the brain in a moment. 

Many of my podcast experts have said the same thing, that the longer a woman ovulates as she ages the healthier she will likely be (given her continuing to have natural estrogen, progesterone, and androgens such as testosterone) and this is true relating to bone health.

One of my favorite podcasts (“Confused About Bioidentical Hormones During Menopause?”) was recorded a number of years ago with Dr. Edwin Lee, and he really emphasized the importance of proactively addressing natural declines in our hormones with bioidentical hormone replacement to reduce a myriad of health risks as we transition into menopause.

Inadequate estrogen levels produced by the body negatively impact a process called bone resorption which results in a decline in bone mass. We see this happen in menopause when natural estrogen levels have significantly decreased, and being on the pill can also cause it. The synthetic estrogen contained in the pill is typically a low dose and the body’s natural estrogen production has been shut down…remember, chemically induced menopause. Healthy natural progesterone levels also rebuild bone by stimulating osteoblast cells that restore bone mass.

Bone health is a huge concern relating to oral contraceptives, especially in adolescent women using the pill over longer periods of time. While genetics accounts for more than 50 percent of a woman’s peak bone mass, the menstrual cycle and ovulatory disturbances such as what happens on the pill have been found to influence peak bone mass density (BMD) levels as well. (9) 

Research suggests that the use of oral contraceptives containing the lower dose of 20 µg estradiol prevents adolescents and young women from obtaining peak bone mineral density (BMD). Evidence on the effect of higher estrogen doses (30 to 35 µg) has been less definitive, but this dose may also impede peak BMD acquisition in adolescents. In general, early use and lower-dosed birth control appear to be the worst culprits. (10-11)

There are also non-estrogenic actions relating to oral birth control use that may affect bone health. The increases in SHBG, decreased androgen levels (testosterone and DHEA), and changes in the production of insulin-like growth factor (IGF), may contribute to a negative effect on bone density although more research is needed. (12) 

Skeletally mature women (over the age of 30) may experience different effects, the research is inconsistent. We know that natural aging is associated with reductions in overall bone health, however, so bone density should be considered a potential risk factor of oral contraception for all women in my opinion.

Bone health can be supported with an alkaline diet and a moderate level of quality protein (as seen in my Keto-Green diet) providing acid-buffering, increased levels of key minerals and nutrients (such as Vitamin D, magnesium, etc.), support of muscle mass, and anti-inflammatory effects. The right type of exercise program in the perimenopause (and beyond) can also be helpful. Check out the linked article for more information.   

Treating symptoms such as irregular periods and PMS with birth control pills can mask underlying conditions such as thyroid disorders. It can also make PCOS symptoms worse.

Perimenopause and hypothyroidism actually have very similar symptoms so doctors should do a thyroid panel prior to considering oral birth control as an option to address period-related types of symptoms.

My medical peers who are thyroid experts will tell you that taking the pill is a thyroid disruptor. There are many reasons for this. Just a few are,

• As mentioned, birth control pills cause nutrient deficiencies, many of which are vital to thyroid hormone production (such as zinc and selenium).

• Oral contraceptives change our gut microbiome, reducing overall immune health. This allows pathogens and infections to potentially trigger an autoimmune response in the thyroid.

• Women taking oral contraceptives release greater amounts of Thyroxine Binding Globulin (TBG) which binds to thyroid hormones making them less available for your body to use. This decreases the free T4 your body has, which impacts how much T3 (this is your active thyroid hormone) is available for use by the body. A woman on thyroid medication will likely need a higher dose if also going on the pill (and conversely, will likely need a lower dose of thyroid hormone medication when going off the pill).

• As discussed, the pill can result in estrogen dominance which is known to trigger the autoimmune thyroid condition of Hashimoto’s.

Given that the majority of women with hypothyroidism will be found to have Hashimoto’s, it is especially important for your doctor to screen you for thyroid antibodies (a marker for Hashimoto’s) as part of an overall thyroid panel prior to prescribing the pill.

Many of my podcast guests have talked about how our natural progesterone loss starting in the mid-30s can increase the risk for thyroid autoimmune conditions as we lose anti-inflammatory support (and progesterone is particularly supportive of the thyroid as it decreases TBG).

Rather than prescribing birth control pills, my peers and I would likely recommend bioidentical progesterone and an anti-inflammatory, alkaline diet (that provides good thyroid-supportive nutrients while removing reactive foods, supports estrogen detox, helps with blood sugar control and insulin sensitivity, and is supportive of the gut), such as my  Keto-Green diet. You can read more about how my Keto-Green diet is particularly optimized for thyroid health in this linked article.

Some of my medical peers feel that polycystic ovarian syndrome (PCOS) can be triggered by use of birth control pills and that oral contraceptives should also never be used by women already having PCOS. Not that birth control pills cause PCOS necessarily, but that they may be one contributing factor (along with genetic predisposition, poor insulin control, inflammation, gut dysfunction, hormone imbalances, etc.)

So it may seem odd to hear that birth control pills are routinely prescribed by conventional doctors to treat PCOS in all ages of patients!

So why is that? Well, the pill does often work well to reduce many of the symptoms such as facial hair and acne, menstrual irregularity, PMS, and pelvic pain, and has been shown to decrease other risks (such as endometrial cancer) that are increased in women having PCOS.

However, the issue is that other side effects of oral birth control can exacerbate PCOS symptoms such as mood changes and weight gain, as well as increase the risk for insulin resistance, dyslipidemia, and cardiovascular disease risk. (13-14) 

These are serious risks and side effects. I and most functional practitioners prefer to tackle PCOS through healthy lifestyle modifications and a nutrient-rich diet. Regaining insulin sensitivity is important for many women having PCOS. For additional thoughts on the subject of PCOS, check out this podcast (“Is PCOS Causing Your Adult Acne and Weight Gain?”) with nutritionist Robin Nielsen. She, too, recommends women stay away from oral contraceptives and use non-hormonal birth control methods when possible.

Natural estrogen, progesterone, and androgen hormones like testosterone play important roles in non-reproductive tissues including the cardiovascular system and the brain, which is likely one reason why studies find less cardiovascular disease occurring in pre-menopausal women compared to same-aged men or postmenopausal women.

There is a known association between a woman having a history of irregular menstrual cycling or ovulatory dysfunction and adverse cardiovascular events. These states result in relatively low estrogen levels, suppressed ovarian androgens, and increased SHBG (which reduces testosterone). (15) Other studies have shown that when women get a hysterectomy and/or ovariectomy before natural menopause, risks for cardiovascular issues, along with many other chronic conditions associated with aging, become accelerated. (16)

Combination birth control pills are also not supportive of heart health in many women depending on her age and her other unique risk factors. Again remember birth control pills cause chemically induced menopause which halts the production of natural estrogen, progesterone, and androgens (testosterone in particular).

There are a number of increased risks associated with the use of combination birth control pills including increased risks for heart disease (venous thromboembolism, myocardial infarction, and stroke), vascular disease, blood clots, and hypertension. (17-19)

One study found that among current oral contraceptive users, there was a 2.5 relative increased risk of adverse cardiovascular events (there was no increased risk found in previous users however). (20)

Generally, women over 35 who have cardiovascular risk factors should not use estrogen-containing oral birth control, and women having multiple cardiovascular risk factors shouldn’t either. Things like smoking, obesity, older age, diabetes (keep in mind birth control pills can increase insulin resistance), hypertension, or having migraine headaches should be considered additional risk factors. Smoking increases the risks substantially. The American College of Obstetricians and Gynecologists (ACOG) guidelines for women 35 and older recommend against the use of oral contraceptives in women with these risk factors. (21)

Women on birth control pills may find they have changes in lab test markers associated with heart disease, such as levels of HDL “good” cholesterol (may go down), and triglyceride and LDL “bad” cholesterol levels (may go up). This can cause plaque inside the arteries over time resulting in angina (chest pain) or even a heart attack. (22) 

The use of progestin-only contraceptives may be considered a safer option but again, you need to ask yourself why you need birth control pills in the first place. Are there underlying root causes for your symptoms that can be addressed? Are there non-hormonal birth control options or hormonal options that aren’t orally taken (such as IUDs) that might have fewer risks? (23)

We know that our natural levels of estrogen and progesterone exert a number of beneficial effects including neuroprotection and mood enhancing effects. How these effects are precisely changed by oral contraceptives for any given woman, however, is less clear and likely dependent on many factors such as genetic predisposition, age, length of use, underlying health, etc.

Hormonal contraceptives have been found to influence the brain and a variety of studies have been shown regarding their effect on cognitive, emotional, social, and sexual behaviors. Additionally, women on the pill have been found to have altered volumes and microstructural changes in the brain. (24)

In my podcast (“This Is Your Brain on Birth Control”) with psychologist Sarah E. Hill she spoke of how there is research showing differences in brain scans between women on or off of the pill.

Some studies have found that irritability, depression, and mood changes remain a problem for some 4 to 10 percent of oral contraceptive users. (25)

Of most concern in this regard is the potential effect on adolescents or younger women taking oral birth control. The research has been inconsistent on this topic as well.

Two large studies strongly demonstrated that the use of different types of hormonal contraception, especially among adolescents, was associated with a first diagnosis of depression as well as positively associated with subsequent suicide attempt and suicide. Another study of 16-year old oral contraceptive users showed higher concurrent depressive symptom scores compared to non-users. (26) But other studies have not found these associations. (27)

So how do you know what your or perhaps your daughter’s risk is?

During our podcast, Sarah pointed out what we all should think about given the inconsistent and evolving research, and that is that while the brain is still developing until women are in their twenties, the more important issue is when adolescents are going through puberty, as that is the time when the brain undergoes a number of really important structural changes. And we just don’t know what taking the pill does, specifically, at this critical time when the brain is basically being hardwired together. 

She said it is something to think about given that the research (even if a bit conflicting) seems to point to young women being at risk for depression and anxiety when it comes to using birth control pills.

The research may conflict partly due to a still undetermined factor, or more likely, multiple factors. It may be there is some genetic predisposition for example. Future animal studies (where genetics can be tampered with) may be able to show whether certain genetic variations increase a vulnerability to the neurobiological effects of hormonal contraceptives. Newer research could find that synthetic chemicals in the pill affect brain development in adolescents in ways that haven’t even been looked at as yet.

I say, why risk it when there are other alternatives for the pill (and again, we want to address the underlying root causes for our symptoms versus chemically inducing menopause!). I have four daughters and I want them to understand these potential concerns (or unknowns) and make their best-informed decisions.

Our gut health is important for many reasons. It is the cornerstone of our immune health and helps our body prevent infections (including all types of viruses), provides vital nutrient absorption, and is important to our ability to healthfully detox excess hormones and toxins. All of these activities are important to addressing underlying root causes for many period-specific symptoms and hormone imbalances.

Oral contraceptives have been found to modify intestinal permeability, resulting in “leaky gut.” This condition in turn is known to trigger autoimmune diseases such as Hashimoto’s and Crohn’s Disease (the autoimmune inflammatory bowel condition). (28)  For example, a meta-analysis of nearly 14 studies showed that current use of oral contraceptives is associated with a nearly 50% increase in risk of Crohn’s Disease. (29)

Along with leaky gut, oral contraceptive use is associated with modifying the actual microbe makeup of the gut microbiome, increasing and decreasing different microbes and decreasing overall microbial diversity. We want a diverse microbiome as that can help prevent chronic disease. (30)

One example of a changed gut microbiome due to oral contraceptives is an increase seen in certain Candida and Prevotella species in our mouths (oral flora) with a resultant increase in risk of periodontitis. (31)

Use of the pill also reduces testosterone levels and testosterone has been shown to modulate immune function including cytokine production. (32) So lower levels mean our gut health and immune system is compromised and we are at increased risk for infections including viruses, bacteria, and parasites. If we’re not using a condom our immune system has to mount an immune attack on sperm and any type of infection introduced into our vagina, such as seen with HPV. 

Dr. Jolene Brighten discussed HPV during our discussion on the pill. Birth control pills have been associated with an increase in HPV infection and an increase in cervical cancer. While researchers aren’t sure of why combination oral contraceptives create a vulnerability to HPV in some women, the results are pretty clear, there is a connection. (33) 

Jolene talked about some of the research and one hypothesis that taking oral contraceptives changes the mucosal tissue and the cervix. And it definitely alters the immune system. So it isn’t surprising that HPV, the number one sexually transmitted infection, may show up more in women on the pill having a compromised gut and immune system.

While researchers can’t definitively say “Birth control causes you to contract HPV,” it is another one of those “Why risk it?” things, and a reason barrier methods like condom use are so important, especially with multiple partners.

Not every woman on the pill will contract HPV, nor will every woman having HPV be diagnosed with cervical cancer. But the pill is associated with an increase in the risk for both, so let’s talk about cervical cancer (and other cancers, as well).

Recent studies have found an increased risk for breast and cervical cancer with oral contraceptive use.

While evaluating cancer research one must always realize that there are multiple co-factors involved in increased risk (genetic predisposition, lifestyle, diet, underlying health, etc.), but the bulk of research (you can wade through a comprehensive 2018 review at the linked publication) does confirm the increased risk for these two cancers relating to oral contraceptive use. So let’s talk about that.  (34)

Cervical Cancer

All studies referenced in the 2018 review support that there is an increased risk of cervical cancer in users of oral contraceptives and that this risk increases with duration of use. Current use appears to result in a higher risk than past use. One study found that risk returned to a non-users risk level after ten years.

One study found a 10 percent increased risk for less than 5 years of oral contraception use, a 60 percent increased risk with 5–9 years of use, and a doubling of the risk with 10 or more years of use. (35)

Breast Cancer

Since breast cancer is by far the most common cancer in women, an increased risk due to oral contraceptive use translates into a substantial number of additional cancer cases. Dr. Jolene Brighten said that while many people think that today’s lower birth control doses have reduced breast cancer risk that is not true. She said that there’s about a 20 percent increased risk of breast cancer compared to women who have never used hormonal birth control.

Studies have generally found that use early in life and increased duration of use increases breast cancer risk. Current or recent use (within one to five years) of oral birth control in premenopausal women has also shown a dramatic increased risk.

In one review, 21 out of 23 studies showed an increased relative risk of breast cancer in younger women who used oral contraceptives before their first full-term pregnancy. This increased the risk of breast cancer by some 44 percent! (36)

And the results of this study revealed that the risk of developing premenopausal breast cancer in women, who during the 1960s used the pill as teenagers, is five times greater than nonusers. The risk for early users is further modified by the duration of use at an early age, implying a dose-response relationship

You’ll see that one of my recommendations for alternatives to oral contraceptives is the copper IUD which is non-hormonal. Note that while using the copper IUD, I recommend supplementing with Zinc because the ratio of copper to zinc is important for immunity. While on the topic of breast cancer, I will state that the progestin IUD Mirena has had some research showing it also increases the risk for breast cancer particularly when a woman is already at greater risk (family history, breast cancer survivor, etc.).(37)

Positive results of oral contraceptives relating to cancer

There are a few instances where the use of oral contraceptives has been found to be protective against cancer and that is relating to the development of ovarian and endometrial cancer. (38-39)  Statistics from cancer.gov show that endometrial cancer risk is reduced by at least 30 percent (increased with greater usage duration) and that the protective effect persists for a few years after oral contraceptive use is stopped. (40)

For ovarian cancer the site states that women who have ever used birth control pills have a 30 to 50 percent lower risk and that this protection has been found to increase with duration of use and to continue for up to 30 years after a woman stops using the pill. (41)

Women need to assess their risk for all types of cancer and I don’t typically recommend trading off the positive effects for these two types of cancer for an increased risk for breast cancer. I’d have to look at a woman’s other particular risk factors (family history, genetics, and the many factors associated with breast cancer, for example) and also look at other natural preventative measures (reducing obesity, not taking estrogen HRT and improving estrogen detoxification, quitting smoking, treating diabetes, and addressing any metabolic issues, etc.) and possibly genetics counseling relating to reducing endometrial and ovarian cancer risks.

I’ve discussed some of these as we went along but will talk about a few at the end of this article. There are also many alternative birth control options to prevent pregnancy. I encourage you to listen to the linked podcasts. These experts are a wealth of wonderful information and clinical insights. All have websites where you can learn more and sign up for ongoing communication.

So, now let’s answer the question, does the pill ever make sense for any given women?

When Do Oral Contraceptives Make Sense?

So based on the earlier information do oral contraceptives ever make sense?

Well, maybe…see my chart!

For the most part, oral contraceptives should only be used when a woman is trying to not become pregnant, and even then…I always think women should evaluate other non-hormonal birth control options first.

A doctor should discuss the pros – and cons – of different birth control options with their patient taking into account the patient’s age, hormone levels, genetics, and underlying health (as part of this I’m hoping your practitioner will have you track your cycle for a few months to gain some awareness as to what is going on during your cycle relating to symptoms, as well as do some woman’s hormone focused and key health marker lab testing).

If a woman does opt for birth control pills to prevent pregnancy I’d then suggest she use it more short-term, maybe with some breaks. Why be on birth control if you aren’t in a relationship, for example; or if you are having sex infrequently (or with multiple partners) perhaps a barrier method makes more sense as you need that to prevent STDs anyways.

A few exceptions to my chart …

There are a few situations where the pill may be the only good option for non-contraceptive purposes. One is excessive bleeding that can’t seemingly be addressed by other treatment options; excessive pain as well. Certain cases of endometriosis and uterine fibroids may call for the pill to be used to reduce the risk of acute pelvic floor inflammatory disease. It’s important to have a good functional doctor who will listen to your concerns, help educate you, and help you understand and assess the benefits versus the risks for your particular case. (42)

Alternatives To Birth Control Pills

If you listen to the referenced podcasts you’ll hear many of my experts’ thoughts on alternatives to the pill. A few of the more common ones include the following:

• Abstinence

• Barrier (condoms, spermicide, diaphragm, cervical cap, sponge) – so important to not forget the pill doesn’t protect against STDs. Remember that infections can trigger autoimmune responses as well.

• Fertility awareness method (Dr. Jolene discusses this in our podcast and here is a link to a resource on her website; Lisa talks about how long we’re fertile (10 days) in our podcast and why the fertility awareness method can be so helpful

• Non-hormonal IUD - copper IUD such as Paragard – I like this for many women as it is non-hormonal and women keep ovulating, but note precautions in podcasts relating to possible copper toxicity and the need to watch zinc level, being a heavy bleeder, etc. It does not help with pain, cramping, or heavy bleeding.

• Hormonal IUD - a low-dose progestin IUD including Mirena, Kyleena, Skyla, and Liletta – contains lower levels of circulating hormone and no estrogen. They can help with cramps and heavy bleeding.

• Implants, progestin shot

• Sterilization: tubal ligation for women; vasectomy for men

There are certainly pros and cons to all birth control (relating to their use as contraceptives), but it is worth learning about the benefits and risks and perhaps going with one that has less risk for your given body and lifestyle. Again, the podcasts and the experts’ resources can be very helpful for more information.

Lifestyle Changes That Can Really Make a Difference

It is so important to look at the root causes for the symptoms we’ve been discussing (and not just shut everything down!) In my experience, supporting your body with key nutrients, adaptogens, and hormone-balancing superfoods can be a game-changer. That’s why I formulated Mighty Maca® Plus —a blend of 30+ superfoods designed to help with hormone balance, energy, and overall well-being. It’s one of my favorite daily rituals and a simple way to support your body naturally.

A few lifestyle changes can make such as difference.

• Reducing reactive foods like dairy, gluten, sugar, processed foods, etc.

• Eating an anti-inflammatory, alkaline, and detoxifying diet that supports insulin sensitivity and a healthy gut (Keto-Green is a great choice! Review my perimenopause survival guide at the linked article!)

• Keep a watchful eye on thyroid health – symptoms can be masked (inexpensive thyroid antibodies testing can help uncover problems early)

• Detoxify estrogen as much as you can (estrogen balancing foods, supportive supplements, maca also has a balancing effect)

• Get a handle on your stress management and try adrenal adaptogens like maca

• Practice good immune support  with lifestyle (fun things, too!) and nutrients

• Don’t forget that bio-identical progesterone (not progestin!) is a girl’s best friend…prescription or cream

• Don’t rush to having a hysterectomy to address period-specific symptoms and pain, read the linked to article and ensure you have a discussion about potential alternatives with a functional doctor who is focused on women’s hormones

• Consider supplementation with magnesium – so helpful for PMS-related anxiety, insomnia, mood, and other period-related symptoms (breast tenderness, etc.). Sleep is so important to our keeping our immunity strong.

• Get a handle on four important lab markers for your optimal health…once you know your areas of concern you can better address them! I always say, “Test, don’t guess!”

• Connect with those around you. Oxytocin can really make a difference in your life! Take my oxytocin quiz to see if you are deficient in this important hormone.

.

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