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Millions of women take the birth control pill for contraception, to treat an underlying hormone imbalance, or both. But are they a good idea? That depends.
As a gynecologist practicing functional medicine, I have a skewed perspective when it comes to the birth control pill (BCP). I’ve seen many women over the years suffering with side effects from BCPs. From vaginal dryness to lost libido, from micronutrient deficiency to worsening mood problems, I’ve seen it all.
So I wish more women were forewarned and fully informed before picking up their monthly packets at the pharmacy. I would even call oral contraceptives the biggest hormone problem for women, and yet it’s prescribed by clinicians and considered by most to be relatively risk-free. They say BCPs are safer than being pregnant—but I don't believe that's the right comparator when it comes to a woman’s quality of life, mood, confidence, agency, sexual interest and lubrication.
How the Birth Control Pill Works
BCPs contain synthetic versions of estrogen and progesterone, the two main female hormones. The hormones in BCPs prevent ovulation, while thickening the lining of the cervix to prevent sperm from reaching any eggs that might have been released, and thinning the uterine lining to make it harder for a fertilized egg to implant.
The pill “tricks” the female body into not having a normal monthly cycle, which prevents unwanted pregnancy in the range of 99.6 percent for error-free users and 91 percent in typical users. In scientific terms, BCPs inhibit ovulation by suppressing your production of luteinizing hormone (LH).
Allow me to be clear: there are proven health benefits to taking BCPs based on epidemiologic studies. In fact, taking a BCP is associated with a reduced risk of ovarian, endometrial, and thyroid cancer.
Still, here's what I wish more women knew:
7 Reasons You Should Rethink the Birth Control Pill
1. It dramatically decreases your testosterone levels, and may cause low sex drive, vaginal dryness, and painful intercourse.
BCPs reduce acne and hirsuitism by lowering your testosterone levels—but sometimes you can get too much of a drop, thereby creating new symptoms. Studies show that free (or biologically available) testosterone levels drop on average by 61 percent in women on BCPs. As a result, approximately 25 percent of women on BCPs have decreased lubrication, vaginal dryness, and lack of arousal. Furthermore, 5 percent of women experience pain with sex.
Two things trouble me about these results: First, many women don’t realize the problems are a side effect of BCPs, so they don’t seek help. Second, when you stop the BCP, you don’t necessarily go back to normal. In fact, up to one year later, your hormone levels may still be out of whack.
2. It can decrease certain nutrients in the body.
BCPs have been shown to lower levels of several nutrients, including vitamins B1, B2, B5, B6, B9 (folate), B12, vitamins C and E, copper, magnesium, selenium, and zinc.
The mechanisms by which oral contraceptives deplete these nutrients aren’t completely known, but the important takeaway is that you may need to replete these micronutrients to keep your body functioning well.
3. It's associated with blood clots.
BCPs come with an increased risk of blood clots (deep vein thrombosis and pulmonary embolus) of up to threefold.
4. It doesn't help PMS.
In fact, it may make it worse (exceptions are for the BCPs containing drosperinone, a synthetic progestin—but these are also linked to greater risk of blood clots).
5. It can lower your thyroid hormones.
BCPs increase thyroglobulin, a protein that binds thyroid hormone. If you are on thyroid medication, you may need to adjust your dose.
6. It could delay conception.
For women who stop the BCP to become pregnant, return to normal ovulation may be delayed. Other contraceptives, such as the copper IUD, have no delay in fertility. Stress also seems to interfere with return to fertility in women who stop the BCP.
7. It may cause weight gain, bloating, and fluid retention.
How To Stay Healthy If You Stay On The Pill
For some women, the birth control pill is the easiest or most convenient choice, and above all else, I support a woman’s right to choose. I prefer nonhormonal forms of contraception like the intrauterine device, cervical caps, diaphragms, and condoms, but I understand they are not always possible, affordable, or appropriately effective.
If you choose to stay on the Pill, take note of any symptoms of hormone imbalance.
Overall, focus on eating a balanced, varied diet that includes selections from all food groups in order to ensure that you replete or prevent micronutrient gaps. If you’d like to increase your dietary intake of these vitamins and minerals that decline on BCPs, I recommend the following:
- B vitamins: poultry, dark leafy greens, milk and milk products, eggs, and seafood.
- Vitamin C: dark leafy greens, citrus fruits, and berries.
- Vitamin E: dark leafy greens, nuts, seeds, and extracted oils.
- Zinc: oysters, seafood, meat and poultry, beans, and nuts.
- Selenium: Brazil nuts, tuna and halibut, beef and poultry, eggs, and spinach.
- Magnesium: dark leafy greens, nuts and seeds, yogurt, black beans, and dark chocolate.
In my opinion, women on the pill should also take a supplement containing B complex vitamins (B2, B6 and B12), together with methylated folate, vitamins E and C as well as the minerals magnesium, zinc and selenium. Take methylated folate because many women in the United States have impaired methylation via the MTHFR gene and need the more bioavailable form. You can also eat dark green leafy vegetables to get more folate. Look for supplements that contain “5-methyltetrahydrofolate” (5-MTHF). Avoid products that say “folic acid” on the label.
The Bottom Line
If you take BCPs, add foods rich in the vitamins and minerals that tend to drop, and consider taking a vitamin B complex and the other supplements mentioned earlier. If you have PMS and want a birth control pill, choose one containing drosperinone as long as you do not have an increased risk of blood clots. While BCPs may reduce your risk of ovarian, endometrial, and thyroid cancer, they may also modestly increase your risk of breast cancer—the data is mixed, and if there's an increased risk, it's modest—so take care to adjust based on family history and individual risk.
My best advice is to avoid BCPs if you can and choose instead a non-hormonal IUD, cervical cap, diaphragm, or condoms. To learn more about how to balance your hormones naturally so that you can get glowing skin, fabulous sleep, and optimized digestion, check out my mindbodygreen course.