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Here's What You Need To Know About Birth Control & Gut Health

Last updated on December 17, 2019

“Look at me doing everything correctly and these skinny jeans still feel skin-tight,” my 37-year-old patient Denise said during our first consultation. “I’m gassy, bloated, feel emphatically un-sexy, and often get depressed for absolutely no reason.”

Denise consulted me because she struggled with post-birth-control syndrome (PBCS) after she made the difficult decision to go off the pill. Reviewing her health history, I noticed Denise’s doctor had recently prescribed several rounds of antibiotics for a urinary-tract infection (UTI). Also, Crohn’s disease ran in her mom’s side of the family and her father’s side had a history of severe depression. As a doctor who helps women treat autoimmune disease and balance their hormones, I drew the parallel between Denise’s symptoms and her gut health.

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Birth control and your gut health

“Studies show that even a short round of antibiotics can create gut chaos for up to two years,” I told her. That wasn’t even the shocking news. “Just like antibiotics, birth-control pills can totally wreck your gut,” I said. “The pill creates mayhem on your gut that can manifest in numerous not-so-pretty ways.”

Among those problems, studies show1 that oral contraceptives impact gut flora, adversely affecting estrogen metabolism1, with all its detrimental consequences, including weight-loss resistance. The pill also increases2 your risk for inflammatory bowel diseases like Crohn’s disease; in fact, two large prospective cohort studies of American women linked oral contraceptive use with Crohn’s. (For the record: These women had a history of smoking.) We’re unsure exactly why oral contraceptives seem to trigger inflammatory conditions like Crohn’s, but researchers speculate3 that impaired immune function, an out-of-balance gut bacteria, and increased intestinal permeability (AKA leaky gut) are potential causes.

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The root of the problem? Inflammation, of course

When I looked at Denise’s problems—among them weight-loss resistance, depression, and leaky gut—one word came to mind: Inflammation. After all, chronic inflammation plays a part in nearly every disease on the planet, including obesity, and it certainly takes a toll on your gut.

Let’s start with Denise’s weight-loss struggles. I’ve found that nearly every patient who goes off the pill and takes proactive approaches to reduce inflammation also starts losing weight. That’s because studies show4 chronic inflammation ramps up obesity and other symptoms of metabolic syndrome like high blood pressure and messed-up cholesterol levels. Conversely, when patients lose weight, they also lower inflammation, which improves5 gut and overall health.

Then there’s depression, which Denise blamed on genetics, but I saw as a gut problem. Did you know that about 80-95 percent of serotonin is manufactured6 in your gut? The pill’s knocking her healthy gut flora out of balance—thanks to inflammation—meant Denise wasn’t making enough of this feel-good neurotransmitter that also plays a role in gut motility, explaining why she felt so bloated. Newer studies, though, suggest that might not be the entire story. Instead, depression might occur7 due to chronic inflammation itself. In other words, if your gut or other parts of your body are inflamed, and most of ours are, you’re more likely to struggle with feeling depressed.

And then there’s leaky gut. When tiny particles that aren’t supposed to slip through8 your gut wall do, an immune reaction results and among its havoc includes—you guessed it—inflammation.

Bouncing back after the pill

Fixing Denise’s problems took a few months and several consultations, but I found these five strategies worked for her and numerous other patients:

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1. Quit the sweet stuff.

Studies show9 that a Western diet—high in added sugars, inflammatory vegetable oils, and other processed junk—becomes a surefire way to ramp up chronic inflammatory diseases, causing you to pack on weight and feel miserable. I asked Denise to keep a food diary and we pinpointed several sneaky sugar sources including almond milk. (Some varieties contain sugar, so read those labels and choose brands without added sugar!)

2. Control stress.

Studies connect10 psychological stress with IBS and other inflammatory gut diseases. Everyone has different strategies to de-stress; for Denise combating stress meant frequent coffee dates with her best friend and 10 minutes of morning yoga each day. Yours might be deep breathing, meditation, or unwinding with a hot bath and chamomile tea after a tough day.

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3. Focus on anti-inflammatory nutrients and foods.

Wild-caught fish is an anti-inflammatory rock star, and Denise wasn’t eating enough of it. (“Yuck,” she replied when I asked her to eat more wild salmon.) So I had her ramp up other anti-inflammatory foods like leafy and cruciferous veggies as well as spices like turmeric, plus I put her on professional-quality fish oil supplements. Studies show11 that the anti-inflammatory omega-3 fatty acids in fish oil could benefit inflammatory bowel disease (IBD) and other inflammatory gut diseases.

4. Get good sleep.

Studies add12 impaired immune function and increased inflammation to the numerous issues poor sleep habits create or exacerbate. Getting 8 hours of solid shut eye initially felt like a challenge, but after a few weeks Denise became a believer in the good-sleep-fixes-nearly-everything mantra.

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5. Nix reactive foods.

Dairy, gluten, and soy are among the chaos-creating foods that trigger leaky gut, weight loss resistance, and numerous other problems. One study found13 that going gluten-free dialed down inflammation and insulin resistance (two big fat-loss and health hijackers) while boosting weight loss. Along with nixing food intolerances for a few weeks and then re-challenging them one at a time, I used nutrients like L-glutamine and quercetin to repair Denise’s gut.

Working with Post-Birth Control Syndrome can be a real challenge, but with the right guidance, you can get back to feeling like your healthiest self.

If you're looking for an alternative to the pill you might want to read this about birth control apps or this one the IUD.

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Jolene Brighten, N.D.
Jolene Brighten, N.D.
Doctor of Naturopathic Medicine

Jolene Brighten, N.D., is a women’s health expert currently working as the President and Chief Medical Officer at Rubus Health in Portland, Oregon. She received her Doctorate of Naturopathic Medicine at the National University of Natural Medicine and a bachelor’s in Nutrition Science from Cal Poly, San Luis Obispo. She is the best-selling author of Beyond the Pill, in which she shares her clinical protocols aimed at supporting women struggling with symptoms of hormone imbalance, including Post-Birth Control Pill Syndrome and birth control related side effects. Dr. Brighten has been featured in the New York Post, Cosmopolitan, Forbes, ABC News, and The Guardian.