Birth Control -What Are Your Options Besides 'the Pill'? Part 1

The combination oral contraceptive pill (OCP) is typically a combination of estrogen and progestin taken orally to prevent female fertility and pregnancy. It was first introduced in 1960, and since then, it has undergone many modifications and has been used by millions of women worldwide. Of Canadian women who use contraception, 32% use the OCP as their method of birth control.^[1] It is one of the most-used forms of contraception in Canada, but more and more women are looking to alternatives to oral hormonal contraceptive methods. What follows is an overview of some of the most common alternatives to “the pill.” Birth control is a personal choice, and it is your right to be informed of the options available for safe and effective contraception.

The Copper IUD (ParaGard®)

A copper IUD* is a small medical device that is inserted into the uterus and remains there as an effective form of contraception for five to 12 years.^[2] This IUD releases copper ions into the uterine cavity, that interfere with sperm so that they are no longer viable to travel or to fertilize an egg, although the mechanism for this is not well understood.^[3] Copper IUDs have become more popular in recent years because they are highly effective (only 2% of women will have unplanned pregnancies within the first year), relatively low-maintenance, and cost-effective over the long term. They contain no hormones and are preferred by women who cannot take hormonal birth control methods. However, copper IUDs can increase cramping, pain, and spotting in the first three to six months after they are inserted. A woman with a copper IUD will still get her period every month. In fact, the copper IUD is known to increase menstrual bleeding significantly, and has been shown to increase the risk of iron-deficiency anemia. For this reason, it is not recommended to women with low blood iron, ferritin, or hemoglobin.^[4] Different versions of the copper IUD are effective for varying time frames, with the ParaGard® being approved for the longest—10 years. New studies are showing it to be effective at preventing pregnancy for up to 12 years, but should be changed at that point to ensure proper copper levels for efficacy.^[2]

Mineral levels in the body are tightly regulated and have significant effects on body processes if levels are too high or too low. In fact, an excess of one mineral can antagonize other minerals and lead to a broader mineral imbalance. Different research groups looking at the effects of the copper IUD have found that blood levels of copper are raised to varying degrees, with newer data suggesting significant increases in serum copper.^[5][6][7] Copper is an essential mineral that is used in many body processes, but at excessive levels it is harmful to the body and negatively impacts the levels of other essential minerals. A mineral imbalance caused by an increase in copper affects many physiological systems and can lead to hypothyroidism, emotional lability, problems with memory and concentration, poor blood glucose regulation, and an increase in inflammatory conditions.^[8] According to Julie Casper, L.Ac., and Rick Malter, Ph.D., of nutritionalbalancing.org, symptoms of copper excess include:

“As copper increases in the body, potassium levels will be lowered and calcium levels will increase. This shift has a tendency to slow the activity of the thyroid gland. With the lowering of the potassium, the Na/K (sodium:potassium) ratio will increase, thereby putting the individual in a more chronic ‘fight’ or ‘flight’ response. Sodium may increase with a corresponding drop in magnesium levels. Therefore, a buildup of excess copper will tend to contribute to more intense feelings of fear and anger in a person. As more and more excess copper builds up, it will lead to a shift from anger and fear to rage and terror or panic. Such intense emotion involving rage and terror or panic will leave such a person feeling ‘out of control.’ This is a very common reaction of a person with high copper levels.”^[8]

Although researchers have not agreed on the possibility of copper toxicity from this contraceptive device, case studies are pointing to possible adverse effects, from emotional to physical.^[9] Research on human copper toxicity remains “surprisingly sparse,” says Terry Gordon, a professor at New York University’s department of environmental medicine.^[9] Animal studies show damage to cervical and ovarian cells from high local concentrations of copper ions from the IUD.^[10] Perhaps the most significant study done on this topic on humans showed increased systemic biomarkers of oxidative stress and inflammation, and the authors concluded the copper IUD should be used for no more than two consecutive years,^[11] as opposed to its usual recommendation of up to five years. New research on the etiology of psychological conditions is showing inflammation plays a significant role in the development of mental health concerns. This link shows how copper, inflammation, and emotions are all connected. In terms of mineral imbalances, serum iron levels have been shown to decrease,^[12] likely due to increased blood loss from heavier menstruation, as mentioned above. Serum zinc levels have actually been shown to increase with use of a copper IUD,^[6][12] which is surprising since copper is known to be a zinc antagonist in the body—the mechanism of action of how this occurs remains unknown to researchers. One hypothesis is that serum levels of any mineral other than iron aren’t meant to be high in the blood, as they are used by the body at the tissue level. As such, it would make more sense to analyze mineral deficiencies using a tissue sample (i.e. hair) or urine source, and perhaps the research is misguided because the wrong medium is being measured.

It is important to get a good idea of what your chosen method of contraception means for your body in the short and long term. The copper IUD is growing in popularity because of its convenience, effectiveness, and absence of hormones, but a broad body of research on it is still lacking. Many women have had successful and satisfactory contraception with the use of a copper IUD. It may still be a good option for you if you are sensitive to other hormonal treatments or prefer it to barrier methods, but it is important to be aware of the link between excess copper, inflammation, and emotions. The best suggestion is to get your mineral levels tested by a naturopathic doctor prior to having an IUD inserted to determine what your preexisting levels of copper and other essential minerals are. Based on the results, an individualized mineral supplementation program can be created which will help prevent potential side effects that may result from the insertion of the copper IUD. The cost to do a hair essential mineral test is approximately $110.

The Hormonal IUD (Mirena®)

The hormonal IUD, Mirena®, is similar to the copper IUD in that it is a small device inserted into the uterus and remains there as long-term birth control for up to five years, though like the copper IUD, in some circumstances it may be used for longer. It is designed to release small amounts of a form of the female hormone progestin, like that in the oral contraceptive pill, into the uterus. While it is unclear how this inhibits female fertility, it is thought to work by thickening cervical mucus (to prevent sperm from entering the uterus and reaching or fertilizing an egg) and thinning the lining of the uterus (to make it less hospitable to egg implantation if there is fertilization).^[13] In the first three to six months after insertion, bleeding and spotting may be irregular, but over time, many women experience lighter and shorter menstrual bleeding than before insertion; however, some may even see a complete cessation in menstruation.^[13] Mirena® is 99% effective in preventing pregnancy and, like the copper IUD, is low-maintenance and cost-effective over the long term versus other methods of birth control. It does contain the hormone levonorgestrel (progestin), but because it is in the uterus, the hormone levels are less than what is used in the oral contraceptive pill, and it is effective without having systemic exposure to synthetic hormones.

Less than 1% of women with a Mirena® IUD inserted in the last year will become pregnant. However, if pregnancy does occur, it is more likely to be an ectopic pregnancy, wherein implantation occurs outside the uterus. This is a potentially life-threatening concern, requiring emergency care. Equally unlikely but important to know, the Mirena® can also embed itself into or perforate through the lining of the uterus and migrate into the abdomen, causing serious complications requiring surgery. These risks occur in less than 1% of women who are using the Mirena® IUD, but they are serious and important to calculate in your decision for birth control. The most common side effects of the Mirena® are irregular bleeding (52%), headaches (12%), breast tenderness (3–9%), acne (15%), inflammation of the vulva/vagina (20%), development of ovarian cysts (13%), loss of periods (1–12%), mood changes (4%), and pelvic pain (12%).^[14] New studies are claiming that it is effective at preventing pregnancy even up to one year after its FDA-approved time of five years, though this may result in more difficulty conceiving after its removal.^[15] Use beyond six years is not recommended, as it may be ineffective and lead to unwanted pregnancy.

As there is a chance you may stop your period altogether while using the Mirena®, it is a good idea to decide if you feel comfortable with this possibility. Although the Society of Obstetricians and Gynecologists of Canada (SOGC) and the Association of Reproductive Health Professionals (ARHP) state there is no evidence that suppression of periods is harmful, it is important to note that there are no long-term studies to specifically investigate this.^[16][17] Menstruation, contraception, and fertility are deeply intimate topics that have been debated by politics and religion for generations. As a result, they can hold cultural significance in addition to their biological purpose. Fortunately women now have the ability to choose the significance for themselves and make that a biological reality. For an in-depth discussion of the history, pros, and cons of missing periods, please read the article “A Brief History of Your Period and Why You Don’t Have it” by psychologist Valerie Tarico in the feminist magazine Jezebel: http://jezebel.com/5928316/a-brief-history-of-your-period-and-why-you-dont-have-to-have-it.