Before Starting Hormonal Contraceptives - What You Need to Know

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The availability of contraceptive birth control has been incredibly supportive of women’s autonomy over reproductive health. As women, we’ve been given this amazing opportunity to be in control of our bodies; whether it be for preventing an accidental pregnancy, or for obtaining relief from hormonal dysfunction. Available as different combinations of low-dose estrogens and progestin (a progesterone-like substance), the oral contraceptive pill (OCP) is often the first choice for women who are trying to prevent pregnancy, as it’s noninvasive and doesn’t disrupt sexual practices. Additionally, hormonal contraceptives are used as a first-line treatment for menstrual symptoms such as heavy bleeding, breakthrough bleeding, painful periods (dysmenorrhea), and acne. Medical doctors will even go as far as to advise, if you are ever going on a beach vacation, that you can continue taking the pill and postpone your period for a week or longer.

This magical pill, however, does not come without a price. After all, the hormones used in birth-control preparations (tablet form, transdermal patch, or IUD) are synthetic and are not identical to our own natural hormones. This means there could be side effects. As well, the body (especially the liver) often needs extra support in metabolizing these exogenous hormones that we’ve introduced. There are things every woman should know when deciding if using hormonal birth control is right for her. There are things to consider such as: How long do you foresee yourself using it? Would any side effects deter your use of them? Is there an alternative for what you’re looking for? There are pros and cons to each option, depending on a woman’s unique situation.

Hormone Therapy for a Normal Menstrual Cycle

Hormonal therapy with OCPs overrides a woman’s endogenous hormones. For women with menstrual symptoms that significantly interfere with quality of life or activities of daily living, this can be a truly remarkable treatment option. In this case, the pill basically tells your ovaries to close shop for the time being, as the synthetic hormones take over signalling and cycle control.

OCPs work by causing ovulation to halt and by keeping the endometrial lining thin to prevent implantation.^{[ 1 ]} This is why bleeding patterns often change while on the pill, often becoming lighter in flow. By overriding these areas, vaginal and cervical fluids and discharge are also often affected. Without ovulation, the cervix no longer produces its ovulation-associated fluid, typically observed as a “slippery” or “egg-white” characteristic clear discharge. What women on hormonal contraceptives might notice is more creamy, thick white discharge or, in some cases, relatively little to no fluid at all. There are many nonpharmaceutical treatment options for cycle regulation, premenstrual, and menstrual symptoms. Naturopathic doctors have many different tools for helping women achieve their best and happiest periods. Acupuncture and botanical preparations such as chaste tree (Vitex agnus-castus) have both been used successfully to treat issues such as heavy bleeding, irregular bleeding, pain and cramping, and PMS symptoms. These same therapies can also be used to help women who want to transition off hormonal contraceptives and back into natural cycles.

Proper Use and Side Effects

Using hormonal therapy primarily as contraception can be very efficacious if used properly. This means taking the pill at the same time every day and not skipping days/doses. Any variation or change in the hormones administered can lead to a rapid response. Missed days or doses can cause breakthrough bleeding, in addition to increasing the risk of pregnancy up to 9%.^{[ 2 ]} It’s equally important not to increase your dose beyond your doctor’s recommendation, as it may increase the risk of side effects due to the larger dose of hormones. With so many different combinations of estrogens and progestins available, finding the right one is important and can take time. One factor that deters women from the pill is the side effects. Some women have great luck with the first brand they try, experiencing zero side effects and maybe even having an enjoyable period. However, there is always the possibility of an adverse reaction and needing to try different brands to find the one that works best with your body. Pay attention to your mood, your energy, and your body as a whole. If you don’t feel right, this type of hormone replacement might not be right for you.

The most common side effects listed in OCP product monographs include:

• Headaches;
• Nausea;
• Back pain;
• Breast tenderness;
• Depression or changes in mood;
• Diarrhea;
• Infections;
• Abdominal pain; and
• Menstrual cramping.^{[ 3 ]}

All that said, you may still want to use hormonal contraceptives, and the wonderful part of this discussion is that it’s your choice. The decision to start any type of medication or hormone replacement should not be taken lightly, and we need to understand that there are pros and cons to each therapy. Here is some additional information to help in your decision-making. Failure Rates: Hormonal contraceptives have a 0.3% failure rate if used perfectly, but a 9% failure rate with typical use. On average, the chance of getting pregnant after having unprotected sex is 33%. As a comparison, condoms when used perfectly have a failure rate of 2%, but with typical use, the failure rate to prevent pregnancy is 18%. Diligent cycle-tracking and fertility awareness method for preventing pregnancy have a 0.4–5% failure rate if cycles are consistent and normal, and if tracking is done perfectly. If not adhered to precisely, the risk of pregnancy increases to 24%.^{[ 2 ]}

It may take months to have a normal ovulation again after you stop the pill. Multiple studies have shown that there is a two‑ to six-month lag in natural ovulation and/or natural hormone cycling post–OCP use.^{[ 1 ]} Additionally, even when ovulation does occur, it can take up to 30 months for cervical mucus to normalize.^{[ 4 ]} If you’re looking to stop hormonal contraceptives in order to achieve pregnancy, plan ahead and allow enough time for your cycles to regulate normally. Fertility and the chance of pregnancy have been shown to “normalize” by one year following cessation of oral contraceptives. One study compared women who had stopped using oral contraceptives for 12 months with women who had either been using barrier methods of birth control, or no method at all, and found that the rate of pregnancy between the two groups was similar.^{[ 5 ]} OCPs deplete vitamins B2, B6, and B12. These vitamins have so many functions in your body, including energy production, red blood-cell production, immune function, metabolism, and production of neurotransmitters like serotonin and dopamine. A deficiency in any of these vitamins can cause fatigue, PMS, mood swings, depression, and insomnia.^{[ 6 ]} Therefore, you may need extra B‑vitamin support while taking OCPs. The pill protects you against ovarian cancer, but can increase your risk of breast and cervical cancer. For women under the age of 35 on OCPs, breast-cancer risk increases from 2 in 1000 to 6 in 1000.^{[ 2 ]}

Synthetic hormonal therapies increase your risk for blood clots and stroke. Women who are smokers should not use hormonal birth control, as they have an increased risk of clots and stroke while on OCPs.^{[ 2 ]} The reality of women having more control over their bodies is absolutely wonderful. A lot of responsibility comes with having a uterus: cycle-tracking, trying to maintain sanity through hormonal shifts, managing any symptoms before or during menstruation, being aware of bleeding, and always being conscious of pregnancy (whether trying to prevent it, monitoring for it, or planning it). The complexity of women and our biology is amazing, and though we are still very much individuals, we all share a similar “reproductive window” in time. Women only have from puberty to perimenopause (often starting in the early 40s) to figure out if they want to have children and to produce those children. Cycle regulation takes time, as does transitioning between synthetic and natural endogenous hormones.

Therefore, it’s necessary to have these discussions to investigate the goals you are trying to achieve for your body and health. Utilizing naturopathic medicine is a fantastic way to help support your body, either naturally or in conjunction with hormonal therapies.