Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
19 Jan

The Pill: What You Need to Know About Oral Contraception

Over the years I’ve received questions about the Pill on a pretty steady basis. As one female reader put it, if you go Primal and do all the work of normalizing your hormones, does taking the Pill undo all the good? Are the cautionary rumors I hear just overblown, or are there substantial risks? What about taking the Pill for a longer period of time? Does it matter if I’m 45 as opposed to 25? Clearly, there are a lot of questions and nuances here. Let’s do what we can to unpack this subject.

Before I begin, let me offer the reasonable caveats. Yes, I’m a guy writing about a women’s medication – a rather personal one at that. I get it. I want to tread gently in these arenas. To be sure, the Pill marked a revolution in reproductive planning. It was the first convenient contraception choice over which women had full control. I don’t want to diminish the personal and social impact of that option. Nor do I want to overlook the convenience and effectiveness that the Pill (when taken as directed) offers to a woman/couple who aren’t looking to start (or increase) a family. There’s a reason some 100 million women around the globe turn to the Pill.

That said, I think most would agree we’re looking at a legitimate health question as well as intimately personal one. From my own humble perspective, I’ll go so far as to say the medical community has done a disservice to women by not being more transparent about oral (and other hormonal) contraception over the years. (Allow me to focus on oral contraceptives today, which are the oldest and most studied form of hormonal birth control.) Women understandably have a lot of questions, important questions. The problem is, the issue too often gets simplified by often well-intentioned practitioners whose main priority is respecting a woman’s choice on the issue. Yes, many personal factors go into the decision, but the conversation between a doctor and patient shouldn’t stop before it’s even begun. Physicians need to acknowledge that women care about the health implications of the decision.

As you all know, I’m first and foremost a supporter (okay, maybe diehard, soapbox, scream from the rooftops, full-on advocate) of full disclosure. People should have access to all of the details for choices they’re obliged to make – whether it be choices involving food, medical procedures, or medications. Although there’s a lot just on the medical side of oral contraceptives, let me do what I can (in the modest scope of a blog post) to at least get the ball rolling.

The fact is, when we’re dealing with matters of the body, there’s no such thing as a free lunch. I think we all know that. Taking hormones on a daily basis (whether natural or synthetic or both) will undoubtedly have repercussions. The body is a finely tuned machine of collaboration and interaction. The shifting amount of one hormone will have a corresponding effect on other hormones, which in turn influences a whole host of other physiological functions and biochemical secretions. But onward with the details….

First a little historical perspective… The dosage of today’s Pill (as many versions as there are) is minute compared to what was initially produced in those very early years. Formulations have changed over time to include lower levels of hormones. The so-called “mini-Pill” contains no estrogen at all. Nonetheless, side effects still exist in part because the human body hasn’t changed (the stubborn vessel it is) and because new formulations contain new versions of the hormones that appear to be riskier than the older versions. As for post-Pill fertility, the evidence suggests taking the Pill doesn’t impair future fertility. I can understand, however, that women would be wary of this possibility especially with new ingredients being added to formulations. I would hope the studies and reviews on this subject continue.

Now for the rundown of health risks – what you’ve heard and what’s true. There’s a lot to cover. Although I don’t claim that a single blog post can cover every study and nuance, let me hit on as much as I can.

First, the “good” news. You’ve likely heard that taking the Pill can lower a woman’s risk for ovarian cancer, endometrial cancer, uterine cancer, and endometriosis. These appear to be true. That said, I obviously wouldn’t suggest a woman take on other risks (forthcoming of course) to slightly lower the chance of developing these conditions.

Breast Cancer

According to research analysis, data from 50+ studies suggest the Pill confers a 10-30% higher risk for breast cancer. Higher estrogen pills are implicated more in this data as is prolonged use of the birth control pill and family history of cancer. Although this heightened risk is definitely worth considering, it is significantly lower than the risks of hormone therapy for post-menopausal women.

Cervical Cancer

In the last few years, there’s been some talk about abandoning pap smears (the procedure that tests for abnormal cervical cells) in exchange for an HPV DNA test. The problem is, HPV is not the sole cause of cervical cancer. The birth control pill is also considered another major risk factor, especially for women who have taken the Pill for five years or more (PDF). If this plan is ever adopted, here’s the message to millions of women on the Pill who are HPV negative: good luck catching any cervical changes early. It’s inflammation at work here, folks. The Pill, particularly estrogen containing versions, causes inflammation.

Gastrointestinal Issues

It’s a known but little publicized fact that increased estrogen can contribute to irritation of the stomach lining and aggravation of existing gastrointestinal conditions like GERD and Crohn’s. Some women are more sensitive to the effect of the Pill on gastrointestinal health. Hint: if your doctor tries to put you on the Nexium (a.k.a. “the purple pill” or any of its assorted relatives), try going off the Pill first.

Cardiovascular Risks

The Pill, particularly traditional estrogen-progestin combination formulations, can raise blood pressure in some women, particularly those who already have high blood pressure. Research also shows that the Pill very slightly raises the risk of stroke in women without stroke risk factors (e.g. migraines and high blood pressure). The difference adds up to approximately a single added stroke per 25,000 women.

Blood Clots

This is one of the risks that’s gotten the most press over the last few years and for good reason. It’s an issue that has dogged the Pill since almost the very beginning. As formulations changed, people assumed the risk would be reduced. But there’s a wrinkle. Newer types of progestins (e.g. drospirenone, desogestrel or gestodene) heighten a woman’s risk for blood clots compared with the older form of progestin (levonorgestrel). Research has shown that women who take a birth control pill with one of these newer progestins have six times the risk of blood clots compared to women who don’t take the Pill. Women who use a Pill with an older form of progestogen have three times the risk of blood clots compared to non-users. The risk for traditional progestin is approximately 10 women in 10,000 each year.

Other Side Effects

Finally, then there’s the more sensitive research that’s come out in the last few years about the Pill’s effect on partner choice. Women’s monthly shift in hormones has implications for their attraction to certain traits in males. Women who met their partners while on the Pill were happier with their partners’ parenting and care taking and were less likely to separate than those who weren’t; however, they “scored lower on measures of sexual satisfaction and partner attraction” and “experienced increasing sexual dissatisfaction during the relationship.” (No comment here, btw.)

So, what’s the take home message? Readers have asked my overall opinion of oral/hormonal contraception. I know what you might infer from the course of evidence here, and you’d be mostly correct. Is there enough medical risk to give a woman pause? Absolutely. Is it enough to discount the Pill as a birth control option for a woman who is otherwise healthy, has no significant family history or risk factors in the relevant areas, and strongly prefers this contraceptive form? No, I can’t say I’d entirely take it off the table. The heightened risks for the above conditions were indeed measurable but generally not dramatic in otherwise healthy, non-smoking subjects who didn’t have significant family histories of relevant diseases. Age doesn’t appear to raise one’s risk except in the case that other risk factors develop (e.g. high blood pressure, etc.).

That said, let me throw in some caveats. I’d certainly favor the lower dose versions. I’d suggest close monitoring by a physician who acknowledges the risks of a hormonal contraceptive. I’d also strongly suggest regular exercise (not the inflammation boosting chronic cardio kind), a consistent anti-inflammatory diet (I think you know one I can recommend.), anti-inflammatory supplementation (fish oil, turmeric, etc.), and vitamin and mineral supplementation. And – although this bumps up against some rather personal factors – I’d recommend looking at other contraceptive options for the longer term. In other words, I wouldn’t suggest being on the Pill indefinitely as some physicians and medical groups say is just fine and dandy to do. Some of these heightened risks (e.g. blood clots, breast cancer) only diminish over a ten-year period after discontinuation. That’s pretty far-reaching.

Yet, I also won’t go so far as to completely count out oral contraceptives because I know every other method has its drawbacks (major or minor) as well. The reality is, there’s no 100% perfectly safe, astoundingly convenient, wholly unencumbered, completely foolproof way to dupe or circumvent nature on this front. It’s not about making a particular choice. It’s about making an informed decision. Not everyone is able to track their cycles with perfect precision. Not everyone tolerates an IUD or diaphragm or spermicides well. Not everyone wants to solely depend on the use of condoms for a host of reasons. Not everyone is ready to go the sterilization route yet. Take all of this, and that’s a whole other ball of wax – and another blog post than this one….

Thanks for reading today, everyone. Share your thoughts on the Pill. What information did your practitioner offer? Have the benefits outweighed the negatives for you, or the other way around? Do you have thoughts/suggestions for women who are considering the Pill? Have a good end to the week, everyone!

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. Haha…it sounds like a quite a large proportion of the primal “community” plans on driving itself to extinction within its first generation.

    John wrote on January 19th, 2012
    • C.M. Kornbluth wrote a sci-fi story about this sort of thing…the title is “The Marching Morons”. Not at all politically correct, but its still a great story.

      Hopeless Dreamer wrote on January 19th, 2012
  2. I was on Alesse for quite some time, and as soon as I went primal, I was spotting between periods.

    My doctor suggested I switch to a higher dose pill. I tried it for a while, but decided I didn’t want to be on the pill anymore.

    Now I use something called LadyComp, and it’s more natural form of birth control. Nothing to take except for my (oral) temperature every morning.

    I didn’t mind taking the pill, but even on the low dosage ones, I was always exhausted the week before my period (and sad). Now that I’m no longer on the pill, my mind and body aren’t all over the place!

    Rosie wrote on January 19th, 2012
  3. I took the pill (not sure which one, but it was a Canadian concoction) for six weeks during which time I turned into a “pill” myself. I felt horrible, and behaved horribly. I quickly sought another way. Many of my friends suggest “Fertility Awareness Method” (FAM) and I bought into it.

    My husband and I shared the duty of tracking my cycles for 4.5 years before we began to try for a family. I confess that there was some nervousness that the reason why FAM worked for us was perhaps because I was simply not fertile. However, just last year in July we conceived (after trying for two months) and I’m now just into my third trimester – due in April! So, FAM worked for us! :)

    P.S. I’m not talking about “Rhythm Method” – I’m talking about charting both temperatures and cervical fluid. FYI.

    gilliebean wrote on January 19th, 2012
    • Gilliebean – I love that your hubby shared the duty of tracking your cycles. On a practical level, how did this work? Did he take/record your temp and you take your fluid, or some other delineation of duties? I ask because we’re about to start naturally tracking for fertility awareness and I’d love to know how to share the load, and hubby is happy to help. It also is a unique bonding experience for us. Thanks!

      Anonymoose wrote on January 20th, 2012
      • For me, hubby takes my temp every morning when the alarm rings (important to take temp at same time every morning as much as you can help it, to see the pattern clearly). He records it on my chart, which is on my bedside table. I check my own cervical fluid and record that each day. It’s nice to have the teamwork… bond-strengthening, I would say. :)

        RSL wrote on January 30th, 2012
  4. I went off Nuvaring 14 months ago because I hated what the hormones did to me. I had been on it for 3 years since I met and then married my husband. Eventually I realised It had ruined my sex drive, made me want to eat all the time (or maybe it was my CW diet) and it zapped me of my creativity (I’m an artist by trade).
    I started using the ‘OvaCue Fertility Monitor’ instead for birth control and haven’t gotten pregnant yet (for about 14 months). I do have to use condoms for one week of my cycle (or abstain, or get creative!) and it is a good idea to log your cycle separately for backup.
    It is not promoted for birth control use, but it tells you when you are fertile. It is way easier than the whole thermometer thing. Plus when I do want to get pregnant it will be just has handy. It is not a cheap device, but I used to spend $50 a month on birth control, so it is definitely cost effective over time. It takes at least 3 months of use to become accurate, especially if you go off hormonal birth control.
    I highly recommend it if you are enjoying sex daily and don’t like taking hormones.

    Daisy Haze wrote on January 19th, 2012
    • Wow, that is scary. I noticed the lack of sex drive, but the things you talk about are unacceptable. I preferred the patch over the ring, but doc said I’m too heavy for it to work right and my fat already makes too much estrogen.

      I think it’s time to talk about getting my uterus cauterized anyway, that should take care of the horrible bleeding issues.

      Kelekona wrote on January 23rd, 2012
      • for Kelekona and anyone else who has damaged uterus/cervix and bleeding from that, supplementing with vitamin C may help. Please research it for yourselves. Vitamin C is also a very strong anti-toxin. Thomas E. Levy is a medical doctor and supporter of vitamin C. You can find good info at too.

        Wenona wrote on January 23rd, 2012
        • Oh, I’ve had horrible bleeding all of my post-puberty life, and only about 2-3 years of BC relieving it.

          I don’t know when I contracted PCOS, (don’t even know if I have PCOS because they aren’t recommending tests since I don’t want to concieve) but I think I grew the beard young and the arm-hair might have been from microwaving food in non-safe plastics.

          Kelekona wrote on January 23rd, 2012
        • I know I’ve posted it before for others but this thread is very long, you should read about iodine and Dr. Jorge Flechas, he treats patients using iodine and I know there are interviews of him giving amazing info about the conditions that iodine reverses/cures. He says iodine deficiency is shown by cysts developing on ovaries, breasts, uterus, thyroid. hope this helps

          Wenona wrote on January 23rd, 2012
  5. When I went in to get a prescription for the pill, I was told NONE of the potential health repercussions. Just “here you go!”

    What made me go off of the pill was the information about its role as a potential cause of early abortions – as a pro-lifer, that was totally unacceptable to me (not looking to start an abortion debate, just mentioning this). Secondarily, I was horrified when I read about the health problems that it can cause.

    One issue that I didn’t see mentioned above was the research that’s come out recently about effects to the environment – because the urine of women on the pill is tainted with the hormones from the pill, it goes directly back into the water system and is having negative effects on various species of wildlife.

    One additional thing I noticed – when I went off the pill, I just felt better – like my body relaxed. It was hard to describe, but I definitely felt better.

    It just makes sense that pouring artificial and unnatural hormones into our bodies on a regular basis would have negative repercussions. Thanks for this article!

    Diana wrote on January 19th, 2012
  6. There is avery good solution for horny hetero couples who do not want to make babies: Non-penetrative sex. Use hands, mouths, friction etc. Most women orgasm through clitoris stimulation anyway.

    theG wrote on January 19th, 2012
  7. I took it a long time ago, so my comments aren’t relevant to the newer formulations.

    I was skinny until I turned 27, when I went on the pill for three years. I had several undesirable side effects. And I gained a lot of weight very quickly. I have had trouble with my weight ever since. I don’t blame the rapid weight gain entirely on the pill, but I am sure it was the major trigger.

    Since that experience, I have stayed far away from female hormonal drugs, including the natural ones.

    Suzan wrote on January 19th, 2012
  8. This reminds me how grateful I am for menopause!
    When my periods first stopped I would cruise the feminine hygeine aisle at the grocery store emitting evil little chuckles and great sighs of relief!
    I fortunately traveled the “pause” with ease and thanks to being primal am healthy enough to really enjoy my freedom.
    Great article, Mark.

    rose wrote on January 19th, 2012
    • +1 Amen to that, girlfriend!!!

      PrimalGrandma wrote on January 19th, 2012
  9. I’ve been primal for two months and have been off oral contraceptives for the same amount of time. I’m feeling amazing and the benefits of this lifestyle are too numerous to list (okay, okay: weight loss, increased muscle tone, acne issues completely resolved, brighter skin, dramatically improved moods and energy, better focus, zero cravings for S.A.D. fare, better sex drive, much more confident, etc). I don’t know if this is because of going off the Pill or primal, but I like to think it is a combination.

    My long term boyfriend and I practice a mix of (lazy) cycle planning, condoms, withdrawal, and other creative and *fun* methods. We discussed my health concerns and agreed that the risk of an unplanned (but not unwanted) baby outweigh the potential harm that long term oral contraceptive use was doing to my body. I understand my situation makes this plausible and would probably reconsider if I were not in a committed relationship.

    Also, I mostly started the Pill because of really painful periods. My formerly debilitating cramps and PCOS symptoms have completely disappeared. My last two periods have barely registered. Much heavier than usual, but shorter and pain free (I do feel pressure and I am aware I am on my period, but it isn’t painful).

    Good luck, Grokettes.

    And Mark, thank you so much for recognizing exclusively female health concerns. It gets a little old to have your symptoms written off as “depression” or some ill defined female hysteria.

    NewButNotGreen wrote on January 19th, 2012
  10. I was on the pill as a young woman, and didn’t have much trouble with it. I liked the double protection of condom and pill at that time. I really wanted to avoid pregnancy! Then, when I was about 24, I switched to watching my cycle, and was in a long-term relationship and then we got engaged…after kid #3, my husband went to get snipped and all is well! Now, I like having normal cyclical hormones much better, and think the pill might be harmful for me as a 38 year old. But for the younger set, it might be the easiest.

    Joni wrote on January 19th, 2012
  11. Hated being on those things! Like other have said, PMS-y all the time, messed up libido, weight gain, etc. Until I went on Yasmin. Yeah, one of the ones you see on the “wanna sue” commercials. I actually felt balanced on that one. HOWEVER, I now have thyroid issues and it absolutely destroyed my gallbladder. Fun stuff (not).

    Kris wrote on January 19th, 2012
  12. Your sentence, “There’s a reason some 100 million women around the globe turn to the Pill” leaves out a major part of US Healthcare. . . many insurance companys and doctors refuse to perform any permanent sterilization on women who request it, unless they’ve a) already had children or b) are over 35/40 years of age. Thus, as a result, many women are forced to turn to long term birth control measures when they’d rather just be sterilized.

    Men, on the other hand, are never questioned repeatedly when they ask for a vasectomy.

    Amy wrote on January 19th, 2012
  13. Gosh, Ive been on the pill for 33 years with a year off for each of my pregnancies. Ive also had a trial of 6 months or so to see how I did off it. Ive never had a problem with anything while being on it. My doctor tells me he wonders if this is why I still look far younger than my age. I don’t know… All I know is that I feel much better when Im on it! The incredibly small amount of time off it made me feel awful. CRABBY, horribly heavy periods and bloating.

    Lisa Martin wrote on January 19th, 2012
  14. Mark, thank you for stepping into this issue (and doing it rather well at that!).

    Im one of those women that has BIG problems with hormonal birth control. I have been on HIGH dose hormones in the past and my body is ultra resistant to hormonal control. I still ovulated, still had a regular period on top of the withdrawal bleeds when on the pill. Increased hormone levels made me insane. I have had a Paragard IUD (non hormonal one) for 5 years now and I am VERY happy with it. I am nulliparous (Have not given birth), 35, and very happy with my current birth control.

    Yvette wrote on January 19th, 2012
    • Yvette,
      Was your doctor on board with offering you Paragard? I had an appointment for a consult today, and they just called to tell me that they won’t offer Paragard because it is non-hormonal. I’m trying to figure out whether I should fight for it or find a more understanding doctor. Thanks!

      Randi wrote on January 30th, 2012
  15. Mark, you were very gentle with this…probably too gentle. You know darn well that the most primal thing any woman can do is to know and understand her fertility signs (regularity doesn’t have as much to do with it.) If you were talking about anything except the possibility of conception, you I think you’d give it a flat out thumbs down.
    sterilization also has physiological effects on the body (for both men and women)

    Milemom wrote on January 19th, 2012
  16. Great post! Do you have any information on the male pill, and its potential affects on men?

    Paul wrote on January 19th, 2012
  17. who needs the pill when you can just have 400 babies!

    alex wrote on January 19th, 2012
  18. I recommend all women read ”Taking Charge of Your Fertility” by Toni Weschler. Great information on how your body works, how your cycle and a great tool for women looking to use all natural birth control.

    Alex wrote on January 19th, 2012
  19. Women who met their partners while on the Pill were happier with their partners’ parenting and care taking and were less likely to separate than those who weren’t; however, they “scored lower on measures of sexual satisfaction and partner attraction” and “experienced increasing sexual dissatisfaction during the relationship.”


    One of the many things that concern me about the Pill is the spread of sexually transmitted disease as a result of unprotected sex. Personally I think that has been a hidden consequence with massive implications for women’s health and we are still not admitting it as a society.

    Alison Golden wrote on January 19th, 2012
  20. I have been on the pill for about 9 years (scary) and I’ve definitely noticed changes… Mood swings, thinning hair, irregular periods, etc. These side-effects could be linked to anything though. Luckily, I take vitamins, eat well, and work out as often as possible.

    Mark – Do you think any damage (or risks) can be reversed by getting off of the pill?

    Karrie wrote on January 19th, 2012
  21. Thank you Mark! I’d always suspected that going on the Pill had contributed to my Crohn’s relapse, and now I have a study to back it up… This was really helpful and encouraging, as I just got off the Pill three weeks ago for fear of what it was doing to my body.

    Stephanie wrote on January 19th, 2012
  22. When I was younger, before menopause, I always tracked my cycle with a basal thermometer. It was pretty easy. Then I used condoms when I was fertile. It worked fine.

    shannon wrote on January 19th, 2012
  23. I tried birth control pills briefly in the early seventies, but they made me nauseous and caused weight gain and fatigue. Then I tried a diaphragm with spermicide. The spermicide caused spotting. Finally I went to the method of tracking my fertility, as mentioned above. It’s interesting as well as practical. You start noticing other things about your body that coincide with where you are in your cycle: moods, interest in sex, etc.

    shannon wrote on January 19th, 2012
  24. A safer option that Catholics practice is Natural Family Planning or the Billings Ovulation Method. This is not the old “rhythm method”.

    Jaki wrote on January 19th, 2012
  25. I’m on the other side of the birth control issue now and dealing with menopause. After a couple of years of hot flashes, night sweats, low libido, and dryness in all the wrong places, I finally started using a low-dose estrogen patch. I’m not a better living through chemistry kind of woman and I tried every natural remedy known to woman-kind first. But being able to sleep through the night regularly for the first time in several years was well worth it. I’ve tried going off of it a couple of times, but the hot flashes come roaring back with a vengence and then it takes about a month to get back to where they stop again. I’ve already been going through this for seven years, and I’m hoping I’ll make it through to the other side soon, but I have friends who’ve been having hot flashes for 10 years or more. I see my doctor regularly and since I’m not having any adverse side effects on the patch, for me being able to sleep is well worth it.

    Kim wrote on January 19th, 2012
  26. I developed chronic depression and didn’t realize it was because of the pill. That’s because none of the many doctors I saw thought to mention anything. And that’s because that half of them are unaware of the side effects themselves! it is ridiculous.

    I also had low or no libido from it and just believed I was not a sexual person. Starting the pill at 18 didn’t give me any chance at all to get to know my body. Anyway, I wouldn’t touch the stuff now with a barge pole and regret the 8 years I spent on it.

    Anna wrote on January 19th, 2012
  27. I went on Yaz when I was fifteen and then switched to the patch last May. However, the patch gave me horrible rashes wherever it was and so when my husband and I decided to go Primal we decided to ditch all forms of medication including the birth control. I noticed that since then my sex drive has improved partly from the raised energy levels of eating primally and partly from stopping all these unnatural medicines being put into my body. We now are going to have my tubes tied next winter and if we want to have children we will adopt as there are plenty of kids out there who need a good home. I know this option isn’t for everyone but I personally would never recommend the pill or anything hormone form of birth control to anyone because it just doesn’t make a person feel good.

    Darcy wrote on January 19th, 2012
  28. I wanted to add that not only is lowered testosterone a side effect of taking the pill, but there is evidence that hormonal birth control can result in a permanent decrease in testosterone production, even after you stop taking it. Eeeek! The best birth control ever – no sex drive?

    Syd wrote on January 19th, 2012
  29. I was on the pill for several months in the mid ’70s when the pill had higher doses of hormones. As many others have reported here, it made me crazy! LOL! Mood swings, irritability, etc. etc. Stopped it and never looked back.

    My doctor had prescribed it because I’d had hormone imbalances resulting in irregular periods and serious issues from ovarian cysts. After stopping the pill my periods were more irregular than ever, although I didn’t have any ovarian cysts until many years later in peri menopause when I had one minor cyst.

    I had difficulty with fertility until after the first child and an “accidental” foray into a lifestyle very close to Paleo. Raised my own organic garden, grass feed beef, pastured chickens, etc. for several years. Had two more children during that period with no difficulties conceiving. Had a tubal ligation after the third child.

    rrustad wrote on January 19th, 2012
  30. I was on the pill for 10 years, and had very few problems other than sort of losing touch with my emotions. So I got off the pill, but now had to choose a new method and I went with the copper IUD. It’s been fantastic! It’s a thing I don’t have to think about, good for 10 years, reduces my bleeding, and I’m pretty confident that it works and I won’t be getting pregnant.

    It hurts a bit going in or coming out, but it’s overall worth it. This is my second one, and will hopefully take me up to menopause, when I really won’t have to worry about getting pregnant.

    Birth control options aren’t well talked about, so thank you for addressing this. The Pill seems to be pretty much the known option, and if you want something else, it seems to be … unusual somehow. I don’t know. I had some difficulty finding information on other choices.

    Kerry wrote on January 19th, 2012
  31. Thank you, Mark, for this great article.

    I’ve seen it mentioned above, but wanted to join the chorus. People who think that natural family planning is the rhythm method really need to take a look at sympto-thermal methods of NFP. It’s so much more advanced and so much more accurate.

    Yes, it requires consistency and dedication and may not be for people who are not in a committed relationship. And yes, it does require periodic abstinence, although not nearly as much as previous “editions” of NFP did. But it also keeps you chemical hormone free and improves communication with your partner.

    “Emergency contraception” and such are even worse than regular chemical birth control to me, because of the massive doses of hormones involved.

    Amie wrote on January 19th, 2012
  32. Fabulous, diplomatic post Mark; such a huge topic for women (and potentially the prostate’s of men) everywhere!

    But I think I have a certain degree of lee-way as a gal who was prescribed the pill at 15 solely to help with cramps to say – that sh*t is messed up. Would add further expletives if I could.

    I understand that it’s hugely liberating and can absolutely be prescribed in a right place/right time scenario, but the lack of information for impressionable young thangs who just want a ‘quick fix’ for teen acne, hormonal upheaval and contraception is deplorable!

    I quit the pill at the beginning of last year after around 7 years and as a result have been plagued by acne, absent periods and the uncomfortable knowledge that my doctor did not give me the down-low, low-down. Nutrient depletion, infertility and higher disease risk is swept under the shag-pile carpet, and it takes a lot of healing and hormonal recalibration to get back in the womanly zone! Just my 5 cents. I’m sure other readers can relate!

    Catie wrote on January 19th, 2012
  33. I got large lumps in both of my breasts from taking the pill.

    Erin wrote on January 19th, 2012
  34. to all the woman wondering what to use if you don’t want to use the pill. Do they still have the sponge? That was a great form of birth control. I don’t need it anymore (hysterectomy) so I don’t know if it is still available.

    bbuddha wrote on January 19th, 2012
  35. Thanks Mark for this post! I’d like to mention a natural alternative to the pill. I’m a huge fan of the book “Taking Charge of Your Fertility” by Toni Wechler. It provides a very clear and thorough explanation of the Fertility Awareness Method (FAM). The book details how you can use different signals from your body to either avoid pregnancy or to conceive — you either avoid sex (or use condoms) when you’re fertile or that’s when you go for it!

    Also, I should note that this is NOT AT ALL the same thing as the rhythm method. You use your basal (waking) body temperature and your cervical mucus to judge when you’re fertile, and give adequate cushions on either side. I used it for years to avoid pregnancy, and then eventually to conceive with my husband. When followed correctly, it has been shown in clinical studies to be as effective as the pill (and has actually been recommended in countries where women need birth control but don’t have the means to get it).

    Anyways, reading the book teaches you so much about your body, I think it should be required reading for every woman.

    Sadie wrote on January 19th, 2012
  36. Thank you Mark; great read. I was on the pill for a couple of years but never once felt “right.” In retrospect, I believe the medication contributed to my endocrine issues (hashimotos, adrenal exhaustion — although obviously my horrible lifestyle and diet were major contributing factors). I totally understand the convenience and the pressure women feel, and would never counsel anyone not to be on the pill. However … if your body doesn’t feel right … listen.

    nikke wrote on January 19th, 2012
  37. I must be proof of the opposite regarding the Pill’s prevention of endometriosis. Taking the Pill was like pouring gasoline on the fire. I had some cramping that naproxen couldn’t touch, so I asked my doc for something better, he said the Pill! It’s harmless! And naïve me thought, “ok!” I know endo doesn’t start overnight but things were manageable pre-Pill and now I’m disabled for 2-3 days out of every 3-4 weeks because of the intense pain.

    Just 3 cycles on the Pill and things have never gone back to the way they were pre-Pill. I had severe symptoms after just one cycle and complained to my doctor, but he told me to stay with it for the 3 months and things should settle down. It’s been 6 years and I’m still battling the awful cramps, heaviness, etc.

    I have had to completely remove entire food groups (I’m talking beyond the basic paleo diet) just to lower the volume (but note totally mute the pain). I will never touch hormones like that again.

    Amy wrote on January 19th, 2012
    • I had similar issues, not caused by the pill, just had problem periods. I finally had a hysterectomy. It has been wonderful, not having to worry about planning around a very erratic schedule and taking way too much pain medication. If you don’t want children or you already have them it is an option.

      bbuddha wrote on January 19th, 2012
      • I agree. I always had hormonal “issues”, couldn’t take the pill, trouble conceiving, etc. Had a tubal ligation after the third child. My problem periods increased and eventually the cramps were like a very painful period almost everyday of the month. Quality of life was in the toilet!

        Five years after the tubal, I was diagnosed with a form of endo called adenomyosis and had a hysterectomy at that time. 25 years later, I have had NO regrets about the hysterectomy. I got my life back. My OB/GYN said that adenomyosis is the primary reason for having a hysterectomy these days and that most women with the diagnosis feel like I do about quality of life, etc.

        rrustad wrote on January 19th, 2012
      • That’s what I ended up having to do. I don’t know if that was the right solution, but I do know that I felt better than ever after getting rid of all the “period” problems. My only regret was that I didn’t do it sooner – like many years sooner. That was when I was over 45 years old 9n 1989. I’m now 67 years old and have never regretted it and like I said — why the hell did I wait so long?

        Sometimes you just gotta know when to fold—

        PrimalGrandma wrote on January 19th, 2012
        • Well, that was how I felt, too – “why the hell did I wait so long!” – even though I was only 36. In fact, what eventually prompted the decision was a scary pap test that led to a cervical biopsy that showed advanced pre-canerous changes. Enough! LOL!

          rrustad wrote on January 20th, 2012
  38. I’ve read in a couple Paleo diet books that the pill also contributes to Leaky Gut Syndrome and can have a hazardous effect on autoimmune diseases.I was on the pill but after reading that I stopped taking it that very night since i have an autoimmune disease. But it seems like there aren’t too many options for birth control that don’t mess with your body’s hormones. anyone have any suggestions? Thanks!

    amber wrote on January 19th, 2012
    • Copper IUD! See some earlier posts…

      Eryn wrote on January 20th, 2012
  39. I have been researching The Lady Comp ( lately. Does anyone have any experience with it? 99.3% effective with no side effects.

    Sarah wrote on January 19th, 2012
  40. I haven’t seen anyone mention the Creighton method of NFP. I realize it would mostly be Catholics who are familiar with it, but I am curious as to whether people have found it easier and more effective than the common NFP methods. Anyone use Creighton?

    Lesley wrote on January 19th, 2012

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