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. The pill has always been a sexist issue, despite being touted as liberating and empowering for women.

    How about a pill to make men temporarily stop producing semen? Wouldn’t that be easier than changing a woman’s entire hormone production?!

    The fact that this has never been considered or invested in shows the obvious sexism in the birth control industry.

    That said: I was put on the pill at age 17 and then went off at 22 after struggling with depression, anxiety and acne. Going off the pill, learning my REAL, NATURAL cycles and of course cutting out grains and sugars from my diet have brought me to a place where I am healthier now than I ever was at 18 or 19 years old.

    When you get off the pill, learn your cycle, actually FEEL yourself ovulate, and respect your woman-ness for what it is, rather than oppress it you will be far more empowered that you ever were on the pill.

    Sophie wrote on January 19th, 2012
  2. Mark, I have been a fan of yours for quite some time now, not only because you have totally changed my outlook on life, but because you keep it real. Thank you for being brave and reporting on subjects that really are important to women like myself. I have long questioned the complex issue that is oral contraceptives, but have often been dismissed by doctors who are all too keen to shove a prescription in your hands. Thank you for providing some perspective, and keep on keeping on!

    Nikki wrote on January 19th, 2012
  3. Don’t forget that hormonal birth control decimates your intestinal microflora which causes havoc in your body and cause issues for your future children. I wish someone had told me that.

    momof2groks wrote on January 19th, 2012
  4. Thanks for the article, and thanks to all the readers for sharing their experience! I’ve been wanting to go off Nuvaring for some time, and get off hormones for good, but didn’t realize there was a non-hormone device available (paraguard). I saw a neurologist 6 months ago about ocular migraines I was getting more and more frequently, and she said the one thing I should do is go off Nuvaring, that she has seen many neurological problems arise from its use. After reading all of this, I’m calling my Dr. tomorrow.

    jb wrote on January 19th, 2012
  5. This is really interesting, especially as Kelly the Kitchen Kop wrote about this recently.

    In the comments at the post, “Dangers of the Birth Control Pill“, a reader named Sharon replied to another commenter who questioned the safety of tubal ligations:

    “Having your tubes tied can cause serious hormonal disruptions in your body. It will increase fibroids, cause an enlarged uterus, heavy monthly bleeding, and the need for a hysterectomy. I did not know this before it was done. If I had known we would not have decided to do this.”
    Some food for thought for those thinking of doing that. This post is not a judgment on your decision. Just be aware of this information and share it with others so they can be informed about all the risks before moving forward. Do not use this information to beat yourself up over what you didn’t know until now!

    Anita wrote on January 19th, 2012
    • Anita,

      Thanks for the caveat about not “beating” ourselves up :-). A good reminder.

      Most of us – maybe all of us – have tried to become informed, to make sound decisions, and all while under some degree of duress.

      Especially before the advent of the Internet as a public source of information and support, we were often at a loss as to where to turn for sound advice. We wanted to trust our doctors’ advice – but look how unhelpful that often proves to be. So, we do the best that we can at the time and sometimes if we had it to do over we would do it the same way again.

      Anyway, what you are referring to is PTLS – Post Tubal Ligation Syndrome. There are now discussion groups, message boards, website, etc. on this topic. From what I read, it seems that how women respond to the ligation – as well as to the reversal process – is similar to how women respond to hormonal interventions – lots of variation in response from good to bad.

      In my own case, I suspected at the time – mid/late 80’s – that my symptoms were at least in part related to my TL, but of course that possibility was denied by several doctors. I had even asked about what effects that ligation might have on my body before making the decision (early ’80’s). Again, multiple doctors poo-pooed my concerns & questions – some of which are now the basis for the major hypotheses about what causes PTLS.

      And, I gotta tell you that at age 59 I am pretty fed up with patronizing, head-patting, dismissive, disrespectful, and down right dishonest doctors! And, that refers to most of the medical doctors that I have seen over my lifetime – and all that even given that I am a highly educated (former) research scientist myself. Even the “good ones” are misinformed on at least some topics, IMO.

      Now I fully avail myself of multiple informational resources and am fully armed to the teeth as my own advocate. And I STILL find that medicine is a Grand Experiment. What works for many others may or may not work for me and vice versa.

      My daughter chose the Paragard IUD over a TL, and I am glad that she did. But how will we feel if she ends up one of the small number of women who have a perforated uterus or sepsis or any other serious side effect?

      The bottom line is that there are NO guarantees in life. EVERYTHING we choose to do as well as choose not to do carries some degree of risk. The best that we can hope for is to play the odds in our favor and to minimize the overall risk.

      As the old saying goes, the only thing certain is life is death and taxes. I like Mark’s “new” saying best – “Live Long – Drop Dead!” If I manage to achieve that – and also to maximize my quality of life along the way – then I think that is success! So far, on the balance I am succeeding.

      rrustad wrote on January 20th, 2012
  6. Right. After reading this article and every comment I am more confused than ever. It seems that everyone reacts differently to various forms of birth control, what works best for one does not work for others and there are simply too many moving parts to diagnose and prescribe the ‘right’ solution.

    My situation? I am in a committed relationship with my partner, have been primal for almost 2 years, have moved from condoms to the morning after pill once (oops), to the pill (no issues on the pill, other than I stopped menstruating for a few months, also likely due to increased training program and low body fat), to Implanon as I wanted a set-and-forget type solution while we went traveling for 12 months. I see children in my future though definitely not for the next few years at least, and I need a solution. Implanon was a great practical solution at first, though disastrous for my emotional and mental well-being, (weight gain, irregular heavy cycles, still some acne and I am in tears all the time and am completely aware that I am not myself, so much so that it frightens me and my poor partner as well).

    We’ve made the decision to remove the Implanon but honestly, I have no idea what we are going to do now. I’m leaning towards going on a low-dose pill. What I think people need to see on this subject is to have some of this data collected, a survey where the results may help point people in similar circumstances in the right direction. In other words, thanks for the post and the comments but… what now?

    I am sick of experimenting with my body and I know there are women and their partners who want to help, properly help, to at least limit the experimentation to a case of what is ‘most likely’ going to work for each person based on their circumstances. I frankly don’t care how successful some claim natural methods to be, it’s still freaks me out and as primal as I am, I want to find the most successful medical solution with the least impact on my health, so that I can continue to enjoy sex and not be fearful of falling pregnant (among other side affects).

    I know one thing for sure and that is that I cannot trust my doctor! Mark, please help us crowd-source the solution!

    lyndal wrote on January 19th, 2012
    • lyndal, as several others have said, I recommend you read the book “Taking Charge of Your Fertility.” Even if you decide not to go with a natural method, I think you might find the information very empowering. You will certainly better understand how your body works! :-)

      Allison wrote on January 20th, 2012
      • Good point, thanks. Anything that will help understand such a complicated thing is an advantage!

        lyndal wrote on January 20th, 2012
    • I’d highly recommend looking into Paraguard, the copper IUD.

      Eryn wrote on January 20th, 2012
      • I will do a bit of research on this (or the equivalent brand in AU) as previously I’d only heard of Mirena. Anyone had any issues with your partner being able to feel it? There seem to be some mixed responses on that subject.

        lyndal wrote on January 21st, 2012
  7. If grains were introduced 10,000 years ago and mankind has not yet adapted, what of “the pill”. Certainly it is not part of a “primal blueprint”. This comment is not based on a moral issue. It’s just not nice to mess with mother nature. Touchy topic for sure. Nice PC blog.

    David wrote on January 19th, 2012
  8. I took the pill for several years, but stopped because I believe that it gave me depression. I also gained weight while on the pill, suffered from mood swings, and had bad gastrointestinal issues. Me and the pill just weren’t meant to be. When I came off of it I immediately noticed an improvement in my mood and gut issues. I’ve been hearing of a male ‘pill’ with less side effects but I don’t think it’s available yet. Still in the works. What are your thoughts if something like this becomes available???

    Sarah wrote on January 19th, 2012
  9. From a Male’s point, (pardon the future pun)I hope they’ve improved the Copper IUD since I was dating. That pesky cord that’s attached, kept stabbing “John Thomas” in the face (not pleasant). On seperate occasions, (with different girlfriends) we visited the Doctor and he showed me the cord in situ. After the first “hug” with any future girlfriend, I could tell her if she had an IUD or not.

    Another Paul wrote on January 19th, 2012
    • poking of the peen is usually because the strings are not curled up around the cervix. Ive had a Paragard (the non hormonal IUD) for 5 years and the ex said he was poked once and that was fairly soon after insertion of the IUD. The strings do soften up after a time and will curl up towards the cervix and the ends of the string will be at the cervix and not facing downward to stab. I have warned partners since that I do have an IUD and if they happen to feel something that feels like fishing line when they are poking around at my cervix to not be alarmed.

      Yvette wrote on January 20th, 2012
      • The strings should wrap around the cervix, mine has never been a problem.

        Eryn wrote on January 20th, 2012
      • …you lost me at ‘fishing line’, lmao

        Jenell wrote on August 30th, 2012
        • and also ‘wrap around the cervix’…I am SO not sold on IUDs…

          Jenell wrote on August 30th, 2012
  10. This is such a hot button issue for me. I went on the pill at 16 because I already had very painful, irregular periods. I started at 10 years old, so my ovaries are quite exhausted. I spent 14 years on birth control, everything from ortho tricyclen, mini pills, seasonique/seasonale, taking it continuously to not have a period. to taking a low dose pill to just have the bare minimum. I always have a menstrual migraine, pill or not, but the pill made it SO MUCH WORSE. I had a terrible time and had to keep switching, but I would be damned if I got pregnant before I wanted to. I turned 30 and wanted to get pregnant so I went off the pill. we tried for 2 years, the first year I knew something was wrong, but my doc refused to check anything. When she did do bloodwork and an ultrasound, she categorically denied that I had PCOS and put me on clomid. I did 4 months of that before going to a specialist. In 5 minutes she diagnosed me with PCOS. Aside from hormonal issues and PCOS, when they did a laparoscopy, they found that my tubes are mangled, making conception without IVF nearly impossible (5%). So all that birth control for nothing, and my hormones are so screwed! Also, endometriosis runs in my family, all the women had hysterectomies in their 40s or died of uterine/endometrial cancer, so I’ve been on the watch for it. When they went in for the lap, my doc said she saw endo, BUT LEFT IT IN. Great.

    Fast forward 3 years, we adoped a beautiful daughter, I’ve been paleo for 8 months, and the only thing that hasn’t resolved itself is the endo. I went to my OB (new) and she first gave me low dose pills to try, but they increased both my blood sugar and blood pressure so dramatically that I couldn’t take them. I started paleo around then and really wanted to give it a chance. This December, after 6 months of really clean eating the 7 days of in bed, on pain killers, crying, going to urgent care or the ER and I was just done. I went to have Mirena put in because others I know have had success with it. Worst. Decision. Ever. I had pain immediately and it never went away. I lasted 12 days with it in, even went to the ER to make sure my uterus wasn’t perforated, but my body was rejecting it with one long constant contraction. So I had it taken out, but my doc basically thought I was crazy and said I couldn’t be in that much pain. She reluctantly took it out and handed me more b/c samples to take. She said no more pain killers, but I could do Depo or Lupron to put me into chemical menopause. Seriously???? She wouldn’t even discuss surgical options to see the severity of my endo or if I had adhesions, and refused to help my pain without hormonal intervention. I spent the next 2 weeks in bed on whatever I could take, rationing pain meds and hoping that my cycle would end and I would be able to start fresh and be without pain for just even a few days.

    Anyway, I have a very jaded outlook on hormonal treatments. After doing fertility drugs and having a horrible time, I will never do anything to alter my hormones dramatically again. Food got me into this mess, and using hormonal methods to fix it is just covering up the problem. Food is definitely the way to control this, because hormonal suppression when it gets to the point of Depo or Lupron is something that can really screw up your body. Unfortunately, my pain has gotten to a level now that I cannot handle it anymore, and am going to an endometrial specialist tomorrow to discuss excision. I’m just generally pissed that my doctor would so casually offer depo provera or lupron without discussing what I know to be dramatic and long lasting side effects. It is not casual treatment. Granted, neither is surgery, but at least with surgery you get the caveats. She was literally in the room with the syringe as if I would just say “oh yeah, i’m in the worst pain of my life, do what you want with that.” For me, hormonal treatment of that level just messes with so many other parts of your body, and your life, it’s not worth it.

    Jen wrote on January 19th, 2012
  11. Is there nothing you don’t address? I have been following your blog for years and have only commented twice, when I was especially impressed that you read my mind. You cover so many important health topic that most people wouldn’t even bother to touch. I am now an IUD user and believer at being on an oral contraceptive for 14 years. I have seen serious longterm implications from my oral contraceptives. I, too, would not take it off the table as it is one of the only truly reliable forms of birth control, but it is so important to make an informed decision

    Amy wrote on January 19th, 2012
  12. I feel like the lack of information related to thyroid function and the pill is the biggest problem with prescriptions. I started on the pill to treat a condition that really should have been dealt with by addressing the thyroid directly. Instead, I probably ended up further causing reduced thyroid function during the year I was on the pill. I’m off now and waiting to see what the changes are. Do your research ladies. Your body isn’t some kind of experimental lab to throw chemicals at.

    Ruby wrote on January 19th, 2012
  13. Thank you for this post. I have never commented on your site before, though read gratefully. I just want to offer this: I am one of the statistics you refer to. I am a breast cancer survivor whose only risk factor was taking the pill in my pre-marriage years. It was actually my GP who suggested the pill (for difficult periods, etc) and I stupidly didn’t look further. When I was diagnosed with cancer, my oncologist said, “There is such a high risk of breast cancer in women who have used oral contraceptives. It’s most everyone I see.” If you’re on the pill, get off it. I say this with the conviction that everyone on this site tells people to get off sugar or grains. Like with them, you may not see obvious or immediate symptoms (or you may) but it is harming you. You may say that you’re OK with a ‘cancer risk’ but, trust me, once you have cancer you will not be OK with it. I say this out of concern and care for every woman out there, not out of judgement.

    Lauren wrote on January 19th, 2012
    • Hi Lauren, my story is very similar to yours. I’m also a breast cancer survivor. At my first oncology appointment I was asked first about any family history (none) then second, had I taken the oral contraceptive pill? When I replied yes, she gave me a kind of resigned nod and commented how common a history of contraceptive pill use is amongst those diagnosed later with bc.

      I only took it for about 5yrs and that was 20yrs ago, but I sure regret it and the chaos it created with my hormones.
      I second your urging for women to strongly reconsider their pill use. As well as checking and maintaining vitamin D and iodine levels.

      Best wishes to you Lauren and thank you Mark for opening discussion on such an important topic

      Caroline wrote on January 20th, 2012
  14. I don’t know if it’s been mentioned yet (I don’t have the time to read through 4 pages of comments):

    The Fertility Awareness Method (FAM) as described by Toni Weschler in her book ‘Taking Charge of Your Fertility’ is a fantastic way to naturally monitor your own fertility.

    It can be used for birth control as well as pregnancy achievement, and it is NOT the ‘Rhythm method’. It is as reliable and effective as hormonal contraception, but has no side effects.

    I was on the pill/nuvaring for 10 years, and would highly recommend FAM as a means of natural birth control.

    Heather wrote on January 20th, 2012
  15. This post is so timely – I was searching through it last week to see what the take on hormonal contraceptives was.
    I’ve been on and off the pill most of my life. I’ve suffered from Chronic Fatigue Syndrome for about 3 years now and was beginning to see some real result eating Primally – and off the Pill – in the last 6 months.

    I recently had the mirena fitted to control heavy bleeding and lower back pain which started up again after the birth of my second child (also about 3 years back) Since I’ve had it fitted I’ve got the same foggy, drugged up tiredness back again. It’s not listed as a side effect – but I’m starting to be unable to ignore the fact I only make progress with the CFS when I’m off all medication.

    Now I’m in 2 minds whether to endure the 6 months everyone says I should do to let side effects settle down, or find something else.
    Oh – and if my libido was low with the Pill , it’s now a flat as a pancake. On that score my husband thinks the Mirena is a very effective contraceptive!

    whalo wrote on January 20th, 2012
  16. Oh…. how inconveniently well timed, Mark you’ve annoyed me, I didn’t want to look at this! I’m going to share a quick summary in case it helps someone (and then I guess I’ll go help myself). I am 27 and I have never had children. I started taking the combined pill just after I turned 16 (thanks mum!) and although I already had some little boobs I was only just beginning to truly bloom into womanhood so I cannot say if my hourglass figure is due to the pill or nature (vanity problem here: what happens when I stop? Love my shape and I don’t want to lose my nice boobs!!). I should point out that I had anorexia type illness prior to taking the pill so that is another confounding factor. The pill did take care of my terrible acne which made me the target of bullies in school, and the crippling (I mean crippling, on the floor gasping) monthly cramps so these are positives. I have struggled with depression / anxiety and lots of milia (fatty spots on face) a few times due to particular brands not suiting me. Most recently (early 2011) my normal pill that I’d been taking for years was in short supply due to production problems and the substitute made me go MENTAL. I was signed off work for a fortnight so I could climb out of the emotional dungeon I fell into. So basically only one ratio of hormones in the world allows me to feel normal. Secondly, the pill has caused cervical erosion which causes symptoms such as bleeding after sex. In 2008 I had to have my cervix cauterised, which was a bit grim, but about 6 months later the intermittent bleeding started again. Now it’s fairly constant causing slightly to very bloodstained discharge daily (sincere apologies to the squeamish) but I have no idea if the ‘damage is done’ or if coming off the pill will stop it. I also have controlled IBS so I wonder what will happen with that if I come off.
    I will also throw in there that during the odd short month where I have been pill free my cellulite vanished.
    Oh, and my libido has virtually vanished but I don’t really know what will happen if it came back since my partner has a uncommonly low sex drive. So in summary, the combined pill can cause even more problems than Mark covered above, but it did help in some areas. I have no idea what to do.

    Charlotte wrote on January 20th, 2012
    • Charlotte,
      I am so relieved to read this. Last year, I also got to experience the joy of silver nitrate cauterization for the exact same reasons. I never imagined the pill as a possible cause because I’ve been on it since my teens. It’s such a relief to know I’m not the only one who has experienced that.

      Randi wrote on January 20th, 2012
      • Oh Randi I think it is so common but no one talks about it! You can PM me any time if you want to talk about it. Recovering from the procedure is pretty grotty. My mum had to come off the pill before she had me due to erosion and that was in the 80’s I guess. I was terrified at first, I thought something terrible was wrong. I wish a Dr had told me about this before I started taking it. In fact, if I remember correctly, he just sighed and wrote me a presciption, signed it and said ‘try this’. End of appointment.

        Charlotte wrote on January 20th, 2012
        • I’d love to learn more about what you’ve been through. I’ve been to several doctors and been tested for everything. Not one doctor ever even mentioned that the pill could contribute to this. They keep telling me nothing is technically wrong, but obviously something is. The bleeding is horrible and even came back a few months after cauterization. How do I send a pm?

          Randi wrote on January 22nd, 2012
        • Oops sorry Randi, didn’t think that one through. If you go to Forum; Community; Members List and then tab through the alphabet, my user name is ‘Nibbler’ and you can leave me a message on my page x

          Charlotte wrote on January 22nd, 2012
  17. Charlotte I’m in the exact same boat as u! I’m 35, went on pill at 17 (with NO probs, all benefits) had the odd 12-18mths off it during baby making/preg/breastfeeding time 2kids. Started primal (slowly but surely) about a yr ago. Came off antidepressants last July and since then have noticed how my body has now gone v different – I’m v emotional, sore breasts, exhausted, v moody before period, even had a few spots too! It’s like my body was in my teens prior to the pill…. I wonder if its cos since goin Primal, my body is now hormonally adapted so now the pill gives me like “anti-symptoms”?! Like my body has reversed somewhat?! I also take into consideration that my body has changed naturally over 18yrs (really that long?!) and I’ve had 2kids which prob changes ur hormones too? It’s also massively affected my libido too :(

    But like u, I’m scared of coming off and facing mths of possibly horrible physical/mental symptoms while my body adapts and the uncertainty all that time if not knowing if it is actually adapting or is there for good – aagghh! I had this a bit in the few mths after I’d finished bf my last baby and its what prompted me to go back on pill even tho I wasn’t entirely happy to do so but when dealing with a baby/young toddler I didn’t have the strength to “try it out”….

    I think I prob will give it a go but do worry about being v hormonal when I’m also currently feeling a bit depressed too – or maybe coming off will cure both….eventually?!

    H x

    HelenC UK wrote on January 20th, 2012
    • Well Helen I have been reading about this all day… I have just spoken to my partner and he says we should try condoms for a bit instead. I’ve made an appointment with my GP to see what other options I have. So maybe this time next week I could be hormone free… God this is liberating!!
      I always believed that children change your hormones although I’ve never had any myself. I think if you understand your body and your moods, and your partner is going to be gentle with you and support you when you come off, it’s worth a go, surely? You can always try something else if you feel a bit funny. Good luck, I’d love to hear how you get on. x

      Charlotte wrote on January 20th, 2012
  18. Incredible that this article popped up just days after a discussion with my parents about whether I should go on the pill or not!

    I’m 20 and suffered body confidence and weight/eating issues during my teens, totally put off the pill because I was scared I’d gain weight. Now I’m Primal and don’t look back – I feel incredible!

    I suspect I have PCOS – all the symptoms are there, including extremely painful and irregular periods. This sparked the conversation with Mum and Dad after two days rolling around in agony. I still refuse to take the pill. I try to avoid any medication – even paracetamol, despite the agony. Why would I want to disrupt my body when there’s clearly something it’s already trying to handle? I’m hoping that the more I commit to the Primal lifestyle and the healthier my body becomes, my periods will become better and more manageable. I’d rather use condoms than risk damaging my body!

    Lucy wrote on January 20th, 2012
  19. Well, I don’t do the pill, but I am on the Depo Provera Injection, and it is hormonal. I gained a lot of weight after I started doing it, but that was the only side effect I really noticed.

    My grandmother told me (at 17) when I wanted to start spending the weekends at my BFs house I had to be on the pill but the doctor reccomended the shot and the only thing she told me is “it’s the most effective form on the market and if you get the injection now you’ll be safe right away you can even have sexual intercourse tonight” she never mentioned any risks or anything. So I just did it. My (now husband) and I don’t ever want kids but in my state you have to be a certian age or have a certian number of children already before they will steralize you so I guess I will just keep on the shot for now. FYI I’m 24 this year and I’ve been on it since I was 17.

    Amanda wrote on January 20th, 2012
    • I really recommend the copper IUD! See some earlier comments about it, lots of women have chimed in. :)

      Eryn wrote on January 20th, 2012
  20. Mark,
    Thank you so much for this article. I have been on and off(mostly on) HBC for the past 28 years. I went off last week due to BP issues and my older sisters having breast cancer. It’s not worth the risk. Every woman needs to know the risk factors of any BC method and many times doctors do not know it or are in with a pharmacuetical company to push the latest pill. Women need to become detectives just to become informed and make the right choices for them.
    I’m curious to see what happens to my BP and LDL levels after being off HBC.
    Again.. many thanks for the article and all the great information you keep putting out there. Primal Blueprint is the greatest thing that has ever happened to me.

    Jeri wrote on January 20th, 2012
  21. I hate having my period. We have our one and only child, and that’s it for us, so I see no pint in suffering through the monthly woes. I take Seasonal, and as soon as I can find a doctor in Canada who knows if that ‘once a year period’ pill is available, I am getting it. I hate the periods this much. They are pointless and messy.

    leida wrote on January 20th, 2012
  22. To the ladies posting above who are afraid that coming off the pill will eliminate the benefits they’ve seen:

    I had menorhaggia; buckets of blood and crippling pains every month. Coming off the pill and being paleo/primal has solved that. My periods are SO much lighter, pain-free, and barely noticeable now. I understand your fear but I would urge you to give your body some time off BCP to regulate and see how your body works now. No doubt it has changed as your diet has changed.

    Heather wrote on January 20th, 2012
  23. I think birth control was an amazing invention. I am thankful I grew up during a time where it was inexpensive and readily available.
    I was on the pill or some form of hormonal birth control for six years. Looking back on it now, I had incredibly mood swings. Highs and lows like you wouldn’t believe. Although I wouldn’t go back and not take birth control, it is interesting to look back on the effects that are very likely related to the birth control. I was young, didn’t know any different and really really didn’t want a baby but really, really wanted to have sex. I married my husband 4 years ago and birth control hasn’t entered my body. My moods are much smoother (ep. after eating paleo) and my lovely husband was smart enough to get a vasectomy. Of course if you want kids this shouldn’t be the route for you but, if you don’t want kids I highly recommend it! Talk to your doctor if you think you are feeling funny on your birth control. It might not just be you. There are so many options and one might work very well for you and another might make you feel horrific. You have options, don’t settle.

    vanc wrote on January 20th, 2012
  24. Anything that doctors shove at me as if it’s totally harmless sets of my alarm bells. The fact that “breast cancer” isn’t even mentioned by gynecologists as a possible side effect of the pill is a scandal. People are figuring out on their own that there is a link between birth control pills and breast cancer. I know three women who got very dangerous breast cancers in their 30s, and all three were on the pill. Upon their diagnoses, each one was told to go off it immediately. That fact alone should give pause to gynecologist’s, but it doesn’t.

    kt wrote on January 20th, 2012
  25. I got on birth control at age 14 due to excruciating menstrual cramps. I stayed on birth control until about a year and a half ago (age 24). I wanted to give my body a break and also try and get some libido back. I was hoping that since I was older maybe my cramps would not be as bad. NOPE…they are horrendous again. Also, my PMS is raging for an entire week before my period. It is only getting worse. I have tried EVERY herbal/home remedy to try and fix this (Krill oil, Magnesium, ect.) but I cannot. I must be one of those women who need the pill to help balance a screwed an already screwed up system. :( I have two samples of Loestrin24 sitting on my counter that I will try in about 2 weeks. Just hope it all works out again so I don’t have to miss work and life anymore.

    Chel wrote on January 20th, 2012
  26. When I was 16 (nearly 20 years ago) my doctor put me on the pill to decrease acne. It was horrible. Not only did the acne persist, but I gained 10 pounds and became depressed.

    Throughout my 20s I used the copper IUD until it started to weird me out that I had a foreign object in my body.

    Now I use FAM so I know when I’m fertile. We just use a condom on those days. It’s been my favorite form of contraception so far!

    Actually, now we’re trying to get pregnant, so we just ditched the condoms. :)

    Gwen wrote on January 20th, 2012
  27. Hey Ya’ll,

    I just wanted to throw it out there, my wife and I as well as a number of couples we know have use NFP (natural family planning) as a way hold off on having children after being married (we had no money, big debt, tiny apartment, etc).

    I can tell you from our experience and that of our friends, in addition to being both completely natural and very effective (when used right, as in any method), it seemed to put us in better touch with our bodies rather than working against them or circumventing them.

    It also was great for our relationship. Rather than simply taking a pill and being done with it, we had to continually discuss our goals and priorities. I had to really learn to listen to my wife and her concerns about having a baby before we were more secure.

    One thing I love about the Primal Blueprint way of thinking, is that I have cut things out of my life that were artificial and toxic. As a result, I feel so much more in touch with my natural processes and balance. It is now not just a diet but a lifestyle of maintaining that balance. In the same way, it has been great to learn with my wife how to work with her natural cycles of fertility and infertility rather than using artificial means.

    Thanks for all the great info Mark. Grok on ya’ll!


    JonMarc wrote on January 20th, 2012
  28. I was lucky enough to have a gyno that told me “You don’t need the Pill”. A conversation would have been better, and I was unaware of the risks and side-effects. That is, until I got to college and heard the tales of woe and weight-gain. Dilligent use of condoms has gotten me through 10 years of sexy times. I’ll have my tubes tied when I’m done reproducing.


    Turbochaser wrote on January 20th, 2012
  29. I’ve never taken the pill. I started my menses around 14, and it’s been pretty regular–every 28 days since. I’ve been careful, never been pregnant and I don’t regret my choice. However, my GYN has urged me over the years to consider taking the pill to lower my risk of ovarian cancer. To me, with a family history of endometrial, and breast cancers (post menopausal/paternal side)–it was never worth the risk. Granted, ovarian cancer is usually deadly, since most of the symptoms–if there are any–are mild or mimic GI or other issues, and by the time it’s found, it’s too late. Nonetheless, I get pelvic exams routinely, and I’m getting a pelvic ultrasound today, which helps to keep close watch on those dear ovaries. Of course, limited or no dairy and a primal lifestyle (I’m a newbie-sort-of) will likely help. Lucky for me, I stopped drinking milk when I was 14.

    elle.k wrote on January 20th, 2012
  30. I recently went off the pill after being on it 7 years. I used it due to insomnia & acne, symptoms I developed beginning in my late 20s probably from dieting and eating low fat. While I was happy to get rid of my acne (I searched and tried to find the cause of it and never was able to– that is how broken the U.S. health & wellness culture is), the mood swings and increase in body fat got on my nerves after a few years. My diet has been semi primal since 2000 so I didn’t gain like a ton of weight on it & also worked out some mid 2000s but I got peri symptoms on it anyway, have been getting up to pee at night since 2008. The sad thing is, I need help hormonally. That’s just my situation being very small, petite & ectomorphic with breast tissue- I thrive on estrogen. Am currently using a higher cholesterol diet, exercise & a small amount of otc bhrt to treat. But most women aren’t so lucky- they don’t understand that a low cholesterol diet & lack of exercise is sending them in to early peri. So when the symptoms show up they read a book, go on a forum, and end up on the pill. It’s really pretty sad.

    kathy wrote on January 20th, 2012
  31. Thank you so much for posting this! I have been looking forward to your opinion on hormonal birth control for some time. It’s been quite the conundrum as my boyfriend and i absolutely do not want children right now, but I hate thinking that I’m pumping some sort of hormone in my body tha could cause cancer (part of the reason I went to Mirena).

    Reen wrote on January 20th, 2012
  32. you should also mention what happens when you go off the pill–what very few dctors will ever discuss with women: messed up hormones and lack of period. Issues because the lack of period can contibute to bone loss, massive hormonal mood shifts and general uncertainty regarding ones body.
    For me it was the devil drug and not one I will ever recommend to my daughters or their friends

    GeorgiaBE wrote on January 20th, 2012
    • What was your experience coming off it, if you don’t mind sharing? This is what makes me kind of nervous despite clear evidence that I need to at least try it!

      Charlotte wrote on January 20th, 2012
      • Charlotte, when I went off it, my cycles took a while to normalize, but my crazy mood swings that I was having from being on the pill, went away immediately. I was happier from the first week. I think it all depends on your body’s relationship with the pill in the first place.

        Angela wrote on January 21st, 2012
      • Just wanted to say, I was depressed while on the pill, but not knowing any better, I thought I was just a really negative person and tried to accept myself. After going off the pill, it was like a cloud had lifted. Emotionally I felt so “normal” again, so balanced, in a way that is hard to describe. You just have to try it.

        I don’t know if you suffer from this or anything else. I also got my libido back (after decades thinking it was just normal to feel kind of blah about sex). I have a feeling it never really got fully back to what it could have been though. I was so young when I started, now I will never quite know.

        Anna wrote on January 21st, 2012
  33. Coming off the Pill ruined my life. I gained so much weight sooo fast. Im talking 30 plus pounds. No change in diet or exercise.
    The cramping was unbearable and the bleeding was tremendously heavy. 2 periods a month.
    I have a progesterone deficiency so without the pill I’m an overweight estrogen dominant mess.

    Spanish Clementine wrote on January 20th, 2012
  34. I am so thrilled to see this!

    I’ve been primal for only 3 weeks, but during that time I went off the pill for only the second time in 11 years.

    For me, the pill was a godsend to help control my PCOS. However, I’ve always wanted to find a way to be ‘normal’ without the pill. I’ve been asymptomatic of PCOS since losing a substantial amount of weight a few years ago. I’m now 37 and hoping that having children is still in my future.

    One month off and I got my period right on the dot on 28 days! Let’s hope it stays that way.

    I do know that, if my PCOS symptoms start to reappear, that I will most likely get back on the pill, but I appreciate all the information that you have offered here, thank you!

    Gretchen wrote on January 20th, 2012
  35. My 20 year old daughter just suffered a massive pulmonary embolism which led to her organs being deprived of enough oxygen to result in multiple organ damage. Her heart and liver sustained damage and she went into acute kidney failure. After a couple of weeks on dialysis she recovered kidney function but it was discovered that she was allergic to heparin and that she has heparin induced thrombocytopenia. The doctors think the blood clots may be because she was on the pill but say they can’t determine that for sure. Her recovery will be long, I’m just grateful it didn’t cost her her life. Thanks for the very good article, Mark. It is such an important decision for women and the thinking that the rare side effects can’t happen to them can’t be the deciding factor. The risks are real and happen to real people.

    Kim wrote on January 20th, 2012
  36. When I was seventeen I went on a campaign to learn as much as I could about my various contraception options. I was frustrated, again and again, by the blank looks and subsequent pushing of cheerful pamphlets I got from medical professionals. Nobody could tell me anything useful. I was asking, “so this stuff makes my body think I’m pregnant and therefore renders me temporarily infertile? What does that actually mean, biochemically, in the context of my body? What else will happen?”

    I was told there were no side effects that wouldn’t “even out” eventually. I wasn’t convinced but I took the DepoProvera shot after a lot of consideration, as a kind of self-experimentation.

    Worst three months of my life. I remember very little of it, besides a lot of bleeding and a lot of crying on the floor.

    Anyway, I’m 21 years old now and haven’t tried anything since. Still not pregnant. Guess what? Condoms work! Then a woman I nanny for was kind enough to explain how my fertility cycle ACTUALLY WORKS, which I realized nobody had bothered to tell me about, not even in Grade 12 Biology. It was always this vague mystery, oh I guess there’s an egg and some ovaries and whatever. What, you mean I’m not gonna have a baby every time I have unprotected sex? What, you mean it’s not entirely random and unpredictable? It almost felt as though all the planned parenthood courses, youth clinics and puberty books were discouraged from revealing the reality: That women have been having unprotected sex for hundreds of thousands of years, and many of them knew how to avoid unwanted pregnancies until that information was lost or suppressed. That, if you understand how your own body works, you are empowered to make your own choices.

    I also read somewhere to do with GAPS that the Pill wipes out your gut bacteria, leaving you more susceptible to illness, less fertile, and more likely to bear children with abnormal gut flora, leading to GAPS (Gut and Psychology Syndrome) conditions such as autism, ADD/ADHD, allergies, asthma, etc. Hmm… I need to research this further, but given the timing of the “unveiling” of the Pill and the recent (and ever-climbing) explosion in rates of diagnosed children (one in 10 has a GAPS related diagnosis)…I’m not entirely unconvinced. <— here's some info on the natural fertility awareness method. There's lots of info out there if you know what to look for.

    Oh, and sex is positively more amazing when you know your body inside and out. Just saying.

    Kesia wrote on January 20th, 2012
  37. The trouble with the pill – is you really need to know what your OWN hormone levels are like before adding in more. Some people don’t produce enough progesterone and then if they take a pill high is oestrogen – it will throw you out of kilter. I suffered bad PMS and was crazy and depressed half of every month – took me a loong time to cotton on to it being the B.C. pills. Much calmer coming off them. Hard to find alternatives though. Copper IUD can cause woman trouble too…you really have to be prepared to listen closely to your own body’s needs. :)

    Tara wrote on January 20th, 2012
  38. The very, very slight decrease in ovarian cancer is greatly outweighed by the increase risk of breast,cervical,and liver cancer – by over 200%. I’ve never seen a woman not have a side effect to a BCP – they just may not realize it’s what is causing their headache, blood sugar handing problem, sleep problem, etc…

    Dr. Gangemi wrote on January 20th, 2012
  39. To anyone curious about the copper IUD, it has no hormones – it works by creating a hostile environment for sperm. while there is a chance for copper toxicity (not to mention the chance you may have a copper allergy), i found it is the best method for me. if I stay (mostly) primal with my diet and/or supplement with zinc when I slip up, I’ve been able to avoid a lot of the reported side effects. I’d recommend anyone interested visit this site: which contains the experiences of women worldwide who have an IUD.
    After the nightmare of hormonal birth control, this is the most effective non hormonal method for me barring sterilization (which doctors won’t do yet because of my age).

    Ashley S wrote on January 20th, 2012
    • IUDs should be banned. It’s a foreign device in a womans body. Though true copper toxicities are rare, mineral imbalances are prevalent especially those that copper must create a balance with – namely iron, molybdenum, zinc, & manganese. Additionally, those copper IUDs influence the copper bile salts that are made in the liver & stored in the gallbladder. So gallbladder problems are not uncommon. I once saw a woman who had an IUD in and then her gallbladder removed 6 months later – not a coincidence.
      Low back pain, hip problems, and other pelvic and low extremities problems are also common with an IUD. I won’t treat a woman with an IUD until it’s removed; it’s a guarantee it’s causing some, if not all of her problems. One of the very few times I won’t see someone until they deal with an issue beforehand. Of course the hormonal IUDs even worse than the copper ones.

      Dr Steve Gangemi wrote on January 22nd, 2012
      • I’ve never heard anything about the copper IUD and gallbladder problems. Could you provide a source of more information, please?

        Also, I’m really surprised to see that an IUD makes the list of reasons to refuse to see someone. I researched them pretty extensively before I got mine and everything I found indicated that they were relatively harmless, especially compared to the risks of other forms of birth control or an unintended pregnancy. I’d be interested to see the research that shows otherwise.

        Gretchen wrote on January 22nd, 2012
        • I’m not sure what has been done in regards to research, but like all drug research (and an IUD should be considered as such) there is always plenty of research to substantiate benefits and risks (or lack thereof). My “source” is my own professional experience over 14 years with treating women with hormonal problems,as well as many other health issues. Not once have I seen a woman not have a problem with her IUD. No, you probably won’t see in the literature a link between the copper and gallbladder problem. Even the patient I saw won’t be classified as a link between the two. Copper, though, as a strong affinity with estrogen, and that is why more women than men have gallbladder problems – due to this estrogen/copper relationship. More estrogen = more copper accumulation.
          BTW – an IUD is the only thing on “the list” that I won’t see a woman until she removes it. The reason is because if they’re seeing me for some health concern, the IUD is going to play a part. It just always will since it’s constantly irritating the uterine tissue. It’s like putting a little stone under your foot and even if you don’t feel it there after some time, it’s going to change your posture, gait, muscle balance, etc.

          Dr. Gangemi wrote on January 22nd, 2012
  40. I wish I would’ve been informed about the gastrointestinal effects of the pill years ago. I started taking the pill when I was 21 years old within about 2 months I had gained 10 pounds. I seemed to never really full or satiated. I also had crazy mood swings, worse than any natural hormonal mood swings I had ever experienced. I went to the doctor and explained my symptoms, her suggestion was a different brand of pill. Fast forward 6 months, I was 35 pounds heavier, depressed, and began having extreme acid reflux and bloating after every meal. I was an avid runner before the pill, but my GERD was so painful I couldn’t even bend over to tie my shoes without stomach acid rushing up my esophagus. I had never had anything like this before, I always though heartburn was just an ‘old people thing’. I went to the doctor for my stomach problems and was put on Prilosec. I kept taking both medications and still had chronic GERD, one time I even went to ER because I had stomach acid coming out of my nose! The diagnosis that time was to start taking 2 Prilosec a day instead of the usual 1. Over the next 2 years I had dozens of blood tests, co-pays, expensive medications, and even an ultrasound of my gallbladder, and I gained 20 more pounds. I was between a rock and a hard place, eating made me fat and gave me heartburn and not eating gave me more heartburn! My last straw was when the doctor wanted to do an endoscopy (a $1200 procedure NOT covered by my insurance due to my young age) and when I told the Dr I have anxiety about going under anesthesia his only response was ‘Don’t worry, I’ll give you some Valium!”. That was the moment I gave up on my doctors completely. I researched the side effects of Prilosec and the Pill and immediately stopped taking both of them. It took a little over a year to heal my GERD and I’m still trying to lose the weight I gained during that time. I had to take TONS of probiotics, I did a Candida cleanse for 4 weeks, and had 5 colonics over the course of that year. Those things combined with primal eating cured my GERD. I haven’t had any symptoms in almost 9 months now and I finally feel like a normal person again. I wish I would’ve known then how dangerous the Pill can be for some people, and I wish that my doctors would have been more willing to consider the pill was the cause of the problems. It was almost as though they didn’t want to admit that there could be side effects like I was experiencing at the time.

    Ashley wrote on January 20th, 2012

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