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. I was on the pill for 3 years, then off, then on for 3 more years. Both times it made me irrational, with mood swings, lost sex drive, and lost physical energy. It also reduced my pms and the length of my periods, but that’s not really worth it. When I got off the pill, my doctor told me I had PCOS, and the only way to “fix” it was to go back on it. I noticed there are a few similar stories about PCOS on this thread….

    Medical studies have shown that the pill reduces women’s ability to build muscle and reduces sex drive. The way it regulates hormones causes our testosterone to get unbalanced, and screws with our natural production of hormones, which for women is a delicate balance. I’m sure this is why PCOS happens afterwards.

    The pill may have been a great political invention at the time, but we don’t need it for political freedom anymore, so it’s time to look at what it’s doing to millions of women around the wold today, medically and psychologically. I know I will never take it again.

    Angela wrote on January 21st, 2012
    • I know I’m replying to a three year old thread, but your comment really struck me. I first went on the pill at 21, and I had zero hormonal problems before then. Perfectly clear skin all my life, annoying PMS, but not unbearable, and very regular periods. I decided to go off the pill at 26, when a long-term relationship ended, and suddenly I had PCOS. My hormones were a mess, my skin was incredibly oily, I had hirsutism, oily dandruff, cystic acne and gained 20 pounds.

      Every doctor told me I would have developed PCOS anyway, and the pill had actually kept it at bay for all those years. But reading so many similar stories here, I have to wonder if the pill is what caused this hormonal imbalance.

      I’m now 35, and doctors have put me back on various forms of bcp over the years, each time with worse effects. The most recent time I became violently ill and stopped it after 3 days. Reading through the stories in this post has convinced me never to try it again. I may have to deal with the after effects of being on the pill for years, but I believe I can balance my hormones with proper diet, exercise and sleep.

      dee wrote on August 6th, 2015
  2. Oh, and for anyone out there reading this and thinking the pill might help you grow boobs… didn’t make a damn difference on me, and I started taking it at 19.

    Angela wrote on January 21st, 2012
    • Me neither, taking it at 18. I’m smallish, and the thought of hormone-induced boobs doesn’t appeal to me anyway.

      Anna wrote on January 21st, 2012
    • Same here :(

      Mary wrote on January 23rd, 2012
  3. I am 26 and was diagnosed with a mild form of endometriosis when I was 21, and that is the reason I’m on birth control (pain and illness during my period were so extreme I was missing 2 days of school/work every month). Being fully Primal for a few months, I’d like to get off the pill, but I worry that the pain and sickness will come back. Can anyone offer any incite?

    Dawn wrote on January 21st, 2012
  4. What is your thought on the Nuva ring? Is it any better than the pill? What do you think of IUDs?
    Thanks
    Jackie

    jackie wrote on January 21st, 2012
    • My daughter takes this… it was recommended for her (she started at 16) because it is fairly low maintenance and doesn’t impact them the same way the birth control shots do.

      Mary wrote on January 23rd, 2012
  5. There is also a device called the baby-comp/lady comp. It was the option we choose so I could get off the pill since I had been on them since I was 16. basically you take your temperature every morning and it tells you when you are most fertile so you can either avoid having sex those days or use some sort of contrceptive or can help you have a baby. Has worked great for us!

    Tiffany wrote on January 21st, 2012
    • Also called the rhythm method…. My friend is catholic and this is what her priest counseled for her and her husband.

      Mary wrote on January 23rd, 2012
  6. I was taking prenatal vitamins (they had them at the shleter I’m staying at) but stopped because one of the staff told me they have a bit of estrogen in them and it doesn’t have to be printed on the label.

    Animanarchy wrote on January 21st, 2012
  7. Thanks for the timeliness of this post!

    I’ve been trying to get directive from my Endocrinologist, DO, and GYN about coming off of the pill for 8 months with no real directive.

    I decided yesterday to stop on my own. I am hopeful that with being off of the pill, that I will have better digestive function, less inflammation, and better overall health. Hopefully I can get to that point before I start having withdrawal hormone rage, lol

    Melissa wrote on January 21st, 2012
    • Change doctors. No directive from your endo? How lame. The others, well I’ve come not to expect much from them anymore.

      Anna wrote on January 21st, 2012
  8. What about Endometriosis? I have been on the pill for the last 8 years to control my Endometriosis, which has worked quite well.
    I have thought about trying an IUD and talked with my doctor, but after reading about the side effects, I decided against it. But it seems the commenters on this forum have had mostly good luck with the Copper and Mirena IUD’s.
    Any other options for those of us who don’t want to live with full blown Endometriosis?

    Veronica wrote on January 21st, 2012
    • I mentioned this in reply to someone else’s post, but it’s relevant to your question/problem too. Please read about iodine and look for Dr. Jorge Flechas interviews/info. good luck :)

      Wenona wrote on January 21st, 2012
  9. Hi all!

    i wrote this article a couple of years ago on BCP- http://bodyecology.com/articles/dangers_birth_control_pill.php

    it goes into some more detail on the topic. besides being used for contraceptives, they’re being over prescribed for women with Polycystic Ovary Syndrome (PCOS) as a treatment (there is no “cure”).

    I’ve been recommending that friends try this diet as well as look at Body Ecology and WAPF and just use condoms instead of BCP

    lauren wrote on January 21st, 2012
  10. I didn’t read all the comments, and I know this is a possible man’s contraceptive method, but I’m going to mention it anyway (and post the link) – heating of a man’s testicles. http://www.newmalecontraception.org/heat.htm

    Wenona wrote on January 21st, 2012
  11. I against all this pills and other supplements, go netural!

    sk wrote on January 22nd, 2012
  12. Wow, I think this is the most passionate comments section I’ve seen on MDA. I’m in menopause now, but tried oral contraception three separate times, several years apart, and each time became a weeping, depressed mess within a week or two, not to mention gaining at least ten pounds in one cycle. I never stayed on long because I liked my body too well to put it through that, and found the Paragard IUD to be a great option– though I wish I’d actually had the ol’ tubes tied instead, as now the Paragard (my fourth and final IUD) is embedded in my cervix and too risky to yank out. Ten years might be a tad too long to leave a foreign object in the human body.
    Mark, I’d love to see you address the NEXT phase of life: menopause and its endless hot flashes.

    Nancy Mize wrote on January 22nd, 2012
  13. does anyone have good/bad things to say about depo? I’ve been on it for a long time, the only side effect i’ve noticed is decreased libido. I’m generally happy with it, as I used to get really bad cramps/heavy bleeding, now rarely even spot.

    Tracy wrote on January 22nd, 2012
  14. for anyone having heavier periods, you should read about and consider trying apple cider vinegar. I’ve heard it helps lighten period flow, but not sure it would work if the cause is an IUD. Just something to consider.

    Wenona wrote on January 22nd, 2012
  15. Hi, Thanks for this article Mark. I was on birth control, and I think that it hid a lot of inflammation symptoms I was experiencing. My skin went haywire, but since going primal, it got a lot better. I feel better, and much more “primal” in my urges than I felt before. I also think that this paper explained a lot of what I was feeling: http://www.sciencedaily.com/releases/2009/10/091007124358.htm
    Basically, this paper states that “contraceptive methods which alter a woman’s natural hormonal cycles may have an underappreciated impact on choice of partners for both women and men and, possibly, reproductive success.” (Since this site is about evolutionary eating, I thought evolutionary fertility/partner selection might also be relevant.)

    in sum, Ladies: Being on birth control might be hiding some serious problems!!! (with your body, or your partner selection)

    LJ wrote on January 22nd, 2012
  16. my mother had an IUD back in the 70’s and still got pregnant. I was on the pill for about 5 years, initially for an ovarian cyst. I saw it on ultrasound, literally looked like a 3rd ovary, same size and shape. Then I liked the regular, short, light periods. I don’t recall having bad mood swings or any other effects besides the “positive” ones. Maybe gaining weight, retaining water, but that could have been caused by my decision to start eating what I wanted w/o trying to be careful. At the end of the 5 years, I just sort of started skipping days when I was supposed to take them. And decided to stop all the way. That was about 6 years ago and I can’t remember anything other than not having my period for a while, which I didn’t mind at all. Now I’m completely against taking any hormones, whether by pill or shot or implant, etc…maybe very rarely some natural progesterone, definitely not synthetic. If you look at the chemical diagram of estrogen and testosterone and synthetic estrogen, testosterone is closer to estrogen than the synthetic estrogen…that’s kind of scary to me. We should try to work with our bodies instead of forcing them to do things.

    Wenona wrote on January 22nd, 2012
  17. I was on the pill (low-dose) from 19-25. I went off the pill a few months before attempting to become pregant and the first time we tried I got prego!
    I tried to take the pill while breastfeeding and, nope, that ain’t happening again; I lost my milk :( Once I stop breastfeeding I may go back on. I didn’t notice any side-effects while taking it for 6 years and I haven’t noticed anything differnt since I’ve been off of it.
    I do agree that pills that make you only have one or two cycles a year are just plain dangerous. I haven’t heard any of my friends who tried them speak nice things about them (except they flush down the toilet extremely well).
    It’s a personal decision and when it comes to something like not bringing another baby into your life I really don’t care if someone deems it “primal” or not. I’ve read some people (on a natural parenting page) insisting that if you know your cycles you’re fine! Yeah, that’s why a lot of those women made a side-note listing child number 3 as that “wonderful little surprise”. I don’t need a surpris like that, thanks. Flowers or money will suffice.

    Andrea wrote on January 23rd, 2012
  18. Have the Mirena, absolutely love it… it is the first birth control I have done that I can absolutely forget about, that doesn’t change my personality or give me physical side effects.

    It is very important to remember that we are all unique physically and emotionally, that is why there are so many different kinds. I have tried many versions of the pill (pregnant twice..) the shot (made me depressed) and the Mirena.

    Of course, I have no intention of having more children and am within the last two decades of menopause so it makes perfect sense for me. Plus I don’t get periods at all any more which I LOVE.

    Mary wrote on January 23rd, 2012
    • I meant the last two decades BEFORE menopause lol

      Mary wrote on January 23rd, 2012
  19. I went off the pill for a completely vain reason. :-)

    http://news.yahoo.com/taking-birth-control-pills-hinder-muscle-gain-females-222300947.html

    The researchers stated, “We were surprised at the magnitude of differences in muscle gains between the two groups, with the non-OC women gaining more than 60% greater muscle mass than their OC counterpart.”

    MLH wrote on January 23rd, 2012
  20. I’ve been on low-dose bc for 8 years now, and it’s definitely made my migraines worse, caused freaky weight gain, and mood-swings, but considered worth it all to avoid pregnancy. I don’t want to be on bc anymore, and don’t want an IUD foreign object either – I may be close enough to peri-menopause to not have to worry but my gyno won’t discuss this with me for whatever reason. So after putting my annual off for 6 mos to avoid the incompetency (not just her but also last 3 gynos refusing to discuss or entertain other options), I guess I’ll just have to switch gynos once again. Why isn’t there a list of docs that are willing to discuss options and test for fertilityor hormone levels? Geez!

    nbongo wrote on January 23rd, 2012
  21. My thanks for this post and all of you who commented.
    After 2 surgeries to remedy the excruiating pain of endometriosis ive been on microgynon for 3 years (that or hysterectomy at 27 i was told by the surgeon).
    Id like to stop it, but worried the endo will flair up again. I cant bare the thought of surgery every few years to clear it all out.

    B wrote on January 23rd, 2012
  22. Thanks for this Mark! I have used Fertility Awareness (there are other factors to chart besides temperature, but for the most part I can tell when I’m ovulating just by how I FEEL!) with great success. I’ve been off the pill for 4 years and am still pregnancy free!

    The best part about learning Fertility Awareness is that unlike hormonal birth control, it actually makes it EASIER to get pregnant when that’s what I want.

    Bex wrote on January 23rd, 2012
  23. I’m a bit late to the party here but from a purely paleo perspective there is the advantage of fewer overall periods by practicing continuous contraception (you don’t take the sugar pills and have around 4 periods per year).

    Ladygrok would have probably been pregnant every 4 years or so and had long stretches of amenorrhea brought on by breast feeding. That’s a very different experience than starting puberty at 12 and getting a period a month until menopause. I’m very interested in exactly how “natural” this is and if it’s doing women any harm.

    Also – many thanks for the citation re: pap smears and the pill. I’ve been looking for this for quite some time, and even asked 2 doctors, and no one has ever been able to give me a good answer on why I’m required to get an annual pap smear while on the pill when my risk factors fall to zero (HPV negative, history of negative smears, HPV jab, and no sex in the last year).

    Seriously, dude, kudos. This is an issue I feel strongly about and this is the first blog within the paleo/natural health community to really give it a fair shake with real science. I love the pill and will continue to take it but doctors don’t give women all of the info before prescribing and, in my experience, tend to downplay the negative side effects that many experience.

    A wrote on January 24th, 2012
  24. Fertility isn’t a disease so it’s no surprise that treating it with drugs can cause problems.

    I also recommend Taking Charge of Your Fertility but to also use charting with a fertility monitor. Using both together gives an extremely high success rate, with either achieving or avoiding pregnancy, your choice.

    Persona, only available in the UK (and maybe Canada?), is the best fertility comp on the market. It works by measuring hormone levels in morning urine, via test strips, 8 days per month. What you want to do with that information is your business. (And the same test strips for the ClearBlue Fertility monitor can be used, so once you get the Persona, you will be able to buy a steady supply of test strips in the US.)

    But someone please tell me why Persona can’t be sold in the US? It’s 100% non-invasive. Could it be because then a good percentage of their customers might stop buying chemical bc? Hmmmm….

    sparki wrote on January 24th, 2012
  25. After having children, I’ve opted for the copper IUD and love it, except for the long cycles. But that is a small price to pay considering the Pill (pre kids) messed up my system so much that my doctor diagnosed me with the non-insulin resistant form of PCOS when I went off of it. I blamed the drugs (the Pill) for messing me up, and after a year with NO cycles due to my jacked up hormones, resorted to drugs to fix the problem. Thankfully they did the trick and I was able to have 2 children. Now my body seems to be back in normal year! :) Personally, I am going to steer clear of the Pill now, and am encouraging my little sister to do the same. I’ve had lots of friends use it with no problem, but if you don’t know how your body is going to react, it is not worth risking your fertility, if that is something you value.

    anonymous wrote on January 25th, 2012
  26. So the pill is made from horse urine-yes. Do I really need to say more. Plus you are lied to about the metabolic pathway it uses. It does not prevent pregnancy. You do become pregnant on the bill but it causes your body to trash fertilized eggs down in the form of your period and you never know the difference. Women who are on the pill probably have had dozens of abortions and then when they go off, they wonder why they can’t get pregnant? Don’t believe me, ask a pharmacist- oh yeah I am one.

    Sassygirl wrote on January 25th, 2012
    • Ok-I do know how to spell. I was just so mad that I forgot how to type.

      The pill has destroyed “the family” to promote sex for pleasure without morality and in-turn, destroying the family will destroy communities (too many single moms need government welfare) and when communities fail and too many people depend on government, societies will fail. Oh wait-does that sound like something we are seeing?

      Sassygirl wrote on January 25th, 2012
      • For all those people who say their Dr’s told them to go on the pill for some bogus medical reason-RUN!

        The urgent medical reason probably had more to do with some vacation your doctor was trying to earn from some pharma rep. There is no medical issue on the planet that is caused by a deficiency is horse urine! If you have irregular periods, change your diet first.

        Sassygirl wrote on January 25th, 2012
        • My last comment and then I am putting this to rest. You women on this site are FAR to special and worth way more than to be a monthly customer to some drug company. I sound like a crazy lady in these posts because I was lied too and it makes me so mad to know that you are all still being lied to.

          You don’t need to pay for some birth control. That is what these companies want you to think. Your body is only fertile 24 hours a month and if you check out NFP (free!!!) you will learn how to gauge this. Please-don’t let someone else control your hormones.

          Sassygirl wrote on January 25th, 2012
  27. I’ve been on various BCP since I was 19 (almost 20 years ago). Took a few years off to have my two daughters. Had I known the side effects, I never would have started hormonal contraceptives. After our second child was born, I was done having kids, my husband got a vasecotomy and I quit taking the pill. Immediately, I had acne worse than any teenager. Deep, horrible, scarring acne that responded to nothing. Within three months, my hair started falling out in huge handfuls. I lost so much of the hair on my head that I looked like a chemo patient. So yeah, the sex drive came back, then I looked like a freak and no longer wanted to have sex. No doctor could find a reason for the mysterious acne and hair loss. I was expected to just deal with it. Suspecting it was hormone-related with stopping the pill, I was patient, suffered through it and waited for things to return to normal. I live a very healthy lifestyle, eat well, exercise daily etc. but this went on for TWO YEARS without showing any sign of stopping. Finally I gave up. I was so depressed, I felt like a shadow of my old self, embarrased to go out, meeting new people was excruciating. So I asked my doctor to put me back on the pill, as an experiment. RESULT: face and neck acne cleared up within a week, perfect skin. The hair loss gradually slowed down over about three months, now after 5 months, the hair had stopped falling out and looks to be growing back. The catch is, I have to stay on hormones…
    So my point is, do your homework, ask questions, be careful before you or yuor daughter start down this path. You can’t undo it. No doctor ever warned the 19-year-old me that this could ever happen.

    Alice wrote on January 26th, 2012
  28. I was on Nexium for gastrointenstinal issues that I am pretty sure were linked to the pill (YAZ), which I stopped taking prior to taking Nexium. Nexium was pretty hard on my body too. I ended up anaemic (hair loss and lethargy) and went off Nexium after 2 months and sought the advice of a naturopath and later accupuncture with a TCM doctor, their help has been incredible! I still have some gastro issues but can at least function without daily pain.

    Heather wrote on January 26th, 2012
  29. As a woman with PCOS, metabolic syndrome, and early onset of high blood pressure, hypoglycemia, etc (started at the age of 21!) I am stoked to see Mark weigh in on this topic. Part of the “treatment” for PCOS is hormonal birth control. I cannot stress how much birth control contributed to my ailing health. Spiraling depression, exacerbation of existing health problems, and massive weight gain… they told me it was the PCOS. Only after I nixed the birth control entirely (I have a female partner so it’s not necessary) did I see some improvement and going primal allowed me to cease all “treatment” meds for PCOS. And I lost 25 lbs. Oh and my depression is gone. Did I mention my health problems resolved themselves?

    Conditions like PCOS and Metabolic Syndrome are further crippled by the inadequate guesswork of conventional medicine and the SAD lifestyle many of us have been led to believe is the cure.

    For women out there with hormonal issues I think hormonal birth control can be a dangerous dangerous thing. Proceed with EXTREME caution and try going primal first.

    Lindsay Grok wrote on January 27th, 2012
  30. Very informative, thanks Mark.

    For years I had side effects from the pill and it wasn’t until I started to use the Nuvaring that I found the contraceptive for me. It’s a super low dose and I can’t recommend it highly enough.

    There’s plenty of options out there for women and it’s important for women to know they have these choices and it’s not one size fits all.

    Tors J wrote on January 28th, 2012
  31. I love all the comments here — it just goes to show how different we all are!

    I’m on birth control, Implanon to be precise — it’s a sub-dermal Progestin-only implant. I originally went on it for birth control, and discovered that it corrected my life-long struggle with intense, debilitating depression. When I have the Implanon, I don’t get depressed.

    I’ve had it out once, and within a few months the depression came back with a vengeance, coupled with crippling social anxiety. I hadn’t properly clued in to the cause and effect at the time, and so I battled with the depression for 6 months before I figured it out.

    I was living in Japan when the depression came back, and they don’t have Implanon there, so I went on the Pill for awhile. My depression went away, but my period was heavy and irregular. Still, the depression being gone was good enough, so I stuck with it.

    Later, I moved back to Australia for other reasons, and decided to try going off the Pill for awhile. Within a couple of months, the depression started creeping back up on me. So, I went and got the Implanon again. Bang, I’m totally fine again, and have been since. And Implanon also regulates my period, and completely frees me from PMS and period pain, which I suffer a great deal when I’m not on Implanon.

    I know there are other health risks involved with hormonal birth control, but quite frankly, being freed from the crippling depression that stole at least 10 years of my life from me, and being able to live a “normal” life now, means a lot more to me than the possibility that I might get sick from something later on.

    It’s a risk I’m more than willing to take, but that’s a choice I made for myself. I couldn’t make it for someone else.

    (And yes, I was on Primal for quite some time when I tried going off the Pill for awhile. Unfortunately improving my diet hasn’t seemed to fix my susceptibility to depression.)

    Karhys wrote on January 29th, 2012
  32. Some of the stomach issues associated with the pill are related to the fact that they include lacstose in the formulation. If you are lactose intolerant this could be causing problem and you may want to try taking lactaid pills and acidopolis. Also primrose oil helps some women with reducing the bloating.

    riky wrote on February 1st, 2012
  33. I was 28-years-old when I was sidelined by a pulmonary embolism. I had no family history of clots, did not smoke, and while I was overweight, I was active and not considered at “high risk.” Oh – but then I started taking an oral contraceptive for the first time in several years. A month and a half later – BAM! – I’m in the ER, hours away from death, with seven blood clots in my lungs.

    I have to take an aspirin every night for the rest of my life as a blood thinner. And if I ever get another blood clot, I will be on dangerous, tricky blood thinners until I die.

    And my doctor did not mention a thing about this risk, saying that because I didn’t smoke I wouldn’t get blood clots. And I stupidly believed her. That was the last time I take a doctor’s advice without doing my own research.

    (Oh – and that’s why I’m going paleo, despite my doctor saying that the only way to lose weight and get healthy is with lots of grains and no fat. Suuuuurrrreeee).

    Miss Dev wrote on February 13th, 2012
  34. Thank you for a very balanced article. I’m so glad you didn’t dismiss the oral contraceptive out-of-hand. Having endured four decades of the monthly inconvenience (latterly fortnightly nightmare) of menstruation, and having recently discovered the benefits of taking a progesterone-only pill (no menstruation), I can safely say that there isn’t much you could say which would persuade me not to take it!

    Liz wrote on April 29th, 2012
  35. Just wanted to recommend NFP/Creighton Method. Super easy once trained. Super cheap. No chemicals and works 98% when used correctly. Works amazingly for preventing or achieving pregnancy. Once primal you can see a huge difference in your chart. I took my chart to my OB who is Creighton trained and pin pointed my issues. Now that I know them hoping the diet will correct them. (PCOS, endometriosis, hypothyrodism, and progesterone deficiency) Been 95% primal since Feb. 2012. Doing ok waiting for that 1 year mark to see the huge difference. Had surgery in Dec. 2011 (ovarian drilling for the PCOS and lasar for the endo also confirmed low progesterone. Hoping for that primal miracle! :)

    Jennw3bbs wrote on June 21st, 2012
  36. I have to agree to sharing concerns about the pill. I’ve been on birth control for most of the last ten years. Its only now as I’m getting married and thinking of starting a family that I’ve realized something: I’ve been experiencing seven of the eight bullet points (plus others!) in “other side effects”, and they are most likely tied to my birth control.

    With a recent increase in side effects, I stopped my pill two weeks ago. With the first day off, it was a drastic improvement. Now if only I can wean off the nexium…

    My big concern is this: When we go to our doctors, and we have a new issue, why isn’t the first step to see if its a possible side effect of current medication? That thinking could have saved me thousands of dollars in medication and procedures.

    Erin wrote on June 22nd, 2012
  37. I just want to put out a word of warning about hormonal methods of birth control. I’ve been on OrthCyclen/Spritec/Mononessa for a decade on and off. I’ve found it to be helpful with adult acne, but it could be causing my very painful monthly menstrual migraines. I’m a little scared to go off it and see what happens, but I’m going to give it a shot.

    More importantly, I had the Mirena for over 2 years. After six months I started developing acne. By the one year point, it was deep, cystic acne that was painful and horrible. My dermatologist was NOT able to successfully treat it, even with peels, topical ointments, and oral antibiotics. I told him I thought it was the Mirena and he told me that it wouldn’t cause acne. I decided to move forward with having it removed around the two year point and went back on the pill. My acne had completely cleared within 3 months (but now I’m a bit afraid to go off the pill). Please be carefull when considering the Mirena. Also, it was always poking my boyfriend, even after I got the wires trimmed. He hated it because it caused some serious penis pain.

    hilarydanette wrote on August 23rd, 2012

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