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
- Overall higher CRP levels (inflammation marker)
- Lower total antioxidant activity as well as specifically measured lower blood levels of many micronutrients. (B6, E, CoQ10, zinc, selenium, phosphorus, and magnesium)
- Impaired thyroid function (Estrogen can influence the availability of thyroid hormone in the body because it increases a specific thyroid “binding” protein.)
- Potentially negative effect on lipid levels – particularly LDL
- Adverse mood symptoms
- Lower testosterone levels, which can decrease libido and make it harder to build muscle mass
- Increased risk of prostate cancer in partners (This is fairly new research that will undoubtedly get more attention in the coming years.)
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!
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Posted By: Mark Sisson
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.
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).
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!
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!
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.
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.
Hi have been on the pill for the last 14years and what to be off them for good this time (2nd try two years later) because I want to try for kids on 2 years. Last time was horrible – bad acne, depression (made worse by acne), thyroid issues causing be to lose weight and have heart palpitations, tirdness and insomnia. I thought all of these problems were something else but after reading many simalar reactions to going of the pill I realised thats what it was from because it all started after stopping the pill and went away again when I went back on it. I didn’t know any of the about the pill until now but it’s really scary (especially the link to PCOS, which my younger sister has and struggled gettting pregnant). I which I was told about this when I went on the pill, but even now most doctors (esp here in NZ) won’t acknowledges the risks of a hormonal contraceptive and try to tell you it’s something else.
Also the comment about the lower scores on measures of sexual satisfaction and partner attraction” and “experienced increasing sexual dissatisfaction during the relationship.” is so true when I think back and even now in my current relationship. It’s great to know it could all linked to something and hopefully fingers crossed it improves once I come of the pill (straight away would be nice).
I hope ALOT improves after I come off the pill, including weight management, moods, libido and fertility of course coz the side affects I have read are all not good being on it or the period in between when your body is getting back to normal.
eeeekkkkk
hoping my partner is understanding. Although I think he thinks I am reading into it all too much and just jumping on a band wagon, but he doesn’t know my body or quite understand really not does he realise the implications it could have. He thinks I am worried over nothing.
nothing in life is ever easy is it!!
Hi,
I am really scared an not sure what to do. I have taken the pill for 7 years and it has served me and my partner well. I am comfortable with it. How much longer can i carry on taking it? Am I already at risk of getting cancer? I was planning on stopping it today but I am hearing two different sides that it’s very very bad for you and that’s it’s ok to a certain point. I need an answer please as I am scared.
Thanks,
Lindsay
Don’t be scared – there’ll always be people giving you opposite opinions, some for, some against and some positively scaremongering. I would go and see your doctor or nurse and discuss it with her/him. There might be better options for you, or you might be fine with the pill you’re on. It all depends on your age, your current state of health, the type of pill you’re taking and the other options available to you. In my opinion, the pill, either combined or progestogen only, are good options for some women, but of course you have to sensibly weigh up the risks and benefits.
Thanks Liz
I have been off the pill for a few years and have felt great since. However recently had an abnormal period and the doctor insisted I go on bc again to make it normal. 4 days later I started having gallbladder attacks for a week straight. I’ve been off the pill again for the last 2 days and my gallbladder symptoms have decreased by 95%. I’ll never touch the stuff again.
I also use a copper IUD. I’ve only taken birth control for about six months and I felt horrible. I think, in my case it was not because of the side effects of the pill, but just the feeling that there was no natural hormonal cycle. I just felt so aweful, never felt anything more unnatural before.
I use a frameless copper IUD named ‘Gynefix’. It is said to prevent increased cramps and heavy bleeding that is usually a side effect of other copper IUD’s. I must say, during the first 4 months after insertion, the bleeding was heavier, but this stabilized after half a year. Now I’m just really happy with copper IUD. I have indeed heard of coppor toxicity when using a copper IUD but I think with a good diet it’s rare. As I’ve read somewhere in these posts, zinc supplements may be good in that case. Anyhow, I think copper IUD’s are a far better choice than hormonal contraceptives.
Great article and discussion! Wow, there’s a lot to learn from everyone’s different experiences.
I went on the pill at 22. I asked my doctor about it and she didn’t give me one word about risks or implications, after reading this article that now makes me rather concerned. The severity of my periods did subside and my breasts grew in size. I was on the pill for 2.5 years. Then, at the same time I went primal I decided to stop taking the pill because I want my body to be completely natural. My breasts have shrunk (talk about a sign of cause and effect) and my period symptoms have incredibly decreased (even more so than when I was on the pill). I’m a firm believer in the Primal Blueprint now based on the undeniable symptoms my body has exhibited.