Menstrual Cycle 101
The menstrual cycle varies from woman to woman and month to month. Day 1 of the cycle starts from the first day of the bleeding and the cycle continues up until the first day of bleeding of the next menstrual period. The first half of the cycle is called the follicular phase (menstruation up until ovulation). Problems such as stress, coming off of synthetic hormones, menopause, travel (this happened to me), breastfeeding, sickness, drugs, dieting and excessive exercise, can delay ovulation and the length of the follicular phase.
The second half of the cycle is called the luteal phase, which is from ovulation up until the day before menstruation begins. This phase lasts from 11-16 days in a fertile cycle. The timing of the menstrual cycle, along with other bodily functions is controlled by the master hormone regulator in the brain, called the Hypothalamus. Throughout the cycle, the hypothalamus stimulates particular endocrine glands (ovaries and pituitary gland) to produce hormones such as Follicular Stimulating Hormone, Luteinising Hormone, Progesterone and Oestrogen, at different levels and times. These hormones cause changes in the woman’s body, to ultimately either support or prevent conception.
Enter Synthetic Hormones Such As The Pill & Other Implants
While there are many synthetic hormone options available, the most common I have seen women using from my Naturopath experience are the pill and hormone implants and devices, such as the Mirena, Implanon/ Nexplanon and NuvaRing. Let's look at how each of these work to provide contraception.
When you take synthetic hormones through the combination pill, they are working to disrupt this natural cycle, resulting in infertility.
The combination pill containing estrogen (ethinyl estradiol) and progestin), it essentially works by shutting down brain signalling to the ovaries, which prevents ovulation. The body thinks it already has adequate sex hormones, essentially suppressing the signals of hypothalamic gonadotropin-releasing hormone (GnRH) and pituitary gonadotropin secretion from the brain and therefore preventing a luteinizing hormone (LH) surge. Without LH, your ovaries don't receive a message to release an egg, therefore ovulation doesn't take place.
Without ovulation, you also don't menstruate. When taking the oral contraceptive pill, you do not experience a natural period, but instead a forced withdrawal bleed from stopping the active hormone pills each month.
The Mini Pill
The mini pill (containing only synthetic progesterone) contains all active pills (no sugar placebo's). It is important to note this synthetic hormone does not give the same positive effects in the body as natural progesterone. The progestin only mini pill prevents pregnancy by creating a thicker cervical mucous barrier which sperm cannot penetrate to reach the egg.
Intrauterine Device (IUD) eg. Mirena
One example of an IUD is the Mirena, a small, T-shaped intrauterine device (IUD) that releases small amounts of a synthetic form of progesterone called Levonorgestrel into the uterus.
This release of progestin prevents pregnancy by thickening your cervical mucous to inhibit sperm from travelling to the egg and therefore preventing the process of fertilisation. The Mirena is up to 99% effective, when inserted correctly.
Implanon / Nexplanon
This implant is also a progestin releasing device, which is inserted into the upper arm, just under your skin. Through its release of the synthetic form of progesterone called etonogestrel, the Implanon therefore has the same action of disrupting cervical mucous in order to prevent pregnancy. The Implanon/ Nexplanon for up to 3 years, before it needs to be replaced.
This is a small, flexible ring which is inserted into your vagina for three weeks of your cycle and removed for one week. When the NuvaRing is inserted, it releases a combination of low dose synthetic oestrogen and progesterone, to prevent pregnancies.
During the week of removal, you will have a withdrawal bleed just as you do from taking the combination oral contraceptive placebo sugar pills. This is not a true period.
When used correctly, the NuvaRing is 98% effective.
Contraindications & Interactions
Note that most hormone contraceptives effectiveness is disturbed by use of the herb St Johns Wort, antibiotic courses and other medications. It is of utmost importance your health care providers are aware of all supplements and medications you are taking and hormone contraceptives you are using, to avoid interactions.
If you conceive while taking hormone contraceptives, there is risk of ectopic pregnancy, so use should be ceased ASAP in the case of a surprise conception. While you are breastfeeding, it is also important to note that small amounts of hormone can be passed through into your breastmilk.
Otherwise, it is not recommended to be taking or using synthetic hormone contraceptives when you have:
- breast cancer
- high triglycerides (fat in bloodstream)
- a migraine headache
- a clot in the small veins that carry blood to or from the retina of the eye
- high blood pressure
- a heart attack
- coronary artery disease
- a clot in the lung
- a stroke
- an inflamed vein due to a blood clot, and/or obstruction of a blood vessel by a blood clot
- blood clot in a deep vein of the extremities
- at risk for formation of blood clots
- liver problems or tumour
- bedridden patient or one unable to move around freely
- allergies to synthetic progesterone (progestin)
- Or if you are a smoker over the age of 35 (smoking increasing your risk of heart complications when taking synthetic hormones).
See your health care provider for a comprehensive health check before starting any hormone contraceptives.
Short & Long Term Side Effects Of Synthetic Hormones
As convenient and highly effective these hormone contraceptives are, they do come at a cost to your health. Let's explore the side effects.
Oral Contracptive Pill
Unfortunately, the convenience of the oral contraceptive pill use and other synthetic hormone devices does come at a cost to your health. Health conditions associated with their use include:
Blood clots, which is also a side effect of transdermal patches, vaginal rings and subcutaneous implant contraceptive use3,4
Increased risk for breast cancer.5,6 The injectable form of progestin, depro-medroxyprogesterone acete has also been shown to increase the risk of breast cancer7
Cardiovascular Disease (increased low density and very low density lipoproteins)8
Cramps, irregular bleeding and other cycle irregularities
Fluid retention and weight gain
Genital tract infections & increased risk of HIV transmission11
High blood pressure12
Increased free radical damage, resulting in early ageing
Inflammatory bowel disease14
Low DHEA levels15
Loss of libido16
Low bone density18
Uterine perforation and pelvic inflammatory disease (with an intrauterine device)
Weakened Immune system21
The Side Effects Of Mirena
Straight from the Mirena website, the potential serious side effects include:
Pelvic inflammatory disease (PID). Some IUD users get a serious pelvic infection called pelvic inflammatory disease. PID is usually sexually transmitted. You have a higher chance of getting PID if you or your partner have sex with other partners. PID can cause serious problems such as infertility, ectopic pregnancy or pelvic pain that does not go away. PID is usually treated with antibiotics. More serious cases of PID may require surgery. A hysterectomy (removal of the uterus) is sometimes needed. In rare cases, infections that start as PID can even cause death.
Tell your healthcare provider right away if you have any of these signs of PID: long-lasting or heavy bleeding, unusual vaginal discharge, low abdominal (stomach area) pain, painful sex, chills, or fever.
Life-threatening infection. Life-threatening infection can occur within the first few days after Mirena is placed. Call your healthcare provider immediately if you develop severe pain or fever shortly after Mirena is placed.
Perforation. Mirena may become attached to (embedded) or go through the wall of the uterus. This is called perforation. If this occurs, Mirena may no longer prevent pregnancy. If perforation occurs, Mirena may move outside the uterus and can cause internal scarring, infection, or damage to other organs, and you may need surgery to have Mirena removed. The risk of perforation is increased if Mirena is inserted while you are breastfeeding.
Other common side effects include:
Pain, bleeding or dizziness during or after placement.
Your Mirena may fall out.
Bleeding and spotting between periods
Irregular or ceased periods.
Cysts on the ovary.
Through my Naturopath experience, I've also noted:
- Weight gain
- Low mood and depression. Which is also indicated with other synthetic hormone contraceptive use in this study. There are however studies indicating no link to depression. Ultimately, if you're experiencing symptoms since using synthetic hormone contraceptives, listen to your body as it may not be agreeing with you.
- Skin irritations and acne.
Implanon / Nexplanon
Straight from the Implanon Patient Information:
Using an etonogestrel implant can increase your risk of blood clots, stroke, or heart attack. You are even more at risk if you have high blood pressure, diabetes, high cholesterol, or if you are overweight. Your risk of stroke or blood clot is highest during your first year of using this medicine.
Common side effects include:
- stomach cramping/bloating/pain
- mood changes
- breast tenderness or pain
- hair loss
- weight gain
- problems with contact lenses
- sore throat
- flu symptoms
- back pain
- menstrual cramps
- changes in menstrual periods*
- vaginal itching, and vaginal irritation or discharge
Other side effects include:
- minor bleeding
- scarring at the site where the rod is placed
*I've heard many experiences of patients over the years where constant bleeding occurred after having the Implanon inserted.
Serious side effects of using this device, listed from the NuvaRing website include:
- blood clot
- toxic shock sydrome
- allergic reaction
- liver complications, including liver tumours
- high blood pressure
- gallbladder issues
- accidental insertion into bladder
Common side effects:
- tissue irritation inside your vagina or on your cervix
- headache (including migraine)
- mood changes and depression
- NuvaRing problems, including the ring slipping out or causing discomfort
- nausea and vomiting
- vaginal discharge
- weight gain
- vaginal discomfort
- breast pain, discomfort, or tenderness
- painful menstrual periods
- abdominal pain
- less sexual desire
- breast discharge
- vaginal injury
- dark skin pigmentation
- increase in blood sugars
- increase in triglycerides (fat in bloodstream)
Gut Health & Nutritional Deficiencies Of The OCP
The oral contraceptive pill (OCP), other hormone secreting contraceptive devices expose your body to synthetic forms of hormones. Although giving short term relief to cycle symptoms, overtime the OCP use may also contribute to nutritional deficiencies23, 24, 25, 26, 27, 28, 29, 30 gut permeability (leaky gut) and a disruption of your good gut bacteria which all impact your overall oestrogen levels.
Taking the oral contraceptive pill not only has a direct negative impact on your gut flora, but also that of your children and grandchildren. It is therefore recommended to take a break for months leading up to a planned pregnancy.
Nutritional deficiencies include:31, 32, 33, 34, 35, 36, 37, 38
Vitamin B6 (and the B6 dependent neurotransmitter Serotonin)
Essential fatty acids
Amino acid tyrosine
If you are taking any form of synthetic hormones, care should be taken to at least supplement your diet with the above nutrients, together with a probiotic and essential fats.
Your Body, Your Choice
While a quick visit to your GP may not bring up safety concerns of hormone contraceptive use, I encourage you to do your own research to read the fine print and understand how it could be impacting your health. At the end of the day, it is your body and you have the right to control your health destiny.
Less invasive alternatives to the oral contraceptive pill and other synthetic hormone devices are available, which do not put such a strain on the body. More on my favourite hormone free contraceptive options, very soon.
In the meantime, join my insta live chat at @KaseyWillsonND with Naturopath Kirsty King on Thursday 30th July at 10.30am (South Aussie time). We'll be continuing the contraceptive chat.
Coming off of hormone contraceptives can contribute to 'post-pill' symptoms. Ease into your synthetic-hormone-free life with hormone health empowerment in my book- Balanced, The Natural Way To Healthy Hormones.
When you’re ready to start preparing you body for pregnancy, having a break from hormone contraceptives months in advance will also help your body rebalance and replenish important fertility nutrients. More info can be found in my preconception guide, Glowing Mumma.
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7) Li CI, Beaber EF, Tang MT, Porter PL, Daling JR, Malone KE. Effect of depo-medroxyprogesterone acetate on breast cancer risk among women 20 to 44 years of age. Cancer Res. 2012 Apr 15;72(8):2028-35. doi: 10.1158/0008-5472.CAN-11- 4064. Epub 2012 Feb 27
8) Nash AL, Cornish EJ, Hain R.Metabolic Effects of Oral Contraceptives Containing 30 Micrograms and 50 Micrograms of Estrogen, Med J of Australia. 1979 Sept 22;2(6):277-81.
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13) Weill A, Dalichampt M, Raguideau F, Ricordeau P, Blotière PO, Rudant J, Alla F, Zureik M. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ. 2016 May 10;353:i2002. doi: 10.1136/bmj.i2002.
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15) Fern M, Rose DP, Fern EB. Effect of Oral Contraceptives on Plasma Androgenic Steroids and Their Precursors, Obstet Gynecol. 1978 May;51(5):541-4.
16) van der Vange N, Blankenstein MA, Kloosterboer HJ, Haspels AA, Thijssen JH. Effects of Seven Low-Dose Combined Oral Contraceptives on Sex Hormone Binding Globulin, Corticosteroid Binding Globulin, Total and Free Testosterone, Contraception. 1990 Apr;41(4):345-352.
17) Jonderko K, Skałba P, Kasicka-Jonderko A, Kamińska M, Bizior-Frymus D, Dyja R. Impact of combined oral contraceptives containing ethinylestradiol on the liver microsomal metabolism. Eur J Contracept Reprod Health Care. 2013 Aug;18(4):284-92. doi:10.3109/13625187.2013.785515. Epub 2013 May 6.
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19) Weill A, Dalichampt M, Raguideau F, Ricordeau P, Blotière PO, Rudant J, Alla F, Zureik M. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ. 2016 May 10;353:i2002. doi: 10.1136/bmj.i2002.
20) Rodenas MC, Cabas I, García-Alcázar A, Meseguer J, Mulero V, García-Ayala A. Selective estrogen receptor modulators differentially alter the immune response of gilthead seabream juveniles. Fish Shellfish Immunol. 2016 May;52:189-97. doi: 10.1016/j.fsi.2016.03.041. Epub 2016 Mar 21.
21) Relloso M, Aragoneses-Fenoll L, Lasarte S, Bourgeois C, Romera G, Kuchler K. Estradiol impairs the Th17 immune response against Candida albicans. J Leukoc Biol. 2012 Jan;91(1):159-65. doi: 10.1189/jlb.1110645. Epub 2011 Sep 30.
22) Thorp VJ. Effect of Oral Contraceptive Agents on Vitamin and Mineral Requirements. J Am Diet Assoc. 1980 Jun;76(6):581-4.
23) Thorp VJ. Effect of Oral Contraceptive Agents on Vitamin and Mineral Requirements. J Am Diet Assoc. 1980 Jun;76(6):581-4.
24) Heese HD, Lawrence MA, Dempster WS, Pocock F. How Selenium Interacts with Oral Contraceptives. S Afr Med J. Feb1988;73(3):163-165.
25) Ahmed F, Bamji MS, Iyengar L. Effect of Oral Contraceptive Agents on Vitamin Nutrition Status, Am J Clin Nutr. 1975 Jun; 28(6):606-15.
26) Webb JL. Nutritional Effects of Oral Contraceptive Use: A Review, J Repro Med. 1980 Oct;25(4):150-6.
27) Kishi H, Kishi T, Williams RH, Watanabe T, Folkers K, Stahl ML.Deficiency of Vitamin B6 in Women Taking Contraceptive Formulations, Research Communications in Chemical Pathology and Pharmacology. 1977 Jun;117(2):283- 293.
28) Rivers JM. Oral Contraceptives and Ascorbic Acid, Am J Clin Nutr. 1975 May;28(5):550-4.
29) Palan PR, Magneson AT. Effects of Menstrual Cycle and Oral Contraceptive Use on Serum Levels of Lipid-Soluble Antioxidants. Am J Obstet Gynecol 2006 May;194(5):e25-8.
30) King JC. Do Women Using Oral Contraceptive Agents Require Extra Zinc? J Nutr. 1987 Jan;117(1):217-219.
31) Thorp VJ. Effect of Oral Contraceptive Agents on Vitamin and Mineral Requirements. J Am Diet Assoc. 1980 Jun;76(6):581-4.
32) Heese HD, Lawrence MA, Dempster WS, Pocock F. How Selenium Interacts with Oral Contraceptives. S Afr Med J. Feb1988;73(3):163-165.
33) Ahmed F, Bamji MS, Iyengar L. Effect of Oral Contraceptive Agents on Vitamin Nutrition Status, Am J Clin Nutr. 1975 Jun; 28(6):606-15.
34) Webb JL. Nutritional Effects of Oral Contraceptive Use: A Review, J Repro Med. 1980 Oct;25(4):150-6.
35) Kishi H, Kishi T, Williams RH, Watanabe T, Folkers K, Stahl ML.Deficiency of Vitamin B6 in Women Taking Contraceptive Formulations, Research Communications in Chemical Pathology and Pharmacology. 1977 Jun;117(2):283- 293.
36) Rivers JM. Oral Contraceptives and Ascorbic Acid, Am J Clin Nutr. 1975 May;28(5):550-4.
37) Palan PR, Magneson AT. Effects of Menstrual Cycle and Oral Contraceptive Use on Serum Levels of Lipid-Soluble Antioxidants. Am J Obstet Gynecol 2006 May;194(5):e25-8.
38) King JC. Do Women Using Oral Contraceptive Agents Require Extra Zinc? J Nutr. 1987 Jan;117(1):217-219.