What You Need To Know About Hormone Contraceptives

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.

Combination Pill

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.

NuvaRing

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
diabetes
high triglycerides (fat in bloodstream)
obesity
depression
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
thrombophlebitis
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:

Anemia¹
Allergies²
Blood clots, which is also a side effect of transdermal patches, vaginal rings and subcutaneous implant contraceptive use^3,4
Bloating
Breast tenderness
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

Depression^9,10
Fatigue
Fluid retention and weight gain
Genital tract infections & increased risk of HIV transmission¹¹
High blood pressure¹²
Heart Attacks¹³
Increased free radical damage, resulting in early ageing
Inflammatory bowel disease¹⁴
Low DHEA levels¹⁵
Loss of libido¹⁶
Liver dysfunction¹⁷
Low bone density¹⁸
Mood changes
Nausea
Pulmonary embolism¹⁹
Stroke²⁰
Uterine perforation and pelvic inflammatory disease (with an intrauterine device)
Weakened Immune system²¹
Yeast overgrowth²²

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:

nausea

stomach cramping/bloating/pain

dizziness

headache

mood changes

depression

breast tenderness or pain

acne

hair loss

weight gain

problems with contact lenses

sore throat

flu symptoms

back pain

nervousness

menstrual cramps

changes in menstrual periods*

vaginal itching, and vaginal irritation or discharge

Other side effects include:

pain

bruising

numbness

infection

tingling

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.

NuvaRing

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
angioedema

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
acne
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 deficiencies^{23, 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 B1
Vitamin B2
Vitamin B3
Vitamin B6 (and the B6 dependent neurotransmitter Serotonin)
Vitamin B12
Folic acid
Vitamin C
Magnesium
Selenium
Zinc
Essential fatty acids
Amino acid tyrosine
Antioxidant CoQ10

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.

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, Path To Conscious Conception.

References

1) Haile ZT, Teweldeberhan AK, Chertok IR. Association between oral contraceptive use and markers of iron deficiency in a cross-sectional study of Tanzanian women. Int J Gynaecol Obstet. 2016 Jan;132(1):50-4. doi: 10.1016/j.ijgo.2015.06.040. Epub 2015 Sep 21.

2) Pelton, R., The Pill Problem, How to Protect Your Health from the Side Effects of Oral Contraceptives. Self published.

3) Lidegaard O, Nielsen LH, Skovlund CW, Løkkegaard E. Venous thrombosis in users of non-oral hormonal contraception:follow-up study, Denmark 2001-10. BMJ. 2012 May 10;344:e2990. doi: 10.1136/bmj.e2990.

4) Vinogradova Y, Coupland C, Hippisley-Cox J. Use of combined oral contraceptives and risk of venous thromboembolism: nested case-control studies using the QResearch and CPRD databases. BMJ. 2015 May 26;350:h2135. doi: 10.1136/bmj. h2135.

5) White E, Malone KE, Weiss NS, Daling JR. Breast cancer among young U.S. women in relation to oral contraceptive use. J Natl Cancer Inst. 1994 Apr 6;86(7):505-14.

6) Brinton LA, Daling JR, Liff JM, Schoenberg JB, Malone KE, Stanford JL, et al. Oral contraceptives and breast cancer risk among younger women. J Natl Cancer Inst. 1995 Jun 7;87(11):827-35.

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.

9) Slap GB. Oral Contraceptives and Depression: Impact, Prevalence and CAsuse, J Adolesc Health Care. 1981 Sep;2(1):53-64.

10) Kulkarni J, Liew J, Garland KA.. Depression Associated with Combined Oral Contraceptives—A Pilot Study, Aust Fam Physician. 2005 Nov;34(11):990.

11) Fichorova RN, Chen PL, Morrison CS, Doncel GF, Mendonca K, Kwok C. The Contribution of Cervicovaginal Infections to the Immunomodulatory Effects of Hormonal Contraception. MBio. 2015 Sep 1;6(5):e00221-15. doi: 10.1128/ mBio.00221-15.

12) Olatunji LA, Usman TO, Seok YM, Kim IK. Activation of cardiac renin-angiotensin system and plasminogen activator inhibitor-1 gene expressions in oral contraceptive-induced cardiometabolic disorder. Arch Physiol Biochem. 2016 Apr 5:1-8. [Epub ahead of print]

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.

14) Khalili H. Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions. Drug Saf. 2016 Mar;39(3):193-7. doi: 10.1007/s40264-015-0372-y.

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.

18) Elkazaz AY, Salama K. The effect of oral contraceptive different patterns of use on circulating IGF-1 and bone mineral density in healthy premenopausal women. Endocrine. 2015 Feb;48(1):272-8. doi: 10.1007/s12020-014-0290-2. Epub 2014 May 27.

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.

What You Need To Know About Hormone Contraceptives

Menstrual Cycle 101

Enter Synthetic Hormones Such As The Pill & Other Implants

Combination Pill

The Mini Pill

NuvaRing

Contraindications & Interactions

Short & Long Term Side Effects Of Synthetic Hormones

NuvaRing

Gut Health & Nutritional Deficiencies Of The OCP

Your Body, Your Choice

References

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