The pill is not a hormone solution
The birth control pill was a great thing for women when it was first released. As a method of contraception, it meant that women could control their own fertility for the first time in history. But since then, “the pill”, as it’s now known, has become a first-line treatment for all kinds of female health concerns that have very little to do with conception.
How the pill works
The pill contains synthetic hormones, which are created in a lab that mimic your own hormones and have biological impact on your body. Usually the pill contains estrogen
(estradiol), and progestins (made to be similar to, but not exactly like, natural progesterone). Some pills are progestin-only.
In short, these synthetic hormones essentially override your natural cycles and STOP the natural maturation and release of an egg, as well as your natural period. On the pill, you have no natural reproductive hormones of your own, and it even depletes some important nutrients like B vitamins (read about this here).
The pill also stops the natural feedback loop of communication between the ovaries (where the hormones are normally made) and the brain, because there is a constant dose of synthetic hormone getting in the way. It’s like the brain isn’t able to hear what your hormones are saying because someone is blasting loud music (synthetic hormones) and drowning them out, so eventually they stop trying to talk over it.
A key point to know is that your natural cycle stops when you’re on the pill, and the body no longer has the ability to produce the natural hormone progesterone. This is unfortunate because natural progesterone is generally calming, anti-inflammatory, and important for sleep regulation and thyroid health. Synthetic progestins that replace the progesterone, on the other hand, are pro-inflammatory, and have been linked to depression, anxiety, and even hair loss. Finally, the “period” you get on the pill is not a real period that signals regular cycling, rather it is simply the reactive biological withdrawal from synthetic progestins (Briden, 2017). For more info about how the pill works, see this link.
What The Pill is Used for Now
“Hormone imbalance” is a term that’s talked about a lot (and is rather vague) but what it means is: if one or more of your hormones is high or low (or not syncing with your other hormones), it can contribute to physical and mental-emotional symptoms, like:
- heavy, irregular, or painful periods
- premenstrual emotional changes and irritability
- osteoporosis
- depression & anxiety
- fibroids
- migraines
- hot flashes & night sweats
- vaginal dryness
- breast tenderness
- infertility
- digestive issues
- acne
- endometriosis
- polycystic ovarian syndrome, and more.
Since the pill has the ability to shut down the hormone cycles and completely replace them with a constant unchanging, predictable level of synthetic hormone, the pill began to be used as a “treatment” for conditions that involve an imbalance of female reproductive hormones. A publication from 2019 stated that 14% of women on the pill take it primarily for reasons other than contraception (Cooper & Mahdy, 2019).
Hormone-Related Conditions
The prevalence of hormonally-related conditions is increasing over time (Golden, 2009), and this is for several reasons, including stress, exposure to chemicals in our environment, nutritional deficiencies, obesity, and other reasons. You can read more about causes of hormonal imbalances here.
Because these conditions are increasing, the pill is being used more and more often to “treat” a hormone condition that has nothing to do with contraception, and is not going to be resolved by suppressing the symptomatic hormone imbalance. Unfortunately, this means that women’s hormonal health is not being addressed or treated properly.
Why using the pill as a hormone treatment is not helpful
Firstly, the pill does not solve any of the issues that lead to hormonal imbalances in the first place. As such, any medical issue that is being treated by the pill is not being resolved, and is likely going to come back once the pill is stopped.
For example, I’ve known young patients who were prescribed the pill for polycystic ovarian syndrome, a hormonal imbalance/insulin issue that can cause irregular periods and infertility, among other symptoms. Going on the pill gave them a regular pill bleed, but when they wanted to become pregnant and they came off the pill, the same issues came back and they struggled with irregularity and difficulty conceiving. The same goes for women prescribed the pill when they’re young to help with premenstrual syndrome; when the pill is stopped, these emotional symptoms can come back just as strong as they were in the first place.
Second, the pill stops the natural production of progesterone. As mentioned above, the pill replaces natural progesterone with synthetic progestins. While progestins do help prevent pregnancy, they do not have the same protective, calming effect on the body. Lara Briden is a naturopathic doctor who writes extensively about the benefit of natural progesterone and how important it is for overall female health. Her book, Period Repair Manual, is an excellent read for anyone struggling with hormonal issues and has questions about contraception options.
Dr. Briden, as well as Dr. Jolene Brighten in her book, Beyond the Pill, also talk about post-pill syndrome, a condition that includes rebound acne, premenstrual moodiness, and even the absence of periods after stopping the pill. For some women, it can take up to 12 months to restore a regular period after long-term hormonal contraception use. This post-pill syndrome is not just a return of pre-pill symptoms, but in fact are a reaction to the withdrawal of hormones that the body is no longer receiving, and is no longer producing itself.
What to do about it
The most important message I want to convey with this article is that there are options for actually treating the underlying hormonal conditions. Hormonal suppression with the pill is not the only option out there for hormonally-related conditions.
Proper treatment begins with a thorough assessment of your cycle and all your related symptoms. Your health care provider should ask a thorough set of questions to understand your cycle and the history of your cycle. Hormonal testing should be done at specific times of the cycle (if possible), and include a full hormonal panel, not just 1 or 2 main hormones. Testing cortisol levels in your saliva 4 times a day may be indicated as well.
Once your provider has a clear picture of what’s going on, there are many gentle and impactful treatments to support hormone balance. Various forms of herbal medicine, nutrition, supplements, and lifestyle change have research to back up their use in targeted hormonal balancing treatments.
You Have a Choice!
If you struggle with physical and mental-emotional symptoms due to a ‘hormonal imbalance’, it means you need an in-depth assessment and then you will have real options in front of you to fix the problem. Remember, suppressing and covering up your hormones is not solving the root of the problem. Truly female-centered medicine listens to the body and responds instead of shutting it down and overpowering it.
If you are using the pill for contraception, read this article and see this resource by Dr. Jolene Brighten for more info about options for hormonal and non-hormonal options. Talk with a Naturopathic Doctor to see if hormones may be playing a role in your health concerns.
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Sources
1. Golden, S. H., Robinson, K. A., Saldanha, I., Anton, B., & Ladenson, P. W. (2009). Prevalence
and incidence of endocrine and metabolic disorders in the United States: a comprehensive
review. The Journal of Clinical Endocrinology & Metabolism, 94(6), 1853-1878
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1740595/pdf/v060p00541.pdf
3. Cooper, D. B., & Mahdy, H. (2019). Oral contraceptive pills.
4. The Period Repair Manual by Dr Lara Briden
5. Beyond The Pill by Dr. Jolene Brighten
6. Herrera, A. Y., Faude, S., Nielsen, S. E., Locke, M., & Mather, M. (2019). Effects of hormonal
contraceptive phase and progestin generation on stress-induced cortisol and progesterone
release. Neurobiology of stress, 10, 100151.
