Pharmaceutical contraception can be a contentious issue. This article aims to equip women with a balanced perspective so they can make an informed choice about what they put into their bodies and in no way suggests women should come off their medications without due consideration. It is important to consider all the pros and cons of any medication. The most widely used contraceptive medications include the combined oral contraceptive pill (OCP) (containing synthetic oestrogens and progesterone) such as Yasmin or Estelle, or injections, patch and vaginal ring. Progestin-only contraception includes the mini- pill (e.g. Noriday 28), the implant and hormonal IUDs (Mirena). Intrauterine devices such as the copper IUD are also a preferred option for some women.
Although contraceptive medications have similar names and molecular structures to female hormones, they have very different functions in the body. Artificial hormones mimic our natural hormone responses by “approximately” fitting into our hormone receptors but provide a different response. For example, progestin used in medications prevents pregnancy by inhibiting ovulation, changing cervical mucus making it unfriendly to sperm and by reducing the proliferation of uterine lining to inhibit implantation. Natural progesterone on the other hand, thickens the uterus lining and helps with implantation of an embryo.
The way pharmaceutical contraceptives are metabolised can vary between individuals due to the type, concentration, duration and timing of medication used. Although generally relied upon as contraceptives, they may also be used to manage issues such as acne, period pain and heavy bleeding.
Albeit highly effective as contraceptives, there is a dark side to long term use of these pharmaceuticals such as toxicity and nutrient depletion through their impact on gut and vaginal microbiomes, liver function, oxidative stress and chemical accumulation.
Let’s now consider the drawbacks and benefits of contraceptive medication.
- Up to 99.5% effective as a contraceptive (depending on type)
- Easy to use (in pill form)
- May manage symptoms such as period pain, acne, irregular or heavy bleeding
- Improves predictability and regularity of bleeding
- May reduce the risk of iron-deficiency anemia if caused by heavy bleeding, some cancers (colorectal and ovarian) and ectopic pregnancy
- Prevent bleeding or symptoms on race day or hard training days (if PMS is an issue)
- Lighten periods
- They don’t prevent sexually transmitted diseases like other barrier forms of contraception.
- Not all women will experience side effects, but some may have weight gain, depression, acne, hair growth, irregular bleeding, nausea, mood swings and headaches. Studies show that women on higher doses of OCP had 50% greater incidence of bloating, breast tenderness and nausea than those on low dose options.
- May impact on the immune system and alter immune response, triggering autoimmune disorders. Studies show an increased risk of developing Lupus in women who take OCPs.
- OCP use is linked to increased risk of cardiovascular issues, high blood pressure, blood clots, and thromboembolism. OCPs may be potentially contributing to an increased risk of cancer and liver tumours, and reproductive issues including premature menopause and reduced fertility.
- May alter the intestinal microbiota and vaginal microbiome composition after just 6 months of use. Both IUDs and OCPs may increase the risk of bacterial vaginosis, trichomonas vaginalis and candida albicans infection in sexually active women. Studies suggest OCPs may also contribute to leaky gut through changing tight junction expression in the gut which can contribute to food intolerances and other immune reactions.
- May indirectly contribute to body toxicity by adversely affecting the capacity of the gut to metabolise and excrete other xenobiotics (e.g. polycyclic aromatic hydrocarbons, pesticides, polychlorobiphenyls, heavy metals, benzene derivatives, dyes, artificial sweeteners) and metabolic by-products.
- May reduce vital nutrients and contribute to excess accumulation of others. Studies show the OCP reduces zinc, selenium, vitamin E, Co-enzyme Q10 (a cofactor in energy production), B12, phosphorus and magnesium levels but contributes to higher copper and cadmium levels. OCP use may also increase ferritin levels, resulting in enhanced iron absorption, but potentially contributing to iron overload and oxidative damage. The toxic effects of potentially high copper and cadmium in the body deplete antioxidant (glutathione) levels, inhibit antioxidant enzyme activity, and increase the synthesis of harmful free radicals and may damage liver cells.
- OCP use is also associated with environmental chemical accumulation in the body. An analysis from the Norwegian study of 1090 women over a 5-year period, found higher levels of the harmful chemical PFAF (Perfluorooctanesulfonate) in women who used the OCP for more than 12 months. Elevated PFAF levels have been associated with infertility, preclampsia, cancer and adverse effects on the liver, thyroid organs and endocrine system.
- High environmental impact from oestrogen contraceptives. Over 700kg/year of synthetic oestrogens derived from contraceptives (OCPs, patches and vaginal rings) are released into the environment and contribute to 16% of the oestrogenic load present in waterways worldwide. Oestrogens and progestin are detrimentally impacting the physiology of fish and other aquatic animals. The impact extends to our water and soils.
- Although the OCP is widely prescribed to prevent further bone fractures or as a protective measure, however the long-term effect of oral contraceptive use on risk of fracture remains unclear. A 2014 study from the University of Wisconsin School of Medicine and Public Health, involving high school athletes concluded there was no difference in the frequency of musculoskeletal injury between athletes who used the OCP users and non-users. Another 2015 study reported there was no difference in fracture risk for women aged 38-49 years of age between OCP users and non-users. A 2015 study published in the Journal of Women’s Health suggested contraception injections such as DMPA have been shown to be associated with low bone mass and osteoporosis in women.
What women can do.
- If you choose to take the OCP or other contraceptive, read up on possible side effects and talk to your prescribing G.P about other options if you experience side effects.
- Ensure your diet is high in nutrients that help with drug and hormone metabolism and detoxification such as the cruciferous family of vegetables ( broccoli, cauliflower, kale, cabbage, brussel sprouts, arugula, daikon, bok choy, horseradish, Chinese cabbage, Romanesco broccoli, kohlrabi, radish, turnip, wasabi, turnips and watercress). These vegetables are rich in indole-3-carbinol and glucaric acid which assists with oestrogen detoxification and healthy hormone metabolism. Glucaric acid is also found in many fruits and vegetables with the highest concentrations also in oranges, apples and grapefruit.
- Speak to your naturopath about your current mineral status. Minerals tests can detect issues in nutrients such as copper, zinc, selenium and other nutrients effected by OCP use.
- Improve your antioxidant status to counteract any side effects of OCP use by including brightly coloured fruits and vegetables in your diet daily.
- Speak to a natural awareness fertility (FABM) educator who can explain other contraception options and methods of predicting or calculating the fertile phase of a woman’s cycle. Natural family planning is estimated to be around 85% effective when performed correctly.
- Speak to your partner about other methods of contraception.
- Reduce your overall toxin and chemical load by using organic skin and personal hair products and opting for non-toxic household chemicals.
- Consider natural options (such as herbal medicines, nutritional medications and dietary intervention) for hormone balancing if you are using the OCP for symptom management.
- If you would like to better understand how you can balance your hormones through good nutrition, download our free hormone balancing meal plan here