Fitter Girls Guide To The Contraceptive Pill

A topic we discuss regularly is hormone health, particularly in Fitter 365 our membership group. Some of the latest content has provoked some interesting discussions about hormone supplementation with many members asking about the health implications, side effects and how they could support themselves more nutritionally. This blog series will get you up to speed on female hormone therapy, kicking off with the contraceptive pill.

In an earlier blog I spoke about the importance of personalising your approach to your own health, nutrition and training. Just because someone tells you their experience of taking the contraceptive was wonderful or horrendous it really means very little to you. Our response to any medications are individual and based on a number of variables. The important thing is that you educate and inform yourself about the implications (short and long term), are aware of the side and compensate where necessary for any negative effects they may have on your body.

My Experience With The Pill

29241_398152942154_663069_nI’ll confess to remaining ignorant for years about the contraceptive pill and at times abusing it to avoid having a cycle (I’d run packs back to pack) or to keep my skin clear. I really wish I’d not been so flippant about taking a medication, knowing what I know now I’ve realised it wasn’t a wise move and can bite you in the backside later.

I was put on the contraceptive pill after my first ever menstrual cycle. I almost fainted one day at school, in reflection I think it was just pure shock at the blood loss, I’d been told to expect a thimble full, the person who started this rumour clearly had massive thumbs!!!  Also I was almost 16 and had told pals I’d had my menstrual cycle for aaaaaaaaages just to be like everyone else (oh to be a teenager again!) so I couldn’t confide in any of my friends. I told my mum how distressed I felt and she took me to the GP to check everything was ok. He asked if I suffered from blood clotting (I did), took one look at my slightly underweight body and pale hands and decided I was at risk of anaemia so taking the pill would be wise. I started off on Microgynon and soon broke out in acne (way more distressing than losing pints of blood in the school toilets) so they added in 18 months of various topical and oral antibiotics before eventually switching me to a pill called Dianette.

I bloomin loved Dianette! I gained half a stone but my skin cleared wonderfully. Acne is crippling at any time but as a teenager having people shout “Oxycute em!” at you in public is really not fun. I was told by the GP I could only remain on Dianette for 18 months due to a high risk of cardiovascular complications. I ignored his advice. IGNORED IT. I was a total idiot, you should never ignore advice like this from a GP (it’s precious for a start). I developed Raynaud’s Disease around this time and always wondered if there was a link or association between the condition and the contraceptive pill, however, I was at university and my nutrition predominantly consisted of cereal and bowls of microwave rice so it could be more of a nutrient deficiency – REMEMBER, as our pal Rannoch Donald constantly states “It’s never one thing!”

Keris RunningI stayed on Dianette for 3 years until I left university and returned to my home town. My new GP was amazed I’d gotten away with repeat prescriptions and instantly took me off it. I think I begged him and maybe shed some tears in his surgery. My biggest fear was my acne returning, I’d just got my first post graduate job and was stressed enough as it was without having to face that all over again. He moved me onto Marvellon (which raises HDL cholesterol so thought to have less cardiovascular risk) and reassured me it would be just as effective for my skin. By this time I had developed dreadful IBS, it’s been hypothesised that the pill may alter the gut microbiome, but then so does antibiotics, stress and too much running (again it’s never one thing!) He was the first GP to suggest managing stress, running less and cutting out gluten and dairy for my IBS, I mention this because people are quick to criticise GP’s but he was grand!

Both Dianette and Marvelon have an anti-androgenic effect by raising sex-hormone globulin (SHBG)  and decreasing free testosterone. I know I always felt I had to exercise more and eat less than everyone else to maintain my weight and never had any muscle definition during my time on the contraceptive pill.

I decided to have a brief break from the pill in my mid 20’s just to see what my body was like without it, surely the acne wouldn’t return now I was older? The outcome wasn’t fun, the acne returned, my cycle didn’t and I was eventually diagnosed with Polycystic Ovarian Syndrome (PCOS). My hormone tests showed high testosterone, high FSH, low LH and cysts on my ovaries. I was told I would need to start a new pill called Yasmin or undergo fertility treatment and consider Clomiphene, a fertility drug, to kick start my cycle. I wasn’t ready for a family so I started Yasmin and for the first two weeks my body didn’t know what hit it! I physically couldn’t exercise. I’d head to the gym and either end up with my head in the loo heaving or my body just felt like lead and refused to move. I stayed with it as the GP said their would be ‘period of adjustment’ and my body eventually settled down.

I stopped Yasmin a few years later when I thought I was ready to start a family, the skin problems didn’t return but funnily enough my cycle didn’t return either for over 12 months. I was prescribed a course of synthetic progesterone but I actually didn’t end up taking it. Life would have it that I left my partner of 7 years (giving me emotional freedom), sold a house (giving me financial freedom) went on a girls holiday to Ibiza (giving me so much laughter and support), slept in every morning (mac daddy of health), sunbathed (vitamin D for hormone health) ate more, exercised less and relaxed… et voila my cycle returned.

IMG_3692People have asked where I am now and sadly when our business took off  and I upped the intensity of my training, work and lifestyle, my cycle went off on it’s hols again. I’ve also had some incredibly difficult experiences including two false positive pregnancy tests where Matt and I celebrated a phantom pregnancy for 48 hours before a baffled doctor confirmed I wasn’t pregnant at all. I’m telling you my story because I know how difficult, confusing and overwhelming hormone health can be at times. I don’t doubt the contraceptive pill contributed and complicated some of my hormone and health issues but we can sometimes be guilty of believing it caused all them when there are so many other factors to consider with hormone health.

I firmly believe stress is likely the biggest f*cker right now for most women (and men!) Whether you’re in puberty, the fertile stages of life or going through the menopause, it can derail everything. My advice is always to consider a top down approach, the hypothalamus gland in the brain regulates hormone health with the ovaries and adrenal glands (which produce stress hormones) and this line of communication needs to be supported by your lifestyle and mindset as well as your nutrition. I’ve been adjusting my psychological health as well as my nutrition and training for a long time to coax my hormones back into a natural rhythm. I have the confidence it will work when it’s ready, in the meantime if any of you ladies want to book a holiday with me that could help 🙂

Most importantly, I want to encourage you to educate yourself about your own female hormone health and fertility so you can make an informed decisions and assess the feedback you receive from your body. I’ll be writing about a number of hormone therapies over the next few week and offering an insight into more natural ways we can support optimal hormone health starting with the contraceptive pill.

The Role of The Contraceptive Pill

You maybe prescribed the contraceptive pill for any of the following:

  • Birth control
  • To treat the symptoms of hormonal imbalances including painful, irregular or absent cycles, Polycystic Ovarian Syndrome or fibrocystic breasts.
  • Skin health

Types of Contraceptive Pill

The Combined Pill

The combined pill contains both synthetic oestrogen and progesterone. The oestrogen stops the body from producing the hormones involved in the menstrual cycle: Follicle Stimulating Hormone (FSH) and Luteinising Hormone (LH). This prevents your ovaries from ripening and releasing an egg, essentially halting ovulation. The progesterone then thickens the cervical muscus that lines the entrance to the womb prevents the sperm from entering and fertilising the egg, it also thins the lining of the womb so the fertilised egg cannot implant itself.

The most common type of pill is the Monophasic 21 day pill. You take it for 21 days and stop for seven days to have a period like bleed before taking the pill again after seven days e.g. Microgynon, Brevinor and Cilest.

There are also Phasic 21 day pills with different sections in each pack, each one has a different amount of hormones and a certain section is taken each day for 21 days followed by a break for seven days e.g. Binovum and Logynon.

Finally there are Every Day (ED) pills, as the name suggests these are taken daily for 28 days with no break e.g. Microgynon ED and Logynon ED.

The Progestogen Only Pill (Mini Pill)

As the name suggests this only contains the synthetic hormone progestogen, not estrogen. Similar to how progesterone works in the combined pill it causes the cervical mucus to thicken and prevents the sperm reaching the egg whilst also thinning the lining of the womb, some will also prevent ovulation.

There are two different types of progestogen only pills:

  • The 3 hour progestogen-only pill (taken within three hours of the same time each day) e.g. Femulen, Micronor, Norgeston and Noriday.
  • The 12 hour progestogen-only pill e.g  Cerazette which must be taken within 12 hours of the same time each day. This pill also stops ovulation in 97% of menstrual cycles.

The Pill and Health

The medical world accepts that there are a number of individuals whom the contraceptive pill should not be prescribed to as there are potential health risks and complications, including adolescents who have be menstruating for less than 2 years (yeah cheers for that!) and smokers. Other conditions where the pill may contraindicate include:

  • Depression
  • Chrohn’s
  • Gallbladder disease
  • Diabetes
  • Heart disease, high cholesterol and high blood pressure
  • Multiple Sclerosis
  • Obesity
  • Fibroids
  • Migraines
  • Breast nodules or fibrocystic breasts
  • Liver or kidney disease
  • Varicose veins
  • Irregular menstrual cycles
  • Known cancer of the reproductive organs

The complete list is actually bigger than this and there are a huge list of potential side effects detailed in the literature that accompanies the medication but few of us read that. Some important ones to note are highlighted by Francesca Naish in Natural Fertility and include:

  • 2-8 times increased risk of blood clots
  • 3-6 fold increased risk of heart attacks
  • Disturbances to blood sugar metabolism
  • Increased risk of gall bladder disease
  • Increased risk of ectopic pregnancy
  • Significantly higher risk of developing breast cancer
  • Increased risk of osteoporosis

It’s important to acknowledge that studies have observed the risks are generally with higher doses of the pill and commonly lower doses are now prescribed, however, it’s important your familiarise yourself with any of the above before deciding to start or continue with the pill.

The Pill and Nutrient Status

The contraceptive pill can also cause nutrient deficiencies, this is due to the fact our requirements are increased by taking the pill. Vitamins and minerals are needed to metabolise and detoxify the extra hormones plus it is suspected it may disrupt the bacterial balance in the digestive tract which will impact nutrient absorption. Studies suggest women have a raised need for the following whilst taking the contraceptive pill:

  • Vitamin A
  • Vitamin B1, B2, B3, B5, B6, B12 and Folate
  • Vitamin C
  • Vitamin E
  • Magnesium
  • Zinc
  • Manganese
  • Essential Fatty Acids: omega 3’s and Gamma Linoleic Acid (Evening Primrose/Starflower Oil)

Many women don’t tend to be aware of the impact of these deficiencies until they stop taking the pill and their cycle doesn’t return, known as post pill amenorrhea, or they may suffer from menstrual cycle irregularities or fertility issues possibly due to their low nutrient status. The complications here are that some of these deficiencies and imbalances may have existed before and the pill was prescribed as treatment  so again it is difficult to make direct associations.

Please do not simply supplement with all of the above, work with an experienced practitioner who can personalise a supplement program to your needs. You can email me for more details about this.

The Pill and Gut Health

photo 3-11Several women taking the pill experience digestive disturbances and the onset of the symptoms of Irritable Bowel Syndrome. It is suspected the pill may cause changes in the gut microbiome and this in turn will impact upon the balance of hormones and detox capacity within the body. There are few studies investigating links between the contraceptive pill and gut health at this stage. Again the situation is further complicated by the fact many women are prescribed the contraceptive to treat hormonal imbalances (e.g Pre-Menstrual Syndrome, PCOS, etc) and skin conditions, there is a strong chance with health issues like these that digestive health may have already compromised. Many women taking the contraceptive pill also suffer from recurrent fungal infections, these are highly opportunistic and usually kept in check by beneficial gut bacteria, again suggesting the pill impacts upon levels of protective gut flora in some way.

Detoxification of the Pill and Genetic Considerations

Liver GraphicAn important to thing to consider when you take any oral hormone therapy is that they are metabolised via the liver (hormones can also be taken topically and sublingually). One of the reasons I covered the phases of liver detoxification in our second book was to emphasise the importance of consuming the nutrients that aid this process. If hormones are allowed to accumulate then numerous health issues can arise from an excess including an increased risk of cancer and ironically many women experience an increase in some of the menstrual related symptoms they are using the pill to treat.

It’s also recently been discovered that some individuals also have impaired detoxification due to a number of genetic mutations. In such cases taking medications, especially on a daily basis, that require processing via the liver will add a substantial burden to an already overwhelmed system and potentially severely compromise your health.

It is estimated around half the population have a gene mutation known as MTHFR which reduces the efficiency of a process known as methylation, vital for detoxification. There is also the possibility that you may have a COMT gene mutation and COMT enzymes regulate the levels of hormones in the body, especially estrogens. Perhaps at some stage testing will be introduced before prescribing medications to allow for a more personalised approached. You can have your genes tested but we recommend you do so with an experienced practitioner as the information can be complicated and overwhelming to many people. I’ve attended several courses on the subject and I’m happy to assist you further if you wish to know more about this topic. You can contact me HERE.

 More on Hormone Health…

Over in our Fitter 365 Membership site we have lots of advice covering nutritional and lifestyle support on balancing hormones naturally, contraceptive alternatives and guidance on how to support your body whilst taking the contraceptive pill or after discontinuing a prescription. I’ll also be discussing the coil, hormone injections and HRT for symptoms of the menopause in blogs over the coming weeks so look out for those coming soon 🙂 It’s FREE to join Fitter 365 for the first two weeks, come and hang out with us there!