The oral contraceptive pill (OCP or simply ‘the pill’) revolutionised contraception back in the 1960s and, since that time, there have been few changes to its design. Only a handful of new, different options have been made available to women, such as the IUD (e.g. Mirena), injections (e.g. Depo-Provera) and, of course, non-hormonal barrier methods such as condoms and diaphragms. Today, the pill remains the number one preferred contraceptive method.
How does the OCP work?
The pill essentially stops ovulation, thus preventing pregnancy, and provides synthetic forms of oestrogen and progesterone that mimic our natural hormones but don’t confer the same protective benefits. Lara Briden [https://larabriden.com/] describes it as putting women into a drug-induced form of menopause, depriving the body of these beautiful hormones.
The pill is often prescribed to ‘balance hormones’, reduce heavy and painful periods and improve skin health such as acne. However, all it is doing is masking the underlying problems. Please remember – a pill bleed is a drug-withdrawal bleed and not a natural period.
What does this mean for women’s health?
The pill is known to deplete various nutrients including B vitamins (especially folate), zinc and magnesium, and have a direct impact on gut health. Any woman wishing to have a baby needs to be aware of this, and I will speak more about what you can do later in this post. It is also important to consider the long-term effects of these nutrient deficiencies, and there is now substantial research to show that women who do not ovulate for extended periods of time (i.e. they are on the pill) are at greater risk of developing conditions such as osteoporosis and heart disease later in life.
What are the alternatives?
If you are taking the pill for contraception, there are numerous other non-hormonal methods available to you that will not negatively impact on your health. For many women in long-term relationships, simply learning how to properly track their menstrual cycle and using barrier methods such as a condom or diaphragm will be sufficient. I would encourage you to do your research here and reach out for additional support if necessary.
If you are taking the pill to reduce unwanted symptoms such as acne, heavy and/or painful periods, then I would always suggest working with a naturopath and getting to the root cause of the issue first. This is especially important for women with heavy periods, PCOS, fibroids and endometriosis, as the pill is simply masking your symptoms while the underlying biochemical drivers continue. For some women, the Mirena is the best option to reduce heavy blood flow and painful periods where other interventions don’t work. In my mind, it is the healthiest option as it contains low dose progestin only which acts locally to prevent build-up of the endometrial lining, thus preventing a bleed or, at the least, significantly reducing it for most women.
Coming off the pill
For many women, there are few issues with simply stopping the pill and they won’t notice any dramatic changes, particularly if their period wasn’t anything major before they started taking it. For others, they may experience changes to cycle length, bleed length and flow and a flare in acne.
If you have any concerns at all, it is always a good idea to work with a professional to determine the best course of action for you before you come off the pill to minimise unwanted side effects.
Preconception care and fertility support
It is essential that you give your body sufficient time to become replete in nutrients, including magnesium, zinc and folate, before trying to become pregnant. For this to occur, I would suggest a timeframe of at least 6 months and possibly as long as 12 months for most women. Folate (and choline) is essential for conception, a healthy pregnancy and, of course, a healthy baby at the end. Furthermore, make sure you get the right type of folate (i.e. NOT folic acid!). I recommend a pregnancy multivitamin that includes activated forms of folate (i.e. folinic acid) and methyl folate, as well as choline.
Female hormones are complex and every single woman I see in clinic will have different genetics, meaning they will produce and metabolise their hormones differently.
Many of you will be able to come off the pill and address fertility on your own. However, if you have questions or concerns, I recommend seeing a naturopath who can give you specific guidance for your situation.
For women with a complex hormonal history, especially with a strong family history of oestrogen-dominant conditions such as endometriosis, I would recommend DNA testing. The power in understanding your unique biochemistry and learning the simple things you can do to improve your hormonal health is nothing short of incredible.
Written by Denise Berry BHSc
For assistance with contraception options or preconception care, consult one of our naturopaths. They will ensure you are fully informed and offer advice and support relevant to your individual circumstances. Book an appointment.