For most women a PCOS diagnosis and a prescription for the oral contraceptive pill go hand in hand.
The Doctors tell us that the pill is one of the only few options to 'control' the unwanted symptoms such as acne, menstrual irregularities, thinning hair and weight gain.
The side effects of the pill are rarely discussed. Especially the fact that this medication can actually make the condition Polycystic Ovarian Syndrome (PCOS) WORSE!
If that makes zero sense to you right now, trust me, you are going to want to keep reading...
Here's What the Pill Does to a Womans Body...
The Birth Control Pill works to prevent ovulation (the release of an egg) and basically shuts down the entire brain to ovary communication signals (Hypothalamic-Pituitary-Ovarian/ HPO Axis). Both of these things effectively prevent the possibility of egg fertilisation, and ultimately pregnancy with rates of 99% efficiency if taken 'perfectly'.
Without ovulation, we cannot make the hormone progesterone, as this is only created by a structure known as the Corpus Luteum, when an egg is released. Progesterone helps to make us feel calm and relaxed, balances oestrogen, helps us sleep well, prevents PMS symptoms during the second half of our cycles and allows us to carry a child if we so wish.
When we are on the pill, our body is given synthetic hormones and we do not experience the wonderful, rhythmic fluctuations of our female hormones throughout the month. We also unable to enjoy the benefits of our own natural progesterone production. FYI...The 'progesterone' in the pill is not the same as the natural hormone produced by our body after ovulation.
Another common misconception is that the pill regulates our menstrual cycle. The truth is that the 'period' you experience on some types of the pill, is actually a withdrawal bleed, chemically induced by the medication! That is why it is technically 'safe' to take certain pills that do not give you a bleed at all, because it's not a real period anyway! The pill manufacturers designed this medication to mimic a women natural cycle, in order to make women feel more at ease when taking the pill, hence the common 28 day cycle.
So, maybe you have recently found out that you have PCOS and your doctor is advising that you go on the pill, or you have been taking it for years to manage your symptoms?....
Here are the Main Ways that the Pill negatively impacts a woman with PCOS:
Increases Insulin Resistance
70% of women with PCOS have insulin resistance. This means that her cells have become 'numb' to the effects of insulin, which is a hormone produced by the pancreas. Insulin resistance causes the blood glucose to stay high, resulting in the pancreas producing more insulin to try and reduce the blood glucose levels. If this continues for a long period of time then the pancreas becomes fatigued and is unable to produce adequate levels of insulin. This is called type 2 diabetes.
Several studies have linked certain types of the birth control pill to reduced insulin sensitivity. (1-2) Excess insulin leads to the over production of androgens (male hormones) by the ovaries and adrenal glands in women with PCOS, driving symptoms such as anovulation, acne, hirsutism and androgenic alopecia.
Insulin resistance also lowers the level of sex hormone binding globulin (SHBG), which causes excess free hormones such as testosterone and oestrogen to circulate. (3)
Depletes Key Micronutrients
The oral contraceptive pill has been shown to deplete nutrients such as zinc, selenium, magnesium, vitamin E, vitamin C, B2, B6, B12 and folate. The deficiency of these nutrients are likely the cause of many side effects associated with the pill. (4)
The B vitamin family in particular benefit PCOS and other endocrine disorders in many ways. They help with the metabolism of our food, our sensitivity to insulin, the production of neurotransmitters such as serotonin, and the detoxification of excess hormones through the liver.
Zinc can help to lower inflammation markers, improve insulin sensitivity and has been found to be helpful for PCOS in several studies (5) It may also be helpful at improving acne and hair loss associated with PCOS, by helping to block the 5 alpha reductase enzyme, thus lowering the levels of the potent androgen, DHT. (6)
Impacts Gut Health
We are all aware of the impact antibiotics have on our gut health, but did you know that other medications, especially the oral contraceptive pill, can wreck your gut too?
It is thought that the pill increases gut inflammation, creates intestinal permeability (aka 'leaky gut') and alters the gut bacteria. This may affect the digestion and absorption of the nutrients which are needed to produce and detoxify your hormones.
The pill has been linked to the increased (up to 3x) risk of developing Inflammatory Bowel Disease (IBD) such as Crohns, especially if the woman has been taking it over 5 years, is genetically predisposed and has a history of smoking. (7-9)
Lowers Thyroid Hormones
PCOS and thyroid disorders are closely linked. Your thyroid is responsible for metabolism and PCOS is a hormonal/metabolic disorder. As I previously mentioned, the pill depletes several nutrients, the majority of which are crucial for proper thyroid hormone production and conversion.
The high levels of synthetic oestrogen in the pill increases the activity of Thyroid Binding Globulin (TBG). More circulating TBG leads to lower levels of free thyroid hormone available for use by our body. (10)
As the pill increases inflammation levels within the body, it can also shunt T4 levels into Reverse T3 (RT3) an inactive form that the body cannot use. (11)
Affects Neurotransmitter Function
95% of our serotonin is created in the gut, not the brain. As the pill negatively impacts gut health, it can affect the production and balance of our brain chemicals. Women with PCOS commonly experience anxiety and depression. It isn't full understood if these conditions are part of the pathophysiology of PCOS, worsened with the use of the pill, or if the symptoms women experience (such as acne, weight gain and hair loss) lead to these neurological conditions.
The depletion of micro-nutrients, especially B6, B12, folate, zinc and magnesium can affect mental health and may lead to symptoms such as depression, chronic anxiety, OCD, perfectionism, insomnia and aggression.
Without ovulation, we are unable to produce the hormone progesterone which dominates the second half of our menstrual cycle. Progesterone increases the levels of gamma-aminobutyric acid (GABA), which is an inhibitory neurotransmitter that calms the central nervous system and reduces feelings of anxiety and stress.
Doesn't Address the Underlying Imbalances
In my opinion, the biggest way in which the birth control pill negatively affects hormonal conditions such as PCOS, is the fact that it does nothing but mask the underlying problems.
Putting a band aid over your symptoms by taking medication is like trying to get rid of the smoke, without tackling the fire.
In the long term, unresolved hormonal and metabolic imbalances will likely lead to further health conditions developing, such as cardiovascular disease, type 2 diabetes and possibly hormone dependent cancers.
This is why I urge women in their reproductive years to really take charge of their hormones NOW and not wait until you hit menopause to make changes.
You can probably tell that I am not a fan of the oral contraceptive pill, however I totally support women who chose to take it. What I am passionate about, is
If a woman with is told about all of the potential side effects before she is given the prescription, and still chooses to take the pill because of her own personal circumstances, that's fine.
And by side effects, I don't just mean the increased risk of stroke, blood clots and hormone dependent cancer, but all of the factors I have shared today, plus issues such as low libido, yeast infections, vaginal dryness, apathy and changes to who you are sexually attracted to! (Yes, you read that right)
Nutritional therapy and Naturopathic Medicine trumps conventional Medicine (in my opinion) when it comes to dealing with endocrine (hormone) disorders such as PCOS. Medication often comes with negative side effects, while nutrition and lifestyle changes can create beneficial effects and can actually help to reverse (not mask) the underlying causes.
Have you ever taken the birth control pill? Would you have still taken it if you knew some of the side effects? Leave me your comments below.
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