It’s been more than 50 years since the oral contraceptive (OC), known as “the pill” revolutionized women’s health and our culture as a whole. Unfortunately a shadow has been cast over what has long been considered a tool of empowerment, by the lack of disseminated information pertaining to its hidden dangers. Since the pill’s release, hundreds of studies have pointed to the effects it can have on metabolic and nutritional processes, yet the findings have remained largely hidden to the millions of women taking it. Most are familiar with annoying side effects such as headaches and weight gain, however many risks are more serious, i.e. birth defects, depression, hypothyroidism, cancer and stroke. While nutrient deficiencies are responsible for many of these conditions, others may be attributed to disrupted hormonal processes. Some consequences of OC use can be easily reversed and others last a lifetime. All in all, it is troublesome that many health issues brought on by the drug could be prevented if information was more available.

The Pill

Female oral contraceptives have been modified and improved since the original formulation, but the general premise remains the same. Basically they work by using synthetic forms of the hormones estrogen and progesterone (progestin) to alter normal biochemical processes, tricking the body into thinking it’s pregnant. Now in its third generation, hormone concentrations are reduced, which has lessened some of the negative effects. Meanwhile, other concerns have arisen with the expanded therapeutic uses, including conditions such as acne, menstrual discomfort, and endometriosis. For many, the benefits come at a cost. For instance, OC therapy in early adolescents has been shown to impede optimal bone mineralization. Because the situation risks a lifetime of compromised bone health, experts advise postponing hormonal contraceptive therapy until at least three years after initial onset of menstruation. With knowledge of risk factors such as this one, safer alternatives could be employed that don’t come with the high cost to one’s health.

Many conditions resulting from OC use are treated with prescriptions, which come with additional side effects. Furthermore, the connection between symptoms and contraceptives frequently goes unrecognized by the doctor and patient alike. Again, this highlights the importance of communicating research findings. Some of the many documented effects of use are as follows:

  • Headaches
  • Fatigue
  • Impaired blood sugar regulation
  • Depression
  • Gallstones
  • Persistent Human Papillomavirus (HPV) infection
  • Increased triglycerides
  • Disturbed protein metabolism
  • Risk of thrombosis and hypertonia (stiff muscles)
  • Birth defects
  • Cervical dysplasia
  • Anemia
  • Cardiovascular disease
  • Altered mucus membrane
  • Insomnia
  • Nerve problems
  • Weakness
  • Easy bruising and poor wound healing
  • Asthma
  • Osteoporosis
  • Loss of smell and taste

Nutrient Deficiencies

The symptoms and conditions listed are primarily connected to the diminished nutrient levels caused by the drug. When considering OC induced nutrient depletions, it is important to keep in mind they may be compounding existing deficiencies from factors such as diet, lifestyle, medications, health conditions, genetics, and stress. Studies have identified the following nutrients as being reduced with OC use: folic acid, vitamin B6, vitamin B12, vitamin B2, vitamin C, magnesium and zinc. On the flip side, they have been shown to cause elevated levels of vitamin K, iron, and copper, which is also not ideal.

Folate, B6 and B12 are typical headliners for any discussion of OC induced deficiencies, and it’s no wonder why. Special note is made of the B vitamin deficiencies, as they are critical for so many functions, and deficiency is a concern even before introducing risks associated with hormonal contraceptives. Folate requirements are especially high during pregnancy and lactation when demands of the mother and child are greater than usual. Traditionally, health practitioners have ignored the need for vitamin supplements until pregnancy has been confirmed. Such as in the case of folate, a prenatal vitamin comes too late, since neural tube defects occur in the first month of pregnancy (risks include brain development, spina bifida, and oral clefts).

With such strong evidence supporting the need for folate, doctors are now recommending 400 ug/day for women who have the potential to conceive, and to continue this protocol throughout the first trimester. Concerns regarding folate have also prompted an interest in manufacturing OCs that contains the vitamin. For the estimated 20% of women having the genetic polymorphism MTHFR (which can impair folate metabolism), and those on vegan diets, the need to be vigilant is even greater.

Increased cardiovascular and stroke risks, especially when coupled with smoking, are some of the more well known effects of B vitamin deficiencies. Lesser known, are research findings resulting in reduced methylation, cancer risk, and reduced neurotransmitters (serotonin, dopamine, GABA, and acetylcholine). These systems do not work in isolation and are highly intertwined with hormonal functions.

Long Term Effects

Pregnancy prevention ends when you stop using the pill, however other effects are long term. In addition to compromised bone health, the following considerations are also important.

  • Studies have shown that long term use can lead to as much as a 40% reduction in the body’s B12 set point. In other words, the body will regulate its levels to maintain a lower level than it would otherwise.
  • Research found Human papillomavirus (HPV) infection persistence to be inversely proportional with B12 levels. Extended HPV infection increases risk of cancer.
  • Reduced free testosterone is a lesser-known effect, which doesn’t resolve upon cessation. Oral contraceptives have lead to elevated levels of a protein called Sex Hormone Binding Globulin (SHBG). SHBG binds testosterone leaving less available for physiological needs, resulting in sexual, metabolic, and mental health consequences.

What To Do

It goes without saying that female oral contraceptives have significant benefits, and it is important to weigh the risks, with the benefits. It is strongly advised that the key factors listed below are part of the conversation between doctor and patient:

  • Consider safer alternatives for some of the many non-contraceptive uses, i.e. nutritional, herbal, lifestyle and bioidentical hormone therapies.
  • Consider alternate contraceptive methods, and limit the duration if you chose to use hormonal ones.
  • When taking hormonal contraceptives it’s important to supplement with at least a multi-vitamin, calcium with magnesium, and Vitamin D3. Additional B vitamins, probiotics and iodine (for thyroid) may also be warranted depending on individual needs.
  • References

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    3. Lassi, Z. Bhutta, Z. Clinical utility of folate-containing oral contraceptives. Int J Womens Health. 2012; 4: 185–190.
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    4. Oral Contraceptive Pill May Prevent More Than Pregnancy: Could Cause Long-term Problems With Testosterone. Science News. https://www.sciencedaily.com/releases/2006/01/060104232338.htm Accessed on July 15, 2016.

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    8. Ziglar, S. The effect of hormonal oral contraception on acquisition of peak bone mineral density of adolescents and young women. J Pham Pract. June 2012; 25(3): 331-40.