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birth-control-pills

Birth Control Pills: How They Work, Benefits, and Risks

August 29, 2012
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Today we are going to kick off the Kick Ass Birth Control series by talking about America’s most popular method: the pill.

The thing is, the pill is so complicated and comes in so many different forms, it’ll have to be broken down.

This post focuses on how the pill works, and what this might mean for health and fertility.  The next installment will cover all the various types of pills, explaining and weighing pros and cons of each.

And briefly, beforehand, the world’s quickest announcement: the T shirt contest has been closed!  We got dozens of awesome designs.  Beautiful, fierce, simple, explicit, exquisite… so thank you, thank you so much, all of you, for caring about and loving this community. So I am sitting on some ideas and going through sketches with my artistic pals.  The T shirts and the giveaways will be revealed as soon as we have that done, definitely within the month.  !

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The normal menstrual cycle and getting pregnant

In order to understand how birth control pills work, it is crucial to first understand the menstrual cycle.

In super brief:

The menstrual cycle is a complex interplay between hormones secreted from the pituitary gland, and the hormonal responses of the reproductive organs over the course of approximately one month.

In moderately brief:

 In a normal menstrual cycle, FSH is secreted by the pituitary gland, which stimulates follicular development, then the ovaries respond with rising estrogen levels.  These estrogens then trigger an FSH decrease and an luteinizing hormone (LH) spike, which induces ovulation, and then progesterone levels rise.  Progesterone peaks and then falls, and the falling of progesterone triggers the shedding of the endometrium in blood flow during what we commonly call week 1.  Then the cycle begins anew.

In details: 

The first day of a menstrual cycle is the first day of bleeding.  During this period, the lining of the uterus is shed.  This bleeding constitutes the first 3-8 days of the first half of the menstrual cycle, which lasts about two weeks and is called the follicular phase.

During the follicular phase, levels of estrogen rise and make the lining of the uterus grow and thicken. Detecting elevated estrogen levels, the pituitary gland increases its production of follicle-stimulating hormone throughout the follicular phase.  This hormone stimulates the growth of 3 to 30 follicles.  Each follicle contains an egg.  With time, the levels of FSH decrease, so only one of the follicles continues to grow.  It produces estrogen, and other stimulated follicles break down.

Detecting this shift, the pituitary now releases luteinizing hormone.  This makes the follicle bulge and rupture, releasing its egg.  This is ovulation.  During ovulation, testosterone, which is otherwise constantly produced at low levels by the ovaries, surges, and estrogen drops.

After ovulation comes the luteal phase.  Here the ruptured follicle closes and forms the corpus luteum.  This thickens the endometriums, which in turn produces progesterone.  But if the egg is not fertilized within about two weeks, progesterone levels fall, which triggers shedding and bleeding.  Here the cycle begins again.  Cycles are generally “known” to be 28 days long, but the length of a regular, healthy cycle can vary from ~20 to ~35 days.

How a woman gets pregnant

A woman gets pregnant when a sperm is implanted in the egg in the dates immediately preceding, during and following ovulation (as much as a few days earlier if the sperm hang around long enough, and 1-2 days later, when the egg dies).   When this is the case, progesterone levels never fall.  Because progesterone levels never fall, menstruation never occurs.  This is why missing periods or “being late” is often the first sign a woman guesses she may be pregnant.

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What birth control pills are

Birth control pills are streams of hormone supply.

They come in either a) progesterone-only forms, or in b) progesterone-estrogen combination pills.

They can be monophasic, diphasic, triphasic, or now quadriphasic, meaning that there can be a) a steady stream of a low dose, or b) a fluctuating amount of hormones.  This fluctuating, cyclical type of pill is thought to approximate a more natural cycle.

Usually birth control pills are taken in monthly cycle, and they deliberately induce menstruation, though now some formulations last for up to three months.

When to take the pill 

A woman takes a pill every single day for a given period of time, and usually at the exact same time.  This is important, because the level of hormones in the blood must be sufficient at all times in order to prevent a cascade of hormones further down the line.

Think of it like this: if you are late in taking your progesterone pill, your pituitary gland might get excited and send an LH signal.  You might later get the progesterone into your system, say 6 or 12 hours late, but by that time the LH has already been released, and ovulation has already occurred.  It is supremely important to take the pills on time.

How it works

Progesterone-only pills were the first pills ever designed.  The idea is simple, and the effect, profound.

Progesterone in the system– as we saw in the review of the normal menstrual cycle– prevents the release of FSH and LH in the brain.   In sum, that means that when a woman takes a daily progesterone pill, FSH and LH do not get secreted.  FSH and LH are responsible for ovulation taking place, so without them, the woman does not ovulate.

In greater detail, that means: in step 1) Progesterone inhibits FSH production.  Step 2) Low FSH levels prevent estrogen levels from rising, and prevent development of the endometrium.  3) Estrogen maintains a baseline low, and that fact, coupled with the high levels of progesterone, prevent LH from being triggered.  And finally, in 4) because there is no LH, no ovulation takes place. Because there is no ovulation, the woman does not get pregnant.

Combined oral contraceptives

Recently after the progesterone pill was developed, estrogen was added to several formulations to create the combined oral contraceptive. The reason estrogen was tacked on (a decade or so after the original development of the pill) was because doctors thought it would stabilize the endometrium and sort of prevent breakthrough bleeding.  Which it did.  What doctors found, however, was that the estrogen also helped prevent ovulation.  This is important to take note of for women who suffer from estrogen dominance and are trying to conceive.

The effect of adding estrogen to pills, then, is to prevent breakthrough bleeding.  It can also be helpful for women who struggle with low estrogen levels (often from low body fat or stress) or from high testosterone levels.  This is because estrogen helps balance testosterone in the bloodstream.  Women with PCOS, for this reason, are proscribed estrogen-containing pills much of the time if they are trying to manage their testosterone-dominant symptoms.

Other ways pills work

Birth control pills also have physiological effects that prevent pregnancy.  Progesterone decreases the amount of and increases the viscocity (thickness) of cervical mucus.  This makes it near impossible for sperm to penetrate through the cervix.

The timing of the pill

Most pills are designed to mimick as much as possible the natural menstrual cycle.    The reason for this is not quite clear, and leans heavily on the psychological.  When they were designing the pill several decades ago, doctors seemed to think women needed to menstruate regularly in order to feel normal or comfortable in their own skin.  That has changed in recent years, though that bias remains somewhat strong.

This fact means that the most common pattern is for progesterone to be taken for 21 days, and then either a placebo or no pill for the next 7 days.  By day 21 of the cycle, ovulation has already been inhibited long past.  This means that progesterone can be dropped of by day 21 with no worry of ovulation taking place, while simultaneously being enough of a drop to induce menstruation.

Another model is to change the 21-7 day cycle to 24-4 days, which can shorten and lighten the periods.

It is also physiologically somewhat important to have a withdrawal bleed, since it is possible that the endometrium will build up too thick without menstruation, which can lead to certain physiological complications such as cancer.  However, those occur on long time scales, and this effect varies widely depending on how much estrogen is in a woman’s system and how much her endometrium grows over time.

However, in general, the pill decreases endometrial thickening, so this is in fact a benefit of the pill–reducing the risk for this type and source of cancer– rather than a negative.

So is it necessary to have a withdrawal bleed every month?

No, in fact, it isn’t.

Some pills extend the cycle to three months long

Though the thing is, we can hardly call a three month long stasis a “cycle.”  It isn’t.  What happens in three-month long pills such as Seasonale is that progesterone continually inhibits LH and FSH without end.  No menstruation or cyclic pattern occurs.

Finally after three months– a somewhat arbitrary number decided on by pill manufacturers and the medical community, a withdraw bleed is induced by taking a few placebo pills. In theory, you could just keep taking progesterone and not menstruate for as long as you desired. But again, because it is nice to “reset” and also to clear up the endometrium, especially if on a pill that contains estrogen, withdrawal bleeds should happen occasionally.

Positive effects of the pill?

Reduction in cancer risk of female-specific cancers–endometrial, ovarian, and colorectal.

If this is true, it is probably in my personal opinion because of the dampening effect progesterone has on estrogen, which itself plays a role in feeding tumors.  However, other studies demonstrate increased breast cancer risk with pill consumption.

Increased vaginal lubrication?

Alleviation of PMS

Decreased Acne

Negative effects of the pill?

Increase in cancer risk (not yet known)

Weight gain

Decreased libido

Decreased vaginal lubrication

Acne

Depression

Psychological disturbances such as anxiety, insomnia, or rage

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Pill acclimatization and amenorrhea

Another affect of going on the pill is that the body might become overly-dependent upon it. Hormones run off of negative feedback loops.  What this means is that detecting certain levels of a given hormone in the blood tells the appropriate glands to stop producing that hormone.  This makes sense, right, in light of the fact that the body wants to maintain proper hormonal balance.

This has negative implications for women who supplement with estrogen or progesterone (ie, take the pill) during their reproductive years, however.  Because the hormones are being eaten or injected into the bloodstream, the body often stops making them. And then after the pill, the body still does not make them. Some women might go several months or up to a year before they begin ovulating and menstruating again.

This is of course not usually the case.  Most women are just fine off of the pill.  Just as with the side effects.  60 percent of women report not having any side effects on the pill.  Most of the rest have some side effects, but bear with them. Others find that the side effects are unbearable, and choose other fertility methods.

Why the pill has both positive and negative effects

Each woman’s body is different.  This means that adding estrogen to the bloodstream might help her symptoms, but in other cases adding estrogen to the bloodstream could do a lot of harm.  The same of course goes for progesterone.  Adding these hormones to the bloodstream has the potential to either increase or decrease the levels above what is natural for a woman– and in fact it is almost certain that they will be differently balanced.

Upsetting the natural balance between estrogen and progesterone, as well as between those hormones and the rest of the sex hormones, particularly testosterone, can have serious effects on a woman.  Estrogen and testosterone need to be specifically and well balanced in order for a woman to have a properly functioning sex drive.  Estrogen and progesterone need to be well-balanced for clear skin.  And so on and so forth.  The list is long.

It is worth noting, moreover, that estrogen and progesterone act as “antagonists” to one another, meaning that progesterone has the power to reduce estrogen’s effects, and vice versa.  This is partly why combination pills are desirable for many women, though it is also why estrogen-dominant women might choose a progesterone-only pill.

That being said…

The pill is complicated!  In my personal experience, it’s just not worth it.  But the negative health effects of the pill are all specific to the individual.  As are the positive effects.  And long term health impacts are not well-understood.  For that reason, it is entirely specific to your body and your needs whether or not getting on a hormonal regimen is “worth it” for you.

As a final note…

As a result of the pill, women are excreting more hormones than usual, which are making their way into the water supply.  This has significantly disrupted the reproductive cycles of some fish.  It is also questionable how much these products make it into the water supply.  Most studies seem to show that small percentages of it do (between ten and twenty percent), but that water treatment plants are mostly effective at filtering them out.

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What I listed above are well-known and popular effects of the pill.  What was your experience?  Did you have any side effects?  Any unusual side effects?  Let us know!  The Pill can do a whole lot more than it is commonly accounted for.

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Managing director of Paleo for Women and author of Sexy by Nature.

56 Comments

  1. Very interesting article. My girlfriend has joined me on the paleo wagon, but if there’s one thing I’ve learned from the paleo blogs around the web, it’s that hormones control EVERYTHING– and a healthy life is all about maintaining a natural hormonal balance. Since the very purpose of these pills are to disturb the natural balance, I’m very much concerned about her taking them. I’m definitely gonna show her your article and talk to her about it. Thanks!

  2. This is an excellent, informative post. I recently decided to stop taking hormonal birth control. Some funny things have happened, like for example the disappearance of about 15 skintags that had grown on my leg. Its crazy what hormones can do to your body, without you even realizing that they were the cause. I was not regular before taking hbc, I’m talking like 2 periods a year irregular, and since stopping hbc in early July I have yet to have a period yet. However, I feel so much better and so much more like myself. No more crazy mood swings, no feelings of just not feeling in control of my emotions. Stopping hbc was never something I would have considered before going paleo last year.

  3. You can add migraines to the list of negative side effects! I never knew what was causing them until I went off the pill to start a family and, whadoyaknow, no more migraines.

    • Sorry that you ended up with migraines. I actually take the pill (partially) to help prevent period-caused migraines. Seasonique (3 months at a time and a low dose pill during “period week”) helps me a lot.

  4. I was on the pill for 12 years before going off. I conceived my son three months aftwerwards. I swore I would never go back on. But after an accidental pregnancy that ended in a misscarriage, I viewed the pill as a sort of necessary evil. I was doing a calendar method for 2 1/2 years successfully before the “oops pregnancy.” It sort of shattered my confidence when I found out I was pregnant. My husband and I were not ready for another and were quite frightened at first but came in to an acceptance and eventually geared up for another baby….that didn’t make it. I went back on the pill for a year and am now off again. I can say with certainty it has lowered my sex drive. My libido has taken a hit. But, I work through it (my poor husband has to really work for it). It’s like, unless I’m ovulating, I could care less. :-/ Either way, I’m done with the pill for good this time. I prefere to be more in tune to my body and its natural cycle.

    • “It’s like, unless I’m ovulating, I could care less.”

      I know how you feel! :)

    • I’ve been saying for a while now that I believed my BC was the main cause of my decreased libido. When I spoke with my doctor, she switched me from Yasmin to Loestrin. It’s a little bit better, but meh. The husband and I are trying to read up on non-hormonal BC methods that would still work for both of us, and also considering a vasectomy for him. We might want kids one day is the only thing (I’m 25, he’s 27 right now) but we feel that that’s the surest way to prevent a pregnancy right now when we are not financially ready for children.

      • I typed ‘CONDOMS’ then read the phrase “that would still work for both of us.” haha. There are lots of good methods. You’ll find one. :)

  5. ah i need help! i was on the pill for 2 yrs and stopped after i finished my pack and got a period last christmas. haven’t had one since! i just got bloodwork done a month ago and they said all my hormone levels are in check and normal…so what gives? no ovulation and no cycle?

    obviously they want me to take provera to induce a bleed but i really want to just cycle on my own. i am taking calcium supplements and have eaten paleo for 2 yrs now.

    any advice i’m 29yrs old & 5’4.5 113lbs? i have been this weight for years and cycled regularly even when i was ~105-107lbs—i was hiking for 3 wks in new zealand and dropped weight.

    • I dealt with this same issue for a couple of years after having my son. I was actually a little curvier then before I had gotten pregnant and I (nor my doctors) could figure out why my cycle wasn’t coming back. I started addijg more fat to everything I ate: more grass-fed butter and coconut oil on EVERYTHING. It was my delicious solution, my cycle came back within WEEKS. I also scaled back a tad on the exercise, we’re talking switching my 30 minute routines to more like 15-20 minutes.
      My body comp hasn’t changed much, if anything I’m a little curvier in the right places. I think my body just needed those extra nutritious calories to make it happy. I’ve been Paleo/Primal for over 2 years now and it’s easy to under eat because everything you put in your mouth is so satisfying.
      Hope this helps!

      • i do eat high fat (avocado/coconut oil/fatty meats) and only exercise 2-3x weekly. one 20min yoga, one 20-30min run and one 20min HIIT. i’m lost but maybe if i just give it more time it will return?

        • I kept saying “This month will be the month!” because I swore I was eating enough and not over-exercising. I kept thinking my body just needed more time. Hey, nobody knows your body better then yourself and you know something is not right. I swore I ate enough fat to nourish my body but it obviously wasn’t. Between that, and the exercise I was doing (a couple strength/ HIIT workouts and plenty of walking) and all the other stresses that inevitably come with life my body was just like “YOU having a healthy baby?? NO WAY!” For me, the answer was just throwing caution to the wind, and becoming more generous with my fat intake. I also became less OCD about my workouts, listened to my body more. And BAM! I’m fertile again. I’ve been charting for over 8 months now and I’m on my 4th month that my cycle has been consistent, and that happened just 3 weeks after making this one switch.
          Also, if you are at all concerned about being fertile do not so intermittent fasting.
          Cheers!

  6. I want SO BADLY to go off the pill. Since I turned 35 two years ago, the hormones just play havoc with my system. I’m nauseated for a week, then fine for a week, then I can’t sleep for a week, then I have my period. Hubby is miserable too because most of those side effects zap my ability to get in the mood.

    Worst yet, I’ve started to forget the pills (after taking them for 20 years religiously, I have no idea why). I can’t wait to learn about more options! The alternatives we’ve tried (condoms, diaphragm) haven’t been great for us.

    We just got married last year and think we may still want to conceive a child together. We have two daughters from my first marriage, so there’s something appealing about NOT having more kids too. Since we’re undecided, we don’t want to go with anything permanent yet.

  7. I had been taking Diane-35 for almost 15 years, initially to control my acne and eventually also as a birth control method. During those 15 years, I tried stopping it once, and terrible breakouts occurred, so I hopped again and stayed with it. I turned 35 this summer and decided to stop it, when I realized that I was experiencing almost ALL of the side effects listed:

    Depression: HUGE check
    Weight gain: Check
    Lower libido: CHECK (more like none)
    Decreased lubrication: CHECK (more like, a desert)
    Bloating, cramps: check
    Headaches, migraines: check
    Nausea: check
    Fatigue: check
    Spot-bleeding: check. I was constantly spotting and had to wear pads almost every day.

    After discussing it with my partner, his reply was, well, for the few times we make love nowadays, if that pill is possibly causing all of this sh**, it’s not worth taking. *heartbreak*. Poor guy, in those past 10 years he saw me go from one extreme to the other, sex-drive-wise.

    It’s been 2 weeks since I have taken my last pill. Can’t say I’m feeling better. But then again, I have been feeling like a mess for so long I doubt this pill was the sole cause in all of this. I hope that my acne does not return and that I can feel better soon. I hope I can get back on the wagon, paleo-wise, as I have fallen off big time in the past few weeks, with the usual guilt-trips/attempts to rid my body of the excess calories . Reading posts from your site and listening to your podcasts has helped me tremendously to try and forgive myself, and move on towards healthier living. Looking forward to the upcoming posts on this serie.

  8. Great write-up, Steph. I never really understood how FSH and LH fit into the cycle before.

    I take BCP as hormone therapy. Not exactly happy about it, but none of my doctors know what to do with me. FSH and LH tested fine; E/P/T hormones all in the basement. After two years on the paleo diet and still no period, I let them give me the drugs. At least on the pill I feel somewhat female.

    • I am about to turn 31 and have never had a natural period. I was diagnosed with Kallman’s disease when i was 26. It is due to my non-functional pituitary gland. My body produces NO hormones what so ever! Last year i went on hormone replacement therapy to try and have a baby…..but had no luck. What i had to inject in me everyday was nasty! i hated every moment of it. I was a different person. i stopped after 6 months and don’t ever want to go through that again. What my (and my doctors) bigger concern now is, is my low bone density due to the lack of hormones in my body. I have now been forced by my doctors to go on the pill and like you i am not happy about it :(. i have been ‘paleo’ for 5 months now (since stopping the hormone replacement therapy) and feel AMAZING!! i am scared that the pill will change everything. Have you had any bad experiences?

      • Some women have bad experiences, some have good ones. You can try a super low dose pill to see if it works, or perhaps an estrogen patch. If you start to feel “off” at all, you can always cut back or stop.

  9. Copper iud next, please!!!!

    • Coming. :)

    • I tried it for 9 months. It was unfortunately not for me. I think I became zinc deficient and borderline anemic. And the cramps I had left me paralyzed sometimes. It finally took bleeding for 3 weeks straight for me to say enough was enough. My husband and I have used the FAM since May 2011 and no babies yet!
      I, too, am interested in what you have researched on it Stefani!

    • At risk of being one of “those people” who self-promotes like it’s their full-time job, we have a post on non-hormonal birth control options: http://whole9life.com/2012/05/nonhormonal-birthcontrol/ Hope it’s helpful.

      • Aren’t you supposed to be bathing in mineral springs with reindeer or something?

        • Ooooo, mineral springs sound good. While eating reindeer. I like the way you think.

          Actually, we leave next week for our seminar in NJ, then we head to Iceland from there. :)

  10. Thanks for this topic! I have a specific question that I am not sure if you will address. I read recently that taking the pill can increase instances of malasma and hyperpigmentation. I am wondering 1.) if that’s true and 2.) if you have any paleo-friendly skin care recommendations to reduce dark spots on the face. I am no longer on the pill, but was for many years (from around ages 18-30). I am new to paleo and absolutely love your blog (and podcast)! I am 34 years old and have some dark spots on my face that I would like to reduce / eliminate without the typical chemical product recommendations. I know it is completely vain to worry about these spots, but I am a work in progress :-) Thanks Stef!

    • Oh, goodness, I’m sorry! I know virtually nothing about skincare. The Pill can do practically ANYTHING in the right individual.

    • I’ve had some hyperpigmentation issues, and vitamin C can help to reduce those. I recommend getting pure ascorbic acid in powdered form from your local health food store, and mixing a small amount with *distilled* water. It’s best if you do this freshly every night, as vitamin C deteriorates with light exposure, etc.

      Apply the mixture to your face with a cotton ball; it should tingle *slightly* but not much, so you can adjust the proportions as you wish.

      You can also buy vitamin C serums that aren’t too scary with chemicals, Mychelle Dermaceuticals is a nice formula. Good luck!

  11. Thanks for this post. If there’s anything I regret in my life, that was taking BCP. My cycles were normal before going on the pill and after 2 years on it, my hormones are out of whack. I was diagnosed with HA last year and PCOS earlier this year. :(

    • :( Just give yourself lots of love and nourishment and patience. It’ll come back to you with time.

  12. The worst side effect for me was swelling and water retention. At the end of a pill cycle, my breasts and feet were so swollen that it hurt to walk and wear shoes and a bra. Two days after starting the placebo pills, I would feel a major release as I started urinating out all that extra fluid. I still get some swelling with natural cycles, but it’s much less, especially when I watch my carb intake.

    I finally quit the pill when I had a really bad cold. I missed a few pills and started to feel better. Then I tried to get back on them and felt sick again, so I quit for good. I felt as if being on the pill was holding all my body fluids in, preventing me from washing out the germs. I’m now using fertility awareness/NFP.

    • I would like to add that vitamin deficiencies can also be a side effect of pills. I did some experimenting of my own after several months post-pill cycle charting. Based on info from the books Fertility, Cycles, and Nutrition and Taking Charge of Your Fertility, I added a few vitamin supplements and noted the improvements to my cycle.

  13. Going on the pill was one of the worst decisions I ever made. But at 18, it made me feel really independent and grown-up, not to mention it was touted as the most effective method of birth control available. At that young age, I didn’t really “know” myself, my body or my mind. I felt really depressed and was prone to crying spells. I even went on Prozac for a while. Also, my once healthy sex drive vanished. Arousal was difficult. I chalked it up to “getting used to” being with my boyfriend and therefore assumed it wasn’t as exciting as before. Unfortunately my doctors NEVER mentioned these potential side effects. They were just too busy trying to get as many women on the pill as possible.

    Ten years later, single for an extended period, I went off the pill. The clouds parted the very next day. Lo and behold, I am not a “naturally depressed” person. Sex drive came back, although to what degree it was permanently reduced, I will never know. I suppose the pill affects everyone differently, but hormones that are so powerful that they shut down your ovaries – I would definitely think twice about taking it, knowing what I know now.

    P.S. Don’t let the “low dose” moniker fool you. Low compared to the mega-doses of the early pills? Anything that changes the fundamentals of your physiology is an extremely powerful drug.

  14. Please add risk of blood clots to the negative side effects. I had been on BCP for endometriosis and after a long-haul flight rushed to the hospital with a deep vein thrombosis and a pulmonary emobolism. I am very lucky I survived. Unfortunately doctors have few other suggestions for endo other than hormonal treatments, but I no longer take the pill.

  15. I hope you also cover the fertility awareness method. I would like to hear another opinion on it. I don’t use it but I hear it works well for those that are willing and able to put in the effort and have the self control to follow it well.

  16. I have endometriosis and PCOS. I’ve had trouble with menstruating since the beginning. I’ve done hbc off and on for many years. My history is too long for a “comment”. 2 years ago I went primal soon after my 3rd son’s birth. Going primal + metformin helped regulate my cycles and also lighten them. Yet for the past 2 years the pain of endo had been increasing. Not during my period only, but with bowel movements and sex. I could pretty much guess that the endo had gotten involved with my colon. I was looking into the possibilty of surgery, but decided to try hbc to see if it would do anything for the pain. About 4 weeks into hbc I realized there was no more pain. I am doing the three month cycle. I have gotten migraines on other brands, but thankfully, if I take it at the same time no headaches. I did gain a couple lbs back but I will take it for now if it means no more pain.

    • I want to second that taking the *right* pill gave me my life back. There are tons of horror stories about the pill and if you are only taking it for birth control, i.e. you have other options, then maybe it’s easier to say “it’s not worth it”.

      For me, I’m now able to leave the house, use the bathroom, stand up straight, sit normally, walk without pain… Endometriosis can be a true disability and you would have to pry my elephant dose of progesterone from my cold, dead hands. :D

      Sure there are side effects, erm, most too personal to comment on. The big one for me is that taking 26x the normal dose has stopped all weight loss for me. Even so, I’d rather learn to work around the side-effects. I can’t even begin to think about going back to how my “life” was before the pill.

  17. Loved your post last week and the one above. I’m excited for the rest of the series! Thank you!

  18. This is something that I just keep putting off thinking about because it’s so complicated so I just keep taking the pill to avoid the hassle of considering alternatives. I was on Depo shots for a few years a while ago – what are your thoughts on that?

  19. I started taking the pill in my late teens, and initially, it worked really well for me. I stopped taking it after about two years and was never really “successful” in taking it again after that. Two years on, then two years off, and then I began taking it again, mostly as a way of reducing acne, which had become fairly severe in my early twenties. My body never seemed to adjust, and after approximately another two years, I was still having breakthrough bleeding, cystic acne and an irregular period. When I stopped taking it, my cycle IMMEDIATELY normalized, and I’ve had a regular, predictable cycle ever since (not counting periods of pregnancy and breastfeeding). So for me, I also came to the conclusion that it is simply not worth it. My body obviously doesn’t like it and starts acting a bit haywire. The annoying thing is that pretty much every OB/GYN I’ve seen since I finally decided to abandon all attempts at making the pill work for me has tried to convince me that it’s a bad decision. Every single time contraception comes up, they try to convince me to take the pill again! As if there was no other legitimate way to prevent unwanted pregnancy. I’ve gotten used to this, but it still bugs me that so many doctors call into question my subjective sense of self when it comes to MY body and MY hormones.

  20. I’ve been taking the pill for 12 years, and the only major side effect I had was acne caused by Yasmin. It took years to fix that, and I am left with some deep scarring as a result. Every other pill I’ve tried has been fine.

    I would love to not take the pill just because being on it for so long does freak me out a bit, but I never want children, and I am not confident in non-hormonal methods. I assume you’ll be covering these this month?

    The thing I always wonder about the pill is if those of us who never want children really need to be concerned about potential fertility problems. I presume I should be, just because fertility and health are linked, but it’s hard for me to get really concerned about birth control’s effect on my natural cycle when I don’t care if I have the capacity to breed!

  21. Being on the Pill turns me into a super psycho crazy biatch in terms of my mood. On that basis alone, my husband won’t let me take it. Ha!

  22. Pingback: Paleo For Women | The Birth Control Series II: The Drosiprenone Pill Warning

  23. I’ve been on the pill for 7 years now and I absolutely LOVE IT! Before the pill I got the worst menstrual cramps. Like, couldn’t get up out of bed, sometimes had to run to the bathroom to throw up kind of bad! The pill has helped enormously with that. Becoming paleo a few months ago has also helped, but I do still get the cramps – they’re just not the cripplingly painful cramps they were pre-pill. Hence my super reluctance to drop the pill. My mom has the same awful cramps and was on the pill for 10 years. As soon as she decided she wanted to get pregnant she had me! So I’m not really worried about long-term effects either. I guess that just goes to show, as you said, it’s all individual!

  24. Pingback: Paleo For Women | The Birth Control Series Part III: Which Birth Control Pills are Which?

  25. This is a great article. I was on bc for over 12 years. Before I had very irregular periods, like maybe once a year. Also, I would have a lot of abdominal pain, but no period. Two years ago I went paleo and decided to come off it with the hope to conceive. But the result was 2 yrs and no period, plus acne! Lots of acne! Its has been rough. I find that most of the issues that women experience on bc I have without. Irritable mood, PMS mood, NO sex drive…. Honestly Im considering going back on it, just for the acne issue alone.

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  27. Pingback: Estrogen, Birth Control, and Women | 70's Big

  28. I had been on the pill for 5 years before recently going off as part of a journey to attain a more natural balance in my life…I started crossfitting and eating paleo about a year ago and stopped seeing results (performance wise and body comp wise) and I believe the added hormones were part of the problem. Only problem is that now I am experiencing amenorrhea 6 months after going off it. I’ve been seeing my doc to rule out other issues but experiencing this has left me really regretting ever taking bc and wondering what other negative side effects I will experience as a result (not to mention a little scared something bigger is wrong). Time will tell!

    • I too am suffering amenorrhea. Had regular periods for years, was on the pill (low dose) for 6 years. Nearly 5 months ago (I am 24 yrs old) I stopped taking it. No period yet. Only other symptom is a complete lack of sex drive. I am waiting it out and hoping it will resolve itself in time (both issues!). I have been advised to see a doctor however I am convinced that they will not be able to do anything for me.

      • Nourishment, stress reduction, and patience really are the tricks to this one. Make sure to eat plenty of fat so your body can make hormones out of it and enough carbohydrate so that it does not think you are starving :)

  29. So interesting – I have never been on birth control and now I am waiting until we conceive and have our first child to start. I have always been most concerned about potential side effects, so this article sums everything up well!

  30. I was on the pill (Diane and Juliet) for 5 years from 15 yrs to 20. I am now 22 years old and I am still struggling with the effects of being on the pill for so long, among other things. I went on the pill because of my acne, it was mild but at 15 and at a private all girls school (we have single sex schools in Australia) it was pretty hard to cope with. For the first 3 months of being on the pill, my appetite was ravenous. I felt hungry ALL the time. And surprise surprise…I gained about 5 kgs in weight as a result. This was quite a shock to me as I am only 5’1 now and was always very small, always ate very healthy and did lots of sport. So effectively the pill solved one problem – my skin, but created another – my weight. So I became determined and obsessed to lose weight (type A, high achiever that I am), one thing led to another, stress at home and at school, went on exchange and boom…I ended up with an eating disorder.

    Anyway…I tried 3 times to go off the pill. The first 2 times my skin came back so bad I couldnt cope. I tried the “mini-pill” – progesterone only at the advice of a naturopath but that didnt keep my skin under control at all. Eventually in 2010 I thought “F**K this shit…Im going off no matter what”. This time my experience was different…the acne came back after 3 months but from the time I went off the pill for about 2-3 months I had CHRONIC tiredness/fatigue. I would literally sleep for 12 hours and feel exhausted.

    Since then, I feel my body has been struggling to try and create those hormonal pathways that it never got a chance to do since I only started menstruating at 12/13 and was on the pill at 14/15 yrs.

    I still have bad skin and I am 22 years. It is mainly genetics (both Mum and Dad were suffers) but I find that a good diet (Paleo style) free of grains and fructose (a little is ok) is the best for it.

    At the moment my other concern is my weight…from having an eating disorder and years of chronic restrictive eating and over exercising (which really all started with going on the pill) I had burn-out in 2010 and gained a lot of weight (10 kgs+) from that. It has been a slow road back down and to recovery. But I have given up on dieting. It DOESNT work and my body just fights me. My focus has been on health and being kind to myself. But stress is a constant factor in my life that I have had to mitigate with meditation etc. Anyway that is another story.

    I also believe my libido was nonexistent on the pill and has increased dramatically whilst being off it. My personal experience has been such that I am adamant never to go back on it again and I hope that I will be able to manage that. I know it can be difficult. I just dont think its good for the body to have artificial hormones, for too long at least anyway.

  31. “This means that progesterone can be dropped of by day 21 with no worry of ovulation taking place, while simultaneously being enough of a drop to induce menstruation.”

    Can you expand on how/why menstruation still can occur suddenly after being on the pill for 21 days? First reaction is that without ovulation and without FSH/LH the endometrium wouldn’t need to build up, so there wouldn’t be any lining to shed. But maybe the lining grows in response to progesterone/estrogen or independent of these?

    thanks!

  32. After some of detective work, I finally realized my IBS symptoms started months after starting the pill and got worse when the brand I was on switched on me. After this month, I’m taking the step to get off it. At first, I wanted to switch to an IUD (rather be safe than sorry), but after researching that, I’m hesistant to even try that. I read Taking Charge of Your Fertility after several recommendations and was so empowered to pay attention to my body that I am going to start charting (with back-up protection too!). I’m very grateful for your posts (and others) that mention the negative effects of birth control because I never heard ANY of them from my doctor.

  33. Conversation started June 14

    2:44pm
    Kim Nelson
    Hi Stefani,
    I am writing you for your thoughts on birth control pills. I recently started taking Natazia for birth control. I am done with the first month in two days and I am considering staying on them even though I will not be needing them for birth control any more. In the past, taking the pill has always caused mood swings and general depression. I am 41 years old and have been dealing with a lot of anxiety, depression, pms, and heavy bleeding for about the last 3 years. I began a more paleo/ketogenic style of eating about 4 years ago. I noticed these symptoms increasing about a year into it. I am actually considering staying on Natazia, even though I do not need it for birth control anymore, because I am feeling like I have more energy, my moods feel more stable, I have less pms symptoms, and I am feeling a little less anxious, depressed, and notice my food cravings have gone down (obsession with food). I am wondering if you could comment on this phenomenon from all the research you have done in the area of women, hormones, paleoish type of eating. My preference is to not be taking hormones, but I am wondering if the estrogen is actually helping me. I have always been told I was estrogen dominant so it is confusing that taking estrogen might mitigate some of my symptoms. If you could even direct me to some of your blog posts that speak specifically to this that would be great. Or if you could refer other blogs/websites that might be of some resource that would be appreciated.
    I have a history of heavy bleeding and actually had a uterine fibroid tumor diagnosed in 2001 and it removed in 2004. My periods did get better, but started becoming heavy again in 2009, about a year I was doing more hard core ketogenic eating. I had a visit with my surgeon in 2010 to make sure I did not have another fibroid, which I didn’t, but he did say I had adenomyosis. He recommended the pill or the mirena iud at that time. I was not interested in either and just managed heavier periods.
    Any insight and help would be appreciated. Thank you. Thanks for all your research you do and post to keep us informed.

    P.S. I realize it could also be the progestrone in the pill that was helping. BTW, I went off the pill 9 days ago and am seeing some weight gain.

  34. Pingback: Plan B doesn’t work for heavier women? | Health and Wellness with Deep Roots

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