How does taking the contraceptive pill relate to my reason for seeking treatment at The Chiro Hub?
It would seem quite peculiar if I decided to delve into your gynaecological history and question whether you had previously been prescribed, or are currently on, the contraceptive pill. Over the past few years, I have come to a great realization that symptoms arising from the musculoskeletal system such as chronic recurring headaches, neck and back pain can result from many other interacting organ systems (immune, endocrine, gastrointestinal, nervous, etc.) at play.
Clinically, there are six types of imbalances that may occur:
The number one reason that the majority of patients who present to a chiropractor or any clinician whose role is to assess, diagnose and treat the neuromusculoskeletal system, is largely owing to structural integrity imbalances across the soft tissues (muscles, tendons, nerves) and skeletal components (bone, vertebrae).
However, what we must realize is that this is a breakdown in end-organ (musculoskeletal) physiology as a result of primary and even secondary imbalances in the other points mentioned above.
We must understand that in order to keep an optimal neuromusculoskeletal system, we also need to optimize assimilation, defence & repair, energy regulation, biotransformation and elimination and communication.
Our goal in this blog is to plant a seed in your mind in knowing that long term use of the contraceptive pill can cause defence and repair imbalances, assimilation and communication imbalances - with consequences even after cessation of the pill itself!
The contraceptive pill is the most commonly used birth control method and approximately 50-80% of Australian women will use it at some point in their lives. It was introduced over 50 years ago and Australia was the second country in the world to have access to it. It’s introduction coincided with the women’s liberation movement with the belief that women now had control over their own fertility.
The pill is used to treat irregular periods, cramps, acne, PCOS, endometriosis, and other conditions. The mechanism of action of the contraceptive pill is that it shuts down ovulation and switches off female hormones! Importantly, it works at the brain level as it is the brain which communicates to the ovaries to ovulate.
What happens when you take the pill? It’s a dose of hormones that is digested, processed by the liver and will mostly be absorbed in the small intestine. Some of it will also actually make its way to the large intestine. Essentially, your system attempts to detox it. It inhibits follicle stimulating hormone (FSH) and luteinizing hormone (LH), therefore follicles are not prepared and an egg is not matured for ovulation. When LH doesn’t spike, we don’t ovulate. This is all fantastic for preventing a pregnancy but the reality is that birth control is working at the brain level which is why women have complained of mood alterations and essentially neurological symptoms since its introduction. Women who take the contraceptive pill have no oestradiol, DHEA, or progesterone and have 50% smaller ovaries than female counterparts without the use of the oral contraceptive pill. Even what is considered a low dose of progestogen is enough to signal to the brain to shut down communications to the ovaries.
Let’s briefly examine the function of each of these important hormones:
After reading these points, it is no wonder why a deficiency or lack of these hormones and immune modulators can play a role in musculoskeletal pain and fatigue and why depression is so widely reported!
If estradiol and progesterone hormones are switched off, or significantly deficient whilst taking and after the use of the oral contraceptive pill, then serotonin, dopamine and GABA cannot be synthesized appropriately. This therefore has negative effects on the nervous and immune systems.
What exactly is in the birth control pill?
Levonorgestrel is the most widely prescribed progestogen but unfortunately has an extremely high androgen index. Progestogens with a high androgen index can cause acne, weight gain, hair loss and changes in voice and other testosterone related symptoms. Although the interaction between the GP and patient consider it to replace the hormone progesterone, this is an extremely far and misleading statement.
Levonorgestrel is NOT progesterone!
It may share a similar structure but has a completely different function. Progesterone “holds” the pregnancy but Levonorgestrel causes abortion. Progesterone is a neuroprotectant hormone and metabolizes into a steroid - allopregnanolone - which is a potent modulator of the GABA receptor in the brain. Levonorgestrel DOES NOT metabolize to allopregnanolone and it has been shown to downregulate GABA receptors and increase anxiety states.
To add to this, a lot of synthetic progestogens used in the oral contraceptive pill are derived from testosterone and this has many side effects. Once again, testosterone is not progesterone and has a completely different function yet a similar structure. Another synthetic progestogen, Ethinyl Oestradiol is used in all contraceptive pills. Although it shares a similar structure to oestradiol it does not share the same function! Ethinyl oestradiol worsens insulin sensitivity compared to oestradiol which increases insulin sensitivity.
Therefore, contraceptive pills can cause insulin resistance and weight gain.
The table below shows high to low androgen index:
Most of these progestogens are made in the lab using synthetic testosterone which is why some have an extremely high androgen index. It enables you to determine how much synthetic testosterone is used in the OCP that your medical professional advised you on.
It has been frequently been reported that the only side effect of progestogens are androgenic alopecia, which is a patterned hair loss in women consisting of hair thinning. However, there are many side effects other than hair loss that you may have experienced or have not been made aware of.
Side effects of high androgen index progestogens include:
Side effects of low androgen index progestogens include:
Other side effects of the contraceptive pill include:
Why is progesterone so important?
So much focus has been on oestrogen that we’ve negated the fact that women need progesterone in terms of brain health. Progesterone is involved in creating myelin sheaths and is also important in neuroplasticity, for bone health and modulation of the immune system to keep inflammation in check. Progestogen will just NOT give you the same benefits. As mentioned earlier, progesterone and progestin are not identical at the structural level and therefore will have very different effects. Remember, progesterone stimulates the GABA receptors in our brain which help us feel calm, chilled out and in love with life. It also helps with fluid retention. One reason for water retention is because progestogen does not have the same diuretic effect. Without natural progesterone, women find themselves feeling irritable, depressed and crying all the time. Most notably when progesterone is low, they experience anxiety, a common symptom of birth control medications. Progestogen actually shuts down or downregulates the body’s own ability to make progesterone and this has also been observed hormonal IUDs. Initially, it was thought that the hormones in the IUDs were localised because we didn’t know the metabolites that needed to be measured in the blood. Therefore progestogen wasn’t present in tests.
To avoid the experience of significant neuro-hormonal imbalances as a result of the oral contraceptive pill, it is important that your doctor has informed you of other methods of contraception for you to consider. Below is an outline of the 2 types of contraceptive methods that may replace the oral contraceptive pill.
Both Type 1 and type 2 methods enable women to synthesise DHEA, Progesterone and oestradiol and allow them to undergo ovulation.
Type 1 contraceptive methods – Most safe yet inconvenient:
Type 2 contraceptive methods - more convenient but also can be more toxic:
Below is a table that states the pros and cons of the copper intrauterine device:
What alternative could you use instead of Levonorgestrel?
Mirena IUCD is a relatively newer approach that has been shown to minimize the side effects compared to oral Levonorgestrel. Mirena works locally in the uterus to prevent fertile mucus and impair sperm and thin uterine lining. Having said that, ovulation is inhibited in some women using Mirena. In a 1-year study, approximately 45% of menstrual cycles were ovulatory, and in another study after 4 years, 75% of cycles were ovulatory.
What about the oral contraceptive pill for endometriosis?
Hormonal suppression with the oral contraceptive pill may have an effect on endometriosis. Endometriosis is not like other periods. It is a whole body chronic inflammatory disease and is probably an autoimmune disease. It needs serious treatment such as laparoscopic surgery which is effective in 70% of cases. Hormonal suppression with hormonal birth control is sometimes unavoidable.
Don’t mistake blood spotting for resumption of a menstrual cycle...
Don’t be mistaken when coming off the pill that you have regained your normal healthy menstrual cycle. Bleeding or blood spotting following cessation of the contraceptive pill is not a period - a real period is about the healthy production of hormones from ovaries oestradiol and progesterone. Blood spotting after stopping the pill is just a withdrawal bleed from the drug. The timing of blood spotting is more to do with the dosing of the drug. It takes 12 years for a woman to mature her hypothalamic pituitary ovarian (HPO) axis. If periods begin at age 14 it will take until age 26 to have established a full communicative, healthy, normal ovulatory cycle.
Putting a 14-year-old on the contraceptive pill up until the age of 30, will take roughly 12 years following the contraceptive pill (42 years of age) until she will have a full healthy normal ovulation cycle. This is a staggering fact that most women are unaware of !
In fact, there has never been a long-term study to tell us exactly what happens to a woman’s body, let alone her brain when she is put on birth control after starting her periods and stays on it for decades at a time.
Other reasons for concern when taking the oral contraceptive pill:
So how can we assist when it comes to understanding your health around your chosen contraceptive option?
Available to you at The Chiro Hub are specific tests we can arrange from high quality laboratories to determine the current state of your hormone health:
Remember however, that the expertise is not in simply having a test administered, but in knowing how to translate the results and effectively create a treatment plan once combined with our comprehensive questionnaires and in-clinic assessments.
Please also note: If you would like further support with your medical decisions around contraceptive health, we have excellent female GPs in the area that we consult with and which we are happy to refer you to.
As always, if you have any query regarding the information in this blog, feel free to call our clinic on (02) 9317 2288 during business hours and we will be happy to have a conversation and guide you.