“The pill” is the most popular form of contraception prescribed in the U.S. with 14% of women aged 15-49 using it. That adds up to over 10 million women. What many of these women don’t know is that in addition to pregnancy prevention, birth control pills can have negative impacts on brain function and mental health.
In fact, a lot of women have misconceptions about how these hormonal contraceptives affect the brain and body and how they influence overall health. It’s time to clear up the confusion.
WHAT ARE ORAL CONTRACEPTIVES?
Oral contraceptives are most commonly associated with preventing pregnancy. However, they are also frequently used to reduce PMS symptoms and other issues that may occur with menstruation, such as:
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Irregular periods
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Premenstrual syndrome (PMS)
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Premenstrual dysphoric disorder (PDD)
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Painful periods
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Heavy flow
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Endometriosis
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Polycystic ovarian syndrome (PCOS)
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Fibroids
Because the pill can effectively decrease symptoms of these conditions, it is commonly prescribed.
HOW BIRTH CONTROL PILLS WORK INSIDE THE BODY
Most oral contraceptive pills (OCP) are made with combinations of synthetic estrogen and progestin, a synthetic form of the hormone progesterone. The main goal is preventing ovulation. They have key effects on menstrual cycles.
After taking a birth control pill, these synthetic hormones enter the brain and hijack your cyclical hormonal process. They act as endocrine disruptors, interfering with the signaling process that is necessary for ovulation.
In particular, they prevent the hypothalamus from signaling to the pituitary gland (which regulates your hormones) to release hormones that cause an egg to be released. In the unlikely event ovulation does occur and an egg is fertilized, the synthetic progestin thins the uterine lining, making it more likely that the egg will be shed.
Many birth control pills include a week of placebo pills that induce monthly breakthrough bleeding, but this is not a real menstrual period. It is an artificial pattern that eliminates the natural ebb and flow of estrogen and progesterone throughout the cycle.
You may already be aware that OCPs have been shown to cause problems with blood pressure and blood clots and nearly doubles the risk of strokes, especially if you smoke or have a history of migraine headaches.
But did you know that OCPs also affect your brain and mental wellbeing?
HOW HORMONES WORK IN THE BRAIN
In order to feel happy and healthy, you need to have balanced hormones. Here is some important information to note about the differences between natural and synthetic hormones.
Natural hormones bind to specific receptors and keep your body in balance:
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Estrogen binds to the estrogen receptor.
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Progesterone binds to the progesterone receptor.
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Testosterone binds to the testosterone receptor (yes, women produce testosterone, just not as much as men).
There is no cross-reactivity.
Synthetic progesterone (progestins) acts differently on the body:
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Progestins do not limit binding to just the progesterone receptor, rather, they bind to many other receptors as well.
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When a synthetic hormone binds to the wrong receptor, that receptor may convey inaccurate signals, which throws the body off balance.
Because synthetic hormones may bind to the wrong receptors, birth control pills may cause hormonal imbalances and detrimental side effects. Not all women experience these problems, but for those that do, side effects can be quite miserable.
THE HEAVY TOLL OF THE BIRTH CONTROL PILL ON THE BRAIN
Research shows that taking birth control pills causes structural changes in the brain, alters neurotransmitter function, and messes with mood regulation.
Brain structure: A 2019 study found that the hypothalamus in women taking oral contraceptives was about 6% smaller than in women who weren’t on the pill.
Impacts neurohormones: Birth control pills also elevate cortisol levels (hello, stress!) and lower testosterone levels (goodbye, sex drive!). And low-testosterone problems can remain even after stopping oral contraceptives, putting you at increased risk for long-term sexual, brain health, and psychiatric disorders.
Microbiome disruption: Synthetic birth control can also disrupt the gut microbiome.
The gut—your gastrointestinal tract (GI)—is often called the second brain because it is lined with about 100 million neurons. That’s more neurons than you have in your spinal cord or in your peripheral nervous system.
Research has shown that gut health problems, such as leaky gut, are associated with mood and anxiety disorders, as well as attention deficit hyperactivity disorder (ADHD), also called attention deficit disorder (ADD).
Micronutrient depletion: Birth control pills interfere with the absorption of essential vitamins and minerals, which can lead to nutritional deficiencies, according to one study.
In particular, key nutrient depletions have been seen in folic acid, B vitamins (B2, B6, and B12), vitamins C and E, and the minerals magnesium, zinc, and selenium—micronutrients that are important for healthy brain function. If you’re taking oral contraceptives, it’s a good idea to take supplements to avoid deficiencies.
SYMPTOMS OF HORMONE IMBALANCES
Often women have no idea that their birth control pills may be causing the following issues:
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Low moods
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Mood swings
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Anxiety
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Fatigue
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Low libido
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Insomnia
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Weight gain
To find out if your birth control pills are contributing to your symptoms, it’s important to get tested. However, simple standard blood tests will rarely detect this problem.
A better option is a 24-hour urine hormone collection, which is the gold standard for looking at all the hormones and their metabolic byproducts.
An integrative medicine physician, also called a function medicine physician, can be helpful in assessing hormone levels, nutrient deficiencies, and other issues related to hormonal birth control.
THE PILL AND EMOTIONAL HEALTH
For decades, many women have complained the OCPs cause such extreme moodiness and other emotional issues that they quit taking them. Studies back up their claims.
In some women, taking the pill is associated with a wide range of psychiatric issues, including mood disorders like clinical depression, as well as anxiety, fatigue, compulsive behavior, anger, and neurotic symptoms.
Scientists from Denmark found that women ages 15-34 taking OCPs were 23% more likely to start taking antidepressants for the first time than non-OCP users. In fact, studies have shown that bouts of depression have been reported by 16-56% of women on hormonal birth control, which depletes serotonin.
Oral contraceptives also affect mental health indirectly. They put you at greater risk of autoimmune diseases and elevated cortisol levels, both of which are associated with an increased incidence of anxiety and depression.
And as mentioned above, they have also been linked to lower levels of testosterone, which is associated with depression, low libido, and memory problems. And low-testosterone issues can persist after stopping OCPs, meaning you could be facing long-term sexual and mental health problems.
ARE YOU READY TO STOP TAKING BIRTH CONTROL PILLS?
Going off a birth control pill isn’t necessarily a quick-fix solution. Some women experience a rash of symptoms—including mood swings, anxiety, and depression—in the months following cessation of hormonal birth control. Some hormone experts have started calling this effect “post-birth control syndrome.”
In addition, it’s important to remember that if you started taking the pill because you were experiencing irregular periods, fibroids, endometriosis, or other symptoms, the pill doesn’t actually address those issues. It only masks the problem. When you stop taking oral contraceptives, that original issue may return with a vengeance.
If you were experiencing irregularities in your menstrual cycle, note that taking natural progesterone can be quite effective for some women—without any of the side effects of synthetic progestin in hormonal contraceptives.
If you’re taking an oral contraceptive pill to prevent pregnancy, there are other non-synthetic, non-hormonal forms of birth control available that you can discuss with an integrative physician.
HOW TO GET BACK INTO HORMONAL BALANCE
If you’re taking the pill, here are three strategies to help you regain balance:
1. Take nutritional supplements.
Because OCPs can deplete nutrient absorption, it’s important to supplement your diet with B vitamins (folate, B6 and B12), vitamin E, and magnesium.
2. Don’t stop cold turkey.
Be aware that stopping OCPs isn’t necessarily a quick-fix solution. Some women experience “post-birth control syndrome.” which can cause an array of symptoms—including mood swings, anxiety, and depression—in the months following cessation of hormonal birth control.
If you want to get off OCPs, investigate other types of birth control, such as an intrauterine device (IUD) or barrier methods like condoms or a diaphragm.
3. Test your hormone levels.
If you’re experiencing emotional, psychological, or cognitive symptoms while taking OCPs or after quitting, it’s critical to get a full evaluation that includes testing for any hormonal imbalance. Brain imaging tests can also help determine the root cause of your issues.
If you’ve been taking birth control pills for many years, it can take several months to rebalance your natural hormone levels. This is due to the chronic suppression of your own hormone production. It is often helpful to supplement hormones during this recovery period.
If you must stay on the pill for any particular reason, consider asking your physician about using natural progesterone and/or testosterone to improve quality-of-life issues while taking the pill.