The Problem with Hormonal Birth Control

Before I get further into this post, I wanted to state for the record that hormonal contraceptives are one of the most important medical breakthroughs for women throughout the 20th century. The ability to control one’s fertility and reproductive health is a fundamental right. As both a health practitioner and a woman, I am incredibly thankful that birth control exists to prevent unintended pregnancy and empower individuals with a uterus. The problem is that so many patients who are told by their doctor to take hormonal birth control aren’t being empowered at all.

Hormonal contraceptives comes in a variety of forms- the pill, the patch, the hormonal IUD, etc. Many of these work in a similar fashion to prevent pregnancy. While there are some exceptions, most hormonal contraceptives contain a combination of estrogen and progestin. Progestin is a synthetic form of progesterone, a hormone that naturally occurs in the body and plays a huge role in fertility. This combination or hormones prevents ovulation, or the process of an egg being released from an ovary. Without ovulation, sperm can’t fertilize an egg, and -voila!- there can be no pregnancy. Some forms of birth control mimic a menstrual period by inducing a “withdrawal bleed” every 28 days. This bleeding occurs because of a sudden drop in estrogen and progestin levels. If you’ve even taken birth control pills, you’ve probably seen that the last week of pills are a different color than the rest of the pack. This is because those pills are basically sugar pills without additional hormones, allowing you to experience this withdrawal bleed that you may refer to as your period.

The main issue that I see in my practice is that hormonal birth control has become a “catch all” solution for any issue a woman may be dealing with, such as acne, menstrual cramps, heavy bleeding, lack of regular menstrual cycles, or PCOS. Birth control is prescribed to “treat” these conditions, but that’s unfortunately not the whole story. By providing exogenous hormones, birth control can help to relieve some of these symptoms…. as long as you keep taking it. If you’re taking birth control for painful cramps and heavy bleeding, those symptoms may be relieved while you’re on the pill, but the cause of these issues has not been addressed at all, so they are likely to pop right back up as soon as you stop birth control. Hormonal contraceptives don’t correct the underlying hormonal imbalance; they just mask the issue for a while.

For the record, if you are taking birth control with the primary goal to prevent pregnancy, that is awesome! But if you were prescribed hormonal contraceptives with the sole intention of treating acne or relieving cramps, I encourage you to consider digging deeper and addressing the root cause of these issues.

References:

Hendrickson-Jack, L. (2019). The Fifth Vital Sign: Master your cycles & optimize your fertility. Fertility Friday Publishing.

Planned Parenthood. (2015). The Birth Control Pill: A history. https://www.plannedparenthood.org/files/1514/3518/7100/Pill_History_FactSheet.pdf