First it was the Pill then the Coil, the Implants and then HRT as women were exposed to increasing numbers of artificial hormones and although in the beginning we were not aware of the risks, the same cannot be said today.

In the 1960’s young women like me rejoiced to find a safe, effective form on birth control that gave us the power to regulate our own fertility. I clearly remember being pleased to be given a prescription for three years supply (yes, really!) of what were initially high doses of hormones.

My generation was the first to be put on the Pill and their daughters happily followed as their mothers moved on to HRT. But we didn‘t escape the risks of the Pill as we moved into menopause as apparently more than three quarters of a million women in the US are taking it for other reasons. Whether that is to control painful or heavy periods, acne or migraines it is a popular choice for symptoms that are hormone related but just how does taking it affect our hormone levels?.

Side effects of Progestins

I speak to many women who tell me they are on a progesterone contraceptive, but there is no such thing. The majority of contraceptive pills and the coil consist of a low dose of an estradiol derivative (ethinyl estradiol) and one of several synthetic progestins (synthetic progesterone), although there are some that do not contain estrogen but only a synthetic progestin. Some of the most common progestins in these products include: medroxyprogesterone, norethindrone, levonorgestrel, norgestimate and drospirenone.

Risk factors on the Pill are mainly directed at women who smoke or are overweight. Common side effects include headaches, nausea, breast tenderness, slight weight gain and slight ’spotting’ between periods. Several of these ‘side effects’ are also symptoms of oestrogen dominance which is also related to the more serious consequences seen with the Pill such as deep vein thrombosis (DVT) or clotting, heart attacks and strokes.

Why take the Pill?

The purpose of the Pill is to prevent the mid-cycle release of LH (Luteinising Hormone) and reduce FSH (Follicular Stimulating Hormone) levels and so inhibit ovulation. So clearly it is primarily used for contraception but I am saying an increasing number of women who are using it solely to reduce very heavy periods – which it will do – but again there are health consequences to be considered.

While the progestins in the Pill typically bind to progesterone receptors, they do not have the same action and it is not recommended to use bioidentical progesterone alongside them if you are trying to prevent pregnancy. Logical really as the role of progesterone is to promote fertility!

There are hormonal consequences to the action of these progestins. Because LH and FSH also stimulate estrogen and androgen production in the ovary, suppression of these pituitary hormones often results in a decrease in androgen production that can have a profound effect on symptoms such as acne. Because the Pill does not address the underlying reasons for hormonal imbalance, many symptoms may return when you stop taking it.

This can be a problem for women who are put on these therapies in their teens to reduce their period pains or manage their acne. When they are ready to start a family they often find that the same symptoms may return and that their normal ovulation cycle can take quite some time to return to normal. Anovulatory cycles (with no ovulation) can occur for anything between 1-6 or more months or more after stopping the Pill and to help with fertility it is a good idea to start supplementing with bioidentical natural progesterone when off the Pill.

Mid life heavy bleeding

Young women are not the only ones on the Pill. Many women are given it not for contraception but to help control heavy bleeding. Such bleeding is often associated with oestrogen dominance and although the Pill will help it does not address the basic problem that the body’s high levels of oestrogen are not being balanced with sufficient progesterone to avoid the consequences of excess oestrogen which has been linked to breast cancer and heart disease.

What happens to your normal progesterone levels?

Testing the hormone levels of a woman who is on birth control can be tricky. The primary source of progesterone is the corpus luteum, which is derived from the follicle after the egg is expelled. When ovulation is prohibited, there is no corpus luteum, and therefore no ovarian progesterone is produced.

That is why normal progesterone levels are found to be very low in women who are currently taking oral contraceptive pills. The normal blood tests do not measure progestins because they are molecularly different from progesterone and do not have the same action.

What will help?

It depends on why you are taking the Pill. If for contraception then using bioidentical hormones will diminish its effectiveness. I you want to use bioidentical natural progesterone to help deal with the side effects of the Pill you will have to use back up contraception if it is essential you avoid pregnancy.

However for those women who are on the Pill to cope with heavy bleeding it can be a good starting point to rebalance the hormones and get oestrogen dominance under control by supplementing with natural progesterone.