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Is hormonal birth control bad for me?

Is hormonal birth control bad for me?

Nicole Knight, AHCJ | January 13, 2021 | Avoiding Pregnancy

Hormonal birth control has long been hailed as a method for women to gain independence from unplanned pregnancies and freedom from menstrual cycle woes. For many women, hormonal methods like the pill are the most effective way to avoid getting pregnant and may, in some rare cases, be medically necessary.

Yet, hormonal contraception comes with potential risks. As with any medication, it’s best to be fully informed about anything you put into your body, whether it’s a ring, injection, implant, intrauterine device (IUD), or a daily pill.

Whether you’re using a hormonal method now or mulling whether to try one, consider this your road map to help you fully understand the ins and outs of hormonal birth control. That way, you can decide whether it’s the right choice for you, or whether alternatives, such as fertility awareness-based methods (FABM) or a nonhormonal IUD, might be a better fit.

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How does hormonal birth control work?

Hormonal birth control works by switching off crucial hormones and shutting down the ovaries. Ovulation, as you likely know, is the release of the mature egg from an ovary. Ovulation also produces estradiol and progesterone, two natural hormones that are not only essential for a healthy pregnancy, but also benefit bones, metabolism, brain health, cognition, and mood (1). 

The vast majority of hormonal birth control contains synthetic forms of these two hormones, or manufactured progesterone alone. There’s no natural progesterone in hormonal birth control. Instead, it’s usually progestin, which has a different makeup of molecules than your own progesterone and is actually more similar to testosterone than progesterone. Progestin prevents pregnancy by making cervical mucus thick and sticky, which makes it harder for sperm to reach the uterus (1).

Some of the most commonly used progestins include (1, 2):

  • Levonorgestrel
  • Drospirenone
  • Norelgestromin
  • Norgestimate
  • Cyproterone
  • Etonogestrel
  • Medroxyprogesterone acetate

In hormonal birth control, the human-made form of estrogen is typically ethinyl estradiol. A few pills, such as Zoely® and Qlaira®, use estradiol instead of the synthetic ethinyl estradiol. Even so, these pills shut down ovulation just like other hormonal pills, so your body doesn’t get the benefit of ovulation (1).

What are the types of hormonal birth control?

Hormone-based contraceptives are medically regulated devices or pills available in many forms, including (2):

  • Birth control pills, which contain a combination of synthetic estrogen and progestin or just progestin alone
  • Patch, which contains synthetic estrogen and progestin
  • Ring, inserted in the vagina where it releases synthetic estrogen and progestin 
  • Birth control shot (Depo-Provera), which contains only progestin
  • Intrauterine devices (IUDs), which come in hormonal and nonhormonal forms
  • Implant, a small rod that goes under the skin where it releases progestin 

[Which birth control method is best for your lifestyle?]

When used correctly, these methods could be exceedingly effective at preventing pregnancy, but each carries certain risks, ranging from minor to significant (2). 

What are the risks of hormonal birth control?

Hormonal birth control comes with a range of minor-to-major side effects and significant-but-rare risks, including (1, 2):

  • Nausea
  • Bloating
  • Hair loss
  • Mood issues
  • Breast tenderness
  • Breast enlargement
  • Absence of menstrual bleeding
  • Bleeding or spotting 
  • Changes in vaginal discharge
  • Gallstones
  • Blood clots
  • Depression
  • Weight gain
  • Liver tumors
  • Nutrient deficiency
  • High blood pressure
  • Reduced thyroid function
  • Slightly higher breast cancer risk

Of course, the potential risks and side effects depend on the hormonal method you choose and other factors, such as your overall health and lifestyle. That's why hormonal methods require a medical evaluation by a provider before they can be prescribed. For example, smokers over the age of 35 are advised against using hormonal birth control due to the increased risk of blood clots and high blood pressure (2).

Beyond these possible effects, hormonal birth control may dampen your sex drive and sexual pleasure. When surveyed, women taking hormonal birth control reported low libido, fewer orgasms, less vaginal lubrication, and less frequent sex (1). 

Quitting hormonal birth control may not immediately cure a low sex drive, according to a 2006 paper in the Journal of Sexual Medicine. The study suggested it may take months to years for sexual desire to return to normal after switching to a nonhormonal method (3).

Hormonal birth control also may hide underlying health issues, which we’ll get to shortly (1). 

What are the benefits of hormonal birth control?

Besides being a reliable and highly effective method of pregnancy prevention, hormonal contraception carries a number of benefits. Depending on the method, birth control may reduce acne and lessen menstrual cramps, premenstrual symptoms, and a heavy flow (2). 

Hormone-based contraceptives may lower the risk of uterine, ovarian, and colon cancer, and may reduce the likelihood of developing iron-deficiency anemia, pelvic inflammatory disease (PID), and noncancerous ovarian cysts (2).

Hormonal imbalance and pills bleeds

You may have heard healthcare providers describe the pill as a method to “regulate” hormones. In fact, 1 in 3 women who take the pill do so to “regulate” menstruation, according to The Period Repair Manual (1). 

What this means is the pill stops your body from making certain hormones and instead replaces those natural hormones with manufactured ones to produce bleeding every 28 days or so (1).

Pill bleeds may seem like “regular” periods, but they’re not a result of natural menstruation. Why? Because when you’re on hormonal birth control, you don’t have a menstrual period. Instead, you have a pharmaceutically induced pill bleed coordinated in a 28-day pattern for most kinds of birth control pills. Bleeding is the body’s response to the withdrawal of synthetic hormones as you shift from taking hormonal pills to placebo pills (1). 

You may wonder, Do I even need a period? Although you don’t need to bleed, you do need ovarian hormones, and a menstrual cycle is the only way to make them. Synthetic hormones aren’t equal replacements for naturally produced hormones and “can pose a big problem for health” (1).

Can hormonal birth control harm my health?

If you’ve done any Googling, you’ve likely encountered a litany of stories questioning whether hormonal birth control is bad for you. Some of the concerns in these articles go beyond potential side effects, centering instead on the fact that hormonal birth control may cover up conditions that affect your health and fertility (1). 

For example, irregular or absent periods could be warning signs of (1):

  • Thyroid disease
  • Endometriosis
  • Fibroids
  • Polycystic ovary syndrome (PCOS)

Indeed, the menstrual cycle’s value as a health indicator is why the American College of Obstetricians and Gynecologists (ACOG) calls it the fifth vital sign. As ACOG noted in a committee opinion, if “the menstrual cycle does not function within normal parameters, general health is at risk because multiple body systems are impacted by menstrual dysfunction” (4). 

Yet, you may miss an underlying health issue while on a hormonal method because monthly pill bleeds make your menstrual cycle seem “regular,” even if it’s not (1).

Hormonal birth control doesn’t cure underlying hormonal imbalances, it temporarily masks them. When women experience hormone problems, it means a disruption to the natural balance has occurred. Perhaps one course is to investigate and address the underlying imbalance, rather than relying on synthetic hormones to suppress the problem (1).

[Find out the safest and most effective nonhormonal methods.]

The bottom line is hormonal birth control can be ideal for many, but that doesn’t mean the methods are free from possible risks or the perfect fix for every hormonal imbalance or menstrual issue.

It’s worth noting that allowing natural ovulation to take place doesn't erase all of your options for effective birth control. One alternative is to get in touch with your cycle and body signs by choosing a FABM for birth control. (Consider these five things before making the leap.) Or, perhaps discuss with your doctor whether a nonhormonal IUD might be a good fit for your health and lifestyle. 

Rest assured, with the wealth of birth control choices available today, you can be empowered to make the best decision for your body and overall well-being.