Jun 11

Jun 11 Hormonal Birth Control & Post-Birth Control Syndrome

Hormones took a sharp turn in the 1960s, with rippling repercussions largely influencing the current epidemic of chronic disease, gut disorders, and autoimmune conditions among young women.

While some were turning on, tuning in, and dropping out, millions of women started taking birth control pills. As of 2020, that number has soared to over 9 million women using the pill or some other form of hormonal contraception (1).

Seeking convenience, less acne, more predictable menstrual cycles, and protection from unwanted pregnancy, so many started the pill under the guise that it was a safe, simple, and supportive option for their fertility and family planning goals.

“What could be harmful about a little estrogen and a week of sugar pills?”

“Could an innocuous IUD that gently releases synthetic estrogen or progestin really be a problem? I don’t even remember it’s in there!”

“It’s GREAT not having to deal with my period anymore!”

THE BEGINNING:

Most women I speak to never received any education about the murky and widely covered up impact of synthetic hormones on their systemic and long term health.

Yet again, I fell into the same trap. As a 15 year-old desiring freedom from acne around my hairline and down my back and an escape from drenching, week long periods, I eagerly jumped on the birth control train for what I thought was an easy way out. (While my periods were forced into surrender and my acne cleared, I also started feeling more fatigued, constipated, and puffy than ever before. I didn’t understand my constellation of symptoms until years later when I started learning more about stress, amenorrhea, liver function, and the not so nice effects of too much estrogen).

I still speak with women that continue taking hormonal birth control as part of their regimen, seemingly unaware of the consequences.

They like the convenience and one less thing to manage.

Who can blame them?

The threat is concealed, the benefits disproportionately inflated, especially when larger breasts and hips come as an added perk (no pun intended).

Doctors continue writing prescriptions for “acne” or “painful periods” and the industry funding corrupt hormonal replacement continues forward, largely unopposed. “Contraceptive use saves almost $19 billion in direct medical costs each year,” due to avoiding unintended pregnancies, they say (2). However, choosing not to factor in the cost of long term impairment from depression, infertility, migraines, and sometimes cancer, questions the stability of such studies and the notion of hormonal contraception as some form of money-saving bargain pill.

POST-BIRTH CONTROL SYNDROME:

After stopping the pill, many women face irregular cycles or complete amenorrhea, hair loss, cystic acne, autoimmune disorders, leaky gut, gut dysbiosis, severe nutritional deficiencies--and the associated bloating, constipation, and diarrhea-- on top of hair loss, headaches, migraines, weight gain, and for some, long-lasting infertility and amenorrhea. (I know, the picture is grim).

But wait! I thought estrogen was good for us? Doesn’t it make us curvy, fertile, and ready to pop out baby after baby after baby?

Yes and no.

We need estrogen to maintain healthy cycles, providing a short term stimulus to our cells to successfully ovulate at the end of the follicular phase.

Yet, we want to keep estrogen levels in check by maintaining our cycles naturally and by boosting our bodies production of progesterone, which require the same co-factors that high levels of synthetic and natural estrogen not so conveniently deplete from us.

In excess, elevated levels of “estrogen steals oxygen from mitochondria, shifting patterns of growth and adaptation” towards inflammation, aging, fatty acid oxidation, and eventually cell death” (3). In the presence of estrogen, cells shift towards behavior consistent with stress physiology as they starve from oxygen deprivation and lack the necessary ATP required to function.

While dubbed “the female hormone” and promising robust fertility as a clever marketing ploy, estrogen and even the accumulation of phyto- and xenoestrogens, when left unchallenged, spells chaos for both men and women desiring balanced health and successful, smooth aging.

LET’S BREAK IT DOWN FURTHER, SHALL WE?

When we take synthetic estrogens, progestins, or combinations of the two, we bypass or completely override our own biological rhythms to “mimic” a cycle. We interfere with the cyclical rhythms of our bodies with lab-synthesized chemicals that have yet to promise benefits to our short-term or long term health.

Instead of ovulating and later shedding the uterine lining, the pill-induced period results from a sudden drop in hormones. The week of sugar pills sends (yet another!) stress response throughout the system that triggers the shedding of the uterine lining.

Just as I experienced, I hear so often that someone’s doctor put them on birth control as early as middle school to help with their acne or to regulate their painful periods. Instead of addressing the underlying hormonal and gut imbalances causing the acne and period problems, the pill snuck in disguised as a bandaid, harboring toxin-filled fangs instead of the supposed gentle, hypo-allergenic adhesive.

I’ve collected comments from friends liking their increased breast size, their smoother skin, and the predictability of the pill, even if they didn’t need it for pregnancy prevention.

Yet, many women continue to take the pill for years, as if unbothered and unaware of its implications for their health and future fertility, especially if they plan to avoid breast cancer or have children in a few years.

CANCER RISK:

When estrogen dominates the hormonal terrain, cellular changes associated with inflammation, cancer, and infertility sneak in. The conductor of the hormonal orchestra takes us on a downhill melody towards disease.

When I used to take the pill back in highschool, my doctor mentioned that it might help protect me from cancer down the line, that the estrogen would support my bone health, and it would “balance” my hormones and help my acne clear up. I look back and laugh! I drank the kool-aid and eagerly popped my candy-like pills, never reading the small print.

The data paints a different portrait: In 2017, a large prospective Danish study reported breast cancer risks associated with more recent formulations of oral contraceptives, which use lower levels of hormones (3):

“Overall, women who were using or had recently stopped using oral combined hormone contraceptives had a modest (about 20%) increase in the relative risk of breast cancer compared with women who had never used oral contraceptives. The risk increase varied from 0% to 60%, depending on the specific type of oral combined hormone contraceptive. The risk of breast cancer also increased the longer oral contraceptives were used (4).

The claims that birth control pills are protective directly counter the current studies showing that even “lower hormone doses still seemed to raise the subjects' risk of developing invasive breast cancer,” and that risk continues for up to 5 years after stopping the pill (5).

If one reads the small print, “currently, all hormonal contraceptives carry warnings and precautions for increased breast cancer risk. In addition, the International Agency for Research on Cancer (ISDA) has classified exogenous estrogen and progestogen as a group I carcinogen due to estrogen and progestin’s mitogenic actions and estrogen’s carcinogenic metabolites (6, 7).

The risk isn’t just observed with estrogen alone:

“An elevated breast cancer risk was found among not only users of hormonal birth control pills, contraceptive patches, and vaginal rings, but also women who used progestin-only implants and injections and hormonal IUDs (6).”

Furthermore:

The ratio of progesterone to estrogen is important. When estrogen rises too high and competes with progesterone, disease states discreetly take root. The body requires certain building blocks to make progesterone, like cholesterol, vitamin A, and active thyroid hormone, all of which could be directed towards other systems if the body is stressed by the attempt to detoxify the synthetic hormones or mitigating the stress of cancerous cells.

Dr. Ray Peat reminds us that “benign breast disease, breast cancer and pre-cancerous conditions have been found to be associated with a progesterone deficiency and estrogen excess” (7).

A progesterone deficiency is further exacerbated by estrogen dominance, high stress, under-eating, over-exercising, estrogenic foods like beer and soy products, and of course, birth control.

“While progesterone is probably the most perfect anti-estrogenic hormone, and therefore an anti-stress and anti-aging hormone, the recognition of a wide variety of estrogen's effects has made it possible to adjust many things in our diet and environment to more perfectly oppose the estrogenic and age-accelerating influences.” -Ray Peat (8)

NUTRIENT DEPLETION:

When it comes to nutrient depletion, the picture shifts to grimmer tones, complicating the milieu of dysfunction even further.

Something as basic as a protein deficiency can cause the liver to fail to detoxify estrogen.

According to the Drug-Induced Nutrient Depletion Handbook, the major depleted nutrients include zinc, magnesium, selenium, vitamin C and E, vitamins B2, B3, B6, and B12, and folate (9). Even after stopping the pill, women have trouble getting pregnant and carrying healthy children, as the body “wastes” the necessary nutrients for fertility to detoxify the synthetic hormones.

These deficiencies likely occur because the liver labels excess estrogen as a toxin. It then uses more of these nutrients to metabolize estrogen in an attempt to detoxify it out of the body. While a replenishment of other micronutrients are also needed to regain fertility and normal cycles following birth control pills, there is ample evidence correlating the aforementioned building blocks as major pillars in the recovery process (10).

As nutrient deficiencies impair the function of the whole body, women experience fatigue, diagnosable depression and anxiety, low libido, skin eruptions and often worsening of acne, insomnia, unexplained weight gain, GI upset, dizziness, hair loss, and hormonal imbalances like hypothyroidism and elevated cortisol (11).

Taking a closer look, consuming birth control pills tends to deplete the body’s supply of folic acid rather quickly. If pregnancy occurs right after stopping the pill, it is more likely to lead to miscarriage or deformity of the fetus (such as spina bifida) from folic acid deficiency. Even on the warning label of the commonly prescribed tri-cyclen, it says “serum folate levels may be depressed by oral contraceptive therapy. This may be of clinical significance if a woman becomes pregnant shortly after discontinuing oral contraceptives” (12).

GUT FLORA DISRUPTION:

Gut health dances closely with hormonal balance.

Dr. David Perlmutter explains that while most medications negatively affect the microbiome by perpetuating the growth of pathogenic strains, daily usage of synthetic hormones is especially worrying for the health of the intestinal terrain.

It can decrease thyroid hormone production as well as available testosterone, which leads to slower transit time, a buildup of endotoxin, SIBO, and increased poisoning from the inside out. Dr. Perlmutter discusses how its long-term use can contribute to insulin-resistance and oxidative stress, increasing systemic inflammation, which then drives more complex disease states like the development of inflammatory bowel diseases, such as Crohn’s and colitis, and eventually cancer (13). The high levels of oxidative stress create more work for the liver, which then down-regulates thyroid conversion and thyroid function, depleting glutathione in the process, which leads to even higher levels of estrogen in the body. Talk about a vicious chain reaction!

DEPRESSION:

Disruptions in our hormonal and microbiota profiles impact systemic physiology, influencing neurotransmitter production and mental health in ways we have yet to fully understand:

“In a nationwide prospective cohort study of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents” (14).

The lasting effects of depression, learned helplessness, and the sometimes permanent changes associated with antidepressant usage compound the problems set into motion by hormonal birth control. There are correlations with hormonal birth controls of all varieties with diagnosable depression, hinting at the long term impairment caused by mood disorders and psychiatric drugs even after stopping the pill.

But even more so: "...New research from Yale University may help explain why women are twice as likely as men to suffer from stress-related mental illnesses such as depression. Animal studies show that high levels of the female sex hormone estrogen affect the brain's ability to deal with stress. Estrogen was found to amplify the stress response in areas of the brain most closely identified with depression and other stress-related mental illnesses. Researchers say the findings may one day lead to the development of treatments for depression that specifically target women. "These findings suggest that there is a difference between men and women in how the prefrontal cortex responds to stress," says graduate student Rebecca M. Shansky, who was the study's lead researcher" (15).

AUTOIMMUNE DISEASE:

Drivers of autoimmunity and immune imbalances often have roots in high levels of inflammatory processes and an overload of stress in a fragile system. In the case of birth control, “estrogens and progestins are known to have profound effects on the immune system and may modulate the susceptibility to autoimmune diseases” in otherwise healthy volunteers.

From a physiological standpoint, estrogen dominance can exacerbate systemic issues that are on the verge of dangerous territory. As estrogen rises, the liver has to choose what to detoxify. If a system is already over-burdened with heavy metals, mold, parasites, infections, viruses, endotoxin, cortisol, xenoestrogens from our environment, pharmaceutical drugs, nitric oxide, and other free-radicals, the system is easily tipped into a state of chaos and disease.

A comprehensive literature review of birth control methods found hormonal contraceptives to significantly modulate the immune system, suggesting that they “may influence the susceptibility to autoimmune diseases with significant increases in risk for several autoimmune diseases” such as such as Crohn’s disease (which causes inflammation of the bowels), Lupus (which causes inflammation in many organs), and interstitial cystitis (which causes inflammation in the bladder) (16).

DIETARY REPLENISHMENT:

In order to re-balance and limit the effects of post-birth control syndrome, it is often best to seek stability through nutrient density and a “food as medicine” approach.

B-vitamins are necessary for fertility and hormonal balance, especially folate. Now is a great time to incorporate organ meats into your weekly routine, especially grass-fed beef liver! If a pate or a pan-seared liver-steak doesn’t spark your taste buds, liver capsules provide a tasteless, nutrient-dense option. For folate sources, boiling your favorite dark leafy greens, like spinach, swiss chard, and even asparagus, and drinking the water will maximize absorption. For people with MTHFR mutations, it is especially important to avoid synthetic folic acid and instead focus on food sources of folate, like that found in greens or, only when necessary, methyl folate from supplements. To increase biotin (b7), liver and egg yolks rank high.
Selenium and zinc from seafood (shrimp and oysters) and grass-fed beef, lamb, and turkey will help bring the balance back.
Cellular antioxidants like vitamin C and E can help lower oxidative stress, boosting glutathione levels that were depleted metabolizing the excess estrogen. Vitamin C and E can also help to antagonize estrogen excess. Liver, citrus, berries, and, if you’re feeling fancy and can find an additive free-version, acerola cherry and camu camu powder are wonderful sources of vitamin C. Load up! Feel free to sprinkle the powder in smoothies or fresh OJ to increase the vitamin C dose.
Get glutathione levels back up with well-cooked sulfur rich greens (if you don't have issues metabolizing sulfur or have a CBS mutation), glycine from bone broth and gelatin, and coffee enemas. Cruciferous vegetables such as broccoli and bok choi can help bind to estrogen and carry it out of the body, while also providing building blocks for glutathione to metabolize toxins as needed.
Carrots and other indigestible, low-anti-nutrient fibers can bind to estrogen, therefore helping to nudge the ratio of progesterone to estrogen to a more favorable balance. If you’re not having at least one satisfying and complete bowel movement a day, estrogen excess could likely be a problem even after stopping the pill. Carrots will help stimulate the bowel and increase peristalsis.
Supporting liver function is essential when it comes to detoxifying from excess estrogen and the onslaught of xenoestrogens from our plastic-rich society (I’m guilty: I love the convenience of pre-made greek yogurt and coconut water, both of which come in plastic containers). Simple measures like eating enough protein, consuming glycine from bone broth, correcting B-vitamin deficiencies, and coffee enemas can all support liver function in profound ways.
Aromatase inhibitors help prevent androgens from converting into estrogens. The good news is that rich sources of flavonoids that inhibit estrogen synthesis are also delicious, such as those found in teas like chamomile, rooibos, herbs like parsley and cilantro, and mushrooms such as reishi, shiitake, and even white button mushrooms (17).

Feel free to reach out or leave a comment below with questions, concerns, or sparks of insight!