Let's chat birth control...

MY JOURNEY PART 1

I began writing this blog almost three years ago when I was living in Canggu, Bali. In true tropical island style, I was trying my best to live my most low-tox life possible. One measure I took was getting off the birth control pill.

Now I want to make it crystal clear, I am speaking only on my personal experience and my experience working with clients. I am not an endocrine specialist, nor am I saying my experience will also be your experience. The intention of this post is in no way is to convince you to follow the path that I took. My intention is to provide you with information so that you can make the best decision for your body.

The first time I ever went on the pill I was 16 years old. It completely f**ked me up. Every side effect possible, I got it. Then six years later I found myself in a long term relationship and in a place where I believed my health (and hormones) were healthy enough to try again.

I did a deep dive into the research to look at contraceptive alternatives and this is what I found...

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THE DARK SIDE OF THE PILL

The oral contraceptive pill (OCP) is the most commonly used form of birth control, followed by condoms and vasectomy.

Every year evidence continues to pile up showing the potential dangers and risks for the millions of women who are choosing to take this hormonal-altering medication.

The pill promotes continually raised estrogen levels, something that is neither natural or safe for a woman's body. The natural menstrual cycle includes both a rise and a fall of estrogen and progesterone throughout the month. The pill works by keeping estrogen at an unnaturally high level throughout the entire month. So high in fact that it fools the body into thinking that it is already pregnant. Once the body believes it is already pregnant it will stop ovulating, meaning that another pregnancy cannot take place.

DANGERS OF THE OCP

• Increased risk of blood clots: the risk for embolism increases as estrogen doses increase. All hormonal methods of birth control have the risk of altering normal blood flow. The pill increases the risk of your blood clotting in your legs or lungs due to excess estrogen making your blood thicker. Thicker blood also poses a risk of blocking blood flow to the brain, which increases the risk of stroke.

• Risk of nutrient deficiencies: for the body to metabolize the pill your liver needs to use extra B vitamins, C vitamins, Magnesium and Zinc which can commonly lead to deficiencies in these important nutrients.

• Can cause or worsen candida: yeast overgrowth is closely linked to estrogen dominance, which is highly influenced by taking the pill. If you suffer from candida check out my Good Gut Guide.

• Moodiness, anxiety, and depression: the brain’s response system from taking the pill is consequently altered, leading to many experiences of psychological side effects. This includes low sex drive, inconsistent appetite, helplessness, disinterest, and even depression.

• May increase cancer risk: several studies show a correlation between taking the pill and an increased risk of developing breast cancer.

• Pigmented skin: many women suffer from an increase in skin pigmentation that presents as patchy light and brown skin caused by estrogen.

• Infertility: some women will have issues falling pregnant once coming off the pill due to the suppression of hormones that the pill has caused, meaning that the body must then realign itself to normal functioning. In some cases, the body will not recover normal hormone production effectively enough for someone to fall pregnant. Yikes!

COMING OFF THE PILL

Coming off the pill can swing your body around giving you all kinds of symptoms, some of which are exciting and new, and others which may even make you question if coming off was the right thing to do at all.

Whilst transitioning off the pill I highly recommend supporting this process with a healthy hormone diet and lifestyle.

Once you go off the pill, you may experience changes in the way you feel, function, and even act. These “changes” are really just a return to the natural state of your body and mind. Often women who started taking the pill when they were still teenagers are surprised about the positives of discontinuation as they had accepted symptoms caused by their birth control as a normal part of growing up. Depending on the woman, the following improvements are usually noticed within the first 3 months of discontinuation.

• Thicker hair and better hair growth

• Better overall mood

• Improved sleep

• No more hot flashes

• Increased sex drive

• Easier time achieving arousal and orgasm

• Improved skin

• Decreased or eliminated PMS

• More energy

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AN UNBIAS LOOK INTO CONTRACEPTIVE OPTIONS

Now that I’ve given my two cents, here is an unbiased overview of all the available birth control methods, their advantages, disadvantages and more.

THE PILL

• EFFECTIVENESS: 99.9-99.5% dependant

• ADVANTAGES: It can be effective to regulate irregular menstrual cycles. The menstrual cycle can be manipulated aka you can choose to not have your period over that special event or whatnot.

• SIDE EFFECTS: Nausea, breast tenderness, weight gain, breakthrough bleeding, absent periods, headaches, depression, anxiety, decreased libido.

• DISADVANTAGES & RISKS: It is essential to be consistent with taking your pill. You need to take your pill at the same time every day for effective coverage. Missing just a couple of pills can mean you are no longer covered for the remainder of the month. Blood clots: some women can be at risk of developing venous thrombosis (blood clots). If you smoke, are over the age of 35, have elevated blood lipid (cholesterol) levels, diabetes, high blood pressure or are obese you are especially at risk. Controversial research surrounding the association of OCP with breast cancer in young women. However, this risk is considered marginal. Controversial research is also surrounding the link between OCP and cervical cancer. Yet again this link is believed to be minimal. If you are on the pill make sure to have annual pap tests. OCP does not provide protection against STDs.

THE IMPLANT

• The implant is placed in the upper arm and is effective for up to three years. It releases a steady small dose of progestin.

• EFFECTIVENESS: Extremely effective. 99.9-99.55 by the third year.

• ADVANTAGES: They are durable and fertility should return soon after the implant is removed. Better for those who have issues remembering to take a pill each day.

• DISADVANTAGES & RISKS: For installing and removing the implant a small surgical procedure is required. Side effects of menstrual irregularities are quite common. Side effects of weight gain, headaches, mood disturbances, growth of facial hair and acne can happen. This method is not recommended for those who are heavy smokers, high cholesterol, severe acne, high blood pressure, depression, migraines, heart disease or a history of ectopic pregnancies. Does not protect against STDs

THE PATCH

• The is worn on the skin and slowly releases both estrogen and progesterone. Each patch has a 1 week supply. The dose is the same a low dose OCP.

• EFFECTIVENESS: back in 2002 a failure rate was listed in the USA of 1 pregnancy per 100 women each year, making it not extremely effective. Even less effective for those over 198 pounds/ 90kg.

• ADVANTAGES: a single patch works for a week meaning you do not have to remember to change daily.

• DISADVANTAGES & RISKS: Overall, similar risks to OCP. The patch itself can also cause skin irritation. The patch can fall off without the wearer noticing, making it ineffective. The patch does not protect against STDs.

THE RING

• The vaginal ring (aka the NuvaRing) slowly releases a combination of both estrogen and progesterone which is absorbed directly through the vaginal wall.

• EFFECTIVENESS: similar to OCP

• ADVANTAGES: the ring is left in the vagina for three consecutives (then removed for a week, when the period is expected).

• DISADVANTAGES & RISKS: If the ring falls out and stays out for longer than 3 hours it will be ineffective for the remainder of the month. The ring does not prevent STDs.

INJECTIONS

• Depo-Provera is a synthetic hormone (DMPA) that can be given every 3 months. It stops ovulation and prevents ovaries from releasing eggs within 24 hours and lasts for the 3 month block.

• EFFECTIVENESS: extremely effective with a failure rate of only 0.3% during the first year of use.

• ADVANTAGES: unlike estrogen, DMPA does not have the same serious adverse effects - eg. blood clots. It actually lowers the risk of some types of endometrial cancers. Problematic or irregular periods can normalize with usage.

• DISADVANTAGES & RISKS: Some women can stop menstruating within just the first year of use. Irregular bleeding may occur. Since the hormone DMPA lingers in the body for months, those who have used it long term can have a significant delay in returning to normal fertility. Usage can cause weight gain, depression, irregular menstruation for up to 1 year following the last injection. More recent studies suggest a link between DMPA and possible bone density loss, however, research is limited. It does not protect against STDs.

THE IUD

• The Intrauterine device (IUD) is a little T-shaped plastic piece that is inserted (by a professional) into the uterus to prevent pregnancy. A small plastic string is attached to the end that makes sure placement is correct and allows for removal. There are two types of IUDs: copper and hormonal.

• EFFECTIVENESS: one of the highest effective birth controls available.

• ADVANTAGES: There is nothing to remember to take daily, weekly or even monthly. It will work immediately and can be removed at any time. Over time they are quite inexpensive and the risk of side effects is relatively low. The IUD is most likely not felt at all by either the user or partner. Those who cannot use the pill because of smoking or hypertension can use an IUD. Commonly the IUD causes lighter bleeding and less cramping. The copper IUD can stay in your body for up to 10 years.

• DISADVANTAGES & RISKS: IUDs can be spontaneously expelled from the body (most likely during a period) in the first year of use for about 5% of women. If an IUD is expelled and the user doesn’t notice they could fall pregnant. Checking for the string regularly is recommended. If you do fall pregnant with the IUD in place the chance of a miscarriage is increased by 50%. The IUD can perforate the uterus wall while inserting for 1-3/1000 women. Severe cramping or backache may be experienced in the first few hours after insertion. Menstrual cramps and bleeding can increase if using the copper IUD. It does not protect against STDs and if contracted they can be more serious in those with an IUD. they can also increase the chance of contracting an STD. Because of this, they are most suited for women in monogamous relationships.

WITHDRAWAL

• The withdrawal method, otherwise known as ‘pull-out’ or ‘coitus interruptus intimate’ is the method of removing the penis before ejaculation.

• EFFECTIVENESS: Depends on the man’s ability to withdraw prior to ejaculation - aka not reliable! The theoretical failure rate is 4% during the first year of use, however, the ‘true’ failure rate is more like 20% in the first year of use.

• ADVANTAGES: no devices, cost, chemicals or hormones.

• DISADVANTAGES & RISKS: High risk of unwanted pregnancy. Does not protect against STDs

FERTILITY AWARENESS METHOD

• The fertility awareness method (FAM) involves monitoring your body temperature and menstrual cycle throughout each month. Usually, the cycle will be monitored to know when you are and are not fertile. If you wish to have sex during the fertile days you will require backup birth control, e.g. a condom. It is recommended that 2 full cycles are tracked before this method can be relied upon.

• EFFECTIVENESS: if tracked correctly it is just as effective as the OCP. However if not tracked correctly, or if backup birth control is not used during fertile blocks you can easily fall pregnant

• ADVANTAGES: No harmful hormones used. Greater awareness and knowledge of the menstrual cycle. It can be successful for increasing the chances of falling pregnant once the time comes where this is your goal.

• DISADVANTAGES & RISKS: Either abstinence or back-up contraception is required during fertile days. The method requires discipline and charting. Without both, the method will not be effective. It does not protect against STDs.

CONDOMS

• Thin rubber sheath placed over the penis that acts as a physical barrier to the passage of semen into the vagina… Do I really need to explain more? Haha.

• EFFECTIVENESS: the most effective method. There is a 4% failure rate however this is due to incorrect usage, not condom malfunction.

• ADVANTAGES: No prescription necessary. Readily available, can be purchased for a low cost at most chemists or groceries. Protect against HIV and other STDs including gonorrhea.

• DISADVANTAGES & RISKS: Decrease the enjoyment of intercourse. Dangerous for those with an allergy to latex. Oil-based lubricants can damage the condom, increasing the chances of breakage.

DIAPHRAGM

• A shallow latex cup with a spring in its rim which holds it in place inside the vagina. Made in different sizes, this cup prevents pregnancy by providing a barrier to the passage of semen into the vagina. When in place, contraception is provided for up to 6 hours. Once 6 hours have passed more spermicide must be added.

• EFFECTIVENESS: depends on correct usage and effective spermicide usage. The average failure rate within the first year is approx. 20%

• ADVANTAGES: No hormones used.

• DISADVANTAGES & RISKS: A healthcare professional must examine the pelvis to ensure correct sizing. Use during a long session of prolonged intercourse can increase the risk of urinary tract infections (UTIs). Use for over 24 hours can cause vaginal erosion or toxic shock syndrome. Without proper training, the diaphragm has a high failure rate. It must be cleaned regularly to prevent odor. It does not protect against STDs.

SPERMICIDES

• Spermicides are chemicals that kill sperm or make them inactive so that they cannot effectively enter the cervix.

• EFFECTIVENESS: less effective than most contraceptive methods, however, they can be used in combination with other methods to boost effectiveness. If used alone failure rates are from 20-50% during the first year of use.

• ADVANTAGES: Since they are a reversible method of birth control, full fertility will immediately return once ceasing usage. They are available over the counter (OTC) and are available in several forms depending on personal preference. There are foams, creams, suppositories, or tablets. They do not affect other body systems, such as hormonal balances.

• DISADVANTAGES & RISKS: They are not immediately effective so several minutes must be waited for their effect to kick in, making them inconvenient. Must be reapplied before each act of intercourse. It can cause irritation for the vagina or penis. They do not protect against STDs.

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A funny little meme, but I can't say I disagree with the message.

MALE BIRTH CONTROL

The options for men are far more limited than women. Other than condoms, there is vasectomy and more recently a "pill for guys" that has recently pasted clinical testing and may be available for use within the year. However, as this too is a hormone modulator, I won't be getting behind the idea.

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MY JOURNEY PART 2

After mulling over the options I decided that Daysy was for me; non-toxic and reliable (as long as you are consistent). So, I jump online and happily make the $400 investment.

After it arrived I began religiously measuring my temperature every morning. But here’s the thing; I wasn’t getting my period.

I understood that it was common for some women to take a couple of months for their regular cycle to return but I would have never expected it would take almost two years!

I had developed something called Hypothalamic Amenorrhea which is when your period stops for an extended period of time due to the hypothalamus (the gland in your brain that regulates body processes) failing to produce the hormones that are required for normal menstruation. This can happen due to dangerously low body weight (not me), over-exercising (not me), or adrenal fatigue - me! A serious hormone imbalance from the OCP combined with the high-stress life of running your own restaurant had my cortisol all over the place.

After drastically changing my career path and putting some serious time and energy into re-balancing my hormones (shout out to Monica Yates for her support during this process) I am happy to say my cycle is as regular as clockwork. Currently, I am tracking my fertility through the Flo app and I will never again use hormone-altering contraceptives.

I love the Fertility Awareness Method because it puts me in the driver seat and in control of my cycle and fertility. You will learn to become aware of your own unique cycle instead of a practitioner simply telling you about the average woman's cycle. Committing to this method takes persistence and mindfulness. For it to be a safe and effective form of birth control you need to go through a learning curve to get used to the process. For those who are interested, I highly recommend the book Taking Charge of Your Fertility aka the fertility Bible! It covers much more than just FAM, delving into menopause, sexuality, endometriosis, PCOS and more.

I was inspired to revisit and complete this blog after a discussion this week in my gal pal group chat. One of the ladies wanted to come off the pill but was feeling overwhelmed and confused regarding alternative contraceptive options. Then one by one each of the other ladies also expressed their frustration with current options and lack of know-how regarding the effects of each alternative.

If you, like myself and my friends, have felt un-informed, frustrated or outright confused about your options for birth control I do hope that this post has shed some light on the topic.

Lots of love,

Shannon Rosie

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