The Oral Contraceptive Pill

Introduced in May 1950, the oral contraceptive pill (OCP) was hailed as a transformational medical innovation, dramatically changing women’s choices by separating sexual practice from conception and pregnancy - a basic health care need for women that was cheap, reliable and readily available!

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At the time, this forced massive reassessment and reevaluation of social, political, and religious viewpoints as women enjoyed their newfound freedom, choice and control over their own fertility!

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Since then OCP has remained big business for big pharma - the global OCP market will be worth an estimated $22.9 billion in 2023 (with an annual growth rate of 6.6%), according to a report by Transparency Market Research. Big pharma want to ensure that their market stays shopping!

Despite the huge profits involved in the selling of OCPs it is pretty concerning to note that these very same companies have invested very little money into research and development for best female contraceptive options since the science was initially developed SEVENTY yrs ago.

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Even though we have different modes of delivery in different places (eg implant, injection, skin patch, vaginal ring) the synthetic forms of hormones still need to enter the bloodstream, which does create a myriad of effects that are often not acknowledge or discussed!

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Synthetic forms of hormones are not ‘natural’, and they do not provide the same benefits as our own naturally produced hormones, and in some cases produces harmful side effects - a common misconception is that OCPs ‘regulate’ or ‘balance’ hormones.

Oral contraceptives contain synthetic forms of oestrogen and/or progestogen, whilst suppressing the endogenous (internally regulated) production of oestrogen, progestogen and testosterone.

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"Despite the fact that over 100 million women around the world use contraceptive pills we know surprisingly little today about the pill's effect on women's health.

The scientific base is very limited as regards the contraceptive pill's effect on quality of life and depression and there is a great need for randomised studies where it is compared with placebos,"

says professor Angelica Lindén Hirschberg at the Department of Women's and Children's Health at Karolinska Institutet.

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The lack of published scientific trials highlights the need to better understand how OCPs affect women beyond the general reproductive, cardiovascular, and lipid outcomes (cholesterol is the precursor to sex and stress steroids) typically measured.

Oral contraceptive pills are the most common form of reversible contraception in Australia, with market sales driven solely by the convenience that a pill offers.

Their high effectiveness is 99.9% when accurately used and 92% when typically used (timing of pill dose and other medication interference most commonly misunderstood).

It is important to note that commencement of oral contraceptives has been associated with increased health risks! This IS worth talking about!

Depression and anxiety: - Some women, especially those in the 15-34 age bracket can experience depression, mood swings or anxiety as a result of the OCP. - One of the larger studies in this area (1 million women over 13 years) showed that 23% of adolescent women who started the OCP and had not experienced depression before, needed an antidepressant prescription after starting the OCP. - Teenage users of oral contraceptive pills (OCP), particularly 16-year-olds, had higher concurrent depressive symptoms than their nonuser peers in an observational study - A 2019 study concluded that OCP use in adolescence predicts lasting vulnerability to depression in adulthood

🧐The occurrence of depression in association with dermatologic (skin) diseases and disorders is very common. This is important for practitioners because the care of patients with skin diseases or disorders may be ineffective if their patient's psychological problems are not also recognised and assisted (eg. through referrals to allied health professionals).

🧐 Neuroendocrine studies have demonstrated HPA (stress hormone) axis overactivity in major depression. In the skin, there exists a peripheral HPA axis similar to the central axis, thus stress and mood disorders impact skin

Reduction in quality of life: - A 2017 study found that both general quality of life and specific aspects like mood/well-being, self-control and energy level were affected negatively by the contraceptives. - On the other hand, no significant increase in depressive symptoms was observed. Which seems odd!

Variations in stress response and stress hormone production: - Scientific evidence makes it clear that the stress response differs quite markedly across the menstrual cycle in naturally cycling women, and that this response differs markedly yet again between naturally cycling women and those on oral contraception. - Sex hormones influence the activation of the two major stress systems, the hypothalamus‐pituitary‐adrenal (HPA) axis and the sympathetic nervous system (SNS).

- Female sex hormones, oral contraceptives, and phytoestrogens, have immunomodulatory effects, and thus a role in inflammation, in the liver, and throughout the entire body. This effect will enhance the development of inflammatory diseases.

- Hormonal contraceptives may positively or negatively influence Autoimmune Diseases.

- Long-term use of low-dose OCP in healthy women can augment the incidence of systolic blood pressure, homocysteine levels, cholesterol, LDL-c, and triglyceride, risk factors for the development of cardiovascular diseases.

- Studies have shown an association between OCP use and risk of Intenstinal Bowel Diseases (IBDs), with OCP use specifically linked to Crohn's Disease and menopausal hormone therapy and risk of Ulcerative Colitis.

- Oral oestrogen has been shown to modify intestinal permeability

- Care should be taken when using OCPs in women with Type 2 diabetes mellitus or cardiovascular diseases, due to the unfavourable links to glucose and lipid profiles.

So... Why is this important to know?

WHO states that depression is the leading cause of disability and suicide deaths worldwide. Scientific evidence has shown that, beginning in adolescence, women are TWICE AS LIKELY as men to develop depression… and considering that our sex hormones play a role in the organisation and development of brain structures it makes sense that the OCP can impact women very individually. Our gut and liver health also play specific roles in depression.

There are two different kinds of birth control pills in Australia — combination birth control pills, which contain EE and progestin, and ‘minipills’, which contain only progestin. The majority of women take OCPs to prevent pregnancy, but around 15% also use them for non-contraceptive reasons such as acne control and hirsutism.

Ethinyl estradiol (EE): Suppresses FSH/follicular development Stabilises endometrium and controls bleeding Potentiates the action of progestins, likely by increasing intracellular progestin receptors Contributes less than progestin to contraceptive efficacy.

Progestin: Suppresses LH/ovulation Atrophies endometrium Thickens cervical mucous Disrupts fallopian tube secretion and peristalsis Is the main contraceptive ingredient.

In short .. progesterone is the hormone that prevents pregnancy, and the oestrogen component will control menstrual bleeding.

Safety considerations that sometimes aren’t considered when prescribed: - Age - Current medications - Smoking - Hypertension - Migraine - Venous ThromboEmbolism/family history of VTE - Lupus - Diabetes - Bariatric surgery - Malabsorptive issues - Current depression/mental health issues - Liver issues - Cancer history (self and family). Questions still remain regarding whether OCP use among women with a family history of breast cancer increases disease risk

Again, not often discussed by medical professionals... The list of following drugs may reduce the effectiveness of OCPs and should be considered to interfere with OCP effectiveness:

Antibiotics - Cephalosporins - Chloramphenicol - Erythromycin - Rifampin (Rifadin) - Bactrum

Anticonvulsants (seizure medications) - Barbiturates - Carbamazepine (Tegretol, Carbatrol, Equetro) - Lamotrigine (Lamictal, Lamictal XR) - Phenytoin (Dilantin, Dilantin 125, Dilantin Infatabs) - Topiramate (Topamax)

HIV Drugs - Nelfinavir (Viracept) - Ritonavir and other protease inhibitors (Norvir)

Others: - Griseofulvin (tinea anti-fungals) - Phenylbutazone (NSAID Butazolidine) which can be taken by people who get menstrual cramps!! - Benzodiazepines (eg Xanax, Valium) - St. John's Wort

Women using OCs should be cautioned that St. John's Wort might interfere with contraceptive effectiveness and may cause breakthrough bleeding.

Paracetamol and Ascorbic acid in high doses will compete with EE for sulfation in the liver. With less sulfate conjugates formed, more EE is available for reabsorption from the gut and serum levels are increased.

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Considering many women begin taking oral contraceptives in early adolescence and continue their usage for many years, it is also important to look at the possible nutritional effects and the flow on increases in oxidative stress that oral contraceptives create in a woman’s body.

If depression is present, the stress hormonal axis is also going to be dysregulated, further compounding nutritional resource load.

Signs of nutritional deficiencies include: - acne, eczema, psoriasis, dry skin - depression and anxiety - muscle cramps, eye twitching, muscle aches and pains - poor nail health – brittle nails which break easily hair thinning or hair loss - poor immune health and recurrent infections - fatigue, shortness of breath, dizziness and weakness - numbness and tingling or burning sensations - irritability and loss of memory or concentration - cracks or sores in corner of mouth - stomach/intestinal inflammation – nausea, vomiting, abdominal pain and diarrhoea.

A vast collection of studies over the last 40 years shown that the key nutrient depletions are Vitamins B1, B2, B3, B6, B9, B12, C and E, Co-enzyme Q10, the amino acid tyrosine as well the minerals iron, magnesium, phosphorous, selenium and zinc, with reductions usually proportional to the duration of contraceptive use.

Some of the Nutrient Roles:

Vitamin B - each of the B vitamins performs unique and important functions. They are necessary for the brain and nervous system to work efficiently, and are involved in maintaining the health of hair, skin, nerves, blood cells, immune system, hormone-producing glands and the digestive system.

Vitamin E is a fat-soluble vitamin vital for healthy cell membrane function. It has high antioxidant potency and works synergistically with Vit C. Vit C is antioxidant, anti-atherogenic, anti-carcinogenic, an immuno-modulator and is essential for collagen synthesis.

Coenzyme Q10 is an essential lipid of cells present in all cellular compartments. It is required for energy production in mitochondria and is highly concentrated especially in the cells of the heart. It is a super antioxidant and has neuroprotective capabilities. It is also essential for collagen synthesis.

Tyrosine is an essential component for the production of several neurotransmitters, including epinephrine, norepinephrine, and dopamine - these chemical messengers regulate sleep, attention, thinking, and multitudes of other critical processes. A lack of tyrosine is implicated in depression.

Selenium is antioxidant, anti-carcinogenic, immuno-modulating and is vital for optimal thyroid function . In the immune system, selenium stimulates antibody formation and activity of helper T cells, cytotoxic T cells and Natural Killer (NK) cells - so therefore assists regulation of skin and all body immune activity.

Zinc is an essential trace element with special importance in the immune system. Low zinc will exacerbate the effects of stress on the body as it plays an essential role in numerous biochemical pathways. Zinc helps with hormone production, cell growth and repair, improves immunity and anti-inflammatory activities, aids digestion and also improves gut function. During chronic deficiency, the production of pro-inflammatory cytokines increases, influencing the outcome of a large number of inflammatory diseases - and a breakdown of collagen. Zinc plays a vital role in regulating the tight junctions found throughout skin and your digestive tract.

Phosphorous plays an important role in how the body uses carbohydrates and fats. It is also needed for the body to make protein for the growth, maintenance, and repair of cells and tissues. It’s most vital role is in the maintenance and formation of bones and teeth.

Magnesium is needed for more than 300 biochemical reactions in the body. It helps to maintain normal nerve and muscle function, supports a healthy immune system, keeps the heart beat steady, and helps bones remain strong. It also helps regulate blood glucose levels. Assists regulation of skin immune activity and aid in the production of skin cell energy and protein formation.

Please note also that IUDs, my second preferred contraceptive option over cervical mucus charting, are not free from side effects, but the side effects are much less than other hormonal contraceptives.

This is because the copper IUD has no hormonal activity and not subject to user error. It is known that IUD can worsen period pain for some women, and like all implants there are slight risks associated with the implantation/removal. The Mirena IUD has uterine localised hormonal activity but seems to be less likely to produce the other risks and side effects than other implants, injections and the OCP.

🚺 There are also environmental implications... excreted OCP hormones (sweat, urine, stool) discharge into our water supply and from there into rivers and lakes that serve as sources of drinking water, as well as into the ground where crops are grown and animals graze.

🚺 Oestrogenic compounds found in our environment have many negative effects ... their culmative exposure, and also potential synergy with other compounds, leave them suspected to be involved in the development of diseases including, but not limited to, reprotoxicity, metabolic disorders, and cancers.

Change the way you think, live and treat! x

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