You won’t get far into any conversation on women’s health without getting into hormonal birth control. That’s because it has become the most popular form of birth control, with 11 million US women on the pill as of 2012. We’re told that birth control is a hard-won prize of the early feminists, and really, how many of us don’t want more control over when and whether we want to begin families? We’re not interested in heading back to the days of our great-great-great grandmothers and we’re led to believe that these tiny pills will give us the ability to have dreams, careers, and families.

But there are questions worth asking before making the leap to start or continue hormonal birth control, questions  like:

What’s the impact of daily synthetic hormones on our overall health?

When we go to the gynecologist to get our prescription, are we being given the whole story?

And importantly, is this the only and best way to take back our power?

Hormones: Not Just for Baby-Making

First, let’s get back to the basics for a second. Hormones are proteins that control pretty much everything that goes on in our bodies. They’re known as “chemical messengers” because they go around giving signals, deciding when processes are turned on and off, and generally allowing everything to run smoothly. When we take hormonal birth control, we’re supplementing our dynamic hormonal landscapes with synthetic hormones. Exactly what we’re adding to the mix differs depending on the type of birth control, but it’s generally either something that mimics progestin (a hormone similar to progesterone) or both estrogen and progestin.

Women naturally have a somewhat predictable cycle of hormones throughout our monthly cycle. There’s this dance between the hormones estrogen, progesterone, and others. Estrogen peaks around the time of ovulation at the middle of the cycle when an egg is released, when progesterone is low. Then estrogen levels go down and progesterone peaks later in the month. While these hormones are commonly thought of as “sex” or “female hormones,” this isn’t really true. While they play a crucial role in the menstrual cycle, they’re also vital for plenty of other bodily processes. Estrogen, for example, is needed for bone growth and cholesterol control, things that are outside the realm of reproduction and crucial for both men and women.

A variety of factors can interrupt this graceful hormonal interplay, and synthetic hormones? Well, they definitely qualify as an interruption. In fact, they work by the very suppression of menstruation, typically preventing pregnancy by stopping ovulation altogether or by changing the consistency of the uterine lining. They’re remarkably effective at this goal, with a stellar success rate of up to 99.9% (with perfect use). But throwing a hormonal wrench into our already-existing cocktail of hormones doesn’t come without its costs, costs which I believe every woman deserves to be aware of so she can make the best, most informed decision for her.

The Birth Control Trade-Off

Concerns are growing about substances in our environments known as “endocrine disruptors,” those things we’re finding which can have devastating effects on our health by altering our normal hormone levels. But hormonal birth control is arguably the most powerful endocrine disruptor of all, given that we purposefully take sizable doses every day, often from our teens all the way up until menopause. If we could take hormonal birth control and get all the intended pregnancy prevention with no ill effects, who could really complain? It would be a win-win. But the truth is much hazier, and too often, all that women get from their healthcare providers about this bigger picture is a mere head-nod to informed consent. So what exactly are some of the trade-offs involved?

Let’s take a look.

1. It impacts your overall health and causes negative physical effects.

Because adding in synthetic hormones and suppressing our natural hormonal cycling affects more than just reproduction and menstruation, we see all the body’s processes impacted by birth control. It acts as a powerful thrust at the dominoes of our biology, impacting everything from thyroid levels to metabolism to cardiovascular health. One biological domino cannot tumble without causing a cascade of downstream effects, both large and small. On the one hand, we have those effects that are generally shrugged off as “minor,” things like decreased sex drive and headaches, breast tenderness and nausea. While these are categorized as minor by medical literature and physicians, the truth is that these physical effects can significantly decrease our quality of life.

2. It increases serious health risks.

On the other hand, we put ourselves at increased risk of serious health problems with this alteration of our biology. One of these is the risk of pulmonary embolism, or blood clots. Those on the pill are at significantly increased risk of both hospitalization and death due to blood clots than those not on the pill. Cancer risk is another concern for those choosing a birth control method, with the World Health Organization categorizing hormonal birth control pills as carcinogens . It also contributes to bone loss, decreases the body’s ability to absorb nutrients, and increases the risk of developing inflammatory bowel diseases.

3. It can have a powerful impact on mood.

Recently, attention has been on research showing that the pill negatively alters mood. A 13-year study published in 2016 found that being on the pill increased the risk that women would experience depression, regardless of whether or not they had a history of mental health problems. This is nothing women haven’t known for years, as mood changes are one of the main reasons 30% of women discontinue the pill due to dissatisfaction. Given what we know about the powerful connection between our psychology and our biology, it’s not surprising that something that alters so much of our biological functioning makes its way to our moods and emotions.

Understanding Our Options

There’s a pervasive modern idea that conventional birth control is the only reliable way to prevent pregnancy. Women who aren’t on birth control are often seen as irresponsible or uneducated, and rarely do we hear about those who choose alternatives to conventional birth control for legitimate reasons. In fact, one of the primary reasons healthcare providers don’t focus on informing women is arguably that many assume there are no other options. Most also don’t know there are alternative methods of birth control that have either decreased risks or no side effects at all that are just as effective as the pill.

When I started learning more about these alternative methods a few years ago, my mind was blown at how much I didn’t know about how my own body worked. How many people don’t know that there are reliable ways to know when your body has ovulated, in real time? Or that you can ovulate at totally different times in your cycle each month. Or even that women are fertile for only 6 days every month, compared to the impressive –ahem– 100% of the time men carry their fertility around. If you didn’t know all of this? This knowledge can be the beginning of the most empowering journey you’ll undertake, a journey of working with your cycle rather than trying to overcome it.

When we come to understand our cycles and bodies better, we realize that interrupting our hormones isn’t the only way to prevent pregnancy, and actually prevents the healthy cycling of crucial hormones that contribute to our overall health and happiness. A whole new world of contraception opens up, some of which is totally without side effects – and with effectiveness ratings rivaling those of hormonal birth control. Let’s go over a few of these most effective, safest forms of birth control.

  • Fertility awareness method

This method of birth control is my personal favorite and highest recommendation. It’s used by tracking your personal ovulation date and provides a cushion of protected sex around that date, taking into account the maximum possible life span of an ovum and sperm. This method has been found to have a stunning 99.4% effectiveness rate, just about matching that of the birth control pill. The fertility awareness method is traditionally done by tracking waking body temperature and cervical fluid texture, making it an easily affordable option. Since the method is individualized and not based on prediction (as in the old “rhythm method”), it will work for you whether or not you have regular cycles.

You may have heard of methods using beads to show which days you will fertile and infertile. While this is a possible form of birth control, it is not as effective as fertility awareness, having an effectiveness of just over 95%. This is because it is based on averages rather than your individual cycle. There are also more tech-savvy options coming out that can make the whole process significantly easier. Kindara is an app that simply helps make tracking simpler when using FAM. Natural Cycles, on the other hand, is an app that has been certified in Europe as a medical device for the purpose of contraception. It works by using an algorithm with your daily temperature, and one study found the app to be 99.95% accurate in determining fertile days. It’s important to know the research and science behind any given device or app before assuming that it is effective just because it’s on the market.

  • Condoms

While condoms are prevalent, it’s safe to say their effectiveness is underrated due to human error. The average effectiveness is 88 percent, which isn’t amazing. But the effectiveness when used correctly jumps to a much more impressive 98%. Condoms can potentially be used alone, and can also be used as protection with the fertility awareness method on unsafe days. Let’s be real, using a condom isn’t rocket science. But there’s enough trouble on this point that it’s worth mentioning a few condom rules to make sure you’re at 98% rather than 88%.

First, make sure to always check the expiration date and throw out any condoms that are past the date on the package. Second, always use water-based or silicon lubricant to help prevent the condom from breaking. When going to apply a condom, don’t unroll it prior to putting it on your partner. Make sure that, when you do unroll the condom down the shaft of the penis, you roll out any air bubbles and that the condom is not too tight. Finally, always purchase condoms with a reservoir tip. This gives the semen somewhere to go, decreasing the likelihood that the additional pressure will cause the condom to break at the most inopportune time. (For more details on how not to mess this condom thing up, head here.)

  • Copper IUD

This tends to be the top-recommended form of conventional birth control by natural health practitioners. Why? Because it’s non-hormonal, effective and relatively safe. (Note the copper IUD is not the same as the hormonal IUD Mirena.) Serious risks include rupture of the uterus which could affect future fertility and possible fatality if one becomes pregnant with an IUD inserted. More common side effects include pain and cramping upon insertion. Many women are satisfied with this form of birth control which is effective for up to 12 years. But for those who aren’t, cramping pain is the most common reason for having the device removed.

Having an IUD inserted can be a somewhat painful experience, and the cramping caused by insertion can last up to 6-8 months, after which it is normally expected to subside. But  understandably, many women don’t wish to experience 6-8 months of pain to start a new form of birth control. IUDs can be a good option, but whether you want to take the jump and see if it will work for you and whether you will tolerate it is a personal choice. The IUD available in the US is the ParaGard.

Your Turn

I encourage you to dive into your own research on your cycle, hormones, and the wide world of birth control options. While I believe everyone should have access to the birth control of their choice, I also believe that women deserve to understand how birth control affects their bodies, the risks it poses, and that other options are available. Without this understanding, no choice is truly an informed choice. If you’re considering going off of hormonal birth control you’re currently taking, arm yourself with the knowledge you’ll need to care for yourself as the effects of altering hormones does not stop immediately after stopping the pill or other birth control method.

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