“I’ve been considering starting hormonal birth control, but I’m concerned about the side effects,” Natasha shared in her first visit. Like many women considering hormonal birth control, she wasn’t ready to start a family and she felt apprehensive that other methods would work for her.
“It’s true that just like your natural hormones, synthetic hormones can affect every system in your body,” I explained. As I share with all of my patients, there is no one-size-fits-all when it comes to birth control and you need to choose the method you feel will work best for you.
Wait, if there are side effects then why would any woman want to start birth control?
Women start birth control for a variety of reasons. Some simply feel it is the best option for pregnancy prevention. Others use it temporarily for conditions like acne because they are getting married and want to show up with clear skin in their photos. There are women with conditions like endometriosis who find symptom relief and are able to leave their house because birth control is suppressing their symptoms. Some women simply don’t want to deal with their period, their hormones or their symptoms and find it helps.
I could go on, but really, at the end of the day it is her choice to use any medical intervention available to feel her best and support her life goals.
As a naturopathic physician who focuses on women's health, it’s my job to educate and support women in their decisions. Yeah, that means give the info and respect her choice.
Natasha was experience fear around sex, having anxiety post-intercourse, and really felt unsure about her current method of birth control—condoms. She was in a monogamous relationship and she and her partner felt that condoms made the experience less enjoyable. “We also aren’t so great about always using them, which I know is bad,” she shared.
“Let’s slow the roll on feeling guilty because you opt to go with the heat of the moment and your logical self gets overrun by your biology,” I told her. As I share with my patients, we shouldn’t judge ourselves harshly or feel ashamed because we know there is a better choice, but fail to make it. Don’t misunderstand me. I’m not advocating for unprotected sex here. I’m just saying we don’t need to beat ourselves up for human error.
When I asked Natasha what she wanted she stated, “I’d like to try the pill.”
When a patient tells me they’d like to start hormonal birth control I provide an informed consent, which includes looking at their individual factors that might put them at risk for side effects.
And I ask that they track their cycle so we can establish their baseline.
Track Your Symptoms & Your Cycle
Before my patients begin any form of hormonal birth control I ask them to track their symptoms and their cycle for at least a month (3 being more ideal) prior to beginning. This allows them to get a baseline for their normal and can help them identify how this medical intervention may be affecting them.
Symptoms & Data Points to Track Include:
- How long is your cycle?
- Is your cycle regular?
- How many days is your period?
- How heavy is the flow?
- Do you have cyclical symptoms like cramps, mood swings, headaches, digestive changes, etc?
- What’s your mood like throughout the month?
- Do you have any skin symptoms?
This is an example of some of the data points I ask patients to track. Your doctor may advise you to track more depending on your health needs.
After beginning birth control I recommend women continue to track their symptoms and evaluate how this medication may be affecting them.
If you have any new symptoms arise that you’re concerned about, meet with your doctor or prescribing provider.
I also recommend getting a baseline blood pressure with your doctor because hormonal birth control can lead to elevated blood pressure in some women.
Get Baseline Lab Testing
There are very real life threatening risks to starting birth control, like stroke, pulmonary embolism (clot in your lungs), and heart attacks.
In my patients wishing to start birth control we screen for risk factors that would be a contraindication to starting birth control.
In Beyond the Pill I give you lots of lab testing to discuss with your doc depending on what you’re experiencing. Some of the screening tests for the risk of cardiovascular events that I share in my book include (see page 164):
- Factor II genes
- Factor V Leiden genes
- Cholesterol panel
- Anticardiolipin antibodies
- Antiphospholipid antibodies
Depending on your personal history, family history, and your current state of health, your doctor may recommend only a few or all of these tests. Having a discussion with your doctor is the best way to understand which test is best for you.
According to the CDC, “5 to 8% of the U.S. population has one of several genetic risk factors” that can increase the risk of developing a clot.
I’ve certainly had pushback from US based doctors stating that high homocysteine, anticardiolipin antibodies and other abnormal labs that are listed above aren’t a contraindication to using oral contraceptive pills (the pill) in women. To that I say, anything that increases the risk of a stroke or heart attack should be screened for before starting birth control.
There is also a difference in what is considered a contraindication in the US versus other countries. Here’s an excerpt from UpToDate on one from of the pill ethinyl estradiol and desogestrel:
“Canadian labeling: Additional contraindications: Ocular lesions due to ophthalmic vascular disease including partial or complete loss of vision or defect in visual fields; pancreatitis associated with severe hypertriglyceridemia (current or history of); thrombophilias (inherited or acquired); severe dyslipoproteinemia; migraine with focal neurological symptoms (eg, aura); hereditary or acquired predisposition for venous or arterial thrombosis, such as Factor V Leiden mutation and activated protein C (APC) resistance, antithrombin-III deficiency, protein C deficiency, protein S deficiency, hyperhomocysteinemia (eg, due to MTHFR C677T, A1298 mutations), prothrombin mutation G20210A, and antiphospholipid-antibodies (anticardiolipin antibodies, lupus anticoagulant).”
Additional screening labs that can be helpful include:
- A complete thyroid panel
- Vitamin D
For Natasha, we ran baseline lab testing and didn’t find any contraindications to starting the pill. We also reviewed her personal and family history. Here’s what’s important to share with your doctor.
Personal and Family History Before Beginning Birth Control
Part of what makes birth control such an individualized treatment is that we all have a unique history, environment and a way that we respond to medical interventions. Important personal and family history information to share with your doctor includes:
- History of stroke, heart attack or clots
- History of depression, anxiety, suicidal ideation, or other psychiatric disorders
- History of breast cancer or other cancers
- History of autoimmune disease, most notably inflammatory bowel disease, lupus, and multiple sclerosis
Natasha’s family history was unremarkable and she didn’t have any personal contraindications to using hormonal birth control.
Starting Birth Control
There are many well documented side effects associated with using hormonal birth control. Here I’ve detailed the side effects of birth control. When you know the side effects to look out for then you can quickly identify when it is time to call your doctor.
You’re probably aware of at least some of these side effects. In addition to the concerns about stroke, clots, and heart attacks, the pill depletes nutrients, raises inflammation, can lead to adrenal and thyroid dysfunction, causes insulin dysregulation, and disrupts gut health.
In addition, you can take steps to reduce your risk of experiencing side effects and improve your health while using this medication.
Do You Have to Wait for Your Period to Start Birth Control?
This was a question at the top of Natasha’s list. By the way, I do recommend taking a written list of questions to your doctor to ensure you get all your questions answered.
The answer is, you can start birth control pills at any time in your cycle.
Do I have to Take Birth Control at the Same Time Everyday?
The consensus is no, however, this is a daily habit and forming a routine can help ensure you do take it every day.
7 Ways to Stay Healthy On Birth Control
After presenting Natasha with her options and educating her on the potential benefits and risks based on her individual factors she was ready to start the pill. She knew her job was to continue to track symptoms and report back if she had issues. We also reviewed the emergency signs and symptoms like swelling of limbs, palpitations, shortness of breath, and extreme headaches that would warrant a trip to the ER.
My job was to see her back in 6 months for a thorough physical exam and blood work to monitor her body on birth control. We can make a lot of generalizations about birth control from the research, but with my patients, my concern is what is true for them.
To support Natasha and ensure she was as successful as possible with her new prescription we implemented the following:
1. Eat a Nutrient Dense Diet
The pill specifically can lead to nutrient depletions like vitamin E, C, B2, B6, B9 (folate), B12, selenium, zinc, and magnesium. Ensuring you’re getting adequate nutrients in your diet is key.
Food Source of Common Nutrient Deficiencies Caused by the Pill
- Vitamin E: nuts, seeds, leafy greens
- Vitamin C: bell peppers, leafy greens, citrus fruit, berries
- B Vitamins: Eggs, meat, seafood, leafy greens
- Selenium: Fish, beef, leafy greens, Brazil nuts
- Zinc: Seafood, oysters, beef, beans, nuts
- Magnesium: Leafy greens, beans, dark chocolate, nuts, seeds
Grab the free meal plan and recipes to help balance hormones I have for you to get your diet dialed in.
In addition, Natasha started a multivitamin to support her body. In my experience, dietary practices aren’t enough to compete with the nutrient depletions caused by birth control. But I want to be super clear, you can’t just take a multi and skip the veggies and think you’ll be good. Nutrition and lifestyle are foundational to health and no supplement can take the place of it.
2. Support Liver Health
While on birth control, your liver takes a hit. Not only because the nutrients it needs to do its job are diminished, but also because it is the role of the liver to detox the extra hormones. The impact on the liver is why some women experience elevated cholesterol, elevated sex hormone binding globulin (SHBG), liver tumors, liver cancer, and blood sugar dysregulation.
Your liver depends on amino acids, B vitamins, minerals and more to do its job. This is why diet is so important, and in addition, monitoring of liver health.
This is perhaps one of the most misunderstood aspects about my work. When I titled the chapter in Beyond the Pill, “Birth Control Hormone Detox 101” the intention was to educate women on how your body detoxifies birth control hormones and your natural hormones. The chapter was originally called “Liver Health” but apparently that’s not too appealing. 😉
In this chapter I educate you about how your body naturally detoxifies both endogenous (what you make) and exogenous (what comes in) waste. Your body does this naturally, but requires certain nutrients and habits for the system to work.
In my practice we use a food based support system to help optimize this for women on birth control and coming off. Sadly, however, there have been companies who have taken what I’ve written and painted this picture that “you have to force your body to detox birth control.”
Let’s be clear, your body has detox systems. You need to support these detox systems. But it is not true that your body will not detox these synthetic hormones without a certain medication or supplement.
3. Mind Your Microbiome
The pill is known to cause intestinal hyperpermeability (leaky gut), disrupt normal gut bugs, and produce an environment that allows for the overgrowth of less desirable critters.
The pill can also inflame the digestive tract, creating immune dysregulation that increases the risk for autoimmune disease.
4. Support Healthy Inflammation
Yes, inflammation isn’t bad, but too much of it can cause big trouble. We know from studies that the pill can result in elevated C-reactive protein (CRP), which can contribute to heart disease, compared with those not on the pill.
Lowering inflammation can improve your mood, help with cramps, and reduce back pain and fatigue. Eating omega-3 rich foods such as wild-caught, cold water fish, wanuts, flaxseeds and grass-fed beef can help modulate inflammation. Including turmeric and ginger in your diet can help too.
5. Get Your Stress in Check
Try incorporating stress reducing practices like meditation (even 5 minutes can do wonders), prayer, mindfulness, finding your happy place, indulging in a massage, acupuncture, time with friends, and exercise are all great ways to reduce stress.
6. Sleep is a Must
Sleep is essential for hormone health, repair of tissues damaged throughout the day, improved mood, and optimal brain health.
Aim to sleep 7-9 hours nightly in a completely dark room. If you’re struggling with sleep, check out these tips for better sleep.
7. Trust Your Body, Your Symptoms & Never Stop Advocating for Yourself
Not all women will have side effects with birth control, but if you do, see your doctor. Some doctors don’t “believe” the studies, let alone women’s stories. This doesn’t mean you should give up. There are many excellent doctors who can help you on your journey.
If your birth control isn’t working for you, advocate for yourself!
If we’re going to move women’s medicine forward then we have to stop arguing whether the side effects are real or if a woman is telling the truth. Instead, we need to begin asking questions about why some women struggle on birth control while others thrive.
For the record, I’m not anti-hormonal birth control.
It honestly feels ridiculous to have to say that, but there are definitely people who don’t want you questioning birth control and use the idea that “Dr. Brighten is just anti-birth control” to try to end the conversation.
I am pro–informed consent. That means doctors giving you all the information you need to consent to taking birth control. I spent more than a decade on the pill and know all too well the symptoms of hormonal chaos that follow when you stop the pill for good.
And there is a whole lot I wish my doctor would have shared with me before starting birth control. The reality is that most doctors aren’t educated on the systemic impacts and haven’t taken the time to go into the research to understand why some women experience the side effects they do.
If this article has been helpful for you, please share it, comment below and get this information out. We can simultaneously be grateful for our access to birth control while we also advocate for women to have access to the information they need.
If you need more support being on birth control, grab my free birth control guide here.