Are you or have you been on “the pill”? Maybe you chose another route and went for a patch or an IUD. Have you been informed of all of the risks or changes that might occur within your body when using these forms of contraception? If you’re using any type of hormonal birth control, you won’t want to miss this week’s episode of IWG Radio with Dr. Nicole and Nutritionist Brooke.
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Dr. Nicole:
Hey there, this is Dr. Nicole and Brooke Scheller from Integrative Wellness Group, and you are listening to another episode of IWG Radio, the place to be for all of your wellness needs. For those of you who don't know us, I am a functional medicine practitioner and Brooke is a functional medicine nutritionist. We work side by side here in Belmar, New Jersey in order to provide a solution for people to get well and stay well.

The goal of our type of practice is to really get to the root cause of why you're experiencing certain symptoms, to then set you up with the proper recommendations and protocol to change your life style in order to improve those symptoms and resolve your current diagnosis.

Brooke Scheller:
This week, we're bringing to you a topic that is definitely a major concern for a lot of women. We're going to be talking about the birth control pill, and some of the side effects and things that can happen when taking the birth control pill for a long period of time.

During my training as a nutritionist, I had to take an entire course on drug and nutrient depletions. We spent actually multiple weeks learning about the nutrient deficiencies and the changes that are associated with what we call oral contraceptives. The most interesting thing to me is that we take a lot of drugs that are more of a short term thing. There are some drugs like antibiotics or even steroids that we take for a week or two weeks or some drugs maybe that we take for a few months or maybe a year.

[00:02:00]
Something like the birth control pill, we see a lot of women that come in that have been on it for five, ten- we've seen upwards of 25 and 30 years that women have been on the birth control pill. We wanted to give you a little bit of insight and background as to the changes that could be happening within your body when you're taking these pills for a long period of time.

I'll have Dr. Nicole start giving us a little bit of a rundown on the changes that are going on in the body when we start to introduce these synthetic forms of hormones.

Dr. Nicole:
Yeah, so to get started, I guess establishing what a normal cycle looks like is important as well.

Brooke Scheller:
I think it's funny that you say that, because I think a lot of women don't really even know what a normal cycle looks like, so being able to give us that insight too.

Dr. Nicole:
Technically we go through four different phases during our cycle. The first day of our technical cycle is the first day of bleeding, which is called the menstrual phase. That's actually when you are shedding tissue, which is what we call our period essentially. Then you move into your follicular phase, then into ovulation, and then into the luteal phase.

Through this whole time period, your hormones are changing pretty drastically. Typically into your end of your follicular into your ovulation phase is when you're going to have the most abundance of estrogen. In your luteal phase is when you have the most abundance of progesterone. These are just the normal cycles that your hormones will go through in order to create proper fertility and then essentially have the opportunity to get pregnant. When pregnancy doesn't occur, that's when you'll have the shedding of the tissue to kind of restart and get ready for the possibility of a pregnancy in the next month, or the next cycle.

That's typically what things look like normally. When you introduce birth control pills, there's a lot of changes that happen, and it really depends on the type of oral contraceptive that you are on as well.

[00:04:00]
Brooke Scheller:
Elaborate a little more on the different types of combinations that we might see in oral contraceptives.

Dr. Nicole:
In the oral contraceptives, I think that we've all heard of some people have the ring, some people are on a shot, some people are on a pill. Most of the time we are being recommended these different types of contraceptives based off of our lifestyle, and based off of our-

Brooke Scheller:
Almost like desires. I know that I was on birth control years ago, and I was-

Dr. Nicole:
Based off of our preference.

Brooke Scheller:
Well, and I think too I was having some problems with acne and so I went to my doctor and I said, "Listen, I think I want to be on the pill. I'm experiencing some acne," and she recommended something based on those symptoms.

Dr. Nicole:
Yeah, definitely. I think it's sometimes it's lifestyle, sometimes preference, and then there's these other symptoms that maybe we're trying to resolve. With that being said, most pills are combination. They contain a combination of progesterone and estradiol, which is another word for estrogen. The other word for progesterone is levonorgestrel. The combination is really trying to give you some progesterone hormone, but also give you some estrogen hormone, and this typically is going to create some level of activity with hormone production within the body, but at lower levels than they normally would be.

[00:06:00]
But also, like I mentioned before, there's going to be certain times of your cycle that your estrogen is more elevated and other parts of your cycle that your progesterone is more elevated. Typically when you're on this combination pill, you're going to have your hormones pretty much equivalent. They're going to be equivalent through the duration of the entire cycle. There's no peaks and valleys, essentially. This is one of the reasons why you're not going to have those PMS type symptoms, because everything is staying stable throughout the entire duration of your cycle.

The other type is primarily just going to be progesterone based. It's called Progestin. Those are typically going to be your IUDs, they're going to be your shots, like the Depo shot, and also the patch. These are interesting types of oral contraceptives because, first of all, yes, they're just emitting the hormone progesterone, but also they actually are creating more cervical mucus, which actually acts as a blockade to sperm.

When Brooke and I were talking earlier, pretty much what we established is you're creating just inflammation in the cervix and the uterus. Going back to what Brooke said about the long term use of these different types of pills, you could be creating an inflammatory response within your body for a very long time, which can be problematic within itself. Inflammation is one of the primary, core reasons for most of our chronic illness that we see, and that goes into everything from high blood pressure to migraines, headaches, high cholesterol and things like that. There's obviously going to be a negative impact when you're having inflammation in the reproductive organs as well.

Brooke Scheller:
Right, and I think it's interesting to mention too, that if we're creating that type of inflammation and it's maybe causing some scar tissue or some changes to the cells, if pregnancy is an option for you at some point in the future, it's definitely something that you want to consider, because there may be some changes to your ability to conceive properly.

Dr. Nicole:
[00:08:00]
I think that's a really good point, because scar tissue is essentially thickening of the endometrium. Yes there can be scar tissue based off of different types of maybe injuries to the pelvis, or surgeries and things like that, but then there is also the concept of a thickening of the lining of your reproductive organs that is induced by excess estrogen. You think about how many women are dealing with things like endometriosis, and the endometriosis is going to be in part because of long term birth control use, especially if you're on that combination pill and you're getting this overabundance of estrogen into your body.

Brooke Scheller:
Let's talk about the role of kind of the estrogen dominance, jumping back to that combination pill and how you just mentioned some thickening. How is that really going to effect the body?

Dr. Nicole:
Estrogen dominance is definitely something that is way too common, and don't get me wrong, this is not only in relation to the use of birth control pills. We're constantly getting exposed to different things that are considered to be hormone disruptors through our personal products, through our meat and dairy. It's not that I'm advocating being a vegan or a vegetarian, it's more so the quality. If you're eating different types of animal products that are not organic, or not grass-fed, you are going to get exposed to the growth hormone that they do administer to the animals.

The other big part of it is definitely plastics. We've heard about BPA and we see everywhere that now most of the plastics are BPA free. The issue with the BPA in the first place was that it was mimicking estrogen within the body and classified as a hormone disruptor. We have, yes, birth control can be a contributing factor to this overabundance of estrogen, and then we also have the plastics, the personal products, soy consumption, and also the non-organic animal products.

[00:10:00]
Estrogen dominance is something that, especially in females, can wreak havoc on the body. What I mean by that is there're so many conditions, hormonal conditions, that are related back to estrogen dominance. What I mean by that is things like PCOS, which is Polycystic Ovarian Syndrome; endometriosis, like we just mentioned; slower metabolism; inability to lose weight; and then weight, especially within the midsection, if you're someone who has belly, if you are also dealing with excess weight maybe in the thighs as well as the buttocks area; then you're also going to have complications with your thyroid. I know some people right now are like, "What?" (laughs) Because I think thyroid is such a hot topic right now, because left and right people are being diagnosed with thyroid issues. Even as young as fourteen, fifteen years old, it's definitely becoming this epidemic, essentially.

With this overabundance of estrogen, there's a couple things that are going to happen. One of them is the body is going to increase binding globulins. It's going to increase the cortisol binding globulin, and it's also going to increase your thyroid binding globulin. If you have a bunch of thyroid binding globulin floating around in your body, then whatever thyroid hormone that your thyroid is producing, it gets bound up. It pretty much gets dissolved by the body and it doesn't actually serve you or benefit you or provide the higher metabolism or the energy levels necessary.

[00:12:00]
The cortisol, on the other hand, I think cortisol has almost gotten a bad rap. We always think of cortisol and we think that high cortisol levels, that's really bad and that means I'm super stressed out, and that means my metabolism is compromised. Yes, that's correct to an extent, but you need cortisol. We all need cortisol. We need it because it's something that plays a role in our blood sugar, and it also plays a role in sustaining proper energy levels. If you have a overabundance of cortisol binding globulin, you are going to definitely have issues with energy, and might even get as severe as being classified as chronic fatigue.

Brooke Scheller:
Then let's talk about the flip side of this. If we're talking estrogen dominance, let's jump to the other hormone progesterone. If we're having an estrogen dominance, we're then having a lack of the progesterone. What's happening in the body with a lack of progesterone?

Dr. Nicole:
Yeah, definitely. As the estrogen goes up, you will definitely have issues with your production of progesterone. I know this can sound somewhat counter intuitive if you're thinking about mentioning that the Mirena, the Skyla, those IUDs, as well as some of the patches or even the Depo shot, those are primarily going to be progesterone based birth controls. It's like, "If I'm taking a birth control that has high levels of progesterone in it, why would I become depleted?" It's really just the way that the body perceives it and processes it.

In reality, you actually, when you're on the Progestin type of oral contraceptives, your progesterone levels actually become low and they stay stable at that low level through your entire duration of your cycle. But after a year, then they drop lower, and then obviously if you stay on it over the long term five years, ten years, your progesterone levels can essentially almost drop to zero. They'll still stay stable through the entire duration of the cycle, so that will prevent those PMS symptoms and things like that.

[00:14:00]
But once it comes time to come off of the birth control, your body is so used to functioning off low levels of progesterone and also has an inability to make proper amounts. This is what is going to make you more susceptible to estrogen dominance, especially if you're getting exposed to it through your environment. But also this is going to effect your libido, essentially. You need proper amounts of progesterone in order to have sex drive. You also need proper amounts of progesterone to have a high functioning metabolism, and to be able to lose weight. Then you also need high levels of progesterone in order to sustain adequate appetite and blood sugar. Again, that kind of comes back to weight, essentially.

Brooke Scheller:
I think it's interesting that you mention kind of over the long term and how that's happening, because we think about this with a lot of different areas of the body, and I always think back to certain types of medications that maybe block neurotransmitters. When your body isn't producing these things over the long term, it starts to go to this, "I don't need to make that anymore, I'm getting it. Why would I produce that, why would I spend my time. I'm going to spend my time working on this excess cortisol that's going on."

A lot of times when people come off of these medications, or these birth controls, they struggle to kind of then have a normal cycle, or then struggle to conceive, or to repair their libido, because their body isn't making that progesterone like it used to before. I think that's an important thing to mention as well.

Dr. Nicole:
[00:16:00]
Yeah, I always give people the example about if they're a gum chewer. What I mean by that is, if you constantly chew gum then- any time you start to chew, your stomach gets ready for a meal. Your stomach starts to pump out a bunch of enzymes as well as stomach acid. If you are chewing gum, obviously there's no swallowing happening. There's no food going into the stomach. Your body produces all the stomach acid, gets ready for that meal, and it's almost like, "Fooled me once, fooled me twice, okay forget it, now I'm going to not make stomach acid anymore because you keep tricking me by chewing, but there's not food essentially coming into the digestive tract."

This is something that over time leads to people having different things like reflux and gird and indigestion. Sometimes it's not always about having an overabundance of that stomach acid, but it's mainly because your body isn't producing as much anymore.

Brooke Scheller:
It's almost like the boy who cried wolf.

Dr. Nicole:
Yeah. It totally is. (laughs)

Brooke Scheller:
(laughs) I think it's important too that a lot of times we think we're not having a deficiency of estrogen, we're not having a deficiency of any of these other types of drugs that we use- acid blockers. We need to support the body's natural function, too. I think that's something to mention. A lot of people think that they then have to go and get hormone replacement, if that's then the case.

Dr. Nicole:
I'm actually really happy that you just said that, because that's I think something really, really important to talk about. Because if we're sitting here talking about, "Okay, you were on this IUD for a long period of time and now your progesterone levels are really low, and you're trying to get off your oral contraceptive or remove your IUD, and now you're going to go into having low amounts of progesterone and maybe starting to have different symptoms associated with it." You might feel like, "What do I do? Now I have to what? I have to get hormone replacement therapy, or I have to get bioidentical hormones, or whatever else in order to improve this situation."

[00:18:00]
That's really not the case. There is definitely ways that you can go about supporting the body through different types of supplements that will stimulate your body's ability to start making more progesterone. Pregnenolone is actually one of those supplements. Pregnenolone is something that you can utilize. I wouldn't necessarily do this on your own, because you need to be very careful with dosing for hormones and replenishing. But regardless, something like Pregnenolone you can utilize and it'll stimulate the body's ability to start making more progesterone.

That is so much more effective than using a progesterone based cream that essentially goes into the blood stream, and your body goes, "Whoa, where'd that come from? We didn't make that." Your body will actually send in a fleet of enzymes in order to break down that progesterone. It's very rare that you're going to hold on to a lot of the hormones that you're putting in synthetically.

Brooke Scheller:
One of our big theories here is that the body is very smart, and if you give it what it needs it's going to work and function properly. Like I said, we don't have a deficiency in estrogen or progesterone necessarily that we need to then replace it. We need to figure out what's going on and support the body's ability to then produce it on it's own. That could be through supplements like Dr. Nicole mentioned, but also certain foods can help with those as well.

Dr. Nicole:
Definitely.

Brooke Scheller:
Let's get back on track a little bit. We did talk about the thyroid, and we talked about the hormones, but tell us a little more about different organ systems and things that are involved in this.

Dr. Nicole:
Yeah, that's the thing about hormones is, you not only have hormones being produced by reproductive organs, but you also have hormones that are going to be produced by your adrenal gland. Essentially, when you're thinking about hormones and you're thinking about balancing the body and balancing hormones, you have to consider the reproductive organs, the thyroid, the adrenal, as well as the part of the brain called the pituitary gland.

[00:20:00]
There are various organs that are part of this puzzle, so you have to consider each one and how they're playing a role in a hormone imbalance. The pituitary gland is really, really important because that's actually where most of your stimulating hormones are coming from. In the event that you are on an oral contraceptive, and you are getting these synthetic hormones, if it is going to be the Progestin or it's going to be the combo of the Progestin and the estrogen, then you have to understand that there is going to be some level of dysfunction within the pituitary gland.

Your pituitary gland will essentially send signals down to your reproductive organs, signalling the appropriate times to make estrogen or to make progesterone. If you have a synthetic form of it, and also you have synthetic form that's keeping your levels the same through your entire cycle, when naturally there are going to be peaks and lows of those hormones, then it's almost like, again, the boy who cried wolf. Your pituitary gland is like, "Okay, clearly there's not much change happening, so we're just not going to send out those stimulating hormones anymore." You will start to see your pituitary gland functioning at a lower level as a result of the long term use of these different types of oral contraceptives.

Brooke Scheller:
Is that going to effect other organ systems as well?

Dr. Nicole:
It will, because the stimulating hormones from the pituitary gland, yes they go to the reproductive organs, but you also have stimulating hormones that will effect your adrenal glands, and they will also will effect your thyroid. You might start to see changes in your adrenal glands, which is very reflective of your body's ability to manage stress, and your body's ability to make different types of feel good hormones. You'll also see changes in metabolism as well as temperature control within your body. You feel cold a lot, because that's a big part of your thyroid as well.

[00:22:00]
Just to finish up today, this is a lot of information. Some of it a little bit technical, but we are going to make sure to attach some different graphs for you, so you can really look at the difference between your cycle on an oral contraceptive, as well as your cycle what it would be normally. You can kind of have that compare and contrast and understand a little bit more about your body.

But something else to understand too is there is a lot of different types of oral contraceptives out there. Many of them are obviously administering different types of hormones, but there is an IUD, if it is something that you're interested in, and that IUD is called Paragard, which is a copper IUD that actually has no hormones. It's a fantastic option if you want to be using some type of birth control but not necessarily wanting to have that influx of hormones. Due to just decreasing the risk for any side effects, as well as hormone imbalance for the future. That's something that we'll definitely give you as a resource as well, just so you can kind of check that out online and see if it's something that would work for you.

Brooke Scheller: Just an important to mention about the Paragard that it is a copper device that's inserted into the cervix, and that does still trigger that inflammatory response in the cervix. Even though it doesn't have the side effects of the hormone imbalances, it does have some different other side effects, so it's important to note those as well.