Oral Contraceptive Pill
As a teenager growing up in Catholic Ireland in the seventies, contraception and certainly The Pill was not an option. Condoms were only accessed by train trips to Northern Ireland where they were easily available. Even when the pill became available by prescription, it was only for married women!
We have come a long way since then in terms of our attitude to sexuality and our relationship with the church.
Imagine for a minute how different the world would be if the pill never became an option. The pill has changed the way that women think about the consequences of sex. And as a result, we have all been able to develop our potential to a greater extent.
Achieving the ability to have sex without having to worry about rushing into marriage or parenthood, has allowed women to focus on educating themselves and building careers before starting families. For the first time in history, the pill has allowed women to plan, so yes certainly on the face of it the pill has been a liberator.
Beyond contraception, the pill is now being prescribed for ‘period regulation’, period prevention for social reasons and even managing acne. The pill has brought many benefits but it does come with a cost to our health. In this article I want to look at 5 ways the Birth Control Pill affects fertility.
Mechanism of action
To put some of these issues in perspective we must first understand the mechanism of action of the Oral Contraceptive Pill (OCP).
Follicle development occurs during the 7 day OCP break. The OCP the has a significant impact on hormones during the following 21 days.
Most OCPs deliver a significant dose of synthetic estrogen and progesterone throughout the 21 days of administration. These daily synthetic hormones suppresses the pituitary from releasing FSH and LH, which ultimately prevents ovulation. The brain then senses more than enough hormones circulating in the body, diminishing the signal to produce more. This results in a lack of communication between the brain, the pituitary, and the ovaries, preventing natural rhythm and communication which affects hormonal balance.
Doesn’t regulate your cycle
The bleed experienced during the 7 day break from these synthetic hormones is not a regular period, it is a withdrawal bleed. So when a menstruator experiences a ‘regular cycle’ while on OCP, this is not as a result of Nature, it is a pharmceutical induced response.
In response to patients experiencing missing, heavy or irregular periods doctors have been prescribing OCP as a means of regulating or balancing hormones. OCP does neither of these, it prevents ovulation which is the source of progesterone. A better way to describe OCP function is that it suppresses hormones rather than balances them. Any hormone imbalance which prompted the prescribing of OCP has not been addressed and will still be evident when the medication is stopped.
Does not preserve egg count
Being on the pill for a long time, you could assume that in coming off it all the eggs you didn’t use while on it are still intact. Not so, follicles containing your eggs continue to be recruited and brought forward for maturation and ovulation but OCP preventions the ovulation step so these follicles are eliminated with the breakthrough bleed. Your egg reserve will continue to diminish as normal while you are taking OCP.
Affects gut health
Synthetic oestrogen affects gut permeability. 70% of our immune system is in our gut. OCP can cause a variety of gut health immunity issues such as yeast infections and urinary tract infections. Gut flora is involved in hormone regulation so it is not surprising to discover hormone issues are worse when coming off the OCP.
Depletes vital nutrients
Mechanisms by which the pill decreases specific vitamins and minerals vary.
Folate, a water-soluble B vitamin, is essential in enzymatic reactions involved in amino acid metabolism and DNA methylation. The lack of this vitamin can create deficiencies that lead to reduced DNA synthesis and cell division. Several studies have concluded that using OCPs negatively impacts folate status.This may be caused by
malabsorption , increased excretion and a quicker metabolism of folates .
Riboflavin, another water-soluble B vitamin, is involved in metabolic processes, energy
production, and normal cell function and growth. Studies have demonstrated the association
between consumption of OCPs and a higher prevalence of riboflavin deficiency due to the body’s
inability to absorb the vitamin.
Vitamin B6, a water-soluble vitamin that includes six compounds, participates as coenzymes in various processes of the body that involve protein metabolism, carbohydrates, and lipid metabolisms. It also assists with the biosynthesis of neurotransmitters (e.g., conversion of tryptophan to niacin and serotonin). A recent large study found that plasma B6 concentrations were significantly reduced in 75% of women taking OCPs who did not use dietary supplements.
Vitamin B12 is also essential in cell metabolism and is vital to DNA synthesis and regulation, fatty acid synthesis, and energy production. Several studies have found low vitamin B12 serum levels in women using OCPs compared to non-users.
Another vitamin that may be depleted by OCPs is vitamin C. It is a cofactor in various metabolic processes, including collagen synthesis. Vitamin C also acts as an antioxidant and maintains metal ions in reduced forms (e.g., iron and copper).
Vitamin E, a potent antioxidant that protects tissues from oxidative stress and free radicals, is decreased in women taking OCPs. Studies have found increases in the clotting activity of platelets and a decrease in plasma vitamin E in OCPs users suggesting an increased risk of cardiovascular disease.
The zinc status of women using OCPs is lower than those who don’t take it. Zinc has roles in RNA and DNA metabolism, signals transduction and gene expression, and regulates apoptosis.
Another mineral that may be impacted by the pill is selenium, a micronutrient that
functions as a cofactor to reduce antioxidant enzymes.
This mineral also plays a role as a cofactor in the functioning of the thyroid gland and every cell
that requires thyroid hormones. Several studies indicate that the consumption of OCPs interferes
with selenium absorption, which can result in deficiency and increase the risk of developing
Magnesium is another essential mineral in the body that may be depleted by OCPs.
Magnesium must be bound to ATP to be biologically active; over 300 enzymes require the
presence of magnesium ions for their catalytic action. Inadequate intake or absorption can
lead to a deficiency, increasing the risk of chronic diseases and altering the calcium/magnesium
ratio affecting blood coagulability.
Delays time to pregnancy
A 1997 study of over 116,000 women in US found OCP delayed time to pregnancy after discontinuation. The length of the delay was dependant on the oestrogen dose in the OCP.
Optimizing your fertility
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