Your Body On The Pill - What's Really Going On?

Women have been using the Combined Oral Contraceptive Pill (COCP) in Australia since the 1960’s. It was embraced by many women as a way to have control over their bodies and delay starting a family. It contributed to many social changes that improved the status of women including better health care, control of their fertility and equal pay for equal work. Since then, many other forms of contraception have been invented. There are now an array of ways women can manage their hormones in order to delay pregnancy. Which is both exciting and scary, because well …  even though we have the ability to manage our hormones, does it mean we should?

Today, the pill is considered the most foolproof answer to not getting pregnant (97% effectiveness when used properly). For many women, this is the main reason they take it. And there are numerous arguments in favour of the pill: it can be relatively inexpensive, the woman ends up with full control over her cycle - vacation to a tropical island but it’s that time of the month? That’s cool, just skip it! And of course, still over half a century later, a huge factor is women having ‘power’ over their fertility.

“Our hormones control everything about us - our mood, hunger, arousal levels and most importantly, they are the catalysts for muscle growth, fat loss and many other impressive bodily functions.”

However, not all women are on the pill for contraceptive reasons. Doctors have been prescribing it as a ‘fix’ for symptoms such as heavy or irregular periods, acne, severe mood swings and more. And while I understand why, (if you were promised to take a pill and your debilitating acne would go away, wouldn’t you try it?) it avoids diving deeper into the more important issue here which is why do you have debilitating acne to begin with? Our hormones control everything about us - our mood, hunger, arousal levels and most importantly, they are the catalysts for muscle growth, fat loss and many other impressive bodily functions. So if you’re showing signs of severe imbalances in your hormones such as extra body hair, acne or severe menstrual cramps and headaches, these should be looked at through an investigative approach to get to the root cause, and find a solution, which is so much more than simply making the symptoms go away.

For a large number of my friends, they’ve been on the pill since they were prescribed it over a decade ago. Within that group of ladies, the slight side effects (tender and enlarged breasts, and dips in mood) seem like a small price to pay - as the alternative painted by so many GP’s is well, pregnancy. And others have been able to feel comfortable in their now clear skin, or don’t have to be concerned about bleeding out from how heavy their period is.

I did it myself. Others had been on it so I felt it was ‘what you do’. A fairly simple process, of heading to the local GP and asking for a prescription for the contraceptive pill. But unlike my peers, I had no real need to mask any uncomfortable symptoms. This was purely a contraceptive endeavour that I jumped on when I was 22. I began to experience irregular periods and extreme mood changes (that I just excused as -”duh I’m female”). But after 3 years of dealing with the side effects (and being told by my doctor that mine “weren’t that bad so I should just stay on it”) I decided to end my relationship with the little white pill.

Women are complex creatures. The way our hormones interplay with each other is actually pretty unreal, something to be marvelled at. But it’s also just plain confusing, and calls for us to really investigate our relationship with our bodies, because as annoying as it is - there are no blanket answers for some of our most frustrating hormonal questions.

Last week we spoke to Renee Lynch, a graduating Naturopathy student and friend, about our cycles and the pill. She helped us out with some answers to these questions …

Q. Without sounding like 5th grade PE, what actually goes down during our menstrual cycle?

A. The menstrual cycle surrounds the complex (and beautiful) relationship between the ovaries, uterus and hormones.

To break it down:

Menstrual Phase (It’s arrived) {DAYS 1-5}

This phase is influenced by the decrease in progesterone and other hormones. The endometrial lining that was built up from the previous cycle has broken down due to the lack of progesterone, this is what is being shed as menstrual blood.

Pre-ovulation: {DAY 6-13}

This phase is where oestrogen comes into play. It is under oestrogen's influence that the endometrial lining starts to thicken again from about 1mm to 6mm thick.

So it’s during this time that the increased oestrogen levels cause glands around the cervix to secrete cervical fluid - yeh you know what’s up - that natural lubricant we get every month? It’s actually a fuel source for sperm, and helps the sperm transport themselves up the fallopian tubes. Now if you’re following closely you can guess right about now that this is the time our body is saying - we’re setting you up for success sister, now go get it! So be careful having unprotected sex during the second half of these days.

Ovulation {DAY 14}

This is when you’re your most fertile on this day - this ONE DAY is the day you’re able to fall pregnant. It’s a tough gig for those sperm, they don’t really stand a chance any other day. Although it is to be noted that sperm has a shelf life of 3-5 days once it’s orbited into the abyss. So, 3-5 days before you ovulate use a barrier method. The lifespan of your egg is 24 hours, so 12-24 hours after ovulation, a woman can’t fall pregnant.

Post Ovulation - The Luteal Phase {DAYS 15-28} 

During this phase progesterone is released which causes the endometrial lining to remain thick and suitable for fertilisation - just waiting for a mate that never comes. So when fertilisation doesn’t occur the endometrium becomes fragile and starts to break down - then bam, we’re back to menstruation and the start of a new cycle.

Q. So what does the contraceptive pill actually do?

A. The pill’s function is to initiate a negative feedback loop to the hypothalamus (our brain), inhibiting the release of a gonadotrophin-releasing hormone mid-cycle which stops ovulation.

Suppression of ovulation is mainly due to the progestin (synthetic progesterone) component of the COCP. It keeps that endometrial lining of the uterus thin, and the cervical mucus thick and impermeable to sperm. Basically, if no eggs are released then making a baby is pretty hard work. You read that correctly, no eggs, no ovulation... quite a shock to many women who believe they still ovulate on the pill. 

Q. Is there anything wrong with being on the pill? It fixed my horrible acne and painful periods so why would I come off it?

A. Whilst it may seem like the pill has mysteriously fixed all of your hormonal problems the truth is it’s actually just masked them. The pill can deplete your body of vitamins B2, B3, B6, Folic acid and Zinc. Zinc and B vitamins are required for sufficient energy production, immune function and fertility and so many more body functions, we'd be here all day if I listed them. 

It can mess up good gut function and deplete your microbiota, which can decrease your immune function and digestive health, depleting vitamin and mineral stores (needed for good bones among every single other body function) and can leave your liver pretty unhappy too, because we need all those B vitamins to power our liver detoxification pathways (hello excess oestrogen). 

Q. Can the pill mess with my fertility?

A. Sadly the answer is ‘it depends’. When you come off the pill it may take some time for your body to switch on again as your hormones have had a holiday. You may also experience the return of symptoms that originally sent you on the path of taking the pill in the first place and that could take some time working through. Quite a number of women with PCOS (Polycystic Ovary Syndrome) are prescribed the pill to dull their symptoms, so make no mistake you’ll still have PCOS once you come off the pill, and this may have an impact on you falling pregnant.

Then of course you have women who merely used it as contraceptive, with no prior concerns or reasons to take the pill who fall pregnant straight away.

Q. What can I do to understand my hormones better?

A. If you’ve been on a hormonal contraception then you won’t have a true understanding of your menstrual cycle. There are a few ways (once you’re off the medication) that you can dig deeper into understanding your hormones. These will help create a better picture of your overall hormonal health if you end up seeing a Naturopath or Integrative Medicine practitioner.

  • Cycle diary: This is the best way to start understanding how your body is functioning. Record symptoms, colour and consistency of the blood, sanitary use how often you change throughout the day (on a need-to basis), libido, moods, foods that made you feel better/worse, bowel movements that coincide with your cycle.

After a few months, you may see patterns arise, like on day 21 all I want to do is stay in and watch romantic comedies and eat chocolate. Or from day 7-14 each month I am consistently hitting PBs at the gym.

  • Fuel: Ensure you are eating a diet rich in good quality animal proteins, eat the rainbow (antioxidant rich fruits and vegetables), a variety of whole grains, good fats such as olives, olive oil and avocados, and make sure you’re getting some oily fish in 1-2 times per week. What we are looking for here is an anti-inflammatory diet that isn't going to exacerbate a body with an inflammatory condition, such as endometriosis. 

It is also imperative to understand how much you should be eating each day (which we focus on here at the gym), because a calorie deficit could be the cause of an irregular or absent period, also known as hypothalamic amenorrhea. 

  • Investigate: If you’re noticing issues or experiencing unpleasant symptoms maybe it’s time to take control of your health. Seeing a Naturopath or Integrated Medicine practitioner - someone who will investigate you as a whole and not just treat your symptoms. They can complete some tests, and take a hormone profile which tracks your hormone cascade across the month. Or perhaps a functional liver test, which will analyse how your liver is coping with the breakdown and removal of hormones.

Each woman’s decision to be on the pill is personal.

And in the end, knowledge is power. If you’re on the pill and plan on staying on it - ensure it’s because it’s the best option for you. As women, I believe we haven’t been properly educated about our cycles and how to navigate our hormones as something that naturally happen to us. Perhaps our fluctuating hormones is something we need to understand and treat with care, not something we need to race to suppress.

If you want to start investigating your health further, head to Sydney Wellnation Clinic and book your appointment with Renee Lynch - available 8-2:30pm Thursdays. 

Melanie Corlett