The subject of birth control is a convoluted one. The complexities were made even more apparent after I reached out to different women for this piece. For a medication so ubiquitous with growing up, why is the information still so mysterious? And while we’re asking questions, how is it possible that almost all of the women I spoke to for this piece has had a negative experience either with the drug itself or the adults manipulating their decisions about it?
It’s time we discuss women’s sexual health in a real, raw, and constructive way. Let’s start sparking conversations about our experiences with birth control and the subsequent embarrassment, shame, and mixed messaging that ensues.
Making an informed decision
Some people take the birth control pill for much of their adult lives without a break. Others use long-term hormonal contraception devices, such as intrauterine devices (IUDS) (The safety of using long-term hormonal birth control may depend on a person’s risk factors, age, and medical history). The choice is completely up to you. However, it is important that you are well-informed.
What are birth control pills?
Birth control pills are oral contraceptives pills (OCPs) that contain hormones, which prevent your ovaries from releasing eggs during ovulation. They also encourage the thickening of cervical mucus to act as a barrier between sperm and any eggs that may be released.
There are different types of contraceptive pills. They all contain synthetic forms of the hormones estrogen, progesterone, or both.
What are some side effects I should be aware of?
Most side effects usually fade within months as the body gets adjusted to the hormones.
A few short-term side effects of birth control included:
- bleeding between periods, or spotting
- vaginal discharge
- headaches
- nausea
- acne
- hairfall
- weight gain
- breast tenderness
- mood swings
- changes to eyesight
8 unexpected long-term side effects of birth control:
- Decreased testosterone
- Libido
- Cardiovascular thrombosis risk
- Cancer risk
- Crohn’s Disease
- Inflammation
- Increased Blood Pressure
- Gallstones
Studies suggest that OCP as a mode of treatment has indicated efficacy in terms of regularising menstrual cycles and improving hyperandrogenism thus reducing clinical symptoms like hirsutism, alopecia, and acne, but at the same time use of OCPs does contribute to the worsening of the disease process. Research data showed the worsening of anthropometric, glucose, lipid, insulin, inflammation, and coagulation parameters indicating adverse effects of the drug treatment. Thus the interaction of drugs with diverse metabolic pathways leads to increased risk for the development of obesity, Type 2 Diabetes Mellitus(T2DM), Cardiovascular Diseases (CVD), Disseminated intravascular coagulation (DIC), and Venous thromboembolism (VTE)
How does birth control affect PCOS?
With treatment, the symptoms of PCOS can be effectively controlled.
Oral contraceptive pills (OCPs) have been the first-line therapy for concurrent treatment of menstrual irregularity, acne, and hirsutism in women with the polycystic ovarian syndrome (PCOS), thus playing an important role in the symptom management of the women with PCOS.
The association of PCOS with metabolic syndrome brings up the debate regarding the risks versus benefits of OCP use in PCOS women. The PCOS Society (India) had a consensus meeting with a multidisciplinary faculty on providing recommendations for the use of OCPs in PCOS women in India. These recommendations were provided keeping in mind the phenotype of Indian women – we tend to have a higher risk of metabolic syndrome and insulin resistance.
Side effects of OCPs such as weight gain, mood changes, and adverse effects on cardiometabolic risk factors may at times exacerbate the problems in PCOS women. Thus, before initiating treatment with OCPs, thorough counselling is essential and this should be backed up by stringent monitoring at every follow-up visit.
A large-scale study published in 2018 indicated that long-term use of birth control decreased the risk of both ovarian and endometrial cancer. Researchers are not sure why birth control pills may lower the risk of certain cancers. It may be because the pill decreases the number of ovulations a person has in their lifetime, which exposes them to less naturally occurring hormones.
Combination birth control and PCOS
Hormonal birth control is considered to be a combination birth control when it contains two hormones. These hormones are usually estrogen, and a synthetic form of progesterone called progestin. These combination pills have the ability to regulate some hormonal imbalances, by increasing a woman’s estrogen levels and decreasing the amount of testosterone her body produces.
Since combination birth control pills contain two hormones that can adjust to hormone issues accordingly, they are the preferred choice for many prescribing doctors.
Combined OCP (COCP) also improves dysmenorrhea and menorrhagia, treats premenstrual syndrome, prevents menstrual migraines, treats pelvic pain related to endometriosis, and decreases the risk of endometrial and ovarian cancer.
However, not all women can safely take combination pills. Risks of taking birth combination pills for women with PCOS –
- A greater risk of diabetes: This is a consideration for women with PCOS who are already at risk for diabetes.
- Risk of cardiovascular issues: Including dangerous blood clots in the legs. Women with PCOS who are obese may have an elevated risk. If they smoke, the risk rises.
- Weight gain: Some evidence suggests that birth control pills can cause weight gain, but other studies disagree. Women who are already obese may be reluctant to take birth control pills. Weight gain can make the symptoms of PCOS worse.
Are there any reasons why I shouldn’t take the pill?
Most teens can take the oral contraceptive pill for PCOS. But for some, taking the combined pill (with both estrogen and progestin) is not an option because of certain medical conditions, called “contraindications.” If you can’t use the combined pill, your health care provider will talk to you about other medications to treat your PCOS.
Women with the following should NOT take combined oral contraceptives:
- History of blood clots
- Migraine headaches with aura (spots and flashing lights or difficulty seeing 5 to 30 minutes before the headache starts), or neurological symptoms (numbness, loss of speech)
- Certain kinds of heart disease
- High blood pressure that cannot be controlled with medication
- Active hepatitis (liver disease) – for starting the Pill
- Jaundice (yellowing of your skin or eyes during a previous pregnancy)
What to consider before starting your birth control journey
The severity of PCOS can vary from person to person and treatment plans are highly individual. Thus, it’s very important to talk to a provider about all the potential treatment options available to you. And while talking to a provider, remember to consider the following factors – cost, desire to have children in the future, regular vs. irregular bleeding, effectiveness at preventing pregnancy, and privacy. You may also consider alternative therapeutic agents and lifestyle modification strategies for better management of the disease.
It’s amazing how much a little pill can impact your life. If you don’t feel like yourself, make a change. Finding “your” method isn’t a one-time decision. As lives change, the ideal method for you might change too. We encourage you to go on a journey to find a method that works for you right now.