Birth Control Pills and Fatigue.

Are your birth control pills causing your fatigue (and depression, anxiety, insomnia, low libido, weight gain, mood changes, pelvic discomfort…?)

This world is filled with women who are unnecessarily suffering from the side effects of their hormonal contraception. The purpose of this post is to help you to understand the truth behind birth control pills, and how they could be significantly influencing your life.

Birth control pills contain synthetic hormones

Sadly, there are too many doctors that are still of the belief that the hormones contained in conventional birth control pills contain the hormones estrogen and progesterone. They don’t.

Yes, they contain a hormone that resembles estrogen, but our cells are pretty smart. They can smell an imposter a mile away.

Ask your GYN what is present in the birth control pills, and I’m betting a dollar that she will say estrogen and progesterone. The correct answer is ethinyl estradiol and progestins (or progestogens). These are not bio identical; they don’t match the hormones that are made in a human body.

This identity crisis persists even in current scientific literature, which is unfortunate. To this day, there are scientific papers being published in prominent journals that interchange bioidentical estrogen (an estrogen identical to the hormone made in a person’s body) with the chemical ethynyl estradiol, the synthetic medicine found in birth control pills.

The synthetic estrogen in a birth control pill effectively tanks our natural estrogen

I’ll show how this happens later in this post. In most women, this decline of natural estrogen promotes some pretty significant effects. And few of them are good.

Pregnancy risk is decreased on the pill, which for many is a good thing. This is the primary reason for their widespread use. But mood, memory, libido, strength and energy also decrease… and the list goes on.

In its simplest form, the importance of estrogen in women is equivalent to the importance of testosterone in men. Both sexes use each these hormones, but typically women have far more estrogen and men have far more testosterone. Pretty basic biology so far.

Imagine how a man would look and feel with zero testosterone– not very good. Now translate that image to one of a woman who basically has no estrogen. Low estrigen defines the menopausal state, and typically women don’t feel their best in menopause.

Estrogen, also known as estradiol, is essential to a woman’s mood, cognitive function, and sense of well-being. It is also essential for the maintenance of multiple tissues throughout the body.

Knowing this, it has never been a surprise to me when a patient on birth control pills presents with vaginal dryness, skin and hair changes, fatigue and foggy thinking. Not surprisingly, these are the same complaints that I hear in my menopausal population as well.

Here’s what happens.

Why women feel crappy on birth control pills

The  synthetic ethanol estradiol in birth control pills stimulates the liver to increase the production of different proteins. Some of these proteins are involved in our clotting pathways. This is why there is an increase in the formation of blood clots while women are taking the pill.

There is another important protein that is produced when a woman exposes herself to high levels of ethynyl estradiol. This is the hormone known as Sex Hormone Binding Globulin, or SHBG. The protein’s action is right there in its name; it binds sex hormones. And it does so securely and indiscriminately.

For a young woman suffering with terrible acne or heavy menstrual cycles, the birth control pill can be transformative. As her testosterone is lowered, the production of oils in her sweat glands goes down as well. Less oil means less food for the bacteria that grow on it, and fewer mini infections. We call these mini infections ‘pimples.’

Check this out. The image attached to this post shows the lab values of a woman who has been on the pill for some time. (Sorry for the image quality.)

I wouldn’t waste my patient’s money on these tests, knowing that she was on the pill, but someone else did. One would expect to see exactly what these results show. I am sharing these results with you, because they are so telling.

Birth Control Pills: SHBG goes up, estrogen and testosterone go way down

First notice the SHBG. It went up, as expected. But look at the estradiol and free testosterone—the active hormones. They are both super low. In fact, the estrogen is below the range of the lab testing.

The total testosterone is normal, but barely. The total testosterone includes the hormone that is tightly bound to SHBG. The free hormone, which is available to the cells, is low and out of range.

Birth control pills create a relative menopausal state

Basically, this woman has no active estrogen and testosterone—two important hormones in a woman’s life. And she felt like crap. I spoke to her today (to get permission to use this graphic) and she told me she had been off of the pills for several weeks. What happened?

She said she was feeling so much better off of the pills, with clearer thinking, more energy and better sleep. She is not currently in a sexual relationship and doesn’t need the pills for contraception.

For women who need both contraception and their estrogen, here’s what I recommend. This advice comes from both the literature, and my experience as an OB/GYN.

Ditch the pills. Consider an IUD

I recommend the IUD. This form of birth control is about 5-10 times more effective than the pill, you don’t have to remember to take it, and it doesn’t affect your ovarian cycling. This means that the ovaries can wake up again and begin to make estrogen.

And you can begin to feel good again.

Birth control and fatigue: Conclusions

• Ethinyl estradiol is not estrogen. Never is, never was. If your doc, or your medical journal tries to tell you otherwise, they’re flat out wrong.
• SHBG earns its stripes; it really works. It grabs onto your hormones and doesn’t let go. This is great for heavy periods and acne, but little else.
• Consider the use of an IUD. The progestin-containing ones release a small amount of hormone to the lining of the uterus. This makes most periods so light that women don’t need tampons or pads. And they’re safe, too. Yes, the devices 50 years ago caused problems, but the newer ones work great (even in women who have never been pregnant).
• Reclaim your estrogen, reclaim your energy, reclaim your life!