Hormonal Imbalance - Part 1
Alright, this is something I've wanted to write out for a while but I wasn't sure how to tackle it. The purpose of this is not only to shed light on this significant portion of my health journey but also because it is relevant to so many of my clients, friends and family. My plan is to break it into two parts: part 1 (this part) I'm just going to talk about my experience with hormonal birth control pills (BCPs) and part 2 I'll explain the steps I took to find balance again and provide some resources for you! Let's dive in!
DISCLAIMER: I am not a medical doctor. This post is not intended to replace the advice from your physician. Though many women experience similar effects of hormonal contraceptives, there are also many women who never experience these things (you lucky ducks!).
DISCLAIMER #2: If you're a dude, this post won't apply to you (sorry) but it most definitely applies to the ladies in your life so feel free to pass it along :)
What are BCPs?
Hormonal birth control is a form of contraception that works by preventing ovulation (no ovulation = no chance of baby). Ovulation is prevented by giving the body doses of artificial hormones - most commonly a mix of both synthetic estrogens and progestins in the combined BCP. Other forms of hormonal birth control include IUDs, patches, rings and progestin-only pills. These fake hormones lack the benefits of the real estrogen and progesterone and come with a handful of less-than-ideal side effects. I'm not going to get into too many specifics here because there have been some very well-done articles written already (I'm all about not reinventing the wheel). Here are a few of my favorite articles that give more information on what hormonal BCPs actually are: How the Pill Switches off Hormones, The Crucial Difference Between Progesterone and Progestins, What's In Your Birth Control, The Little-Known Link Between BC and Depression.
My doctor recommended hormonal BCPs during my senior year of high school in order to "correct" my irregular and terrible periods. Among my friends and family this was the norm so I took her word for it and started. Right off the bat I had issues with it. The most noticeable change was an alteration in my mood stability. I had always been a very positive and upbeat person and for the first time in my life I suffered from some pretty wild mood swings - and not just around my cycle. These mood swings weren't debilitating by any means but they were certainly outside of the norm for me.
Weight gain is one of the most common concerns I hear from women about the pill and is something that I experienced; though, if I'm being honest, you have to think about the other factors that were going on at that time like a change in food quality (campus dining), an increase in drinking and a huge decrease in physical activity. The senior year in high school through freshman year of college was the perfect storm for weight gain for me with all of those factors adding up. BCPs alone were not the major contributor to my freshman 15 but they created an environment in my body that, when paired with my diet and lifestyle choices of the time, was not ideal. Here is a very brief overview of the ways BCPs may contribute to weight gain (links to studies are included for my fellow science nerds out there) :
- They increase SHBG (sex hormone binding globulin - basically a molecule that makes our sex hormones inactive) 
- They decrease testosterone which means less muscle mass (read: slow metabolism and a decrease in results you should expect from a particular training regimen) [1, 2]
- They deplete B-complex vitamins that help us convert food into energy as well as Zinc, Magnesium, Vitamin C and E. 
- They completely stop our natural production of progesterone (progestins are NOT the same) and can result in low progesterone and estrogen. 
- They impact carbohydrate metabolism altering glucose control and promoting insulin resistance. 
- They alter the gut microbiome (this is a huge area of research in the nutrition realm, will talk a lot more about this later) 
These rarely talked about side effects above come in addition to the ones we already know about: a significant increase in blood clot risk and a possible increased risk of certain cancers. Though I didn't know about all of this stuff at the time, the idea of taking birth control never felt right to me and I remember saying several times "it can't be good to be taking fake hormones, it just cant". Due to the side effects of mood changes and weight gain, I continually changed brands of BCPs trying to find one that was the lowest dose in hopes that I would feel better. I tried yasmine, yaz, ortho-tricyline-lo, lo-estril, you name it. Sadly, it wasn't until 2013 when I finally started diving into all of the research on this and toying with the idea of going off of BCPs. Every OB/GYN I encountered scoffed at this idea, I might add. Ultimately, the biggest driver of this decision was when I completed some incredibly advanced blood testing through one of my jobs and learned I had an extremely elevated, genetically-derived risk for blood clots: lipoprotein(a). Fun fact about me: I'll webMD myself into a frenzy if I think somethings wrong. Once I learned of my lipoprotein(a) levels in conjunction with an increased risk of clots from BCPs alone I stopped taking them immediately (and may or may not have seen a cardiologist and forced them to complete their entire battery of diagnostic testing to confirm that I was not, indeed, dying in the next 20 minutes).
So I finally Went Off
I thought it would be all rainbows and butterflies, back to my old self right away. Boyyyyy was I mistaken about that. The first few months post BCPs were filled with mood swings (fake estrogen withdrawal), acne, stomach issues and still having a difficult time with body composition. Armed with the knowledge from my research, I gave my body 2 months to try to normalize on it's own and then I got a huge blood panel done that showed the following:
What it looked like on paper:
- bottomed out free testosterone
- essentially zero progesterone on day 21
- the DHEA-S of an 80 year old woman
- functional deficiencies in: the entire B-complex, zinc, vitamin D, glutamine and glutathione
What it felt like in real life:
low energy, low mood and no motivation
- low sex drive
- zero results in the gym (you've gotta have testosterone if you want to see muscle definition)
- intense sugar and carb cravings
- a very sensitive tummy
The good news
It took time but I was able to correct a lot of the damage that BCPs had done to my body. Stay tuned for part 2 and I'll walk you through what worked well for me as well as some non-hormonal options for contraception. Does that mean the same plan will work for you? Not necessarily. But I hope to at least save you some time and connect you to the resources you need to start balancing your own hormones. The best advice I have is do your research (or work with a professional), be consistent and be patient. It takes about 3 months to see a difference in your cycle so no quick fixes here. If you made it this far and you relate I'd love to hear from you! See you next week with part 2 :)
1. ORIGINAL RESEARCH—WOMEN's SEXUAL DYSFUNCTION: Impact of Oral Contraceptives on Sex Hormone‐Binding Globulin and Androgen Levels: A Retrospective Study in Women with Sexual Dysfunction. Panzer, Claudia et al. The Journal of Sexual Medicine , Volume 3 , Issue 1 , 104 - 113
2. Effects of seven low-dose combined oral contraceptives on sex hormone binding globulin, corticosteroid binding globulin, total and free testosterone. Van der Vange, N. et al. Contraception , Volume 41 , Issue 4 , 345 - 352
3. Oral Contraceptives Suppress Ovarian Hormone Production. Diana S. Fleischman, C. DavidNavarrete, Daniel M.T. Fessler. Psychological Science. Vol 21, Issue 5, pp. 750 - 752. First published date: April-22-2010 10.1177/0956797610368062
4. A Modern Medical Quandary: Polycystic Ovary Syndrome, Insulin Resistance, and Oral Contraceptive Pills. E Diamanti-Kandarakis, J Baillargeon, MJ Iuarno, DJ Jakubowicz. Journal of Clinical Endocrinology and Metabolism. (2003) 88 (5): 1927-1932. https://doi.org/10.1210/jc.2002-021528
5. M. Palmery, A. Saraceno, A. Vaiarelli, G. Carlomagno. Oral contraceptives and changes in nutritional requirements. Eur Rev Med Pharmacol Sci. Year: 2013. Vol. 17 - N. 13. Pages: 1804-1813
6. Khalili H, Higuchi LM, Ananthakrishnan AN, et al. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut Published Online First: 22 May 2012. doi: 10.1136/gutjnl-2012-302362