|July 2, 2014||
Birth Control Pills And Hormone Balancing
Article by content partners Labrix Clinical Services, LLC
Though not a form of hormone replacement, birth control pills or oral contraceptive pills (OCPs), have
multiple hormonal effects on the body when taken. As a health care provider, it is common to suspect
hormone imbalance as the underlying culprit of many of the complaints in your patients utilizing OCPs
but exactly how are the active ingredients in her birth control affecting her endogenous hormone
levels? Which hormone levels are appropriate to test? Is bioidentical supplementation an appropriate
treatment approach for her?
Let’s look at each question in a bit more depth: OCPs provide a
convenient, noninvasive and affordable way for many women to take control of their contraceptive
needs. OCPs typically contain both estradiol and a progestin (a synthetic progesterone analog),
although there are a few progestinonly choices currently on the market. Though OCPs have many
actions that decrease the likelihood of pregnancy, the primary mechanism of action of most OCPs is to
suppress ovulation via estrogen’s effect on the hypothalamus and subsequent suppression of FSH and
LH production by the pituitary. This suppression of ovulation is further aided by the progestin’s effect
on the hypothalamicpituitaryovarian axis and by a change to the midcycle surge of FSH and LH.
With this alteration of the ovulatory cycle, women taking OCPs may present with lower estradiol levels. In
addition, the suppression of ovulation means that the oocyte, follicle and corpus luteum are not
allowed to mature. With the corpus luteum being the main source of endogenous progesterone
production, failure for it to mature causes a dramatic decrease in endogenous progesterone levels. This
dramatic decline in progesterone levels relative to the decline in estrogen levels often causes these
women to experience many symptoms of estrogen dominance including moodiness, water retention,
breast tenderness, tearfulness and foggy thinking. Suppression of ovarian function often leads to lower
endogenous testosterone levels as well, which may contribute to vaginal dryness, depressed libido and
compromised bone health.
Although women taking hormonal birth control have decreased levels of progesterone,
supplementation with progesterone is typically not recommended as progestins bind to progesterone
receptors, causing competition for absorption at the cellular level. This competition will likely
compromise the wouldbe therapeutic benefit of bioidentical progesterone supplementation and
could potentially result in a lowered OCP efficacy.
Since OCPs suppress estradiol, progesterone and potentially testosterone levels, many providers
question whether or not it is useful to do saliva testing at all in these patients. Based on symptoms and
clinical suspicions the answer is often times a resounding ”Yes!” Testing androgen (DHEA and
testosterone) and diurnal cortisol levels can often identify underlying hormonal imbalances and be of great benefit
in developing an individualized treatment plan thatsuccessfully addresses your patient’s
concerns and symptoms. Additionally, assessing and addressing any concomitant neurotransmitter
imbalances can be beneficial in alleviating mood, energy and additional concerns that may be present.
Addressing these potential neuroendocrine imbalances for women using OCPs as their contraceptive
management of choice may be beneficial in alleviating and/or decreasing her ancillary symptoms.
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