Birth Control Shuts Down Your Ovaries

know your body Jun 14, 2017

Touted as "the" option for preventing pregnancy and "normalizing" painful and difficult menstrual cycles - most women I see in my office don't seem to fully understand that shutting down your ovaries is the implication of using birth control pills. Moreover, if you thought about birth control pills in this way what do you think the response would be from roughly 60-70% of the Canadian female population who use them?

What if you asked a man to take something that stopped him from producing sperm, what do you think he'd say? ... and therein lies my point.

Let's talk about how oral contraceptives work...
In the last two weeks alone, I have had several women look at me with shocked expressions when I explain to them how birth control pills work. They have ALL said - they just wish they had known, as they may have made different decisions regarding long-term contraception methods. In fact, when I was in naturopathic medical school our whole classroom of naturopathic med students responded the same way, men included.

Please understand, as a naturopathic physician, I am not categorically "anti-birth control pill", as the benefits of taking it are obvious and useful for many women. I am however, "pro-informed choice", and this over-looked aspect of birth control education appears to game-changer for enough of my patients, I thought you might find it useful.

What's In Birth Control Pills?

The answer depends on the particular product, but generally oral contraceptives fall into 2 groups:

  • Progestin Only Pills deliver a low daily dose of synthetic progesterone. This option is not popular due to a lower efficacy and occurrence of spotting throughout the cycle.
  • Progestin/Estradiol Combo Pills deliver a constant low dose of synthetic estrogen over 21 days, plus a low but increasing dose of progestin. *Note the 28-day products include an additional 7 sugar pills so that women can keep on track while menstruating and start the next pack on time.

How The Pill Works To Stop Ovulation

The pill is believed to inhibit ovulation via means of a "trick" played on the ovaries and pituitary. To understand this, you need a simplified crash course in ovarian hormone cycling... bear with me...

  • During days 1-12 (Day 1 is first day of your period) your ovaries are building/increasing your estrogen. Your pituitary gland secretes follicle stimulating hormone (FSH) in order to trigger the ovaries to produce estrogen and so, recruit an egg. The pituitary will continue to secrete FSH until estrogen levels are high enough in the blood.
  • During days 12-16 your ovaries are either ovulating or preparing to. Once estrogen levels are high enough, it triggers a surge in luteinizing hormone (LH) from the pituitary, as well as a smaller surge in FSH. The hormone surges cause the ovary to release the egg! Ovulation can be likened to a cyst/blister on the surface of your ovary "popping". Some women actually feel this happen, but most do not.
  • During days 16-28 your ovaries are building progesterone. The release of an egg causes the ovary to switch to producing progesterone (which builds the uterine lining) instead of estrogen. Estrogen levels start to fall. Rising progesterone causes the pituitary to stop secreting its hormonal instructions. The ovary can only produce progesterone for so long without hormonal instructions from either the pituitary or a fertilized egg. Eventually, without a fertilized egg, progesterone levels also drop off.
  • Restarting at Day 1 you are menstruating (or you are pregnant!). This is when progesterone levels hit an "all-time-low". Without a fertilized egg to take over the hormonal process, your uterine lining begins to shed (i.e. you get your period.) And the estrogen/egg-recruiting process begins again.

Phew... now, back to the birth control.

So, with birth control pills providing post-ovulation levels of the ovarian hormones (estrogen and progesterone) to your body without the work of your ovaries, your pituitary is kind of "in the dark" - assuming everything is going "according to plan" and it is just humming along doing it's thing. If your ovaries aren't producing the hormones because the pills are, they aren't doing the work (i.e. no egg recruitment). The trick is, by shifting hormone levels to make it appear like you've ovulated, the pituitary doesn't provide the LH/FSH surges required to release an egg. This is how we believe the birth control works to prohibit ovulation. Effectively, your ovaries aren't doing much of anything... At best, they push the odd hormone around, but mostly are waiting for hormonal instructions from the pituitary (FSH/LH) that never come.

Now imagine, this has been going on for 5-10 years or more without a break! It's surprising how many people do this to their ovaries, and then when they decide to become pregnant are baffled as to why they are having trouble with it.

Implications for Long-Term Fertility

The short answer to what that means for your fertility, is that we don't know. Whether you plan on having children or not, it seems counter-intuitive to have the function of any body part suppressed for that length of time. What risk implications does this have for your health in the long term? Menopausally or as a senior? We don't know that either. Not really...

As a physician, I am concerned that our young women are being prescribed birth control pills routinely as a method of "regulating" painful or difficult menstrual cycles. When in fact, their young pubescent ovaries are simply being "turned off" before they even get the hang of things. Young women seem to believe that their bodily menstrual cycles are "regulating" with birth control use, which is the exact opposite of what is happening. 10 years later for the same woman now wanting a child, finally coming off of birth control pills, this means that their ovarian function (and so, fertility) may be compromised.

The consolation prize is, that many fertility treatments (including natural ones) out there are helpful in improving ovarian function. But, wouldn't you consider condoms more seriously if you understood that it would mean healthy ovaries and avoiding the need for expensive fertility treatments and procedures in the future?

Now, I'd love to hear from you!

Some of the most important discussion happens in the comments below. I invite you to share your thoughts and ideas, so that we may all benefit!

Discussion questions to get you started: What is your reaction to this information? Was my explanation clear enough for you to understand exactly how oral contraceptives work? What considerations will you weigh in your mind before starting or continuing oral contraceptive pills?

Thank you so much for reading! I'm so honoured to be able to help educate as many people as I can about these important health topics. If you know someone who would benefit from this article, please feel free to share it.


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