The Oral Contraceptive Pill
Types of Pills
The combination (oestrogen and progesterone) pill works by: making you sterile using negative feed back on pituitary; causing abortion by removing the lining of the uterus through influencing gonadatrophins; and is a contraceptive by creating hostile mucus.
The mini pill (progesterone) causes abortion by making the endometrium, unsuitable to implantation and the smooth muscle activity of the fallopian tubes is suppressed. There is an increased risk with this form of pill you as need to take it at the same time every day and it may cause ectopic pregnancy.
Oestrogens
Ethinyl oestradiol ultra low dose 15 to 20 mcg, normal 30-35mcg used to be 50 to 100mcg
Mestranol 50mcg is converted to ethinyl oestradiol in the liver
Progestins
1st generation: norethrindrone, norinthindrone actetate, ethyndol dracelate
2nd generation levono…
3rd generation desogesterol, norgestimol lots of health concerns esp CVD
latest: drospirenone (slight testosteronic action)
Progesterone only pills
Microlnt, Microval 30mcg 28/28Micronol Norethisterone 350mcg 28/28
Combined Pills
Ovulen
Ethynodiol 500mcg and ethinyloestradiol 21/28
Microgynon 50 21/21
Nordette 50 21/28, 7/28 placebo
Combined formulations sequencial
Biphasal and triphasal
How the Oral Contraceptive Pill works
- Inhibits ovulation, decreasing LH
- Thickens cervical mucus especially progesterone only pill
- Ovulation inhibition decreases FSH
- Changes in secretions of the endometrium
- Changes in the ability of the fallopian tubes to transport sperm and ova
Usually recommend 6 month before attempting to conceive after coming off the pill.
PCOS and endometriosis patients should try straight away with in 6 month before disease regresses
Over 35 may also want to begin earlier due to falling fertility.
Safety and efficacy of the Oral Contraceptive Pill
Lower mortality than pregnancy
Mortality associated with thrombo-embolism, myocardial infarcts and strokes
Risks lower with low dose progesterone except the 3rd generation ones (desogesterol, norgestimol) which have higher CVD risks
Mortality rise in women over 35 and who smoke
Delayed return of fertility after cessation of the Oral Contraceptive Pill (1% don’t return within one year, 55% resume ovulation in 3 months)
Higher pregnancy rates on very low dose pills, statistics often disclude pregnancies related to illness or forgetting to take the pill therefore increasing apparent success rate
ranges from 90 to 98%
Longer use associated with cervical dysplasia (beta carotene, zinc and folate) and cervical cancer
10 year usage increases risk four fold for incidence of cervical cancer
Contra indications for the Oral Contraceptive Pill
Neurological migraine
Breast cancer or family history of
Fibroids or family history of
Smoking
Gallbladder disease
Epilepsy (due to medication interaction, drug increases metabolism of the pill therefore need a higher dose pill.
Do not recommend pill to girls who have not established a regular bleeding pattern, ie the hypothalamic-pituitary axis has not matured, as the artificial cycle may mask endometriosis, PCOS and affect ability to fall pregnant later.
Benefits of the Oral Contraceptive Pill
Reduction in menstrual irregularity
Reduction of menorrhagia
Reduction of PID (10-70% less)
Reduction in ovarian (10-80%), endometrial (50-60%) and colorectal cancer
The Oral Contraceptive Pill is used clinically for:
Contraception
Dysmenorrhoea
Acne
Menorrhagia
Improve bone mineral density (athletes and low body weight)
PCOS, endometriosis management
Side effects of the Oral Contraceptive Pill
Up to 50% of women discontinue the Oral Contraceptive Pill in first year due to side effects and fears of long term risks
1% of women fail to ovulate again after coming off the pill.
the Oral Contraceptive Pill can cause erosion of the cervix, which may lead to cervical mucus production problems and thrush.
The Mini pill during breast feeding affects protein quality, fats and mineral levels. It may cause neonatal jaundice and masculinised female babies.
There is increased risk of deformity in foetus conceived quickly after coming off the Oral Contraceptive Pill.
Injected or implanted contraceptives are associated with side effects such as bleeding, depression and impaired fertility. They may cause problems with the thyroid.
Long term use of pill increases the risk of breast cancer.
Poor cycle control ie intramenstrual bleeding especially on low dose pill
When trialling a pill, should really be taking for 3 months as this is the time required for the liver to generate the enzymes required for the specific detoxification of the pill.
There is generally poor compliance with low dose pills as need to be taken at the same time to give full contraceptive coverage.
The pill lowers blood levels of pyridoxine (B6) and folic acid. Synthetic oestrogen reduces circulating levels of Vitamin E increasing the risk of thrombosis and atherosclerosis.
Coronary heart disease, obesity, cerebrovascular disorders/strokes, benign liver tumours, hepatocellular carcinomas, gallbladder disease/stones and hypertension are all attributed to the the Oral Contraceptive Pill.
Other things such as nausea, vomiting, fluid retention, weight gain, headaches, migraines, acne, pruritis, amenorrhoea, breast discomfort, leucorrhoea, depression (if sensitive to progesterone),loss of libido, fibroids and decreased glucose tolerance can be attributed to the use of the pill.
The Oral Contraceptive Pill and Nutrition
The pill alters the metabolism of magnesium, B6, Vitamin A, B2, B5, B9, C and zinc
Women on pill long term with poor diet and are smokers have increased nutritional needs and so are at risk of deficiencies.
Biotin levels are lower in the Oral Contraceptive Pill users.
B12 levels are lower in the Oral Contraceptive Pill users, esp. vegetarians
Migraine, premenstrual symptoms, muscle cramps, dysmenorrhoea, loss of appetite, nausea are help by magnesium (nuts, seeds, whole grains)
B6 deficiency causes depression, anxiety, impaired glucose tolerance, fluid retention, irritability (bananas, walnuts, tofu, vegemite, chicken, fish)
Vitamin C, the the Oral Contraceptive Pill causes the levels to drop by up to 30%. Vit c is also necessary for the production of the sex hormones. Since this is something the body will need to start to do after the pill, a deficiency will make it harder for the body to resume normal hormone production. Vitamin C is reduced in many tissues, causing bleeding gums, muscle weakness, fatigue. Caution high dose vitamin C may effect low dose pill especially over 1500mg or to bowel tolerance
Bioflavonoids are decreased by the Oral Contraceptive Pill
Vitamin E need is increased while taking the pill as it helps normalise oestrogen levels
Vitamin K higher levels occur with the Oral Contraceptive Pill use which may lead to blood clot formation
Vitamin A is actually raised on the pill inadvisable to take supplements of A or cod liver oil, try beta carotene instead.
Magnesium and potassium, deficiencies common on the pill and may be associated with fertile mucus production
Selenium is reduced by the Oral Contraceptive Pill
Copper absorption is increased increasing the need for Vitamin C and disrupting the zinc balance
Zinc levels are significantly lowered by the pill
prostaglandins, certain ones are lowered by the pill
Blood lipids - low density lipids, cholesterol and triglycerides are increased during pill use, increasing the risk of heart disease.
Iron, less may be lost due to lighter periods
Calcium absorption may be improved
Recommended supplements: B6 plus B complex, Zinc, EPO plus EPA especially in breast tenderness and bloating.
Herb and Oral Contraceptive Pill interactions
Hypericum even after short duration of treatment (3 weeks to 3 months) affects cytochrome P450 enzyme increasing the metabolism of the pill so may cause break through bleeding, which indicates poor contraceptive cover.
Do not use vitex while on the the Oral Contraceptive Pill as it encourages development of the corpus luteum and increases progesterone
Also applies for other hormonally active herbs such as False unicorn, true unicron, paeonia, licorice, (rubus is OK)
St marys in high dose may interact with low dose the Oral Contraceptive Pill by increasing liver metabolism of hormones, decreasing circulating oestrogen. Also interacts in the same way with other narrow therapeutic index drugs such as warfarin, SSRIs, digitalis etc
Drug interactions with the Oral Contraceptive Pill
Anti epilespy drugs increase need for higher dose pill
Antibiotics, if cause diarrhoea increasing clearance of oestrogen
Antifungals such as griseofulm
Thyroxine may require higher dose pill
Coming off the Pill
3 to 6 months are needed to eliminate artificial hormones from the body. The process is sped up with treatment of the liver, nutritional supplementation and zinc.
Try a Cleansing diet for 1 to 3 months (fruit, veg, no coffee, no alcohol, low protein or at least a healthy diet)
If no menses after 2 months try an internal herbal treatment.
If you have come off the pill due to side effects or are wanting to start trying for a baby it is highly recommended that you see a professional to help eliminate the pill and rectify the nutritional deficiencies it creates. It is very likely that you will need to support the ovaries to produce hormones and have a healthy cycle due the the way the pill works (suppressing ovarian function). Natural Fertility Management is a great way to learn about your fertile signs for both conception and natural contraception
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