Are oral contraceptives, including the low-dose forms, really safe?
Click here to read,Things Every Woman Should Know About Birth Control.
Click here to read,Things Every Woman Should Know About Birth Control.
Birth Control Pills and Hormone Balancing
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,
non-invasive 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 progestin-only 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
hypothalamic-pituitary-ovarian axis and by a change to the mid-cycle 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 would-be therapeutic benefit of bio-identical 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 that successfully 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.
Resources
*
Speroff, Leon MD and Marc A. Fritz
MD. Clinical Gynecologic Endocrinology and Infertility, 8th edition.
Philadelphia: Lippincott Williams & Wilkins, 2010. Print.
*
Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History,
Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths;
1990.via http://www.ncbi.nlm.nih.gov/books/NBK283/
*
John Lee,
M.D. What your Doctor May Not Tell You About Premenopause. 1999
Received in a newsletter from Labrix.com, [email protected]
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,
non-invasive 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 progestin-only 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
hypothalamic-pituitary-ovarian axis and by a change to the mid-cycle 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 would-be therapeutic benefit of bio-identical 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 that successfully 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.
Resources
*
Speroff, Leon MD and Marc A. Fritz
MD. Clinical Gynecologic Endocrinology and Infertility, 8th edition.
Philadelphia: Lippincott Williams & Wilkins, 2010. Print.
*
Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History,
Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths;
1990.via http://www.ncbi.nlm.nih.gov/books/NBK283/
*
John Lee,
M.D. What your Doctor May Not Tell You About Premenopause. 1999
Received in a newsletter from Labrix.com, [email protected]