I see it in my practice consistently. A female of (insert just about any number) age develops painful cramping, or a very heavy bleed, or a frequent cycle. Perhaps the cycle is fine but they have acne. To the prescribing doctor, using hormones to deal with what seems to be a hormonal issue makes sense, and includes bonus contraceptive action. To me, it seems like a terrible idea, because it’s not always a hormonal issue. It ends up being like putting a piece of duct tape over your car’s “CHECK ENGINE” light.
I want help spreading this message to as many females as I can, because they end up in my office with bigger problems than they started out with – and while I absolutely love my job and love helping people out of health binds, I would prefer to help you and many others minimize the suffering (let’s call it what it is) in the first place.
Let’s be clear right from the start. Each and every one of those symptoms is a sign from your body that something is wrong, and needs re-balancing. And those signs mean different things for different people, so there is no blanket solution. That’s why this article is a multi-point list, and is just the start to untangling things.
And let’s be clear about something else – I do NOT automatically recommend someone stop birth control, and I do NOT think that birth control is inherently bad (nor is any other drug for that matter). I am just asking for a logical and critical look at some of the reasons why they are prescribed, and seeing if another approach could better address the issue.
Reasons why birth control does NOT fix your period problems:
Why was the cycle off in the first place?
If your body is in a state of stress, you are producing cortisol - at the detriment to your other hormones. The body will prioritize cortisol over your sex hormones, and divert resources there, in a biological process called the “Pregnenolone steal.” It functions much like if a town has a water shortage, they prioritize drinking water over lawn watering.
In this case, cholesterol is the building block for your steroid hormones (estrogen, progesterone, testosterone, and cortisol) –which get built through a common pathway up to a point. Then the body will prioritize cortisol over the other hormones, and divert resources there instead of to your sex hormones. So you end up with symptoms of your hormones being out of whack, but adding in more hormones does nothing to address why that happened.
You’ve probably had this play out for you in real life, or to a girlfriend. Something stressful occurs in life and a period is missed, or a few. However, the biggest point I’d like to make here is that you don’t have to feel stressed in order for your body to be pumping out cortisol. I was probably the queen of keeping my cool through med school exams and other trying things, but my body told me otherwise by way of symptoms that just got worse and worse until they couldn’t be ignored anymore. So while I wish I could make your stress go away, but I can help your body deal with it better and help modulate that cortisol response.
Hormone levels mean nothing without context.
The critical hormones for period issues (once we’ve addressed the cortisol issue) are estrogen and progesterone. These hormones exist as a bit of a duet, with levels fluctuating throughout the cycle. However, symptoms that might seem like an excess of estrogen can actually be a deficiency of progesterone, which I call a relative deficiency. The importance of knowing this situation is that I wouldn’t want to treat the patient for excess estrogen, I would rather need to increase progesterone to get the desired outcome.
Symptoms of an estrogen excess pattern, whether relative or true, include: classic PMS symptoms (mood swings, bloating, headaches, food cravings, breast tenderness), heavy periods, brain fog, and yeast infections that occur before your period. You may have this estrogen excess pattern for several reasons:
Xenoestrogens – you’ve probably heard about these by now. They are compounds in your creams, beauty products, plastics, etc that mimic estrogen in the body, and create an excess condition. Get them out of your life. (Stay tuned for a future article.)
Probiotics and poop. Are you going every day? You should be. Estrogen metabolites (as well as a whole lot of other things) get excreted via your stool, and if they’re not excreted in a timely manner they will get reabsorbed by the large intestine (yep). Part of this process requires the right bacteria in the intestines to process estrogen, to break it down when it isn’t being used anymore. We are at the tip of the iceberg with understanding just how much bacteria help the body do critical work – look for more on this topic in the years to come.
Another part of this process requires fiber, both to keep the bowels moving properly and as food for those super bacteria. The recommended daily fiber is around 25gr for a female but most adults only get around 15gr. Go a day reading labels and using a website like myfitnesspal.com to see how much fiber you are getting in a day. Heck do the exact same thing for protein and sugar too- the results may surprise you and you’ll be a bit more informed with what you’re putting in your body every day.
3. Adipose tissue creates estrogen. The more adipose tissue you have, the more extra estrogen is being secreted. This occurs to men as well as women and is the reason why overweight men can develop gynecomastia.
4. Hyperinsulinemia induces estrogen formation. This means that if you’re spiking your blood sugar over the course of the day (eg carbohydrates/sugar for breakfast, sweets for a snack, coffee with sugar, etc), your pancreas secretes more insulin, and you end up with down stream signaling for estrogen synthesis. Hyperinsulinemia is compounded by decreased insulin sensitivity.
You want to get to the bottom of what your pattern is, and it’s sometimes tough to tell a true excess from a relative one by clinical symptoms alone. Since the approach to treatment is completely different, it’s always best to test, not to guess!
While you’re waiting for your test results, untangle whether the above factors are contributing to your hormone imbalances and address them.
Birth control pills can make the original problem worse:
Birth control pills are known to deplete the following vitamins and minerals:
magnesium, zinc, vitamins B6 and B1, and folate.
These are not theoretical depletions, they are well studied and known. All doctors, pharmacists, and naturopathic doctors have access to the same online database that can quickly tell them this information – they just have to look. The question becomes whether they are significant enough depletions to have an effect – and my clinical experience says yes. When I see symptoms improve by repleting these nutrients (without necessarily even addressing the hormone picture), it tells me they are significant. You need to know that the amount of those listed vitamins and minerals are not high enough in any multivitamin I’ve seen. Symptoms only improve when a therapeutic, research-based dose is used for a few cycles. (Read more here about nutrient testing.)
Those very vitamins and minerals are cofactors and building blocks for healthy hormone function. Some of them help attenuate a stress response (cortisol), and some of them are needed to make neurotransmitters like serotonin, dopamine, and adrenaline, which are in charge of serenity, cravings, and upset. In other words, the very things that feel out of whack during the PMS rollercoaster.
So at minimum, when someone is sitting in front of me with concerns of period problems, I want to make sure that all of these factors are being considered whether that person is on birth control or not. A certain amount of tweaking can be done even while on birth control.
I love that my job involves untangling all the factors that go into health and dis-ease, following the biochemical pathways to get answers when things seem less than clear, and being a medical detective. My best allies are lab tests, symptom tracking, and therapeutic doses of nutrients. Most importantly, I love that women start to feel better once we check how the engine is working.