The Case:
- Jenny went on the pill as a teenager to regulate her irregular and heavy periods.
- After 20 years on the pill, she decided to start a family.
- Going off the pill led to fatigue, insomnia, hair loss, acne, and when her periods returned after 3 months, they were painful, heavy and irregular.
- Her symptoms led her to suspect hypothyroidism but her levels came back normal.
The Investigation
The first thing I did when I started working with Jenny was to run a full thyroid panel. While her TSH was normal, as her doctor had said, her free hormones were off. I knew that there had to be a connection between Jenny’s long history with birth control pills, her menstrual issues, and her thyroid but was the thyroid causing the issue or did the pill create a thyroid problem?
To discuss this further, I reached out to Emily Sadri. She’s a board-certified women’s health nurse practitioner and midwife who runs a functional medicine practice for women in Cleveland, Ohio. She specializes in abnormal bleeding, perimenopause, menopause, and fertility so I knew she would be a great resource for this episode.
How the Birth Control Pill Became So Popular
Most people are familiar with the birth control pill and yet, most of the time this medication is prescribed it is not specifically for family planning as it was designed. Instead, women often turn to the birth control pill to help them deal with other issues. For example, it is common for young women to turn to the birth control pill to lessen heavy and/or painful periods. They may also start taking the pill to help them deal with acne or irregular bleeding. This will often happen soon after a woman starts her menses.
Emily says this is a bit of an issue because a woman’s cycle takes time to find it’s rhythm and if a medication is used to regulate that early on, it may never find its own rhythm because the feedback loop between all of the hormones is interrupted.
How Menstruation Works
To fully understand why this is an issue, we needed to go back for an anatomy lesson and reconsider what is going on in a girl’s body as she starts to cycle. The average age of onset of menses is around 11 years old. Prior to that, the young woman’s pituitary gland and hypothalamus (in the brain) start to send out little signals to her ovaries. This feedback look is called HPO access or hypothalamic pituitary ovarian access. It’s like the feedback loop. So, the hypothalamus talks to the anterior pituitary. The pituitary gland sends out hormones to stimulate the ovaries and release estrogen. That estrogen is released in little bursts over the years leading up to a young girl’s first cycle and may still be firing irregularly during the first year or so of menstruation.
The estrogen builds up in the uterine lining which starts to thicken the endometrium (lining of the uterus). The hormones from the anterior pituitary stimulate the release of a follicle (aka an egg) from the ovary. That first follicle is released prior to the first bleed. The follicle has a lining around it called the corpus luteum which releases progesterone. The progesterone stabilizes that thickened endometrium. When that egg is not fertilized, the body picks up on that and then the endometrium sheds and that is when you get a menses. All of these hormones have to rise and fall in the cycle and find their rhythm in those first few years of menses.
And remember, often at this time in a woman’s life, she is dealing with other things that can impact the release of these hormones including stress and/or not getting enough sleep.
How the Birth Control Pill Works
The birth control pill interrupts the natural feedback loop by introducing hormones that weren’t called for or stimulated by the system. The pituitary hormones, the hypothalamus calibrating hormones, that normally communicate with the ovaries, sense the circulating estrogen and progesterone so there’s no stimulation required. This quiets the whole system and the body either stops producing or produces very little of its own estrogen and the endometrium doesn’t build up as much as it might without the pill. In a traditional birth control pill, there would be 3 weeks of active pills and a week of sugar pills. The absence of the hormones causes a withdrawal bleed. This is different from actually menstruating. This is one of the biggest myths about being on the pill – it does not regulate your period; it eliminates it and triggers a monthly withdrawal bleed. So, any of the problems that existed before going on the pill haven’t been fixed by going on the pill, only paused. Often, women will discover that the pill has only masked the problem.
The Menstrual Cycle is Not Steady
It’s also important to note that certain birth control pills deliver consistent levels of hormones each day. This is not how the body naturally produces hormones. Progesterone and estrogen ebb and flow throughout the natural cycle.
These natural ups and downs are responsible for creating variety in our mood and feelings. Hormones around ovulation can provide feelings of passion or happiness. It may also be a time of creativity and productivity. Whereas later in the cycle, you might be feeling more introspective. Understanding the natural cycles can be a gift, says Emily.
Having a steady state of hormones that do not fluctuate as they naturally should can actually lead to even more mood swings and even things like depression, and a lower libido.
Birth Control Pills, Hypothyroidism and Autoimmune Diseases
While Emily believes that women should embrace the ups and downs of their natural cycle, she does note that these hormone fluctuations can be problematic for those with autoimmune disease. And while fluctuations can cause flare ups, she still feels that it’s important to dig deeper because these responses or flare ups could be a clue to what’s really causing the issue.
When it comes to the effects the pill might have on hypothyroidism, lab tests may show lower circulating free hormones (even if TSH is fine). This is what we saw with Jenny.
Progestin-Only Birth Control Pills
The progestin-only pill is popular for women postpartum for a few reasons. The first is that they already have such high circulating levels of estrogen. The second is that estrogen dramatically increases a woman’s risk for blood clots.
This option is also preferred by those who are at higher risk of complications.
Progestin-only birth control pills work differently than the more common estrogen/progesterone. It doesn’t always fully suppress ovulation however, it really suppresses the development of the uterine lining. So over the course of your cycle, your estrogen develops the endometrium and makes it thick and rich (perfect for an egg to implant). Because this birth control pill limits the development of the endometrium, it is not sufficient for an egg to implant.
Possible side effects include irregular spotting, depression, mood swings, and mood abnormalities.
Long Term Birth Control Usage
Women who are on the pill from an early age to their mid thirties (when things naturally start to change) can develop issues that are hard to diagnose because they never developed a natural HPO access. As women age, they experience hormonal shifts that, when combined with continued use of birth control pills can lead to a variety of issues. These include:
- Headaches
- Migraines with aura
- Thromboembolism
- Spotting
- Sore Breasts
- Constipation
- Digestive Changes (bloating)
- Yeast Infections
- Leaky Gut
- Nutritional Deficiencies (specifically vitamins C, E, B2, B6, B12, and folic acid)
- Metabolic Issues (and weight gain)
- Low Libido
These can be exacerbated by poor diet, poor gut function, slow transit times in their colon, as well as the potential for estrogen dominance.
Preventing Hormone Imbalances
Any conversation about balancing hormones or starting on birth control pills, according to Emily, should also address nutrition. Estrogen recirculation and excretion of hormones requires good digestion and healthy gut function. This means eating vegetables and getting sufficient fiber to ensure healthy intestinal motility.
Stress management is also important in avoiding hormone imbalance. Stress has become quite normalized for young women and it can lead to serious hormone imbalances. Ongoing stress can elevate levels of cortisol which decreases progesterone, which throws off estrogen levels.
Estrogen dominance is another issue to watch out for. This can be driven by the gut recirculating excess estrogen, exposure to environmental toxins, among other things.
Supplements for Hormone Balancing
For estrogen dominance, Emily is a fan of Vitex which is an herb that helps balance hormone secretion. She suggests 1000 milligrams daily in the morning as a way to boost progesterone and decrease excess estrogen.
Vitamin E used during the last 7 days of the menstrual cycle and the first 4-7 days of the menses. Vitamin E may help to decrease pain as well as dysmenorrhea. Essentially, you want to use vitamin E for the 10 most symptomatic days of the cycle. Emily recommends taking 1000 milligrams per day in divided doses.
Next Steps in Solving Jenny’s Mystery
The first step in helping Jenny with her issues was to work on her diet and lifestyle to support reducing inflammation and stress (which as we heard, is so critical for hormone balancing).
We then did a DUTCH test (a urine test for hormones) which revealed that Jenny was experiencing estrogen dominance due to poor detoxification of estrogen.
Her thyroid labs revealed low free hormones as well as a low T3 uptake showing us that she was binding up too much of her thyroid hormones. This is very common with birth control use and I see it all the time.
These were key clues in solving her mystery since her symptoms. The high estrogen was causing the heavy, irregular periods. This was also causing binding which resulted in low free T3 and free T4, even though her TSH is totally fine. The impact to the thyroid likely contributed to the fatigue, sleep issues, and overall feeling off. This is actually one of the common thyroid types that I teach about in my upcoming Thyroid Mystery Solved course (scheduled for release in January 2022).
With the mystery solved, it was time to get Jenny feeling better. She took Calcium D-Glucarate and DIM Evail to facilitate the estrogen detoxification. We also supported her gut health (making sure she was eliminating well and getting rid of the bad bugs). For this she took enzymes, Microgone, GI Microb, probiotics, and R’s Koso (a probiotic drink). We supported her liver with N-Acetyl Cysteine (NAC), and LV-GB Complete.
Happy Ending
After 4 months her periods normalized, her energy and sleep improved, and her skin started to clear up. And, she got pregnant within 6 months!
Eliminating Health Mysteries
This discussion with Emily reminds us that taking the pill to deal with symptoms doesn’t typically fix whatever issue caused those symptoms. It merely masks it while you are on the pill – something that is not explained to many young women looking for instant solutions to their menstrual issues. As with Jenny, those symptoms can come back as soon as you go off the pill. In this case, we were able to get to that root cause of her health mystery and help her not only regain her health but conceive as well. Could prolonged use of the birth control pill be the missing clue for you or someone in your life?
Links:
Thanks to my guest Emily Sadri. You can connect with her on Instagram or check out her website (and grab that free guide on balancing your hormones naturally).
Suggested Products
R’s Koso Japanese Fermented Drink (Save 10% by using INNA10 at checkout) Calcium D-Glucarate DIM Evail Enzymes GI Microb Probiotics N-Acetyl Cysteine (NAC) LV-GB Complete.Related Podcast Episodes:
Why You Don’t Want to Ignore Symptoms of a Hyperactive Thyroid [Ask Inna] Answers to Your Questions about Hypothyroidism and Hashimoto’s The Case of the Missing Periods w/ Nutritionist, Aynsley KirshenbaumThanks for Listening
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