By: Jandra Mueller, DPT, MS, PHRC Encinitas
If you are a female reader of our blog, have experienced painful intercourse, and happened to have come to the Pelvic Health and Rehabilitation Center (PHRC) for treatment, then you are probably familiar with our talk about how systemic birth control like oral contraceptives (OCPs) or “The Pill,” may be the underlying culprit.
The pill is a controversial topic in the world of pelvic pain. Many providers prescribe the pill for many many reasons and rarely state that there can be side effects regarding their sexual health. Of course, many providers will screen for the risk of blood clots as that was a big issue with certain brands and most know of this side effect. But what about your sex drive? Lubrication? Ability to orgasm? You may have wondered about this yourself and your doctor has told you it can’t be the pill. Unfortunately, that may not be the case.
If your health care provider has recommended to go off the pill for any particular reason, or more importantly to go on the pill, you should become educated on all the benefits as well as the risks and make sure this is the right decision for you. I do believe that there are benefits for certain people to use birth control pills – for example, it can reduce very painful periods for some, it can regulate periods, improve acne, help with treatment of PCOS and endometriosis. However, I won’t deny that there are risks, some are told to us, but many are not, and I just don’t think that is fair. Now, it is not the fault of the prescribing doctor, they may honestly not know and they truly want to help you and your symptoms. Despite the good intention, the risks are there, and they are often hidden by lengthy fine print and confusing medical jargon. Allison Behringer, host of Bodies podcast, shares her story about her journey into painful sex, misguided information, and her debacle with the pharmaceutical company. Both Drs. Andrew and Irwin Goldstein make an appearance and share their research into the causes of painful sex with the use birth control. You can listen to her story here.
For those of you reading this blog that have at some point been on the pill or are currently on the pill and have experienced subtle or not so subtle side effects, a delay in return of your period, difficulty with conceiving, irregular or infrequent periods, acne, and cramping, bloating, or dietary issues, you are not alone and this blog hopefully will be quite helpful in how to tackle some of these issues.
Going off the Pill and what is thought of as “Post-Birth Control Syndrome”
While many women experience return to normalcy in just a few months of going off of the pill, others can go for quite a long time with experiencing hormonal imbalances for their body to regulate. In popular media, these symptoms have often been referred to as “post-birth control syndrome.” While this is not a true medical term and you cannot find information in the literature on this “syndrome,” many women having come off the pill can vouch for their symptoms and state that their symptoms are indeed real. 1
I have worked with many women who have been recommended to stop taking their pill by their doctors in order to help treat their pelvic pain, specifically symptoms of vestibulodynia. While some women are happy to be off, this may also create a lot of anxiety around other issues including the return of terrible acne, unwanted pregnancy, and terrifying periods. Other concerns once off the pill also include complaints of irregular periods or periods not coming back at all. Those that have stopped their pill because they want to get pregnant, may find it difficult as well. While many women have no problem transitioning off of the pill these are still very real concerns for many women and they do happen. These occurrences are what some complementary and alternative providers, integrative practitioners, naturopaths, and holistic health providers are now calling “Post-birth control syndrome.” The symptoms are listed below.
Common symptoms of “post-birth control syndrome”
- Irregular or skipped periods
- Heavy periods
- Mood swings
Is this a real syndrome?
When searching reputable databases like pubmed, there is no information at all about “post birth control syndrome.” However, if you do a google search, you will find sites that discuss this and they are usually all non-western medical providers, which are often not under scrutiny of the pharmaceutical companies and taught to recommend treatments only if there is high quality evidence to support their decisions. Now, while it is important to have some guidelines when recommending treatment, we have to remember that there may be bias in studies and we cannot ignore that these symptoms exist even if there is not an abundance of high quality evidence to support these findings. Aviva Romm is a western trained medical doctor (MD) who then went and did training in more integrative and functional medicine and provides a lot of information about women’s health that you do not often find in your standard OBGYN or general practitioners office.
Experiencing these symptoms after coming off the pill is extremely frustrating, especially if they were one of the reasons you went on the pill in the first place. However, there are many practitioners that can treat these issues such as functional medicine doctors, naturopaths, integrative MDs, nutritionists, etc. so that your body can self regulate. This is especially important for our female population that need to come off of the pill because it may be involved in what is causing their symptoms in the first place. It is equally important to be reassured that while they may now have pain-free sex, it is not at the expense of acne, irregular periods, and mood swings. There are treatments out there but it may require lifestyle choices such as diet changes, sleep changes, managing stress and anxiety, correcting nutrient deficiencies, but most of all patience.
What to know if you are currently on the pill….
Below I have listed some of the side effects of vitamin and mineral deficiencies that have been associated with the pill. This is a summary from an article by Palmery et al. called “Oral contraceptives and changes in nutritional requirements.”
Fluid retention – Our sex hormones affect fluid retention by both enabling sodium retention (estrogen), and also blocking sodium retention (progesterone). In combined oral contraceptives, the progestones may be devoid of this and unable to activate the system that allows sodium to not be retained, therefore causing bloating (which may be thought of as weight gain).
Folate deficiency – Folate is a B-vitamin that is important for preventing neural tube defects during pregnancy and has shown to be important for many processes in our bodies, especially DNA methylation (part of the detoxification pathways in our body), and is the nutrient that is often talked about in pregnant women to prevent issues with pregnancy. Studies have shown that women on OCPs do show deficiency but that this typically returns within three months of going off of the pill.
Vitamin B2 (riboflavin) – B2 is considered an essential vitamin that is very important for normal cellular function and energy production that involve carbohydrates, proteins, and fats as well as turning other substances into their active forms so that our bodies can use those nutrients. It is a water soluble vitamin and it is found in most animal and plant tissues. Low B2 status or deficiency has been linked to other common conditions such as nervous system changes, endocrine dysfunction, skin conditions and anemia. Studies dating back to the 70’s have shown this correlation and it has been shown that supplementation has restored the deficiencies.
Vitamin B6 – Another water soluble vitamin that has been shown to act as a coenzyme (helps assist other processes go faster and/or more efficient) in more than 100 reactions in the body, mostly in regards to metabolizing our proteins; it also plays a role in synthesizing neurotransmitters such as serotonin, which plays a role in mood. Many studies have shown the correlation between vitamin B6 deficiency and OCPs. Interestingly, B6 deficiency has been independently associated with increased risk of arterial and venous thromboembolisms; which, partly accounts for the increased risk of blood clots that are associated with the use of OCPs.
Vitamin B12 – another essential nutrient that plays a key role in cellular functioning – especially DNA synthesis. Vitamin B12 does only come from animal sources or supplementation, therefore, it is critical that we obtain this vitamin through our diet. If our DNA synthesis is missing a step, that changes how everything is going to process in our body! This is especially important for cells that turnover very quickly – like our cervix! Vitamin B12 and folate are very interconnected, but studies show that the mechanism for deficiency in women using OCPs is actually different.
Vitamin C – You may think of orange juice or Emergen-C! This is an important vitamin to maintain our immune system but it also has many other roles in the body as well. Deficiencies can result in scurvy, poor wound healing, vasomotor instability and connective tissue disorders. Studies have shown that as long as women who are on OCPs use supplementation, this is not an issue; however, it may be an issue for women that have poor diets, unhealthy habits or a pathology of malabsorption. More recent studies have shown that in women on a low dose of OCPs show increased oxidative stress (which means there is less vitamin C or “anti-oxidants”) to bind the free radicals that are induced by the hormonal therapies in women that were not on a vitamin C supplement and supplementation can improve this which prevents against cardiovascular risks associated with OCPs.
Vitamin E – Vitamin E is an antioxidant and is found in many food sources including fats, oils, nuts, fruits and veggies, grains, and fortified cereals. Some preliminary studies have shown that there is increased clotting in the presence of low vitamin E and that low vitamin E may be associated with some of the cardiovascular risks that are associated with OCPs, but further studies need to be performed.
Zinc – This micronutrient has many roles in the body including DNA processes, reproduction health, gene expression, brain functioning, and learning. Several studies since the late 1960’s have shown that women on OCPs have decreased levels of zinc as compared to women who are not taking OCPs and may be due to either absorption, excretion, or tissue turnover.
Selenium – Selenium is a very important micronutrient that is an antioxidant and it is important for thyroid functioning and all cells that use thyroid hormones. It also plays a role in prevention of cancers and cardiovascular disease. Studies have shown that OCPs reduce the absorption of selenium.
Magnesium – This is my favorite micronutrient and does so many things when you do not have it present. Examples include making your cramps worse, causing that annoying twitching in your eye when you feel tired, and telling your brain that you NEED that chocolate bar. But actually, you really may need that chocolate bar to get that magnesium so that molecule of energy (known as ATP if you remember back to chemistry), can become activated in your body and you can actually stay awake, work out, or read this blog. Actually, over 300 enzymes need magnesium to function properly and all enzymes involved in energy production need it. Foods high in magnesium include dark chocolate, avocados, nuts, seeds, tofu, legumes, whole grains, leafy greens, some fatty fish, and bananas. Magnesium deficiency may cause muscle spasms, cardiovascular disease, anxiety disorders, and migraines.
Take home points:
The birth control pill can cause many issues that are not intended for it to and your health care provider may not share all of this information with you. However, there are things you can do. Like many of the nutrient related deficiency, supplementation has shown to be very beneficial to combat many of these side effects which is great news! Like I mentioned before, some women do need to and many of these issues can be handled with proper diet changes, or supplementation. In addition, finding a pelvic floor PT and doctor that can help you diagnose and treat hormone deficiencies are key. We recommend the “Find a Provider” section from the International Society for the Study of Women’s Sexual Health (ISSWSH) and the America Physical Therapy Association Section on Women’s Health “PT Locator” function. Most importantly, decide what is best for you and seek help from your local community of integrative health professionals, naturopaths, and/or nutritionists to help you figure out what your body may be lacking to help reduce these unwanted side effects like bloating, acne, and mood swings!
Additional comments and reading:
If you are a new reader, or have sought out treatment and are on some form of birth control, you may want to check out our guest blogs from Dr. Andrew Goldstein – “Do oral contraceptives cause vulvodynia?” and Dr. Joshua Gonzalez – “Jagged Little Pill.” If you are a male reading our blog and have noticed changes in your partner regarding hormones or your sex life, you may want to pay attention and inform your other half. Most importantly, if you do suffer from painful sex and/or pelvic pain, read Stephanie’s blog about vulvodynia, vaginismus, and vestibulodynia to become more familiar with evaluation and treatment and get help! If you are unsure what pelvic PT is all about, read Katie Hunter’s blog about what a good Pelvic PT session should be here.
- Romm, A. (2018) The Post Birth Control Pill Hormone Reset. Retrieved from: https://avivaromm.com/post-pill-reset/.
- Palmery M, Saraceno A, Vaiarelli A, Carlomagno G. Oral contraceptives and changes in nutritional requirements. European Review For Medical And Pharmacological Sciences. 2013;17(13):1804-1813.