Has the contraceptive pill outlived its usefulness?
In my last blog post I referenced the fact that the combined contraceptive pill has long been used as the solution to most period problems. Is it really a solution though or is it simply masking something deeper going on in the body?
The contraceptive pill was revolutionary when it was first introduced in the 1960s (1). Finally women were getting the reproductive rights they’d fought for and there was better ability to choose when and if you wanted a family. However, 60 years later, perhaps it’s time to take stock and ask the question is the pill still a good solution for most women?
The combined contraceptive pill works by “switching off” ovulation. It does this by suppressing luteinising hormone (LH) and follicular stimulating hormone (FSH). That not only inhibits ovulation but in turn switches off the production of natural oestrogen and progesterone (2).
This raises two questions: does it matter if a woman ovulates or not and does it matter if the oestrogen and progesterone in a woman’s body is natural or synthetic?
My reading of Dr Lara Briden’s book from this month’s book club pick would suggest the answer to both of these questions is yes!
Firstly the importance of ovulating, or at the very least knowing whether a woman is ovulating or not. The problem with prescribing the pill, especially from a young age, is we can mask potential underlying health problems, for example the common condition Polycystic Ovarian Syndrome (PCOS). PCOS usually presents with the symptom of irregular periods (3). and the pill is often prescribed to “regulate periods”. What it doesn’t do is look at the possible underlying causes of PCOS; primarily insulin resistance and give that woman the opportunity to look at dietary and lifestyle options to treat this and hopefully avoid the long term health and fertility consequences.
Secondly, our own natural hormones matter, they are there for a reason and they can be good for our bodies and wellbeing. For example natural progesterone has been shown to be good for mood and sleep, good for hair growth and to have an anti-androgenic effect *. This compares to the synthetic prosterones found in the pill called progestins that can raise your blood pressure, contribute to anxiety and depression and cause a small but significant increase in your breast cancer risk (4).
To summarise, the pill started off as a revolution for women’s reproductive rights but in light of our current knowledge we need to be advocating for better options that allow women to ovulate and have access to their own beneficial natural hormones. For period problems this includes looking at potential underlying issues rather than just treating the symptoms in isolation. For contraception I feel healthcare professionals, GPs like myself included, need to feel more confident in offering natural and effective methods such as sympto-thermal tracking, now more accessible through FDA approved apps such as Natural Cycles (5).
The contraceptive pill will always have a place and this discussion is not to downplay how effective it can be in helping some women, but in 2024 it should no longer be our first line go to and women should be counselled more effectively in their options.
References:
The Crucial Difference Between Progesterone and Progestins (larabriden.com)
Natural Cycles: Natural Birth Control | No Hormones or Side Effects
*This blog post is discussing the difference between endogenous (body produced) progesterone and progestins (sythetic progesterones found in the combined pill). There are body identical progesterones commonly used in hormone replacement therapy but that is different from those used for contraception and beyond the scope of this post.
