The Pill
The birth control pill. Myths and Truths
It always surprises me that so many people use combined hormonal contraception – colloquially known as and referred to in this piece as “the pill” – and have no idea what it actually does to their body to control their cycles and/or to provide contraception. Due to this tremendous drought in information, harmful myths run rampant; some people even think that the pill can cause abortions. I’ll debunk everything now as your friendly neighborhood gyno! Note: this is applicable to combined hormone patches and the combined hormonal contraceptive ring. They all essentially do the same thing with different routes of administration.
Myth #1: The birth control pill causes abortions.
TRUTH: The birth control pill does NOT cause abortions: it just pauses ovulation.
Here’s how: combined oral contraception puts your ovaries into suspended animation. Just like Sleeping Beauty, they are inactive with the potential for “waking up” when the process that keeps them “asleep” stops. When you take a daily pill, you give your body estrogen and progesterone. Your ovaries naturally produce these two hormones, which act as signals to your brain. When in their natural state (not suppressed by pills), your ovaries produce different amounts of hormones daily that are cyclical. They signal your brain to grow eggs in the follicular phase, release a dominant egg in the ovulatory phase, and then prepare for implantation and pregnancy in the luteal phase. When you are taking a monophasic pill (same dose of estrogen and progesterone every day for 21-24 days) or a tricyclic pill (a different dose of estrogen and progesterone each week) you trick your brain into thinking that you are on the same day of your cycle – every day. Without fluctuation of hormone signaling to your brain to produce and/or release an egg, there is no egg. If there is no egg, there can be no pregnancy. In other words, the pill stops ovulation.
Myth #2: The Pill can only be used to prevent pregnancy.
TRUTH: While The Pill can prevent pregnancy, it can also help relieve common medical conditions caused by irregularities in hormone levels. By shutting of the daily fluctuations of hormones, people can relieve many common maladies associated with the changes in estrogen and progesterone during the menstrual cycle. The pill is an excellent tool for someone who has cyclical migraines caused by their periods. If you no longer have fluctuations in your hormones, you essentially stop the initiating factor that causes these symptoms. The pill works well with people who have polycystic ovarian syndrome (PCOS) by regulating the hormones that are dysregulated by hormonal inconsistency. It can also help with people who have Premenstrual Syndrome or Premenstrual Dysphoric Disorder (PMDD) by stopping the elevation in progesterone in the second half of their cycle that leads to the drop in their mood. In regards to heavy bleeding, sometimes the pill has less estrogen and progesterone than what your body actually produces. This can result in lighter periods. Less estrogen causes a thinner lining in the uterus. A thinner lining means that there is less tissue to shed therefore less bleeding.
Myth #3: The Pill will result in infertility.
TRUTH: The pill does not cause infertility. Anyone who has missed one or two pills in their monthly dose pack resulting in an unintended pregnancy will tell you otherwise! The combined oral contraceptive pill is quickly metabolized and out of your system within a few days. This is why someone who misses a pill needs to use a back-up form of contraception if they miss more than two doses in a pack. Our bodies have no memory of the pill ever being there. Like Sleeping Beauty when she wakes up: she picks up life where she left off, having no idea she was even asleep. Oftentimes the ovaries will be slightly overactive after stopping the pill. Like they are making up for lost time, they will “hyper-ovulate” for the first few months after stopping hormones.
Myth #4: You need to be off The Pill for three months before trying to get pregnant.
TRUTH: You do not need to wait any amount of time after stopping the pill to get pregnant. I think this idea may be a hold over passed down generationally from mothers to daughters harkening back to the time when the pill was invented. I surmise that in the time before supersensitive pregnancy tests and ultrasound pregnancy dating that doctors needed to know what a woman’s (AFAB) cycle was for a few months to be able to date a pregnancy based on last menstrual period. Now, the medical world has become so technologically advanced that a pregnancy can be dated accurately in the first trimester with ultrasound. So: if you are thinking about getting pregnant and you are on the pill, don’t stop until you are ready to be a parent. Then, finish out the pack you are on and go for it! You have a high chance of pregnancy in the first three months – don’t waste it tracking your cycle and using condoms. You have a higher chance of scoring a goal when you first “pull the goalie.”
Myth #5: If adolescents are put on the pill for non-contraceptive reasons, it will cause them to become sexually active earlier.
TRUTH: The Pill does not have magical properties that immediately turn horny teenagers into sex fiends. Their bodies are already doing that. The drive to reproduce is strong at a time when sexual maturation happens. Biologically, this is when a body wants to get pregnant because it usually will handle pregnancy better from a physiological standpoint. However, our society says it is not a great idea to start reproducing in our teenage years. It turns out when AFAB teens are on hormonal contraception, they often will delay their sexual debut. The fact that they are thinking about sex, being responsible about it, and that it is a conscious decision may be part of this process. A person’s sexual debut is a complex thing that does not hinge on taking a combined hormonal contraception. If a teenager is contemplating beginning a sexual relationship, wouldn’t it be more helpful to have conversations around safety and avoiding pregnancy than about not having sex at all? (See my blog on talking to children about sex for more info). Furthermore, by suppressing the ovary, testosterone naturally produced by the ovary decreases. This theoretically should decrease sex drive, if we believe that testosterone is a driver of libido.
Myth #6: The longer you are on The Pill the greater your chances of getting cancer.
TRUTH: Cancer and The Pill is a complex assortment of information that is difficulty for even doctors to sort out. The Pill has been shown to increase risk slightly for breast cancer and cervical cancer in numerous studies. This risk seems to decrease over time with discontinuation of the pill. However, it has also been shown to decrease risk for ovarian, uterine, and colon cancer even in high- risk populations (women with genetic mutation that increases their probability of getting breast, colon, uterine and ovarian cancer). This risk reduction is sustained after use of The Pill which has also shown decreased overall cancer risk. Much of this information was obtained from “Oral Contraceptives and Cancer” published by the National Cancer Institute and was updated in 2018.
In conclusion...
Combined hormonal contraception is a powerful tool that gynecologists have in their arsenal to help prevent unintended pregnancies, manage symptoms of PCOS, help with acne, manage moods, or lighten period bleeding. It also can help with peri-menopausal brain fog, mood swings and heavy bleeding. This option is not a “one size fits all,” and there are many types of estrogen and progesterone on the market. Speak to your doctor and see if this could be an option for you – don’t let fear and misinformation lead you away from what could be a solution to your medical concern.
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