There is no denying that women’s lives were transformed by the introduction of the birth control pill. For the first time in history, a pill enabled women to decide when and if they wanted to have a child.
As women began to use the pill, we saw higher college enrollment and graduation rates. Women also experienced a rise in wages, which could be attributed to birth control. One study found that the pill was in part responsible for a 10% increase in wages beginning in the 1960s with estimates climbing to 30% by the 1990s.
However, the pill isn’t without side effects, and although it’s been available to women since the 1960s, there is a lot we still don’t know about it. The possible side effects associated with the pill range from relatively minor to downright terrifying, yet women are not often given the full story on what birth control does in their bodies.
Women are not often given the full story on what birth control does in their bodies.
While I believe women should have access to birth control, I also believe women deserve to have all the information they need to make the best decision for themselves. In this article, I’m going to address some of the most common myths about birth control so you can have a better understanding of this medication and what you may be experiencing.
Myth 1: Birth Control Will Fix Your Period and Your Hormones
This might be the most common myth told about the pill. Many women are put on the pill early in their teen years because they are experiencing irregular cycles, a missing period (amenorrhea), painful periods (dysmenorrhea), or periods that are too heavy (menorrhagia). Other women start it for acne, headaches, or symptoms of PMS.
Doctors typically go straight to the pill because, yes, it can induce a monthly bleed and will suppress symptoms. But here’s the thing, birth control works by shutting down your menstrual cycle and stopping your ovaries from producing hormones.
A medication that shuts down your reproductive system isn’t fixing the underlying issues. Rather, it's a tool for symptom management, and what is often left out is why a woman is experiencing those symptoms in the first place.
Birth control works by shutting down your menstrual cycle and stopping your ovaries from producing hormones.
Ask yourself, what happens to my symptoms if I stop birth control? If the answer is they come right back, then you can understand that this medication was suppressing them, not fixing them. There’s no shame in using birth control for symptom management. I mean, who doesn’t want to feel better? But as doctors, we need to acknowledge that this does not correct the underlying imbalance.
Myth 2: It Will Heal Endometriosis
Unusually heavy periods accompanied by debilitating pain (I’m talking nausea-inducing, can’t-get-out-of-bed pain) can be a sign of endometriosis. Many women with endo are offered the pill because their period pain is so bad that it completely hijacks their life. Symptom management is important, especially when those symptoms are keeping you from living life to the fullest.
But birth control is only one tool and doesn’t actually address the root cause of endo. The truth is—we don’t know what causes endometriosis because the research is seriously lacking. What we do know at this point is that it appears to be autoimmune, it has an inflammatory component, and estrogen does play a role in encouraging the growth of lesions.
In my clinical practice, whether a woman is on or off birth control, we address endometriosis by healing the gut, supportive nutrition and lifestyle practices, balancing hormones, and symptom management. Since the majority of your immune system (which is responsible for creating inflammation) lives in your gut, this is a key area that must be addressed.
Since the majority of your immune system (which is responsible for creating inflammation) lives in your gut, this is a key area that must be addressed.
The pill can be effective at reducing the pain caused by endometriosis for some women, as well as the severity of bleeding, but it does not cure endometriosis. It’s also important to know that many women manage their endometriosis without birth control or only use it for a short period of time while they work on supporting their body naturally. I encourage you to talk with your doctor and evaluate what’s the best treatment for you.
Myth 3: You Can Get Pregnant Immediately after Stopping
We all know that woman who came off the pill and got pregnant immediately. It does happen, but for many women, this is not the norm.
While there are no studies showing that hormonal birth control has a long-term impact on fertility, we do know that it can take some time to begin ovulating again after you stop. On average, it can take three to six months for your monthly cycle to resume after stopping birth control. For some women, it can take as long as eighteen months to see their fertile cycles return.
If you were prescribed birth control without any investigation as to what was causing your symptoms, it is possible that you may experience infertility when you stop the pill due to an underlying issue. For example, if you began birth control for acne and irregular periods, then it may very well be due to PCOS. PCOS is associated with infertility because, in this condition, women do not ovulate consistently.
As I share in Beyond the Pill, “research has shown that the rate and duration of pill use for severe menstrual cramps during adolescence are higher in women who are later diagnosed with endometriosis. This is one more condition the pill can be masking! It’s also important to note that adhesions—scar tissue that is common in endometriosis— can be responsible for an estimated 12 percent of female infertility cases.”
The rate and duration of pill use for severe menstrual cramps during adolescence are higher in women who are later diagnosed with endometriosis.
If having a baby is in your future plans, talk with your doctor to ensure you do not have underlying conditions that would make it difficult to get pregnant. I also recommend considering discontinuing the pill with a back-up method of birth control in place at least six months before trying to conceive. For some women, stopping up to two years in advance can be beneficial in ensuring they are successful when they do try.
Myth 4: The Pill Can Help Increase Progesterone
Progesterone is a lovely hormone that helps us feel calm and collected, plus makes PMS almost non-existent and periods a lot easier. It is only made after ovulation by a structure in the ovary called the corpus luteum.
The pill contains no progesterone, yet, you’ll hear many researchers and clinicians state that it does. Instead, it contains progestin, a synthetic form of progesterone that is structurally different and doesn’t offer the same benefits.
The pill contains no progesterone, yet, you’ll hear many researchers and clinicians state that it does.
Progestins have been associated with an increase in depression. In fact, in a 2016 study in JAMA Psychiatry, it was found that women taking the combination pill (estrogen and progestin) were 23% more likely to be prescribed an antidepressant. Women taking progestin-only (mini-pill) were 34% more likely to be prescribed an antidepressant.
Progesterone is beneficial to neurological and breast health. Progestin doesn’t appear to provide the same beneficial effect. A study of 1.8 million women in the New England Journal of Medicine found that progestins are associated with a mild increase risk in breast cancer. If you’re experiencing side effects from taking birth control, consider speaking with your doctor.
Myth 5: You Need To Have a Monthly Period While on the Pill
False. In fact, that’s not even a real period! It is a medication-induced withdrawal bleed, which isn’t the same thing as having a period or menstrual cycle.
In a healthy menstrual cycle, there are fluctuating hormones that lead to favorable shifts in our mood, metabolism, creativity, and productivity. Ovulation occurs, which provides us with progesterone that helps nourish our brain, bones, and other tissues. While on the pill, ovulation does not occur — at least it shouldn’t.
Much of the focus of the menstrual cycle falls on the period, but there is so much more happening in your body. While on the pill your reproductive system is on hiatus — you’re not building endometrial tissues (lining of the uterus) in the same way, which is why you don’t need to have the monthly withdrawal bleed.
Myth 6: There Are No Issues with Stopping the Pill
There are both bad and pleasant issues that can come with stopping birth control. For example, you may find your long lost libido returns and vaginal yeast infections clear. Or you might find your period has gone missing, you have new acne popping up, and for the first time in your life you’re experiencing hormonal headaches or migraines.
You may find your long lost libido returns and vaginal yeast infections clear.
These not-so-fun issues are part of Post-Birth Control Syndrome (PBCS). PBCS is a collection of symptoms that arise when women stop the pill (or other hormonal birth control). Women may experience the return of symptoms the pill was suppressing or brand new symptoms they’ve never experienced before.
When it comes to birth control, there is no one-size-fits-all. In Beyond the Pill, I provide a comprehensive guide to understanding how to balance your hormones without birth control, protect your health while you’re on it, and transition off successfully when you’re ready.