We know that hormonal birth control comes with a whole host of negative side effects, both physical and mental. Dr. Naomi Whittaker, a board-certified Ob/Gyn and surgeon specializing in NaProTechnology and Restorative Reproductive Medicine, tells us, “The birth control pill is designed to shut down the natural hormone release by the body by overriding it with artificial chemicals which mimic, in some ways, natural hormones. This can have some wanted side effects, like a reduction in acne, but can have unwanted side effects too, like increased anxiety in adolescents, decreased libido (which kind of negates the whole point), inflammation, change of the microbiome, increase of vaginal infections and contracting HPV or other STDs, and vaginal dryness or even atrophy (more common with the very low dose kinds). There is also a link to breast cancer for up to five years after discontinuing use. Breast cancer affects 1 in 8 women, and it’s the number one cancer present in women.”
Hormonal birth control also has deleterious effects on the body through nutrient depletion. Dr. Whittaker says, “The pill causes vitamin deficiencies like folate and magnesium, zinc, vitamins D/E/B, and selenium. These are important for egg health, fertility, preventing birth defects, and overall health.”
Another common issue with hormonal birth control use is that doctors prescribe it as a band-aid, one-size-fits-all solution. Dr. Saru Bala, a licensed Naturopathic Doctor with a focus on managing chronic hormonal issues in women, describes how hormonal contraceptives can mask hormonal and reproductive disorders. “For many women, they’re placed on birth control early on at the first sign of hormonal issues,” she tells us. “Period pain? Birth control. Heavy bleeding? Birth control. Irregular period? Birth control. Acne? Birth control. See the pattern?”
She continues, “These symptoms are your body’s way of signaling something is off with your hormones, and it needs to be addressed. Instead of addressing it, birth control masks those symptoms while you’re taking it. So you think the problem is gone, but as soon as you discontinue, it’s back, and sometimes it’s worse than it was previously since you haven’t been addressing the factors that caused it in the first place.”
If we believe hormonal birth control is unhealthy for women (which we do!), then we need to increase education on the benefits of cycling naturally and embracing the built-in balancing act of estrogen and progesterone that is part of being female – for our own health.
Your Cycle’s Two Big Events: Menstruation and Ovulation
To really discuss estrogen and progesterone, we need to back up to where the cycle starts – your period – as well as the main event of your cycle – ovulation. I’m sure I’m not the only one to have wondered why do we even have a period? What’s the point of bleeding every month?
Your cycle starts with menstruation, i.e. your period, in which your body sheds the cells that line the inside of your uterus, called the endometrial lining. The length and flow of your period are indicative of your hormone health. Dr. Bala says, “I like to think of periods as another vital sign. Your blood pressure, your temperature, your heart rate, etc. all give you vital information about your health. Your period is the same.”
A really heavy period could indicate too much estrogen. Spotting leading up to your period could indicate insufficient progesterone. A missing period could indicate a major hormonal imbalance or a thyroid problem or being underweight or under too much stress. As you can see, your period can convey some significant information about the internal state of your body. “Women have this gift of a womb that connects to the outside world to tell us what is going on inside,” says Dr. Whittaker. “I think this is for a reason. Women tend to be in tune with their bodies, and this is a beautiful way for the body to communicate with us that it’s healthy or needs help.”
Our bodies are designed to have a monthly period bleed, and when a woman doesn’t shed her uterine lining regularly, like when she is on birth control and only having a withdrawal bleed, she can develop “endometrial hyperplasia,” which is when the lining of the uterus is really thick. The risk associated with endometrial hyperplasia is that it can lead to the growth of abnormal cells and even cancer.
Biologically, a real period starts a chain of events and hormones that leads to ovulation. Ovulation, in addition to releasing an egg, is also the way the body creates estrogen and progesterone. These two female hormones play a role in more than just the reproductive system. According to Dr. Whittaker, “Receptors for these hormones are found all over the body: your brain, bone, breast, uterus, and ovaries, for example.”
Let’s get into more specifics about estrogen and progesterone, and how they impact female health.
The Benefits of Estrogen
Estrogen is the primary female sex hormone. It’s the hormone that makes women women. When you were a baby growing in your mother’s womb, your developing body was bathed in high levels of estrogen to direct your body to grow as female. You experienced another peak of estrogen in your body during puberty, when you developed secondary female sex characteristics, like getting your period and developing breasts. Estrogen plays a key role in your cycle, telling the ovary to prepare an egg to release (ovulation). But estrogen also does much more.
Dr. Whittaker says, “Both hormones, but especially estrogen, are important for optimal bone strength and prevention of osteoporosis in women.”
Estrogen is “important for maintaining bone formation at the cellular level.” Its effects on osteocytes, osteoclasts, and osteoblasts prevent bone loss and maintain bone formation. During menopause, when women lose their cycle and exposure to estrogen, they experience bone loss, known as osteoporosis. Research indicates that up to 20% of bone loss happens during menopause.
Low estrogen can cause brain fog and memory issues. The American Psychological Association says, “Estrogen increases the concentration of an enzyme needed to synthesize acetylcholine, a brain chemical that's critical for memory. Estrogen also enhances communication between neurons in the hippocampus, an area of the brain that is important for verbal memory.”
Estrogen’s impact on memory was further explored in a November 2021 study that found estrogen plays a role in preventing Alzheimer’s disease. The research suggests that the longer a woman’s brain was exposed to estrogen, the larger her gray matter volume. Estrogen’s “potent anti-inflammatory factor” likely exerts influence on the brain regarding this too.
The connection between estrogen and the heart is still being studied, but it’s known that estrogen promotes healthy cardiovascular tissue and stable blood pressure. High estrogen also lowers bad cholesterol and increases the good kind.
Estrogen is a mood regulator; it “sensitizes the brain to oxytocin” and “boosts the mood-enhancing neurotransmitters serotonin and dopamine.” It also impacts endorphins. Insufficient estrogen can cause depression. And we’ve all felt the mood swings that hit us right before our period comes – they’re caused in part by the low levels of estrogen.
Estrogen also improves insulin sensitivity and supports libido and sleep. Too little estrogen can cause “severe insomnia.” Estrogen and its many roles in the body are still being studied.
The Benefits of Progesterone
Unlike estrogen, which is present in your body continuously until menopause, albeit at varying levels, progesterone is only dominant at a certain phase in your cycle. After ovulation, the follicle in the ovary that grew and then released the egg changes into a temporary organ known as the corpus luteum, which produces progesterone. Ovulation is so important for female health because, as Dr. Bala says, “Without ovulation, you don’t make progesterone.” (Side note: The progestins in hormonal birth control are not progesterone. They’re actually chemically closer to testosterone. Most types of hormonal birth control suppress natural progesterone.)
Dr. Carrie Jones, the head of Medical Education at Rupa Health, describes progesterone as “our calming, soothing, everything is going to be okay hormone.”
Progesterone helps to stabilize your mood, which is why insufficient progesterone can cause PMS symptoms. Dr. Whittaker explains, “Progesterone is very useful in treating anxiety related to PMS/ PMDD and postpartum depression. It crosses the blood brain barrier and attaches to GABA receptors to cause this calming effect (these are the same receptors affected by alcohol and anti-anxiety medications).”
Hair and Skin Health
Dr. Bala says, “Progesterone nourishes your hair and skin. Acne can sometimes be traced back to inadequate progesterone levels.” This is because progesterone reduces androgen levels (testosterone is a type of androgen), which results in faster growing hair and less oily skin (which means fewer breakouts). Women produce small amounts of androgens in their ovaries and adrenal glands, and progesterone helps keep those hormones balanced.
According to Dr. Whittaker, “Progesterone has anti-inflammatory properties and offers neuroprotection – in mouse and animal models. It has also been used in the ICU setting. Decreasing progesterone is also associated with increased Alzheimer’s risk.”
One study examines how progesterone, especially during pregnancy when it’s elevated for nine months, can reduce the risk and expression of the auto-immune diseases lupus and rheumatoid arthritis.
Endometrial and Breast Cancer
Breast cancer is the most common cancer in American women – and in women around the world. There are more than 3.8 million women with a history of breast cancer in the U.S. alone. Dr Whittaker explains the connection between progesterone and cancer: “The lining of the uterus goes through a cycle with your female hormones as do breast tissue. Both of these are important. It’s well understood that progesterone helps combat endometrial cancer risk, and it’s likely that natural or bio-identical progesterone is protective against breast cancer too. It’s well known in the medical community that having a term pregnancy (where progesterone surges very high for a long time) by 25 years old is a protective factor for reducing a woman’s risk of breast cancer. The most likely mechanism for this is progesterone.”
I’ve been taking bio-identical progesterone in my luteal phase to raise my insufficient levels, and I can personally attest that progesterone helps you sleep deeply! In addition to reducing pesky anxiety that could keep you awake, like I mentioned above, progesterone also “stimulates sleep centers in the brain.” One study showed that progesterone reduced the amount of time awake, increased REM sleep, and didn’t negatively affect cognitive ability during the day.
Progesterone is essential for getting pregnant and staying pregnant. If your body doesn’t make enough progesterone after ovulation, then the uterine lining (which thins out and matures in response to progesterone) won’t be in a good state to allow for the implantation of the fertilized egg. Progesterone is also the dominant hormone during pregnancy – it tells your body that you’re still pregnant! Dr. Bala tells us, “Progesterone is what’s responsible for maintaining your uterine lining during pregnancy until the placenta takes over (usually around 12 weeks' gestation). When you have inadequate progesterone levels, we often see miscarriages.”
Progesterone also interacts with your thyroid gland. It stimulates your thyroid to boost both your metabolism and your energy levels.
The Balancing Act
Estrogen and progesterone work together as a team to keep your female body healthy. The surge of estrogen before ovulation is what triggers ovulation; ovulation is what allows for the corpus luteum to form and produce progesterone. According to Dr. Lara Briden, naturopathic doctor and bestselling author of Period Repair Manual, “Estrogen also works in every tissue to promote progesterone receptors.” And “progesterone can also promote future ovulation by providing important hormonal feedback to the hypothalamus.”
These two hormones also produce different effects when you exercise. When estrogen is dominant in the first half of your cycle, you have more energy and your body builds more muscle. In the second half of the cycle, when progesterone is dominant, you burn 30% more calories from fat when you exercise.
Even more importantly, estrogen and progesterone balance each other out and mitigate each other’s downsides throughout your whole body. In your uterus, estrogen thickens the lining while progesterone thins it, which is how progesterone causes you to have lighter periods. In your brain, estrogen has stimulating effects while progesterone is calming. In your breasts, estrogen increases cell division (which could be one reason why hormonal birth control increases your risk of breast cancer), while progesterone slows cell division. Together, estrogen and progesterone promote your long-term health.
Dr. Briden says, “Natural ovulatory menstrual cycles are beneficial for health because ovulation is how women make hormones. It’s an elegant system that sometimes results in a baby. Even when ovulation does not result in a baby, it’s still worth doing because regular ovulation delivers the beneficial hormones that the body absolutely expects to have…each and every ovulation is like a monthly deposit into the bank account of long-term health.”
If you want to fully embrace living with your natural cycle, and eat and exercise in ways that support the natural rise and fall of estrogen and progesterone, sign up for the free feminine fitness platform, 28 by Evie. Timed to your unique cycle, each day you login, you will be given hormonal insights, nutrition recommendations, and workout videos designed with your female hormones – and all that entails – in mind.
This article is the final installment in a miniseries on fertility. Read Part 1: The Discouraging Truth About Egg Freezing And IVF Success Rates and Part 2: Forget Freezing Your Eggs, Here’s How To Preserve Your Natural Fertility.
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