Journal Tag: reproductive medicine

Are Contraceptives Harmful?

Are Contraceptives Harmful?

One source of chemical exposure that particularly affects women are pharmaceutical contraceptives, which while providing important birth control benefits, can also have adverse effects on the body, particularly when we have systems, organs or tissues with suboptimal functioning or diseases or nutrient deficiencies. (4)

In our modern world, we are all exposed to a significant amount of chemicals from food, water, medications and the environments we live in and ongoing research increasingly indicates a link between such exposure and the presence of disease and/or health imbalances. (3) In this blog, I’ll dive into the specifics around contraceptive toxicity and what you can do to help yourself clear it whilst 

What types of contraceptives are there?

The most common contraceptives used by women are combined oral contraceptive pills (COCs), progestin-only contraceptive pills (POPs) and intrauterine devices (IUDs – such as the Mirena). Lots of abbreviations there!

COCs contain various combinations and doses of synthetic oestrogen and progesterone (known as progestins), while POPs are progestin (synthetic progesterone) only medications. Each are available in pill, patch or vaginal ring dosage forms. 

The most common type of synthetic oestrogen used in these medications is a compound called ethinyl estradiol (EE) (others that can be used include chlorotrianisene, dienestrol, diethylstilbestrol, fosfestrol, mestranol or quinestro). 

Progestins (the synthetic version of progesterone) can contain old (norethisterone, levonorgestrel, gestodene) or new forms (drospirenone, dienogest, trimegestone). The two types of IUDs are available are the copper-bearing (Cu-IUD) and hormonal-releasing forms. [1,5-7] 

How are contraceptives processed by your body?

So, you either ingest these contraceptive medications orally or they are present in your body following insertion. What happens to these hormones once they are in your body?

The pharmacokinetics (how they are absorbed, distributed and removed from the body) varies depending on the different types and dosage forms used, with oral medications generally having more significant biological effects compared with topical, vaginal or intrauterine forms. (But not always). [4] 

For the oral dosage forms, once it makes its way down the gastrointestinal tract/gut, EE is absorbed quickly (though the rate of absorption can vary from 20-65% between individuals, from day to day and with long-term use). 

Nerdy fact 1: this can be one of the reasons why one woman will respond differently to these medications to another (the fascinating joys of physiology!) 

Once the contraceptive medicine is absorbed, it undergoes metabolism (conversion) in the liver. This produces a range of oestrogen metabolites (substances that have been converted to a different form) that then either leave the body via the kidneys or bowels, or are altered by bacteria in the large bowel/intestine and reabsorbed and recirculated throughout the body. [4,8] 

Nerdy fact 2: this is one of the reasons why gut health influences hormone levels and activity in the body and therefore menstrual health and fertility). 

So, what about progestins (our synthetic progesterone)? They only go through the step of conversion in the liver (they aren’t reabsorbed and recirculated like oestrogens are). Though (you know what I’m going to say here…) the rate (how quickly or slowly) that progestins are metabolised will be different depending on the type of progestin in the medication used. [8]

How do synthetic contraceptive hormones get processed in your body?

The summary so far:

  • How these synthetic hormones are absorbed and distributed in the body will vary from one woman to the next depending on the type and duration of medication used. 
  • It will also vary because of the wide range of differences between us all in our physiology (which body systems and organs are working well and which ones need some love). This will influence the degree to which such substances can adversely affect our bodies in one way or another. 

Contraceptives and their side effects

The types of adverse impacts associated with such contraceptive medications and devices can include our gut and vaginal microbiomes, liver function, oxidative stress levels, chemical accumulation and nutrient status. [9-16] 

That sounds like a lot, right? Keep in mind we will all respond differently to such medications, so it’s important to consider your own individual response and if a particular contraceptive is right for your body or not. 

It’s all about the bugs….(gut and vaginal microbiome) 

The link between contraceptive medications and the gut microbiome is complex/complicated. 

Certain intestinal bacterial species with a particular enzyme called beta-glucuronidase and beta-glucosidase in the colon (you may have heard of the term ‘estrobolome’ which this is referring to these type of gut bugs) alters the structure of oestrogen in bile. How is this relevant? This will influence the amount of oestrogen that is reabsorbed and recirculated around the body. [17,18] 

Nerdy fact 3: intestinal dysbiosis (an imbalance between beneficial and non-beneficial bacteria in the gut) can mean more oestrogen is recirculated in the body, and in this case, more is not better when it comes to too much oestrogen!

And here’s the thing…both oral COC and IUDs can alter gut microbiota and vaginal microbiome composition and the integrity of our small intestinal lining (which can cause, contribute to or exacerbate dysbiosis). [9-16] This means that contraceptives may indirectly contribute to body toxicity by adversely affecting the capacity of the gut to metabolise and excrete other environmental chemicals we are commonly exposed to (xenobiotics including polycyclic aromatic hydrocarbons, nitrotoluenes, pesticides, polychlorobiphenyls, heavy metals, benzene derivatives, azo dyes, artificial sweeteners). [20] 

Take home message 1: the balance of your bugs matters when it comes to hormone health and fertility. 

Contraceptives and your liver function

Contraceptives can also affect how happy your liver is, which is important because one of the key functions of this important organ is to detoxify a HUGE range of substances from the outside (chemicals from our food, drink, environment and medications, including the hormones from these contraceptives) and inside our bodies to make them safer for removal from the body.

That is, certain contraceptives (and our gut bugs) can affect the activity of our liver enzymes (the good guys that carry out these detoxifying reactions). [21] This can present a problem when the level of our chemical exposure exceeds the ability of these liver enzymes to detoxify them, resulting in higher levels of circulating (unconverted) toxic metabolites, further contributing to an overload of these liver detoxification pathways. [4,8,22] 

Take home message 2: healthy liver function is another key aspect of hormone health and fertility. 

Contraceptives and their impact on nutrient and trace mineral status

Contraceptive medications may also contribute to endogenous toxicity by modifying endogenous nutrient, heavy metal and trace mineral levels, subsequently influencing (nutrient-dependent) hepatic detoxification and cellular antioxidant enzyme activity.

A range of studies have shown that nutrients that can be lower with use of OCPs, IUDs or injectable contraceptives include zinc, selenium, phosphorus, magnesium and vitamin B12 while higher levels of iron, copper and cadmium can also occur. [31,32, 33, 34, 35]

Lower levels of selenium, zinc and magnesium can influence body toxicity as they are required for the synthesis and activity of antioxidant enzymes in the body (including glutathione (magnesium), superoxide dismutase (zinc), glutathione peroxidase and selenoprotein enzymes (selenium). [36] 

The toxic effects of the heavy metal cadmium in the body include by depleting glutathione levels, inhibiting antioxidant enzyme activity and increasing the synthesis of free radicals/oxidative stress [37] Copper, when it’s too high, can contribute to pathological oxidative processes in much of the body, including inactivation of glutathione peroxidase and oxidation of hepatic mitochondrial cells, while excess iron results in the formation free radicals. [33,38,39] When there are excessive levels of oxidative stress in body cells and tissues with use of contraceptives, this can have a detrimental impact on detoxification processes and overall body toxicity and functional capacities.   

Take home message 3: nutrient status and oxidative stress can be adversely affected by contraceptives, particularly if you have used them for an extended period of time. 

What can you do if you think contraceptives are adversely affecting you?

The use of pharmaceutical contraceptives has an important place in the population for birth control and family planning purposes – this blog is not a directive to come off all your contraceptives! 

However, their potential detrimental impact on the body (and your reproductive health and fertility in many cases) is an important consideration. This means it is important to identify if the health issues you are experiencing are associated with your contraceptives and getting individualised support with strategies including functional pathology, dietary modifications, nutrient, herbal and lifestyle changes to address such imbalances. 

Written by Senior Fertility Naturopath & Nutritionist, Georgia Marrion MHNut, BHsci (Comp Med), Adv.Dip HSci (Nat) MNSA, MANPA, MFSA

Make a free 10 minute booking with Georgia to get started on your journey towards better health.

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Congratulations Tina & Gina!

Both Tina Jenkins and Gina Fox recently received their Masters of Reproductive Medicine (with Excellence). Here’s a picture of Tina at the graduation ceremony in NSW. Well done ladies!

Here’s what Tina had to say about getting her Masters degree…

“Obtaining a Masters degree has been a long process for me; 4 years of hard work and study alongside my usual consulting work at Fertile Ground and my weekly student clinic supervision for final year naturopathic students. I have always been more academically minded and furthering my knowledge in the very specialized area of fertility was my main inspiration for embarking on the journey towards my Masters. A Masters in Reproductive Medicine requires a Health Sciences degree as a prerequisite along with clinical experience and the course itself is primarily done by GP’s, obstetricians/gynaecologists, nurses and embryologists. All the subjects are medical subjects (Clinical Reproductive Endocrinology, Laboratory Techniques in the IVF lab etc). There were very few naturopaths studying with me, however I was really fortunate to have my Fertile Ground colleague Gina Fox completing it at the same time. Not only did completing my Masters allow me to continually keep up to date with the latest research in the field of fertility, it also allowed me the privilege of learning from some of the great IVF specialists currently working in Australia. All the subjects were taught by renowned IVF and fertility specialists who were all in clinical practice and who were all continually taking part in cutting edge research  in the area of infertility.

I have no doubt that my patients have benefited significantly as a result of this additional training. Not only do I have a much greater depth of knowledge in regards to the medical approach to fertility issues, but I also have a greater knowledge of the latest medical advances in this area. This has not only helped me to work more collaboratively with patient’s medical professionals and specialists but has also allowed a greater level of understanding of  my patients medical issues and their fertility medications.

On another level, it has also enhanced my teaching knowledge so that the students I supervise in student clinic benefit in turn.

Personally it has also been a significant achievement for me. Balancing looking after a young family alongside work commitments (and still trying to have some downtime!) has been an achievement in itself and one of which I am extremely proud.”