The Pill was an important step in our struggle to legalize contraception. I celebrate that, of course. Hormonal birth control can also be medicine for debilitating conditions such as severe endometriosis and very heavy periods. I celebrate that.
What I don’t celebrate is the distorted message that hormonal birth control is the only birth control. What I don’t celebrate is its widespread prescription as ‘hormone balance’ for virtually any hormonal symptom that might arise in women and teenage girls.
Not the only birth control
How did hormonal birth control come to be synonymous with birth control in general? It’s not unusual for me to have a conversation with a patient that goes something like this:
Me: “What do you do for birth control?”
My patient: “I don’t use birth control. I use condoms.”
The message seems to be: “Hormonal birth control or nothing.” Yet the failure rate of condoms (2%) and Fertility Awareness Method (0.6%) are comparable to perfect use of the combined Pill (0.3%). It’s worth noting here that non-perfect-use of the Pill (a missed dose) has a rather worrying failure rate of 9%. Some methods are completely off the radar of most patients, like the non-hormonal copper IUD, which has a very low failure rate of just 0.6%. Many young women have never even heard of IUDs. There is also Daysy contraceptive device.
Hormonal birth control is not effective for hormone balance
To prescribe birth control for ‘hormone balance’ is simply nonsensical. The Pill does not balance hormones. It switches them off.
The Pill switches off hormones because it switches off ovulation, and ovulation is rather important.
Pill steroids are not real hormones
The Pill switches off estradiol and progesterone, and replaces them with the pseudo-hormone drugs ethinylestradiol, levonorgestrel, and drospirenone. They’re only vaguely like hormones. They do not have the same molecular structure as human hormones, and they do not have the same benefits.
What are the differences? Progesterone promotes hair growth. In contrast, its drug-equivalent, levonorgestrel, causes hair loss. Progesterone is beneficial for cardiovascular health, but drospirenone (used in Yasmin) is decidedly bad for cardiovascular health, and increases the risk for fatal blood clots by 700 percent. Progesterone improves brain health and cognition, while drospirenone causes depression. Estradiol improves insulin sensitivity, but ethinylestradiol and levonorgestrel cause insulin resistance. The Pill’s insulin problem makes it a particularly inappropriate treatment for PCOS and acne —two conditions caused by insulin resistance.
⚠️ Tip: Yes,the Pill masks acne. Ethinylestradiol and drospirenone are great at reducing skin oils, but only for as long as you take them. When you stop the Pill, the acne will return — often worse than it was before. Read: How to Prevent and Treat Post-Pill Acne.
As a doctor, what concerns me most about hormonal birth control is not the rare event of a fatal blood clot, but rather the soul-crushingly common side effects of hair loss, depression, and loss of libido. I witness women endure these side effects, but rarely connect them with birth control. Instead, they blame themselves and their own personal inadequacy.
Would men put up with hormonal birth control?
Imagine a world where we routinely switch off the hormones of teenage boys and men.
“We will switch off your testosterone,” we would tell them, “And replace it with a synthetic pseudo-testosterone. It’s going to cause weight gain, depression, and loss of libido—but don’t worry! All the other boys take it.”
This is the world in which we currently live for teenage girls and women. It is time for a serious rethink.
How to come off hormonal birth control
I receive many questions about how to come off the Pill. It’s such a big topic that I wrote an entire book about it: Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. You can also check out my post How to Come Off Hormonal Birth Control.
Yours in health,