When the birth control pill was introduced in 1960, it ushered in an era of rapid social change, enabling women to take charge of their fertility. Today, approximately 16 percent of women of reproductive age take an oral contraceptive not only for preventing pregnancy, but also for alleviating conditions such as PMS and acne. (1)
While, on the surface, the birth control pill seems like a boon to women, it, unfortunately, has some significant side effects, including an increased risk of blood clots and breast cancer. Furthermore, cessation of the birth control pill can incite an array of debilitating symptoms, collectively referred to as “post birth control syndrome.”
Gut problems are among the most common symptoms experienced by women with post birth control syndrome. Recent research supports the experiences of these women, indicating that the pill does indeed affect the gut!
Read on to learn how the birth control pill affects your gut and what you can do to restore your gut health if you’ve been adversely impacted by the pill.
How Do Oral Contraceptives Work?
While countless women take birth control pills, few understand exactly how they work. There are two types of birth control pills (BCP): The combination pill and the progestin-only pill. As the name implies, the combination pill contains a combination of estrogen and progesterone hormones, whereas the progestin-only pill contains only progesterone.
The combination pill prevents pregnancy in several ways. It prevents ovulation by suppressing the production of hypothalamic gonadotropin-releasing hormone and luteinizing hormone in the hypothalamus and pituitary glands of your brain, respectively. Without luteinizing hormone, your ovaries don’t receive the signal to ovulate, so no egg is released.
The progestin-only pill prevents pregnancy in different ways. It makes the endometrium (the lining of the uterus) inhospitable so that an embryo can’t implant. It also thickens cervical mucus and impairs the motility of the Fallopian tubes, making it harder for a sperm to reach an egg and vice versa. (2)
Oral contraceptives are great at preventing pregnancy, but they essentially shut down your body’s natural hormone production mechanisms. While this may be beneficial and desirable for temporarily alleviating symptoms of PMS or acne, disruption of the female body’s natural hormonal milieu is potentially harmful over the long-term.
In fact, the female reproductive hormone disruption caused by the pill may contribute to the negative implications of the BCP for gut health.
Emerging research indicates that the gut microbiota plays a pivotal role in the regulation of estrogen levels in the body. The gut bacteria that modulate endogenous estrogen levels are collectively referred to as the “estrobolome.” (3)
Microbes in the estrobolome regulate the enterohepatic circulation of estrogens by producing an enzyme, beta-glucuronidase, that deconjugates estrogen into its active form. In a healthy, undisturbed gut, bacterial members of the estrobolome produce just the right amount of beta-glucuronidase to maintain an optimal estrogen level, allowing the rest to be excreted from the body.
The synthetic estrogen in oral contraceptives disrupts this delicate balance, ultimately altering the composition of the estrobolome and the health of the gastrointestinal system. (4)
Research indicates that disruption of the estrobolome has serious downstream effects; it is linked to an increased risk of many hormonally-mediated diseases including obesity, cardiovascular disease, osteoporosis, endometriosis, PCOS, and breast, endometrial, cervical, and ovarian cancers. Maintenance of a healthy, well-functioning estrobolome is crucial for your health!
How Do Oral Contraceptives Affect the Gut?
The birth control pill has three significant effects on the gut:
Increases intestinal permeability (aka “leaky gut”).
Alters the gut microbiota.
Induces intestinal inflammation.
Impairs nutrient absorption and increases nutrient requirements.
The Birth Control Pill Promotes Leaky Gut
The epithelial lining of the intestine is composed of a single layer of sequentially-placed cells linked by proteins called "tight junctions." The tight junctions regulate the permeability of the intestinal barrier, typically allowing only beneficial substances such as nutrients and water, to pass through while preventing the passage of gut bacteria, food proteins, and environmental toxins.
When intestinal permeability is increased (a condition referred to in the functional medicine community as “leaky gut”), the tight junctions between intestinal epithelial cells are damaged and thereby allow inappropriate substances to leak from the gut lumen into the systemic circulation.
When the immune system sees these foreign substances in the circulation, it launches an inflammatory response in an attempt to eradicate them. If left untreated, increased intestinal permeability precipitates a chronic inflammatory reaction that may lead to the development of autoimmune diseases, acne, allergies, asthma, and mental health disorders. (5, 6, 7)
Oral estrogen, such as that found in the combination birth control pill, increases intestinal permeability. This phenomenon may explain why long-term use of the birth control pill frequently instigates a slew of health problems, many of which are rooted in chronic inflammation.
The Birth Control Pill Alters the Gut Microbiota
Can birth control cause stomach pain, gas, and bloating? Recent research, as well as the clinical experience of many functional medicine practitioners, suggests it certainly can!
The reason the pill may cause GI symptoms is because it alters the balance of good and bad bacteria in our digestive tracts, and may thereby induce gut dysbiosis.
Oral contraceptives change the composition of the vaginal microbiota, and these effects likely extend to the gut microbiota. (8) Synthetic progesterone, found in the progestin-only pill, has antibacterial effects against H. pylori, a common human gastrointestinal pathogen; it remains to be seen whether these antibacterial effects also affect the beneficial bacteria in our digestive tracts. (9)
Oral contraceptives also increase levels of Candida and Prevotella microorganisms in the oral cavity, which is essentially the very beginning of the GI tract. Candida is an opportunistic yeast that normally resides in the oral, vaginal, and gastrointestinal tracts but can cause yeast infections when there is insufficient beneficial gut flora to keep it in check.
Prevotella bacteria are also ordinary residents of the vaginal and gastrointestinal tracts but can cause periodontitis when present in large quantities in the mouth. (10)
Dysbiosis is a well-established etiological factor in the development of many chronic diseases, so the contribution of the birth control pill to gut microbiota disturbances is concerning.
The Birth Control Pill Causes Gut Inflammation
The medical community has known for years that oral contraceptives increase the risk of inflammatory bowel disorder (IBD), an umbrella term used to describe chronic inflammatory disorders of the gastrointestinal tract, including ulcerative colitis and Crohn’s disease.
Oral contraceptive use is associated with a 24 percent increased risk of Crohn’s disease and a 30 percent higher risk of ulcerative colitis. (11) Inexplicably, this information has remained largely unknown by the public, including the millions of women taking the birth control pill! The observed association between oral contraceptive use and IBD risk is likely mediated by the complex interaction between exogenous and endogenous hormones, the gut microbiome, and immune function. (12)
The Birth Control Pill Increases Nutrient Requirements
The birth control pill has been shown to deplete critical nutrients, including folate, riboflavin, vitamin B6, vitamin B12, vitamin C, vitamin E, magnesium, selenium, and zinc. (13)
The pill induces nutrient deficiencies by reducing nutrient absorption in the gut and by causing the body to burn through vitamins and minerals during the biochemical metabolism of the pill.
Why should you care about birth control pill-induced nutrient depletion? The vitamins and minerals depleted by the pill are essential for maintaining optimal health and reducing the risk of chronic diseases.
Folate deficiency increases the risk of adverse pregnancy outcomes, including an elevated risk of miscarriage and preeclampsia, neural tube defects, cardiovascular malformations, and orofacial clefts. Folate deficiency also increases the risk of cardiovascular disease, cancer, and cognitive impairment. (14)
Riboflavin deficiency increases the risk of cardiovascular disease and cancer. (15)
Vitamin B6 is crucial for maintaining hormonal balance and a healthy heart and brain. (16)
Vitamin B12 deficiency significantly increases the risk of Alzheimer’s disease and other neurodegenerative diseases. Deficiency may also promote cancer, cardiovascular disease, neural tube defects, and depression. (17)
Vitamins C and E are important antioxidants in the body that combat oxidative stress and inflammation.
Magnesium is essential for hormone balance, insulin sensitivity and metabolism, and bone health.
Selenium and zinc are cofactors for antioxidant enzymes and support thyroid health. Zinc is also essential for maintaining the integrity of the intestinal epithelium.
If you’ve been on the pill for years, your nutrient status may be compromised. A comprehensive nutrient assessment, such as the NutrEval, can identify where you may be lacking nutritionally and can direct you as to which foods and supplements you should focus on to replenish your stores.
Heal Your Gut After the Birth Control Pill
If you’ve taken an oral contraceptive for years and have suffered GI consequences or have developed health conditions known to be caused by leaky gut and dysbiosis, you are not alone! Fortunately, there are steps you can take to heal your gut post-birth control pill.
Taking probiotics and eating fermented foods can help reestablish a healthy gut microbiota. Our Megaspore spore-based probiotics help generate 80+ different friendly bacteria in your gut!
Supplementing with nutrients you are lacking in, such as vitamins C and E, magnesium, and zinc, promotes the repair of leaky gut and intestinal inflammation. Our prenatal packs can restore the nutrients that birth control depletes.
Targeted treatment of gut infections, such as small intestinal bacterial overgrowth and parasites, with herbal antimicrobials and other natural substances can further reduce inflammation and restore balance to your GI tract. We offer a Gut Infection Kit that lets you address these issues yourself!
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Oral contraceptives have some seriously concerning effects on the gut that I believe warrant our utmost attention! Your gut truly is the foundation of your health, so minimizing harmful influences, such as the birth control pill, and maximizing the quality of your gut bugs and the resilience of your intestinal barrier are crucial. If you suspect the pill has harmed your gut health, it may be time to consider an alternative with the help of your doctor.
Now I want to hear from you! Have you experienced gut disturbances, such as leaky gut or dysbiosis, as the result of taking an oral contraceptive? What have you done to heal your gut? Let me know in the comments below.
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