The Oral Contraceptive Pill - Does it mask 'who we really are?'

I get asked this……. a lot. Like, every week!

“If taking the oral contraceptive pill suppresses my ‘real hormones’ does that in effect means that it suppress the real me?”

I hear phrases such as “I feel like everything is just dull” to “I am constantly moody and my PMS is worse than ever before” and even “I went on the pill to avoid mood swings and while it has helped, my skin has broken out and I get constant headaches as a trade-off”.

What disappoints me the most is how many of us are being told that going on the pill will ‘regulate our periods’.

So, I am going to bust some myths and set a few records straight. You deserve to know how the contraceptive pill works and to ask yourself - am I really who I am while on the pill?

Female Hormonal Physiology 101: How does the pill work?

Estradiol and progesterone are your two ovarian hormones which are produced for the purpose of reproduction, linked to our thyroid function and play a crucial role in metabolism and our moods (Briden, 2018). When taking the oral contraceptive pill (OCP) you are ingesting steroid drugs which contain ethinylestradiol, drosperenone, levenorgestrel and others. They are NOT human hormones, but rather chemical messengers or pseudo-hormones (Briden, 2018).

The most commonly used is levenorgestrel which is incorporated in the Mirena IUD, the morning after pill and the OCP. It is a progestin and similar to the hormone progesterone. It works by thinning the uterine lining and suppresses ovulation. Progesterone (our own physiological hormone) improves cognition and our brain health. Progestin on the other hand has been linked to depression and anxiety (Briden, 2018). Whilst progesterone benefits human hair health and promoting growth, it is the opposite for levonorgestrel, due to its similarity to the male hormone Testosterone, and therefore, hair loss can occur.

How does the pill balance your hormones? Does it preserve your fertility?

In 2 words: It doesn’t. It suppresses the production of your own physiological hormones. It cannot balance what is not being produced. Taking the OCP does not preserve your fertility by saving your ‘eggs’ - in fact, there is a belief that it can delay menopause. Taking the OCP may even bring on menopause earlier (Briden, 2018).

Does the body think it is pregnant? Is that why you don’t ovulate?

No it doesn’t. The pseudo-hormone drugs which are in the OCP are NOT the same as the hormones produced by the body during pregnancy. Synthetic hormones shut down the process of ovulation. They do not have the same effects as the pregnancy hormones hcg, estradiol and progesterone.

The difference between the combined pill and the mini-pill:

The combination OCP contains two synthetic hormones: ethinylestradiol and progestin such as levonorgestrel. Each unique brand of OCP contains the same synthetic hormones, BUT they are branded according to the amount of estrogen and type of progestin (Briden, 2018).

The mini-pill means that this pill contains only one drug not two like the combination pill. The mini pill contains progestin and does NOT primarily work to suppress ovulation but rather, works to thin the uterine lining and impair cervical mucus (fluid) to make it inhospitable for sperm to survive. In some cycles, it can suppress ovulation. It is was thought that because it only contained the one hormone, progestin, less side effects would occur. However, in 1956, the first pill was tested and there were so many reported side effects that they added estrogen to make the pill more tolerable to take! The mini pill is known to cause irregular bleeding patterns - which are not true menstruation bleeds, but rather, anovulatory cycles (no ovulation has occurred) or ‘breakthrough bleeds’ when the body has not been exposed to progesterone (Briden, 2018).

Do we need a period?

Dr Aviva Romm M.D describes female’s menstrual cycles as our ‘sixth vital sign’. The menstrual cycle is the window into health and wellbeing of females and changes in our cycles that occur can alert us to the fact that something is amiss. The OCP has been well researched with many disheartening results being published about the effect it has on our overall health and wellbeing. For example:

• Affects our sexual desire (and possibly even our mate selection!)

• As the pill prevents ovulation it prevents the mid-cycle surge of energy or creative flow that has been found to exist in those with regular, healthy menstrual cycles

• Creates bloating, sore breasts, headaches/migraines, acne breakouts, mood disorders such as depression and anxiety (including panic attacks) and increased PMS

• Hair loss, weight gain and a deficiency in folic acid, vitamins B2, B6, B12, vitamin C and E and the minerals magnesium, selenium and zinc https://pubmed.ncbi.nlm.nih.gov/23852908/

  What if I have been prescribed the pill because I had all the above side-effects in the first place?

  It is likely that taking the OCP will help with the troubling effects of your menstrual cycle, which at times can be debilitating for some. While it may halt or prevent these effects, as soon as you stop taking the OCP, they are likely to still be there and can sometimes even be worse for a few months post-pill. Remember, they do not cure or resolve the underlying issues, they simply stop occurring whilst you are ingesting synthetic hormones.

  What if I choose to use contraception - what are my best options/alternatives?

• IUD: Copper or Mirena IUD. Most find that with a copper IUD they suffer from heavy and or irregular bleeding. The Mirena seems (in majority of people) to be better tolerated, however side effects such as headaches, skin breakouts and mood disorders have been reported and this is due to the progestin levonorgestrel. Learn more here: https://www.familyplanning.org.nz/

• Natural Fertility - Sympto-thermal method. By learning your unique signs of fertility, you can choose to abstain or use a barrier method during your fertile phase. During your non-fertile phase of your cycle, you can enjoy unprotected intercourse without the fear of pregnancy occurring. When taught by an accredited educator, the effectiveness is 98% effective in preventing pregnancy. Learn more here: https://www.naturalfertility.co.nz/home/avoid-pregnancy/information-on-avoiding-pregnancy/

So, essentially you can ask yourself if the OCP can halt the production of hormones, can it also suppress who we actually are? If we suppress our moods and improve our acne - for sure, this is a bonus, but really what else is it suppressing and is this healthy short term? Long term? If our moods are affected and our uptake of vitamins and minerals are not as optimal or absorbed as well due to the OCP - then how REALLY are we feeling? Add in stressful careers, children, a pandemic and it is no wonder we aren’t living with optimal reproductive cycles or have the ability to tune in. Could it be time to find out just who you really are when you are not taking the pill? I invite you to find out for yourself.

Further supportive measures for hormonal health:

• Registered Naturopaths, Homeopaths, Nutritionists, Natural Fertility Educators

• Registered Acupuncturists, Reiki practitioners

• Yoga, mindfulness, breath work

Highly recommended books to read:

Lara Briden - Period Repair Manual - Every Woman’s Guide to Better Periods

Aviva Romm M.D - Hormone Intelligence: The complete guide to calming hormone chaos and restoring your body’s natural blueprint for wellbeing.

Further Resources:

Family Planning NZ: https://www.familyplanning.org.nz/

Natural Fertility NZ: https://www.naturalfertility.co.nz/about/

References

Briden, L. (2018). Period Repair Manual: Every Woman’s Guide To Better Periods. MacMillan.

Romm, A. (2021). Hormone Intelligence: The complete guide to calming hormone chaos and restoring your body’s natural blueprint for well-being. Harper Collins.

BIRTH TRAUMA - Its a Hot Topic & For Good Reason

Trauma is the response to an event which activates the body to enter survival mode. It is subjectively determined.

Trauma envelopes all of our 5 senses and unleashes all emotions - in no typical order or set pattern. It has the ability to hide and approach us without notice. It can be folded into pieces within our nervous system and popped open like a champagne bottle when least expected. And it happens in the birth space.

We are hearing about birth trauma more than ever before, yet we may wonder did it happen to us? Could we possibly say we had/have trauma resulting from our birth experience? Or was it something that just ‘happened’ and now you are expected to glow right on into motherhood? Healthy mother, healthy baby…. right?

I’m speaking from a Childbirth Educator and Birth Doula perspective, and in approx 4 years, I will be able to add RM to my name… but for now, this is a discussion that needs to be had, here and now.

My goal has always been to endorse the power behind natural, physiological birth where possible. Once you are a Childbirth Educator and Doula, you cannot ‘unknow’ what you know about the role of hormones during the labour and birthing phase designed to work in harmony with the process as nature intended. So why are we so afraid of birth? Why does it never go as planned? Why do we even make birth plans? Who do we trust and why?

I want all mothers-to-be to have the right to be informed about EVERYTHING. How your birth can go so straight-forward at home as you wished, OR, how one simple thing made your birth centre birth plan no longer. But lets start with FEAR.

FEAR is ONE fo the biggest reason doulas are called upon. That unwavering support we provide that reminds you that every sensation you are feeling, the intensity and the pressure that envelops you is bringing your baby one step closer to you. That the pain is nothing to be feared - it is pain with a purpose. Understand the birthing process, welcome the feelings. And when you feel you can’t anymore, you probably could, but perhaps now is a good time for pain-relief? But does that mean you failed yourself? Did you give in? Are you weak? Why was this harder than you thought?

There is a fine line between pain and suffering in the birth space and I have seen it too many times to recall. As a doula, I ask is this a tough moment following a super intense surge (contraction) where she is saying enough! Or, is this something we can work through? At what point do you know in your rational mind that you really are at your limit? At what point when you look back at your birth, did it all become traumatic?

Was it that your labour was fast, surges were back to back without a break and you were left in shock? Were you transferred to hospital after a planned home birth because you were so consumed by the pain? Did you require intervention with Syntocin, or an instrumental delivery? Emergency caesarean section? Medical emergency? Were you stead fast in a ‘no epidural’ in your birth plan, but ended up having one? Did it actually work? Or just on the one side? Were you felt cared for, listened to? Did you feel coerced into making a decision? Were your wishes respected? Was your support person supportive or do you think you required more? Did you tear or suffer an injury? See: The 2021 Accident Compensation (Maternal Birth Injury and Other Matters) Amendment Bill, will also include a reversal of changes made by the former National government in 2010. It will be introduced to Parliament later this year with the expectation of being passed by mid-2022.

Trauma is about how YOU felt during and after your experience - and it is relevant. All of it is relevant. Physical and/or emotional. If you feel anxious, tearful, upset, angry, irritable, have flashbacks and insomnia, or all of those intertwined, you could well be suffering from birth trauma and it is crucial that you speak up and seek support.

In July 2015, Carla Sargent published her research on Birth Trauma - available at https://www.healingbirth.co.nz/. Carla writes that “The issue of birth trauma appears to be poorly recognised within New Zealand. Consequently, maternity practitioners, primary postnatal care providers and maternity care consumers are at times unaware of the concept of birth trauma, its subjective nature and its potential implications”.

Reasons for not seeking support or seeking help included to busy caring for a newborn, embarrassed, felt it would be not well received, too scared to complain, did not want to hurt LMCs feelings, still in a state of disbelief, to what’s the point as nothing will get done about it, cost, don’t know who to reach out to (counsellor or psychologist), concerned baby might be taken away if they feel they are of unsound mind. Deeply saddening to know this.

So, if you have or feel you have suffered from birth trauma - I encourage you to PLEASE speak up. Even if you feel it’s irrelevant, it isn’t to me, I’m trained to fully support you through the process. Birth Trauma practitioners will listen without judgement, help you to make sense of what happened and why, explain and support you through a complaints process if you wish to go down this path and more. If we feel that you may need support from a medical professional or a referral is required, we will speak to you openly about this.

The more we speak up and the louder we speak up, the more we will be heard.

Excerpts from Birth Trauma in New Zealand, by Carla Sargent (2015) https://www.healingbirth.co.nz/

Did your partner feel traumatised/helpless/distressed by the birth experience? - 68% said yes, 14% said no and 17% said I don’t know

Despite a large number of partners being negatively impacted by the birth experience, just 6% were offered support for dealing with their trauma and 88% said no support was offered.

Poor pain management and/or other physical trauma was sited as a cause of their birth trauma by 42% of respondants. Pain was unbearable, emergency c-sections, physical trauma resulting in multiple surgeries to ‘fix’ things to an experience triggering past abuse.

- 58% fear falling pregnant again

- 50% had depression

- 49% had difficulty breastfeeding, or were unable to

- 45% mistrust of midwives/doctors/the maternity care system

- 44% Difficulty bonding with baby, at least initially

References:

Birth Trauma (2015) Carla Sargent https://www.healingbirth.co.nz/