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  • Writer's pictureSaniya S

Contraceptives: the good, the bad, and the poorly researched.

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Contraceptives have been instrumental in the push towards gender equality on a macro-scale. Today, 90% of females have used contraceptives in their lifetime to avoid unwanted pregnancies, giving women much greater reproductive freedom. [1] With the various options available, women have the ability to select a method that suits her best. While oral contraceptives are the most popular, there are also physical barrier methods available. [2]

Barrier methods of contraception.

These methods are generally the easiest to use because they are simply a barrier that prevents sperm from fertilizing with an egg. Barrier methods do not impact the menstrual cycle, and unless otherwise indicated, the woman’s hormones. Below are some of the most common barrier methods:

  • Condoms: Male condoms cover the penis, while female condoms are inserted into the vagina. Both prevent sperm from entering the uterus. [2]

  • Spermicide: A substance, such as jelly or cream, that destructs sperm cells. [2]

  • Diaphragm and cervical cap: These tools are cups that cover the cervix and are inserted into the vagina. [2]

  • Contraceptive Sponge: A small sponge, containing spermicide, that covers the cervix. [2]

Hormonal methods of contraception.

These contraceptives work by changing hormone levels within the body, rather than just by providing a physical barrier from sperm. The effect of these pills is to“trick” the body into believing it’s pregnant by increasing progestin levels. This prevents ovulation and also thickens the mucus of the cervix, making it more difficult for sperm and egg to meet. [3]

Some oral contraceptives still result in bleeds, referred to as pill bleeds. These bleeds are not a result of ovulation but instead pharmaceutically induced to assure the patient that the body is doing something natural.

Oral contraceptives.

There are a number of oral contraceptives that can be prescribed, which are selected based on factors such as health history as well as personal preference. Every woman’s hormone levels are different, so it is important to identify and trust your body’s own reaction to the pill.

  • Combination pill: This progestin and estrogen packed pill is not only prescribed for preventing pregnancy, but is also frequently prescribed to address conditions such as acne, excessive hair growth, endometriosis, and polycystic ovary syndrome. Recent research is now questioning whether the pill is actually able to address these issues effectively. The hormones in this pill work to stop the process of ovulation, thin the uterus lining, and thicken cervical mucus.

  • Minipill: This pill consists of the progestin hormone, affecting the cervical mucus and thus inhibiting sperm entry into the uterus. The FDA recently approved a minipill, Opill, as a non prescription birth control pill: the first non prescription oral contraceptive. [4]

  • Morning-After Pill: This pill is an emergency-only pill, which can be taken no later than five days after intercourse. This pill also contains the progestin hormone and prevents ovulation, and implantation of a fertilized egg to the uterus. [5]

Non-oral methods.

Other contraceptive mechanisms that deliver the hormones progestin and estrogen non-orally can be utilized.

  • Vaginal ring: This device releases both hormones into the body when inserted into the vagina, preventing ovulation and implantation. [5]

  • Patch: A patch that can be directly placed on the skin is another way to release the hormones into the bloodstream. The patch may contain a higher concentration of hormone than other contraceptive methods which may result in stronger side-effects. [5]

  • Hormonal IUD: A device that releases progestin when placed in the uterus, preventing ovulation and implantation. [5]

Do hormonal contraceptives address women’s health issues?

In recent years, birth control methods have been used clinically for more than preventing pregnancy. There are several women’s health issues such as migraines, acne, endometriosis, PCOS, which can result in a birth control prescription. This is typically due to the hormonal interference that several contraceptives introduce. [6]

In the case of acne, pills that contain both estrogen and progestin are effective. However, some pills actually contain formulas with acne-inducing strains of progestin, creating the opposite effect. [7] Not all brands of oral contraceptives will work the same way, and some might suit you more or less. Sometimes, contraceptives will mask the symptoms of conditions, such as PCOS, instead of fully curing it, which can actually result in other issues down the line. [8]

Do contraceptives impact fertility?

A frequent concern about using contraceptives is the question of whether or not long-term use can cause infertility. Luckily, while some methods (such as contraceptive shots) may delay returned fertility, contraception does not usually impact long-term fertility.

That being said, as mentioned earlier, the use of contraceptives to address other women’s health problems (such as PCOS) don’t solve the root of these issues and may only mask the symptoms. Failure to address these conditions can result in infertility. Moreover, the use of an IUD is associated with tubal infertility, which is infertility that occurs as a result of damage to the fallopian tubes. [9]

Do contraceptives impact menopausal onset?

The usage of certain oral contraceptives may mask the effects of menopausal symptoms. Menopausal symptoms are caused by a rapid decline of estrogen and progestin in the body. [10] Combination pills deliver estrogen and progesterone into the body making menopausal symptoms, such as irregular periods, less apparent. [11] HRTs are specifically made for menopausal women and are still the recommended therapy. [12]

While some say that menopause onset is unaffected by the use of birth control [11], other research has shown that women who used high-dose birth control pills for a very long time experienced a slightly earlier menopausal onset. (Read more about the impact of an early menopause here.) [13] Using lower dose birth control pills, however, did not seem to affect the timing of menopause significantly. [14]

How can contraceptives impact health?

Other than the common side effects previously discussed, the use of contraceptives may pose greater risks further down the line.

  • The common side effects: Depression, insomnia, mood swings, and vomiting include some of the more alarming side effects of using hormonal contraceptives. [15] These side effects occur due to the change in hormone levels in the body. [16] For example, depression is a side effect of hormonal contraceptives because hormones act as the body's chemical messengers, influencing mood, overall health, and cognitive functions. [17] Women's sex hormones specifically play a significant role in impacting their emotional well-being and mood. [18]

  • Cardiovascular Disease: Research suggests that the ingestion of oral contraceptives, due to their estrogen content, increases risk of cardiovascular disease: venous thromboembolism, myocardial infarction (MI), heart attack [15] and stroke.

  • Neoplastic Disease: Research also strongly suggests that oral contraceptive usage increases the risk of hepatocellular adenoma, a rare liver tumor, which may lead to severe bleeding within the abdomen and death. [9]

  • Other health risks: Some other alarming health risks from the use of hormonal contraceptives include: blood clots, gallbladder disease, and liver cancer. [15] Moreover, the usage of oral contraceptives to ameliorate conditions, such as menstrual pain, may mask the root of the problems and worsen them. For instance, taking oral contraceptives to lessen menstrual pain may delay treatment of endometriosis and amplify the issue. [19].

IUD risks.

The use of an IUD comes with four significant health hazards:

  1. Spontaneous abortion: A natural loss of pregnancy. This may be followed by a septic abortion, a potentially fatal condition.

  2. Puncture of the uterus: This may result in internal bleeding or sepsis [20]

  3. Pelvic inflammatory disease: A common cause of pelvic pain.

  4. Tubal factor infertility: Blockage of the fallopian tubes that results in infertility. [9]

Key Takeaways:

  • Contraception is used to not only prevent pregnancy, but can also be used to manage other health conditions like migraines, irregular periods, acne, endometriosis, and PCOS. Although they are frequently prescribed, they don’t necessarily treat the root cause of these conditions.

  • Barrier methods can be used to prevent pregnancy through the use of a physical barrier to sperm entry, which does not impact the menstrual cycle.

  • Hormonal methods, such as birth control, work by altering hormone levels. They trick your body into believing it is pregnant to stop ovulation. The combination pill contains estrogen and progestin, while the minipill contains only progestin.

  • Combination pills (estrogen and progestin) may mask the symptoms of menopause because they contain hormones that regulate the menstrual cycle. However, the minipill may still cause irregular bleeding and hot flashes during early menopause.

  • Research has suggested that heavy use of birth control may increase your risk of an early menopausal onset.

  • Contraceptives may pose serious risks, such as threats to cardiovascular health, threats to mental health, the masking of other health issues, and can even contribute to mortality.


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