More than 11 million American women are using the birth control pill. (1)
Could a seemingly harmless pill be at the root cause of your fatigue?
Think back to when you got your prescription for the birth control pill…
Did your doctor mention the potential side-effects?
What about the long-term effects?
I’d bet she glossed over the adverse effects and gave you a prescription. All in less than five minutes!
I’m not advocating to avoid the pill, I’m advocating for an educated and informed use of the pill. This is what is missing. For all the benefits the birth control pill has, it has adverse effects. It’s this perspective that is never mentioned.
Today, I’ll show you the research supporting the downsides to the birth control pill. Fatigue being one of many potential side effects. By the end of this post, you’ll be able to make an educated and informed choice on whether or not the pill is right for you.
Let’s get going!
The smorgasbord of contraception
You live in amazing times. Available to you, at very low cost, is a plethora of birth control options. This post will not focus on the many choices you have. Instead, today’s post will focus specifically on hormonal contraception.
Under the umbrella of hormonal contraception you have the following options:
- Oral pills
- Implants under the skin
Injections, implants, patches, and IUDs do not have a long history of research like the birth control pill does. Therefore, I will focus on the most solid research – that is the studies done on the pill. My reporting may or may not apply to the other forms of hormonal contraception. At the time of this writing, there are not long-term studies to support either point of view.
Everything your doctor didn’t tell you about the pill
You know the pill works. You know that it works by altering your hormones. You know that the hormones it alters has to do with estrogen and progesterone.
Are we at the edge of your knowledge now?
That’s everything your doctor tells you. In her defence, a 5-10 minute appointment doesn’t leave time for much else. Let’s get to learning about the pill. The birth control pill works via one of two different ways:
- Combined methods – using both estrogen and progestin
- This is the most popular form of oral contraception.
- These are the pills you take for 21 days followed by 7 days of a placebo pill.
- These pills work by suppressing ovulation. (2)
- Progestogen only methods
- These pills are taken everyday. There are no placebos or breaks.
- These pills work by thickening cervical mucus. This inhibits sperm penetration. In high doses, they can also inhibit ovulation.
There are complicated feedback loops involving many other hormones you’ve probably never heard of. But how these work are not essential to understanding this post. If you really want to get into the weeds, you can learn all about the complex hormone cascade involved in birth control here.
This is just the tip of the iceberg. Everything else you don’t know about birth control pills is lying under the surface. Next, we’ll discuss how the birth control pill affects your stress-response system.
Fight, flight, and the pill
You’re familiar with the fight or flight response, right?
That’s your body’s best weapon against stress. Your body uses something called the hypothalamic-pituitary-adrenal (HPA) axis to regulate it’s stress response. Cortisol – the celebrity stress hormone – it’s regulated via the HPA axis. Your HPA axis is absolutely essential for stress management. Too much cortisol and you feel anxious. Too little cortisol and you’ll be exhausted. Your HPA axis helps to ensure your cortisol levels stay within healthy parameters.
I bet your doctor didn’t tell you that the birth control pill affects your cortisol levels. That’s right, the pill actually raises cortisol levels. (3, 4) Over a period of a month or two, elevations in cortisol aren’t a big deal. But there’s not many women out there taking the birth control pill for one to two months. If your cortisol remains elevated for years – the duration most women are on the pill – then you start running into problems.
You see, cortisol is what is known as a catabolic hormone. Meaning that it breaks stuff down. The area of your body most affected by high cortisol levels is your brain. More specifically, your hippocampus. This is the part of your brain responsible for memory. Too much cortisol for too long of a time and your hippocampus starts to shrink. (5) If you combine the hidden stresses known to contribute to adrenal fatigue with the birth control pill, you’ll be heading towards adrenal fatigue at an alarming rate.
In the early days of birth control, you’ll be more prone to developing anxiety than fatigue. That’s due to the initial elevation of cortisol levels. Over time, your brain will instruct your HPA axis to dramatically decrease cortisol production. This is done in an effort of self-preservation; remember, cortisol shrinks your brain! When your HPA axis goes into self-protection mode, you’ll feel tired. Very tired. This is one way the birth control pill causes fatigue.
Next, we’ll explore how the birth control pill affects your vitamin status.
Did your doctor mention the vitamin deficiencies you’ll experience on the pill?
Probably not. I’ve yet to meet a patient whose doctor recommended she supplement vitamins and minerals while taking birth control. Deficiencies in vitally important vitamins and minerals occur with long-term use of the pill. (6) Here’s a list of the most common vitamin and mineral deficiencies associated with oral contraceptive use:
- Folic acid
- Vitamin B2
- Vitamin B6
- Vitamin B12
- Vitamin C
- Vitamin E
A single deficiency in any of the above vitamins or minerals is associated with fatigue. (7) Stack multiple vitamin and mineral deficiencies on top of each other and you’ve just created a fatigue cocktail.
Remember, nutrient deficiencies don’t occur over night. Which means it’s bloody impossible to connect your birth control pill to your energy levels. For the first few months or years on birth control, your nutrient levels will not be adversely affected. But one day, they will catch up to you. You may wake up wondering why it’s so damn hard to get out of bed.
You’ll think that it can’t be your birth control because you’ve been taking it for years without issue. Not the case. The fatigue brought on by birth control happens slowly. You don’t develop low cortisol and vitamin/mineral status overnight. These conditions often take years to manifest.
Even more adverse reactions to birth control
But wait, there’s more!
Mood disorders are cited as the more common reason for discontinuing use of the birth control pill. New studies are beginning to show a connection between depression and birth control use. (8) Let me qualify that statement by saying that these are new studies and there has not been a causal link established between the birth control pill and depression. But it warrants caution. More compelling research shows that those with a family history of mood disorders are more likely to go on to develop similar mood disorders after taking birth control. (9)
Who doesn’t have a family history of mood disorders?
If you’re feeling low or depressed after starting birth control, don’t rationalize those feelings. Your symptoms could have less to do with your head and more to do with your hormones.
The pill & inflammation
Have you heard of c-reactive protein?
On your lab tests, you’ll see it written as CRP. If your CRP is elevated, your body is dealing with inflammation. And lots of it.
Here’s something your doc didn’t tell you about the birth control pill: women taking oral contraceptives had three times higher levels of C-reactive protein than women not taking the pill. (10, 11, 12) The only conclusion you can draw from these studies is that the birth control pill causes inflammation.
Those dealing with chronic fatigue are always dealing with inflammation. Not necessarily general inflammation as indicated by CRP but definitely some form of inflammation. Also worth noting, generalized inflammation (like that found in elevated CRP levels) is a major risk factor in developing depression. (13)
Why you experience fatigue after stopping birth control
I’m not saying that taking the pill will inevitably lead to fatigue. I’m saying that if you’re fatigued and you’re taking birth control, this is an area worth exploring. This article has shown you multiple pathways that the birth control pill can alter your energy. The birth control pill can cause fatigue by:
- Altering your HPA axis eventually negatively affecting your cortisol levels.
- Causing vitamin and mineral deficiencies.
- Increasing your risk of developing mood disorders.
- Elevating inflammation.
If you do find that the birth control pill is sapping your energy, consider the use of non-hormonal contraception. Copper IUDs, cycle tracking devices like Daysy, and condoms won’t make you tired.
Now, I want to hear from you!
How has the birth control pill affected your energy levels?
What did you do to reclaim your energy?
Leave your answers in the comments section below.