Deciding on the right form of contraception that is both effective, and without side effects can be a difficult decision. Depression, anxiety, mood disturbance and other adverse effects of the Pill are well established, but there are other options without resorting to synthetic hormone preparations as Dr Dach outlines here.
Amy, a 21 year old college student came into the office with her mother because of depression, anxiety and severe mood disorder. Her other symptoms included forgetfulness, insomnia, and alternating euphoric and depressive states. Her medical history was unremarkable except for the past two years she had been on birth control pills (OC’s.) Her laboratory studies showed a severely low B12 level and the patient was advised to discontinue OC’s as the most likely cause of her symptoms. Six weeks later, after discontinuing it and taking B12 supplements, Amy reports all symptoms had resolved.
The IUD (Intra-Uterine Device) is actually a better option than the Oral Contraceptive, and Amy was switched over to the Paraguard Copper T IUD, which is a plain IUD containing no hormones. The Paraguard is safer and more effective than OC’s for women of all reproductive ages according to guidelines from the American College of Obstetrics and Gynecology. Amy was now a happy camper, as she no longer had the adverse effects and mood disturbances from “the Pill”, while she still had a safe and effective method of Birth Control in her IUD, the Paraguard Copper T.
What About the Mirena? Amy was advised to avoid the Mirena IUD because of the synthetic hormones impregnated into the Mirena.
Problems Associated With The Pill
The medical literature is full of reports of various nutritional deficiencies caused by oral contraceptives. Dr Brenda Herzberg reported that 25% of her patients stopped the OC’s because of headache, depression and loss of libido and that 74% of patients found the IUD acceptable.
Dr Melitis reported that OC’s are among many drugs that deplete the body of nutrients such as B6, B12 folate and Magnesium, and disturb Tryptophan metabolism which may cause depression. He says: “OCPs have been shown to increase the risk of cardiovascular events as well as breast, cervical, and liver cancer. 5,6 Estrogen/progestin hormones have been shown to deplete many nutrients. Specifically :
1) Vitamin B6 deficiency is believed to be associated with a disruption in tryptophan metabolism.
2) Depletion of riboflavin (vitamin B2), folic acid, cobalamin (vitamin B12), ascorbic acid (vitamin C), and zinc.
3) Decrease by 40 percent of both folic-acid and serum B12 levels with oral contraceptive use.
4) Clinically, lower folic-acid levels appear to correlate with increased prevalence of abnormal smear results.
5) Increase in coagulation, which may lead to an increased risk of thrombosis that occurs with estrogen supplementation.
Summary of Vitamin and Mineral Deficiencies Caused by Oral Contraceptives:
1) Birth control pills cause folic acid depletion with increased risk of cervical dysplasia and vascular thrombosis, Megaloblastic anemia, platelet hyperactivity and stroke: The authors recommend supplementation with folic acid at doses of 400-800 mcg per day, especially in women contemplating stopping the BCP’s to get pregnant. BCP induced Folate deficiency in the mother increases risk of neural tube defect in the embryo.
2) Oral contraceptives cause vitamin B6 depletion and depression, most likely associated with interference in the role that vitamin B6 plays in facilitating the tryptophan to niacinamide pathway. B6 deficiency and disruption of tryptophan may cause depression relieved by supplemental B6 (pyridoxine) tablets. Since pyridoxine in high doses can cause neurotoxicity, the P-5-P version is B6 is recommended.
3) OC’s cause B12 deficiency – supplementation with B12 is recommended.
4) OC’s cause decreased Vitamin C levels- supplementation recommended.
5) It is well established that OC’s increase risk of venous thrombosis and stroke.
Oral contraceptives are to blame for deficiency in B6, and Tryptophan as well as deficiency in folate and B12. These can cause mood disorders of depression, anxiety and even frank psychosis. In addition to affecting the brain, B12 and folate deficiency can cause peripheral neuropathy, and megaloblastic anemia.
For women contemplating going off the Pill and getting pregnant, folate deficiency increases risk of neural tube defect in the embryo, and folate supplementation is advised pre-conception (with 5-Methyl-Tetra- Folate preferably) to avoid birth defects.
The Testosterone Factor
Another disturbing finding is that OC (oral contraceptive) suppression of ovarian production of testosterone which may reduce levels by 50-60 per cent, thus making OC’s useful as a treatment for acne. Serum Binding Glubobulin is increased dramatically by OC’s and these effects on decreased testosterone and loss of libido may continue many years later after discontinuing Pills. The increased thyroid binding globulin can also make thyroid tests inaccurate. ,
Why Are Oral Contraceptives Such a Problem?
The answer is that they contain synthetic, chemically altered hormones that are foreign to the human body. Any slight alteration in a hormone structure creates a “monster” which can wreck havoc on the fine tuned biochemistry of the human body. For an idea of how fine-tuned this is, the difference between estrogen and testosterone is one hydrogen atom added to the chemical ring structure of the molecule. If as small a thing as one atom of hydrogen (the smallest atomic particle) can determine the sex on an individual whether male of female, then imagine the potential damage of the larger chemical alterations in the synthetic birth control pills.
So what is the answer? If we take away birth control pills, what are the remaining birth control options for young women who wish to avoid pregnancy?
As it turns out, a recent ACOG News Release June 20, 2011 answers this question: They say the IUDs, (Intrauterine Device) are “the most effective forms of reversible contraception available and are safe for use by almost all reproductive-age women.” This statement comes Eve Espey, MD, MPH, who helped write a Practice Bulletin by The American College of Obstetricians and Gynecologists (The College). Dr Espy says , “The major advantage is that after insertion, IUD’s work without having to do anything else. There’s no maintenance required.”
Which IUD to Use?
Avoid the Mirena which has implanted synthetic hormones. Instead go with the Paraguard which has a proven track record and has no added synthetic hormones. Features of the Paragard Copper T IUD:
1) Most effective method at preventing pregnancy
2) Most method cost effective when used long term
3) Does not impair fertility after removal
4) Can be used by women of all reproductive ages.
5) No Hormones in this Copper T IUD, and no increase in blood clots or stroke associated with BCP’s
Recent research has also endorsed Intrauterine devices (IUDs) as a potential protector against cervical cancer. This is the conclusion of the broadest epidemiological study to date which was published at The Lancet Oncology.
The results show that women who use IUD halved the risk of developing cervical cancer compared to those that had never used an IUD. These results are contrary to popular belief that IUD could be a risk factor of cervical cancer. Previous studies on possible effects of IUDs use on the development of this cancer have yielded inconsistent results.