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Hormonal contraceptives are used to prevent pregnancy. When taken correctly, they are a highly effective form of birth control and have given women the opportunity to manage their family planning in a way they never could before.

However, in today’s world, hormonally-driven contraceptives, such as the oral contraceptive pill, are used to ‘treat’ a myriad of female health concerns, from irregular or heavy periods, to acne and premenstrual syndrome (PMS). The question is how effective are they and should we be happy with a solution that merely masks the symptoms, rather than solving the underlying problem? 

What are some of the conditions the pill is regularly prescribed for?

• Endometriosis. Endometriosis occurs when the tissue that normally forms the lining of the uterus (the endometrium) grows elsewhere in the body. The two main symptoms of endometriosis are pain and infertility. Whilst the pill is never going to help resolve any difficulties women may be having conceiving; it does have widespread use in managing the pain associated with the condition. In this case, the pill works by reducing the growth of endometrial tissue both within and outside the uterus, which usually results in less pain. 
• Polycystic Ovary Syndrome (PCOS). PCOS is one of the most common conditions affecting women of reproductive age. It can prove challenging to both diagnose and treat as it usually presents as a set of symptoms that can vary woman to woman, and even month to month in the same woman. The three defining features of the condition are anovulation, signs of androgen excess (hyperandrogenism) and polycystic ovaries; and two of these three need to be present for a diagnosis to be made. The pill is frequently prescribed to women struggling with the symptoms of PCOS:
  • Anovulation/irregular periods. The pill is often claimed to regulate abnormal menstrual cycles. However, the menstrual cycle is not actually being regulated because the monthly bleeds experienced are pill withdrawal bleeds, not normal menstruation, so regular, cyclical ovulation is still not occurring.
  • Acne/hirsutism/alopecia (hyperandrogenism). The pill reduces the levels of androgens produced by the ovaries, which subsequently alleviates the physical signs of an androgen excess.
• Fibroids. Fibroids are non-cancerous growths that can cause heavy periods and cramping. 
  • Menorrhagia (heavy periods). The synthetic version of the hormone progesterone, progestin, which is in the pill, thins the lining of the uterus, resulting in lighter periods. Menstrual fluid volume is also reduced.
  • Dysmenorrhoea (period pain). The pill prevents ovulation, which normally triggers the release of prostaglandins. Prostaglandins cause the uterus to contract during menstruation, causing cramps and discomfort. Without prostaglandins, period pain is significantly reduced.
• PMS. Using the pill prevents ovulation and inhibits the normal menstrual cycle. Although it might appear you are still having a monthly period, this is not the case and without the normal hormonal fluctuations seen during a typical cycle, the unwanted symptoms of PMS and PMDD can be significantly reduced.

What are the advantages to using hormonal contraceptives?

For those women not looking to conceive, taking hormonal contraceptives can bring welcome relief from otherwise relentless pain and discomfort. Heavy and/or chronically irregular periods are more than just an inconvenience; they can impede day-to-day life, impact mental health and even increase your risk of suffering from other medical complications, such as anaemia.

Preventing ovulation also reduces the risk of experiencing pelvic inflammatory disease and ovarian cysts, which can be serious if they rupture.

Women with unmanaged PCOS are at increased risk of developing endometrial cancer due to unopposed exposure of the uterus to oestrogen. The pill can lower this risk. 

What are the problems with using hormonal contraceptives to treat female-related healthcare issues?

The major problem with the pill having such widespread use in modern gynaecological medicine is that it does not rectify any of the underlying healthcare issues. It is a relatively ‘quick fix’ option that can give the illusion of symptom alleviation; when all it really does is mask the consequences of a condition. In all likelihood, once you stop taking the pill, your symptoms will return, in some cases more pronounced than before.

Taking the pill for pain management, or to control the signs of androgen excess, is one thing and in these cases, perhaps it can provide some relief. However, for those women who are seeking help to manage their irregular cycles, perhaps with a view to improving fertility; hormonal contraceptives are not the optimal solution. The components of the pill are synthetic; artificial versions of the hormones they are attempting to replicate. Whilst it would be amazing if the pill contained some sort of stimulating agent that coaxed the body’s own endogenous hormones into behaving as they should; this simply does not happen. Menstrual cycles that appear regular with pill use are artificial and will not be maintained once treatment is ceased.

What is the alternative?  

One alternative to symptom management is attempting to understand the root cause of your issue. Obesity and PCOS are closely associated and lowering BMI has been shown to improve the symptoms of PCOS. In fact, many women will find that making simple lifestyle adjustments, such as losing weight, can help to restore fertility. 

A number of the conditions described above are exacerbated by high levels of endogenous oestrogen; for example, high oestrogen contributes to the heavy periods and pelvic pain experienced by women with endometriosis and can trigger the growth of fibroids. By preventing ovulation, the pill reduces oestrogen production, but there are other more natural methods of reducing oestrogen. Lowering body fat by exercising more, and limiting caffeine and alcohol intake can all help. Smoking can make period pain worse, so giving this up can also help significantly.  

A number of women rely on complementary medicine to manage their gynaecological health issues. Unfortunately, in most cases the data is limited on the effectiveness of such approaches. Melatonin might have some use in rectifying disrupted sleep; but other supplements, including fish oil, vitamins B1 and E, zinc sulphate, fenugreek and ginger have had negligible benefits in scientific studies.  

To conclude, the pill is an option for managing a number of gynaecological health issues. However, you should be wary about relying on it long-term and it might be worth speaking to your doctor about alternative solutions.

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Sources:

• “Noncontraceptive Benefits of Birth Control Pills.” ReproductiveFacts.org, American Society for Reproductive Medicine, www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/documents/fact-sheets-and-info-booklets/noncontraceptive-benefits-of-birth-control-pills/.
• Pattanittum, Porjai, et al. “Dietary Supplements for Dysmenorrhoea.” Cochrane Database of Systematic Reviews, vol. 3, no. 3, 22 Mar. 2016, doi:10.1002/14651858.cd002124.pub2.
• Sachedin, Aalia, and Nicole Todd. “Dysmenorrhea, Endometriosis and Chronic Pelvic Pain in Adolescents.” Journal of Clinical Research in Pediatric Endocrinology, vol. 12, no. 1, 6 Feb. 2020, pp. 7–17., doi:10.4274/jcrpe.galenos.2019.2019.s0217.
• “What Birth Control Method Is Right for You?” Womenshealth.gov, 14 Feb. 2019, www.womenshealth.gov/a-z-topics/birth-control-methods.
• “Which Birth Control Pills Can Help Reduce Acne?” Institute for Quality and Efficiency in Health Care: Germany, by Mona Nasser and Peter Sawicki, www.ncbi.nlm.nih.gov/books/NBK279209/.