How Hormonal Birth Control Impacts Gut Health
Birth control is one of the most widely prescribed pharmaceuticals. In the last couple of decades, its use has been expanded beyond just preventing pregnancy. These days, many menstruating individuals find they're being recommended birth control whether or not they are looking to prevent pregnancy.
Irregular periods? Birth control.
Acne? Birth control.
Cramps or heavy bleeding? Birth control.
I think it's fair to say that most of us intuitively know that birth control is not actually solving any of these issues. However, medical doctors have a medical toolbox that mostly revolves around managing symptoms, not addressing the root cause issue. The main problem with this approach is that the treatment can create its own set of symptoms making the problem bigger while trying to cover it up by reducing symptoms.
This is a huge issue with hormonal birth control in all forms: the pill, patch, ring, shot, implant, and hormonal IUD (not copper).
Despite the fact that the potential side effects known include: blood clots, thyroid issues, mental health issues, and gastrointestinal problems, - these are rarely discussed in the doctor's office.
More frustrating is the fact that when you return to the doctor with digestive issues after starting birth control, they are treated as completely separate issues.
Here are a few ways your hormonal birth control could be affecting your gut health:
1. Birth Control and the Gut Microbiome
Research has shown that birth control does impact the microbiome, but not much is known about the impact of this. Despite the fact that we really don't know what this means for long-term health, doctors are still not discussing this with patients.
When the good-to-bad bacteria ratio becomes imbalanced in your gut, you might experience an increase in gas, bloating, constipation, food intolerances, and even yeast infections. Certain gut bacteria produce an enzyme called beta-glucuronidase which can allow estrogen to re-circulate in the body, rather than being eliminated. These estrogen-metabolizing gut bacteria are referred to as your "estrobolome."
If beta-glucuronidase is elevated and your body becomes "estrogen dominant" you might experience issues such as:
2. Birth Control and Gut Inflammation
Studies have shown that there is a link between hormonal birth control use and inflammatory bowel disease (IBD) like Crohn's. The proposed mechanism for this is the way that hormonal birth control increases inflammation in the gut lining, and increases gut permeability.
Increased gut permeability (sometimes referred to as "Leaky Gut") is a risk factor for autoimmune diseases, which include Crohn's and Colitis. Other autoimmune diseases, like Hashimoto's, are also associated with birth control use.
There is a genetic component to this one, as not everyone will be predisposed to develop autoimmune disease. If you have a history of autoimmune disease in your family or personally, it's like a loaded gun and hormonal birth control can pull the trigger.
If you were diagnosed with IBD after taking hormonal birth control, that's a definite red flag that it's impacting your gut health.
3. Birth Control and Nutrient Deficiencies
Most drugs deplete nutrients. A quick Google search will bring up known depletions for specific drugs, and birth control is no different. The nutrients depleted by hormonal birth control include:
Many of these nutrients are especially important for gut health. Zinc is an important mineral for stomach acid production and for keeping our gastric lining healthy. Selenium is associated with a better diversity of gut microbes. Magnesium can help prevent constipation.
Increasing gut inflammation can also reduce your ability to absorb nutrients from food, so the effect is two-fold here.
4. Birth Control and Digestion
Excess estrogen can have a significant effect on your gallbladder, reducing bile flow. This is bad news because bile is essential for fat digestion and absorption of fat-soluble nutrients like Vitamins A, D, E, and K.
Bile is also anti-microbial, meaning that it reduces bacterial growth. Without sufficient bile, you're more likely to develop SIBO (small intestine bacterial overgrowth) which is responsible for over 80% of IBS cases. I see clients every day who were diagnosed with IBS after using hormonal birth control, and who have a bacterial overgrowth at the root of their IBS. This is a huge issue.
Some birth controls use progestin (synthetic progesterone) only, instead of estrogen. This comes with its own set of issues, as progestin can slow motility. Slow motility can also contribute to SIBO because food is not being swept along for elimination, constipation can be increased. The implant and birth control shot both provide progesterone only and, in my experience, seem to be the worst offenders for wreaking havoc on digestion.
How to Support Your Body on Birth Control
Despite these risks, hormonal birth control is sometimes the best option! It's a good thing that these drugs exist for people who need them. What I hope to see is more education around the impact they can have on overall health and how you can support your body while you are taking them.
Here are a few strategies you can implement to offset the drawbacks of hormonal birth control:
Eat foods that support estrogen detoxification: raw carrots, beets, apples, grapefruit, and raspberries
Take a good quality probiotic (get a list of my favorites here)
Eat a high fibre diet
Take an A.C.E.S + Zn formula and B-Complex
Use anti-inflammatory herbs like turmeric, ginger, and chamomile
Try digestive bitters with your meals to increase bile flow