Hormonal Birth Control Side Effects: Debunking the Myths (Episode 567)

Full Transcript: Episode 567

Lisa Hendrickson-Jack:

This is the Fertility Friday Podcast, episode number 567. Today I’m sharing another brand new episode in my FAMM Research Series. I found a really interesting paper — at least I think it’s really interesting — and we’re going to get into it today. The title of the paper is called “Common Myths and Misconceptions Surrounding Hormonal Contraception.” This is a brand new paper, it’s dated 2025, and it’s — yeah, I almost feel like it’s written for me. And so I’ll start and I’ll explain why I said that so that it makes sense.

Yeah, there’s a lot that we’re going to get into today with this paper, but suffice it to say if I were to sum up what it is — it’s a paper of essentially the establishment, the medical establishment coming together to address apparently some of the common myths and misconceptions around hormonal birth control. And in many ways I feel like this is a sign that we’ve made some progress in terms of shedding light on some of the most common side effects and highlighting the actual research that is out there about some of the most prevalent issues with birth control. And so this paper is damage control. It’s incredible to read, and we’re going to go through some of the just the responses that they give and talk through what it actually means.

And I think that this really highlights why it’s essential to be able to not only read research but understand that research is written by human beings. It’s written by people, just like books are written by people. And everybody who is writing anything does have a perspective and they’re writing from that perspective. And so though the research does provide us in general — as a general statement, research provides us with an incredible insight into what’s happening when studies are done well and they’re high quality. It really gives us an insight into what actually works, what doesn’t work, and it certainly aids your clinical practice when you’re working with clients to know what actually works instead of everything being anecdotal. But at the same time there are some limitations and some kind of perspective issues that you should be aware of.

And this is something I’ve talked about a lot in this series. So if you’ve listened to several of the FAMM Research Series episodes you may already be familiar with some of these talking points, if you want to call them that. But essentially when you’re reading research, it’s really important to know that you can have a study and the results can be the same. You know, you could have a study where the researchers find X finding, and if you had the paper written by one researcher they may come to a completely different conclusion about what the same facts mean than another researcher. And you’re going to see several examples in today’s study. So without further ado, let’s go ahead and jump right in.

So the title of today’s study is called “Common Myths and Misconceptions Surrounding Hormonal Contraception.” And like I said at the top, it could have been written for me or anybody in the field who is not necessarily a medical professional but who has been exploring some of the research around hormonal contraception and sharing it essentially with women. It could also apply to anybody who has created a platform, has allowed women to share their own experiences with contraception in their own words.

So if I get into just the introduction and essentially where the researcher is starting — so this is a review study, they’re looking over a variety of research and providing a bit of an overview of it. And so they’re not studying per se a specific thing, but they’re reviewing several research papers as we’ll get into. So they start as usual with some general information about contraception, and I already — I’m already irritated at the beginning. But I’ll share just my thought process here. So they start by saying that hormonal contraceptive methods are used by over 150 million worldwide. So they’re talking about how prevalent it is, the different types of contraceptives that are used. And then I mean, if you think about that for a minute — that’s an incredible number of people. Imagine if you owned a pharmaceutical company that created a product that 150 million people were using, and it’s not something that they buy once, it’s something that they use over and over again for many, many years.

So you know, they’re not also saying — so in The Fifth Vital Sign I also share the stats at the time of writing the book. And you know it’s a multi-ridiculous billion dollar industry, you know, a 20 to 30 billion dollar a year type scenario. So they left out the money part, but what they’re getting at is from their perspective, from the establishment perspective, contraception is a miracle. And I feel like they’re still in awe of this miracle. You know, according to them, it’s — according to their talking points — it is a safe and effective reversible contraceptive method that is very effective at preventing pregnancy. And therefore, even though 150 million women estimated worldwide are using it, the big problem for them is — and I’m going to quote this here: “while globally we have seen an increase in the use of contraception, population surveys from the United States and the United Kingdom find over one in 10 women who are having vaginal sexual intercourse are not using contraception.”

Okay. So you know, from my perspective — and again I also come to these studies with a perspective, I definitely have some bias here, a lot of it, so I’m not going to pretend that I’m neutral — but basically if you look at it from a financial perspective, I mean, if you’re making so many billions of dollars and 10% of women are not using your product, imagine what would happen for your profit margin if that 10% actually started using the product. Like that’s a lot of money. If we’re talking billions, to increase that profit margin by 10% is outrageous. Right? And so I feel that that’s so interesting because they’re basically saying like, we have almost a total monopoly on the market, like we have 90% of women according to this sentence using our product, but because there’s a little bit more than one out of 10 of these women who don’t use it, this is a huge problem.

And I’ll just read another sentence here: “while non-use may be driven by difficulties in accessing the method, lack of uptake will also be affected by more individual level factors.” And then they go on to say — I’m just going to read a little bit more — “personal experiences, knowledge gained from others, and misinformation shape how women perceive and experience non-contraceptive effects and how they interpret bodily responses.”

Now every word in this paper is very carefully selected. And there’s a general theme that I want to highlight in this type of research. And I think it instantly irritates me just because I’ve read so many papers. And so there’s certainly a specific message that these authors are putting out. And like I said, I believe it’s damage control. And as we get into it, I also believe it’s full-on gaslighting. So by kind of putting — coupling in personal experience, knowledge gained from others, and misinformation into the same sentence — I feel that it’s highly dismissive of personal experiences.

They go on to kind of single out social media influencers and so-called hormone coaches, as they describe it, as people who are the purveyors of this misinformation. And if I go on to read a little bit more of this introduction, it says: “in recent years, increasing numbers of people are turning to the internet and social media to obtain information about contraception, which may be inaccurate or misleading. An analysis of TikTok identified 700 unique videos on contraception with a total of 1.18 billion views. Half of these videos recounted personal experience, with around a third covering side effects including comments on the size and length of information sheets found in contraception packaging. These social media platforms also spread information about the ‘dangers’ of hormonal contraception. TikTok in particular hosts numerous ‘holistic healers’ or ‘hormone coaches’ who promulgate myths and misconceptions about hormonal contraception. These social media influencers are persuading young women to rely on natural family planning methods, overstating the effectiveness of these.”

Okay. So this is why I said at the very beginning that it could have been written for me. Right? It’s targeting everybody who is not part of the establishment, who is essentially sounding the alarm, if you will, and informing women about the side effects. Now, if we look back at when the pill was first invented — I always share the story, and I’ve shared the story a few times, definitely a few times on the podcast — but if you look at how the pill came to be, initially when it was developed they did not have that pill bleed as part of how they presented it to the women. They didn’t have that kind of sugar pill week to cause a withdrawal bleed. And when the women were not accepting of that — so they would just stop menstruating altogether and they became alarmed and confused and they weren’t sure what was going on, some thought they were pregnant — the researchers added in the withdrawal bleed. But it’s not that they went and found the mechanism of how it worked and explained to the women that it wasn’t a true menstrual period, that it was just the effect of the hormones. They were happy to let the women think that it was just the same as getting your normal period, except that you can’t get pregnant.

And there certainly is this history around contraception specifically where there is a specific systematic plan — and I’ll just, you know, I said it — to really put a spin on the side effects, or to minimize the side effects, or to not talk about the side effects, or hide the side effects, or cover up the side effects, whatever word you want to use. They don’t want to be honest and straightforward and upfront with women about the side effects. I mean, the pill was the first drug — the reason that we have drug inserts in medication is because of the pill. Because the first iteration of the pill — all these women were taking it, there was huge — the estrogen levels in those early pills were just off the charts, and a lot of women got really sick, some women died. And it was only after that situation that whatever legal suit came out of that, that this legislation was enacted to force these drug companies to actually disclose the side effects.

So it’s literally because of the pill and the fallout of those early pill formulations that drug companies have to include that insert. And what I’m saying is that before they were forced to, before there were laws that made them do it, they didn’t tell you. So they would just happily have you taking the drug without being open and upfront about what is in it. Now you could argue that these drug companies are being upfront about what’s in the drugs and the side effects because they do list it in the package label. But at the end of the day, we live in a world where we are told to trust our primary care physicians, and they are the ones prescribing the pill in a lot of cases. Now there’s a movement to get the pill over the counter so that you don’t need a prescription — that’s another conversation. But ultimately, the way that we’re typically interacting with this drug is that our doctors are prescribing it to us. And so if at that point of contact they are not being open and clear and honest about the side effects — and the pill’s been around for over 60 years, there’s multiple tens of thousands of research papers on them, probably hundreds of thousands — there’s a lot of research on the pills. So there’s no hiding it, there’s no pretending like the side effects aren’t real. So ultimately, the only strategy is damage control.

So the only strategy is: yes, we have this study that shows this problem, but this is why you should still take the pill. And that’s literally what this paper is. So that’s my introduction, and we’re going to get into it.

So what they do in this paper is they break down some of the most common side effects and they break it down into categories. So I’m going to go through a few of these. They break it down into physical side effects and they talk a little bit about weight gain and just other common physical type side effects. They talk about mental health and mood changes in an interesting way — it’s very dismissive. They talk about the impact on sexuality. They talk about the impact on fertility. They address this question of are hormonal contraceptives unnatural, which is a very interesting little tidbit there. They address the question of hormonal contraception and cancer. And they even talk about hormonal contraceptives and STIs — sexually transmitted infections — which I find interesting. And then they briefly address the issue of blood clots and stroke, and then they make a plea for the destigmatization of the side effects.

So that’s where we’re going to go, and we’re going to go through some of these here. So if you think about some of the concerns that are commonly raised by women, I would say that the mood changes are first. However, in their paper they address the physical side effects first, so we’ll go with their order here.

So the main issue that they are talking about is weight gain. And they’re really looking at what are the things that people are talking about that would be potentially preventing somebody from taking the pill or causing them to come off. Some of the things that are really a concern to women. And their intention is to like set the record straight.

So in terms of weight gain, they go through some of the research, and to summarize: all contraceptives don’t have the same effect on weight gain, but not all women experience the drugs in the same way. So this is a complexity that we should just put out there right now so that we can understand that if you take the same exact drug and give it to a thousand people, you’re not going to get the same exact result for all of the people. And so this makes research always — it’s not this thing where we’re robots and everyone responds the same. We have different genetics, we have different sensitivities, there’s a lot of differences there. But then the research helps us to see kind of the overall or most common issues that are going on.

So in terms of the different types of hormonal contraceptives — whether we’re talking about the shot, the pill, the patch, the ring, the IUD, the implant, etc. — weight gain is most highly associated with the shot. So if we look at the research, and they kind of bring that up, they do show — the drug that kind of consistently shows that higher likelihood of weight gain is definitely the Depo shot. So Depo-Provera. And so they highlight that, they can’t really deny that one.

And so there’s a theme that I see as I go through their kind of review of the literature, where they do go through the specific studies and then it’s just straight minimizing it and justifying why it’s still okay. So they’ll say — and I highlighted a couple things they said — one thing as well, I think is really interesting. So you know, they’re talking about these different studies and they’re like, well, there were these two studies that did identify weight gain, and then they kind of show a couple of studies where the results are a little bit more ambiguous. And of course they throw in these little pearls: “perception of weight gain associated with some contraceptive methods may differ from actual weight gain.” So they’re saying, well, you know, in some of these cases it could just be that she was on social media and they told her she was going to gain weight, so she was anticipating that she would gain weight, and even if she didn’t gain weight she still thought she did. So I mean, that’s one way to look at it. Or you could just look at studies that show that women actually gained weight.

And you could also look on social media — again, everyone isn’t going to be the same. So if we looked at the Depo shot and people’s experiences with it, there’s obviously going to be women who took the Depo shot and didn’t gain weight. But there’s going to be a whole range of weight gained by women who used it. And so some of the women would have gained a lot of weight, some of them would have gained a few pounds. And so yes, you’re going to have this situation where women are going to look at that and say, oh my goodness, maybe that’s not what I want to use because I’m nervous that I’m going to gain weight. But is that a bad thing? If we know that this particular drug is associated with weight gain, should we not have the option to not take it because we don’t want to have that experience? And just because some women didn’t gain as much weight as others, or some women used it and didn’t gain weight at all, does that mean that we have to throw out the whole thing and not have a conversation?

So this is — you can already tell where I’m going with this. I just find this whole thing to be so interesting.

So mental health and mood changes. Now I feel that this issue was kind of skirted over. And I guess one of the themes that comes up is in their analysis of it: when they’re looking at specific research, if you think about it, it’s not as easy and straightforward to measure a person’s mood. You know, to measure their depression and anxiety. There’s just certain things that are easier to measure — for example, if I was to measure blood levels of vitamin D, I feel like that’s easier than to measure mood. So when we look at the research, there are a variety of different studies that are trying to get at this information in different ways. And so when you put all of that information together, it does show that women’s mood is affected. And they are — I mean, if you’re honest and you actually look at the research, it does show that. But it’s not the same as measuring blood levels of vitamin D where it’s very black and white.

So for example — and I thought this was a coincidence, but in The Fifth Vital Sign, when I talk about this issue of depression, one of the studies that I shared is actually the same study that they share. It’s this study where they actually looked at teenage girls and they find that teenage girls who are on hormonal contraception are much more likely to also be on antidepressants. And so that shows a strong correlation. Now it doesn’t prove causation, because when you look at it from a research standpoint, just because two things are correlated doesn’t mean it’s causal. But again, when you look at a variety of data —

There was another study that I cited in The Fifth Vital Sign for a different reason — you know, it was a study that was just, and I’ve talked about this study before on the show — they were looking at the characteristics of women who complained about contraception. And what the purpose of me talking about that study in the book is to highlight how these doctors’ goal is to understand who’s complaining, what their problem is, to try to find creative ways to convince them to still go on the pill. And that’s ultimately even their stated goal with this study. But the reason I bring it up is because in that study, 50% of the participants were dissatisfied with hormonal contraception due to a variety of mood and sexual side effects specifically.

And so again, when you look at studies like this — if you collect the data, there are studies that show that when women are put on contraceptives, hormonal birth control, about half come off in the first year of taking it, and either find a different method or switch to a different type of pill or patch or whatever. So half. And they come off because they’re dissatisfied with the side effects. And often those side effects are including mood changes, depression, and anxiety.

And so again, if you take an honest look at the literature, you can’t just deny it. But if you want to put your blinders on and just go into the very kind of scientific thought process — yes, you can say, okay, well there’s all this research that shows this link between the pill and mood changes, but it doesn’t definitely show that it caused it. And, you know, a lot of these studies are done with women who are in their 20s. And they’re kind of implying, I guess, that we’re unstable at that age. I don’t know. Like, it’s so interesting. So what, in this section, they’re kind of saying: well, this study kind of shows a link, and this study kind of shows a link, but ultimately we don’t have conclusive evidence that there’s any link, and so basically it’s not as big of a deal as they’re saying.

It’s highly minimized. So again, I feel like the words are chosen very carefully, again, because it’s like they want to reassure women that it’s fine. And so they want to kind of find holes to say, well, this study that was done on adolescents, it doesn’t show causality. And you can’t really generalize that to the greater population or whatever it is. And some pills or some studies don’t show a relationship. So therefore — and I feel like that’s word soup, because ultimately on the actual insert it does — like if you have if you’re taking contraceptives, look at the insert. I’ve often shared that when I wrote The Fifth Vital Sign, my editor — she didn’t know that hormonal contraceptives come with a black box warning. And a black box warning is issued to drugs that could kill you. And I remember she was like, I didn’t even know — I looked it up and I saw that it actually does come with this label. And I was like, yeah. So, you know, we can continue this word soup, but by law these companies are required to put the actual side effects that have been shown in their own studies to get the drugs approved. And in those inserts it clearly states mood changes, anxiety, depression, panic attacks, that kind of stuff.

So I just find this to be fascinating to watch this full-on damage control, gaslighting paper try to explain away things that we actually know to be true. Now I think that the big concern by the establishment is that people like me who highlight the research in these areas and share it and say, okay, there are women who took the pill and had these mood changes and issues — as if we’re saying no one should ever use the pill and whatever. But I think we should just take a step back, treat us like adults, and like anything else, we should be aware. So there’s plenty of women who need hormonal contraceptives for their life situation. That’s their comfort zone, that’s what they feel is best for them at the time. I’ve used hormonal contraceptives in the past. And I just feel like a little heads up is really helpful. Because what I don’t like is that when we don’t tell women about these potential side effects — and again, 50% means half of the women did not experience side effects that cause them to come off, right? So when I talk about some of those stats, remember that there are women who used contraceptives that didn’t notice or didn’t experience the same side effects. And again, it’s because you could give the same drug to a thousand people and everyone is not going to have the same experience. So it’s very possible that for you personally you might not have that mood change experience. But wouldn’t you want to know if you were on something that could do that? Wouldn’t you just want the heads up?

Some women who take this have this experience. So if you have this experience, instead of suffering for months or years and not having any idea that your symptoms could be related to the drug that you’re taking — maybe if they told you, then we could both know. And if I do experience some of those symptoms, I could experiment with either coming off of it for a while to see if my symptoms improve, or switching to a different option that is actually better suited for me.

I just find this to be really, really interesting. Because ultimately it’s like they don’t want us talking about it, they want — they don’t want us to share our experiences, they certainly don’t want us to pay attention to all these anecdotal accounts of, you know, I had this experience, I had that experience. Because they feel like it’s going to cause us to not want to use the drugs. And really and truly, it’s almost like they’re saying it’s wrong not to use it because we all should be using it. And I feel like we’ve lost the plot if that’s what we’re saying. Because you should be able to hear what other women have experienced with these drugs and it should influence your decision to some extent. Because now you know what other people have experienced. And many women will still choose to take it. But then they got the heads up. If they have a negative experience on it, then they can immediately know that, oh, this could actually be related, instead of suffering in silence.

So they go on to talk about the impact on sexuality. And again the theme really, as you read through it, is that they’re really glossing over it. But at the same time they do list the research. So I think what’s positive about where we’re at is that all the women who’ve been complaining about the side effects online, and all the women’s health practitioners who have been shedding the light on the research — now they’re kind of painted into a corner because they can’t deny that the side effects are there. Because it’s not just someone ranting. Like in my book, for example, I systematically go through the research. So it’s not the Lisa show where I’m like, and I have this opinion and I have this opinion and I had this girlfriend who — nope. It’s: this is what the research shows. And so what it’s really — just to read this paper — they are having to put it out there because they can’t not, because the research is out there. Right? And so they have to say what the research actually shows, but then they have to put in their interpretation of that, which is kind of like, well, it’s not a big deal.

So again, with the sexual side effects — now they’re going to choose what studies they put in there. I put some of the scary studies in my book, in The Fifth Vital Sign. I say there are two scary studies — the two scariest studies that I share in The Fifth Vital Sign. And you know, study number one is the study about clitoral shrinkage. Now there are a variety of studies that do show that the pill has a negative impact on the kind of vulvar tissues. Now, I’ve been criticized for using that study and pointing it out because it has a small sample size — I believe it has 50 or less participants. And so yes, it is a small sample size. And what they did is they gave these women the contraceptives for a period of time — if I remember correctly, it’s about a 3-month period — and measured the vulvar tissues including the size of the clitoris. And they found that while these women were on the pill, the clitoris shrunk by — in all of the participants — by an average of 20%. And then there were also studies that show the thinning of the tissue around the vaginal opening.

Now some women go on hormonal contraceptives, and when you understand what happens with hormonal contraceptives — so the main mode of action for many, particularly for the combined contraceptives that have the combination of the synthetic estrogen and progestin — the main mode of action is to suppress ovulation. That’s the whole point, because if you don’t ovulate you can’t conceive. So that’s what makes it highly effective. But when you shut down that ovarian function, you suppress the production of your natural estrogen and progesterone significantly. And you also significantly reduce the testosterone production — to the tune of like 60%. So there’s a significant reduction in free testosterone. And then there — you know, with the influx of the synthetic estrogens and synthetic progestins — it also causes there to be an increase of sex hormone-binding globulin, SHBG. And that operates — the best way to understand what it’s doing to your testosterone is that it’s like a magnet and iron filings. If you’ve ever seen that, where the magnet kind of attracts the iron filings. And so in that way, the SHBG binds to the free testosterone. So not only is the testosterone — the testosterone that you’re producing is less — the free testosterone that you have is also scooped up by the SHBG. And again, this is your body trying to sort itself out, because when you have this influx of artificial hormones your body’s kind of trying to even things out. So women on the pill have significantly lower testosterone. And one of the ways that this kind of shows up is this thinning of the vulvar tissues and shrinking of the clitoris. And it’s terrifying. That’s like — I say it’s one of the scariest papers.

And so when people say, you know, how, why would you use this study? You know, it has a small sample size, and arguably we can’t really use that data definitively. My response is: okay, but why don’t you ask — if there’s a study, and it was all of the participants had shrinkage, and the average was 20%, that if it was a pilot study, it shows some really concerning results. So years later, I have not seen a follow-up to that. It doesn’t mean that it wasn’t done or proposed — it could mean that it just wasn’t published. But we also have to remember who — like, research is extremely expensive. And if there’s no financial benefit to finding — I mean, how would that affect the drug company if there was a huge study with a thousand women and it showed an average of 20% shrinkage of the clitoris and thinning of the vulvar tissues? Do you think that would have good PR for these companies? So no. So of course they’re not going to mention that type of research in their rebuttal. They’re looking at the studies that are just kind of asking women — so the studies where they do the questionnaires and they’re, you know, reporting on their sexual mood and stuff like that.

And at the end of the day, like I said, not all women experience a reduction in sexual function. But many women do. You know, many women find that it reduces their libido. And some studies even indicate that women on contraceptives have lower sexual function — as in, let’s say, they’re not as sensitive, or they have a harder time reaching orgasm, to be specific. So there are studies that do show things like that, which they mention. But there are also studies that would show that that’s not the case. And with anything you look at, there’s typically studies that show the result and there’s typically studies that show the opposite. So they bring up a result where there was even this study where the women who took this particular contraceptive showed an increase in sexual function. And they were talking about IUD studies. And I have to say — they were saying, you know, there are studies that show that the hormonal IUD has beneficial impact on sexual desire and arousal. So they were citing a study that shows that. And I would be really keen to look at the study because many women choose the IUD because it is — they don’t have to think about contraception, it’s there once it’s inserted, you just have your birth control, you can kind of be free and stuff like that. So who’s to say that it’s actually the hormones that are making them more happy with it, versus the freedom associated with the continual birth control? So I would have some questions there. Not to say that it couldn’t be, but generally speaking, there is sufficient research to show that many women, or you could say some women, do experience a negative impact related to their sexual function.

So again, it’s really interesting to see how these things are positioned. And after having read a lot of papers, it does feel like there are standard talking points for these specific issues. So whenever certain issues are brought up, they’re always addressed in a certain fashion to really minimize the concern and to highlight — basically, bottom line — why you should still take it.

So they talk about the impact on fertility. And so of course this has been discussed a lot more. And again, these are all — like, if anyone has read my books, you could go through my book and it’s like, this is discussed. I’m not saying that it has anything to do with me, but I’m just saying that I find this to be really, really interesting.

So the impact on fertility — what they’re saying is, now you have young women who are concerned that the pill could have a negative impact on fertility. Now, I’ve been extremely outspoken about the pill and fertility and how it could impact. And when you look at the data, I always say the data doesn’t indicate that the pill has a lasting negative impact on fertility. So there’s no evidence to show that you take the pill and it’s like causing you not to be able to have children or something like that. But when you look at the data, there is enough data to show that there is a temporary reduction in fertility. There is a temporary period of subfertility.

And I feel that the way they overcome this in the research — and I’ve shared this in my books, I’ve been on interviews, I’ve talked about this on this podcast consistently — if you read enough papers, this is what I have observed. Now in this section of their paper they specify — so they talk about the different types of pills and they talk about fertility. But what they focus on is that there are a variety of studies that show that after a year of coming off the pill, the pregnancy rate tends to be very close to the normal pregnancy rate. So generally speaking, in a general population they usually say that about 85% of people will get pregnant within a year of unprotected sex. And so when they show this — these women come off contraceptives, and at the 12-month mark, typically somewhere between 70-something and 80-something percent of these women have a child or are pregnant at the end of the year — and therefore it’s the same as the regular population. So they’re like, we’re all done, good, we’ve solved that problem.

But when you look into the research itself, it is very hard to find studies — especially more recent ones — that break down the time-to-pregnancy rate per month. And so in The Fifth Vital Sign and in Real Food for Fertility, I share a couple of the studies that I found that do break it down month to month. And that’s very rare. There was one study that really broke it down month by month and by type of contraception. And so we can keep repeating the talking point of, like, at the one-year mark, at the one-year mark. But when you broke it down month to month, the women who did not use hormonal contraceptives — the average time to pregnancy was four months. The women who were using combined oral contraceptives — the average time was eight months, which is double the time to conception.

And although for the purpose of their research papers they’re saying this doesn’t matter, it’s the same, this is unfounded concern — women who are actually going through this experience of coming off birth control, after being told that they could get pregnant every day of their cycle, when they are in month three and they’re not pregnant, month four — there’s a lot of stress. Many of these women are now reaching out to fertility clinics and seeking support and getting expensive procedures. And nobody told them about this temporary period of subfertility. Where if they were told about that, they could potentially come off the contraceptives, use a non-hormonal method for several months while their body adjusts, and then move on.

They also mention — they do briefly mention the fact that women who are on birth control have lower ovarian reserve parameters. Now they don’t go into as much detail as I do in my book, where the second scary paper — so I shared the first scary paper, which is the one about the clitoral shrinkage. I would say the second scariest paper that I share in The Fifth Vital Sign is the paper that talks about ovarian shrinkage. When you learn that women on birth control experience a reduction in their ovarian reserve parameters — so that’s their AMH levels, their antral follicle count, and also the ovarian volume. And women who are on contraception, the ovarian volume is about 50% lower on average. And that means the ovaries are shrinking to half the size, because they’re dormant, because the pill — the primary mode of action is to stop ovulation by interfering with the communication between the hypothalamus, pituitary gland, and ovaries. And so the ovaries are literally just in limbo. They’re dormant, and you know, they’re not being used. It’s like you put them on the shelf. And so the result of that is that the volume decreases.

And so those studies, when they’re looking at these results, it does show that in about 6 to 12 months or so, the ovarian reserve parameters do rebound and they do go back to normal. But we shouldn’t just skirt over this. This has implications for natural conception. If we know that the pill is having a suppressive effect on ovarian function — because that’s literally what it was intended to do — and if we know that there’s a temporary suppression of these ovarian reserve parameters, then instead of having a paper where you’re just like, well at the 12-month mark everything’s fine — why don’t you just tell the women that there’s this temporary period of subfertility, and encourage them to come off earlier and take that into account when they’re planning their families? But no, that’s not what they want, because then they would have to admit that there is an effect on fertility. And their talking point is that it’s reversible and it doesn’t affect fertility, it has no effect — at the 12-month mark everything’s the same, stop looking at the data. It’s just completely insane.

So the way that they address it is by not addressing it. They tell you that they do know that there’s this impact on AMH, but they don’t go into the detail that I do. And again, their goal is to just get you to take it.

There’s one other thing that I want to say about the research — they can’t get away from the fact that women who come off the shot, the Depo shot — it takes them longer. Like, it takes a longer time for ovulation to return and longer time for the fertility to resume. So they do kind of put the data points in there in their paragraph, but they don’t go on to kind of explain. They still kind of minimize it.

And if you were to read this for yourself you would see it. But one of the points I always want to highlight is that if you find those studies — and again we’re still in the “does it have an impact on fertility” section — so they’re highlighting specific studies that are saying like, at the 12-month mark, X% of women who came off combined oral contraceptives were pregnant or whatever. If you find those studies and you read them, you will see for yourself that they exclude any woman who had an existing issue with her cycle. So any woman who had PCOS, had hypothalamic amenorrhea, had irregular periods, had excessive pain or endometriosis or anything — all of that, they’re excluding. And of course they are, because in research you can’t have all these compounding factors or you can’t make any conclusions. So they’re going to exclude everybody who doesn’t have those risk factors.

And so again, think about how many women are put on the pill for non-contraceptive reasons. How many women are put on the pill because they have acne? Because they have imbalanced hormones? PMS or PMDD? Because they have period pain that they can’t manage? Because they have quote irregular cycles? Because they have missing cycles or whatever the case? So all of them are not included in the study. And so when they say 83% of women conceived, and da da da — they’re not talking about a whole percentage of the population who they’re not talking about. And so again, the conversation needs to be more nuanced. And essentially, this approach of just, okay, well, this is the stat, and it’s fine, and whatever — it’s just not enough.

We’ve passed the point where they can just say it’s fine and we can just say okay, I’m going to trust the authority figure. Like we’re at the point now where we have access to the research, we can read it too. And so if we can all read it, then we can both know what’s going on. And you can’t just keep telling me that all of my concerns are invalid, and anytime a woman shares her anecdotal experience, that we just have to ignore it. It’s just completely insane.

So I’m going to go on, but that was a big point. Because I feel like they didn’t really address — again — the research. Because if you just have a cursory look at the research, you can come up with one answer. But if you look deeper at, well, how did they determine those numbers? And who is included in the studies? And what about this research? Like if you look at the broad variety of research around the fertility question, then you can get your nuanced answer.

And so to sum it all up: there’s no evidence to show that the pill has a long-lasting negative effect on fertility. But there is evidence to show that there is a temporary period of subfertility when women come off the pill. And it’s further kind of exacerbated by the fact that many women use the pill for a really long time. And during that time that they’re using it, they’re also getting older. So the pill didn’t cause them to get older. But now that they’re older, there are different reasons why they might face challenges. Or they could have had an underlying issue and the pill could have been masking that. So if they weren’t getting their period, or if they did have an issue with their period, and they’re taking the pill — that issue could still be worsening in the background. But because they were on the pill and they got a bleed every 28 days, they might have thought it was fine.

So as we kind of start wrapping up — they address a couple of other points. They address this concept of: are contraceptives unnatural? Now I feel that this is just a way to combat the natural health movement. So there obviously are a lot of women who are questioning contraceptives because they’re saying, like, it’s artificial hormones. So that part is really interesting. If you want to read some weird mental gymnastics, just read that section of this paper. They’re just — well, actually, because there’s this movement towards natural, companies are now trying to make bioidentical hormones. And so they are natural. And this type of brand, it’s created in a lab but it’s very similar to your natural estrogen, and this one is very similar to your natural progesterone. And so it’s just word soup.

At the end of the day, women who have concerns about that aspect of it — not everyone is concerned about that aspect of it, and again, all women are different — but some women are concerned about the fact that synthetic hormones in the contraceptives are not the same as the hormones that we make. And there’s — like, that’s a true statement. Like, it’s a factual statement. Like, you can’t be like, oh, that’s not true, like they’re not the same. In order for you as a drug company to make money, you have to create your molecule that is different enough so that you can patent it. And that’s the reason that they don’t make it identical. Because you can’t patent life. And then anybody could just do it. In order for this specific drug company to make money, they have to make their own molecule, they have to patent it, and then they own it for a certain amount of time until the patent runs out. And that’s how they make their money. So like, we can continue to have this conversation and pretend like what I’m saying isn’t the truth.

So they’re looking at the science, which is important. I look at also the financial implications, because you can’t pretend that it’s not there. Because hormonal contraceptives are a very, very lucrative aspect of these pharmaceutical companies’ bottom line. So anyway, that was an interesting gymnastics to watch them just kind of talk around the point that synthetic hormones aren’t the same as natural hormones.

Just a couple of other things — I feel like I could go on forever, but I do want to wrap this up at some point. They do briefly talk about the bleeding issues. And so that is an issue for a lot of women, where especially the IUDs — for the first six months, the research shows that one of the most common reasons for discontinuation of IUDs is because of the bleeding. And so during the first six months it’s not uncommon for women to have sporadic, unpredictable, unscheduled bleeding. And then eventually the bleeding kind of subsides and typically either goes away or kind of regulates once the IUD has been in place for six months or more. So they kind of minimize that a little bit.

The conversation about cancer — if you ever look at research about hormonal contraceptives and cancer, there are just certain truths they can’t get away from. Hormonal contraceptives are associated with an increased risk of cervical cancer and breast cancer. It’s also associated with a reduced risk of ovarian cancer and endometrial cancer. So whenever you see cancer talked about with regards to hormonal contraceptives in research, they always bring that up. Because what they want you to take away from it is that yes, it does increase these rates of cancer, but it lowers these rates of cancer, so it’s all a wash. Like, you’re totally good. And if you feel that that’s logical, then I’m just going to leave it right there.

And then the last point I find interesting — they put in at the end that they then have to address the fact that women who take birth control as directed die every year. So there is a study that shows that in the United States alone, it’s anywhere from — if I remember correctly, because I’m not looking at the study — but somewhere in the area of 200 to 300 women a year die just because they used the pill as directed, from blood clots and stroke, pulmonary embolism, all the things. And in that study, they say it’s equivalent to a jumbo jet crashing every year, which is one way — it’s a very hyperbolic way of stating that.

So of course, again, these are just facts. Like there are women who are going to use this and literally die as a result of it. Now the chance of it is small because in terms of absolutes — so in the paper they say that 3 to 15 per 100,000 women — that’s how many will die. And that’s obviously compared to random people who are having blood clots and strokes — it’s significantly more. And this is — I almost find it comical, but it’s not. So they’re saying this is the risk of women who are using hormonal contraceptives, and obviously contraceptives increase the risk. So in The Fifth Vital Sign, when I shared about this risk, I believe women who are on contraceptives are up to seven times more likely to die. It’s a — like, it’s all about how you word it. Right? But they’re not going to tell you how much more likely you are to die if you’re just using it versus not using it. What they do is they throw in what I consider to be an unrelated data point. So they say, well, nonetheless, the risk is low compared to pregnancy. And I’m sitting there like — what are you — so in the research, though, I’ve read this before. So again, whenever they have something they can’t get away from, they try to find a way to frame it to try to minimize it. So they’re like, oh, well, you know, yes, if you take the pill you’re more likely to die of, you know, a blood clot or something. However, you know, you’re much more likely to get pregnant. And if you got pregnant, you might be at a higher risk of having a stroke. So — basically, take the pill. It’s just wild. Again, if you think it’s a fair comparison, then you let me know. But I just feel like it’s very — if you look at how they systematically minimize all of this data and always want to frame the real risks with something else that is potentially unrelated, to make it seem like, well, the risk of pregnancy is higher than this. How are you comparing — are you seriously comparing getting pregnant with having a stroke? Like what is happening?

So basically, you know, at this stage we’ve gone through most of the points. These were the points that I wanted to talk about. I wanted to go through this paper kind of point by point and share my thoughts on how they’re presenting this information. And the main theme, as you could get and as you gathered just by listening, is that I feel like we’ve made progress. So first of all, I think that for all the women out there who’ve been sharing their personal stories, all of the healthcare professionals who have been reading the research and sharing it and bringing it to light, all of the journalists who’ve been writing articles and sharing about this data to actually help women to have more awareness about the most common side effects of birth control — I feel like this paper shows that there has been a change.

I think that clinicians, primary care doctors, are starting to get more pushback and starting to get more questions about birth control. And so this is their way of again doing damage control. Unfortunately they’re not addressing the concerns of the women. They’re still in this kind of “acknowledge but dismiss” stance. But the fact that they had to list the actual data — even though they’re trying to backpedal and frame it and whatever — they still had to put it there. So the data is still there, they can’t escape it. They’re just trying to change how you think about the data. They can’t change the actual data.

So one of the last points in this paper is the section they title “Destigmatization of the Side Effects.” So it’s really interesting. It’s like they use all these words but they don’t say anything. But basically they’re kind of telling clinicians: you are going to have to actually address their concerns, but you’re going to have to find a way to frame it in a positive light. So it’s like you have to acknowledge their concerns, but you have to find a way to frame it in a way that’s not going to discourage them from using the pill. Because we still want — at the end of the day, they want us on the pill. That’s what they want. But they have to find ways to acknowledge that the data is saying that there are these side effects, but how are we going to spin it and talk about it and kind of deconstruct it in a way that still encourages them to take it?

At the end of the day, what they said at the beginning of the paper was that 150 million women worldwide use it. Including myself, because I used it. And they said that like nine out of ten women were using hormonal contraceptives, according to what they said. So I find it interesting — they have the majority. Most women do use it. So what are we talking about here? Like, you’re so scared because there’s a tiny, tiny percentage of these women who are now kind of skeptical, and this is like this huge problem for your multi-billion dollar empire? I just don’t have the patience.

So I hope that you enjoyed today’s episode. I hope that this was an interesting kind of review of this. But like I said, I do feel like papers like this show that we’re making progress. Because they have to now acknowledge that this is a problem. Like they can’t — they’re kind of beside themselves. Like, who let these women go on social media and share their stories? It’s influencing their decisions. Like, we need to step in and tell them the truth. And the irony is that they don’t.

So one thing that I found really interesting — I’m going to see if I can find this one quote. I think it’s at the very beginning. So at the very beginning, they again are telling us how beneficial hormonal contraceptives are. So they acknowledge some of the side effects. They say: “beyond the complex interplay of all these influences, side effects associated with hormonal contraceptive methods, including changes in bleeding, mood changes, depression, and weight gain, are other important attributes considered by women when deciding upon which method to use.” But when they kind of go through these challenges, they are talking about some of the reasons why we really should use contraceptives. And so they like to talk about the non-contraceptive benefits. And what they say is: “these methods are not only highly effective for contraception but also offer a range of non-contraceptive benefits. Such benefits include reduced acne, lighter and regular periods with respect to the oral contraceptive pill, and reduced menstrual bleeding and pain with hormonal IUDs.”

So while that statement is mostly correct, for anyone who’s been listening to the show for quite some time, you’ll notice that they said that one of the contraceptive benefits is that it regulates the period. It gives us lighter and more regular periods when we’re taking the pill. Now one of the first things I’ve done with this show — when it first started ten years ago — was to squash that myth that the pill regulates the menstrual cycle. Because it doesn’t. It actually shuts down your ovulation, and what you’re having is artificially induced withdrawal bleeding whenever you withdraw the hormones that you’re taking. So to set the record straight: even in their research study, while they’re talking about all these influencers who are promulgating myths and misinformation, they are literally promulgating misinformation right there. That was a myth that they just put out as fact, and it’s not even true. So I feel like that’s a great place to end.

I hope you enjoyed today’s episode. I hope that you found it interesting. And if you’re wanting to take a deep dive into the study, even though it just came out, unsurprisingly they’ve actually not put it behind a paywall. So you can read it if you want to. You can head over to fertilityfriday.com/567 and we will put the study in the show notes page. And if you know somebody who might be interested in hearing this episode, if it makes an interesting topic of conversation, you can feel free to share. So fertilityfriday.com/567. I hope that you have a wonderful week, weekend, whenever you’re tuning into the show. And of course as always, until next time, be well and happy charting.