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Is Hormonal Contraception Really Safe?

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Is Hormonal Contraception Really Safe?

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Hormonal contraception (birth control) acts on the endocrine system and is one of the best ways for pregnancy prevention in the majority of women.

Medically reviewed by

Dr. P. C. Pavithra Pattu

Published At August 25, 2017
Reviewed AtOctober 5, 2023

Introduction:

According to WHO (world health organization), at least 214 million women in the reproductive age group belonging to developing nations want to avoid pregnancy but are either unaware of the different methods of contraception or do not have proper access to it. It is a well-known fact that the appropriate and timely use of contraception prevents the need for unsafe abortions, thereby saving the lives of women and adolescent girls. The choice of contraception should be given to the women after a comprehensive counseling session. This is necessary for maintaining the autonomy and well-being of the women. But, at the same time, it is widely felt that hormonal contraception is not only misused but also harms the woman's body.

How Do Hormonal Contraceptives Work?

Birth control pills contain Progestin medicine with or without Estrogen. Both these Progestin and Estrogen are manufactured in the laboratory, and they are similar to the hormones that all women naturally produce. These two hormones work to prevent pregnancy.

  • They prevent ovulation (prevent the release of eggs).

  • They make the mouth of the womb thicker so that the sperm cannot enter the uterus (womb).

  • They make the uterus lining thin in order to prevent a fertilized egg from attaching itself.

What Are the Available Forms of Hormonal Contraceptives?

Newer hormonal contraceptives in the form of tablets, plugs, patches, implants, intravaginal rings, and intrauterine devices are now available on the market. All the hormones are synthetically prepared. They are an efficient and convenient way of preventing pregnancy but, the risks involved outweigh the benefits, particularly in the case of combination pills of estrogen and progesterone.

Combination pills are used for other varied conditions in gynecology like endometriosis, DUB (dysfunctional uterine bleeding), and PCOD (polycystic ovarian disease), but for a limited time. They are also used unconventionally in menstrual cramps (dysmenorrhea) for the suppression of ovulation to avoid cycles and premenstrual tension. Today's adolescent girls consider menstruation as a problematic phenomenon like they would a disease.

Many are acutely aware of the changes in their body during the premenstrual phase and hence take pills to postpone or avoid menstruation. This is a very alarming trend as menstruation is the barometer of health for a woman. Pulse, blood pressure, respiration, and skin color are indicators of health. Similarly, women are gifted with another indicator of health. That is the regular menstrual cycles that reflect the intricate balance of the hypothalamic-pituitary-ovarian axis. We all know that pituitary hormones are interlinked and affect and control all the parts of our body. So, suppressing the sexual hormones will, without fail, affect all the systems of our body.

When Should Women Avoid Using Hormonal Contraception?

Women having the following conditions should avoid using hormonal contraceptives. They are a previous or present history of,

  • Thrombophlebitis or clotting disorders.

  • Stroke.

  • Coronary artery disease.

  • Thrombogenic (clotting) complications in the heart valves.

  • Untreated high blood pressure.

  • Diabetes with circulatory problems.

  • Headaches with neurologic symptoms.

  • Major surgery with decreased activity.

  • Known cancer of the breast.

What Are the Absolute Contraindications of Hormonal Contraceptives?

Absolute Contraindications:

It is a well-known fact that the pills and implants have numerous side effects, openly mentioned in the brochure that comes with them. It is to be certainly avoided by women having the following conditions.

  1. Liver diseases.

  2. Uncontrolled diabetes.

  3. A family history of breast cancer.

  4. A history of stroke, angina, or heart disease.

  5. A history of migraines.

  6. A clotting disorder, vein inflammation, or thrombosis.

What Are the Side Effects of Hormonal Contraceptives?

Further, it can cause numerous side effects such as endogenous depression, mood swings, weight gain, acne, breast tenderness, and a decreased amount of bleeding. This reduced bleeding is not physiological (normal) bleeding but is a sort of withdrawal bleeding which is perceived as convenient by youngsters as they feel it is hassle-free. It is now a known fact in the medical community that the return of ovulation after stopping these combined hormonal contraceptives takes a long time, especially if they have been taken for quite a while.

Teenagers are more vulnerable to this side effect if they had been on these pills soon after attaining menarche. This is because the hypothalamic-pituitary-ovarian axis is trying to establish its pattern and rhythm at this age. It is falsely believed that ovulation occurs immediately after stopping the pills. This is far from the truth, especially if you have been taking hormones for more than a year. As a result, it takes even longer to establish fertility. Also, the hormones are detrimental to bone health, as they can alter bone mineral density.

Summary:

So, summarizing the detrimental effects of combined pills will be a long and frightening list. Progesterone-only pills are comparatively safer, but nevertheless, they also have serious repercussions.

  1. Increased risk for breast cancer, fatty liver, liver diseases and gallbladder problems including gallstones.

  2. Changes in the liver enzymes lead to changes in the clotting mechanism, thereby increasing the risk of deep vein thrombosis, clot formation, and stroke.

  3. Changes in the lipid metabolism leading to an increased risk of angina and heart attack.

  4. High blood pressure.

  5. Migraines and headaches.

  6. Osteoporosis.

  7. Marked mood swings and depression.

  8. Nausea and vomiting.

  9. Intermenstrual bleeding or spotting.

  10. The suppression of the pituitary axis leading to the suppression of ovulation.

  11. Weight gain.

  12. Water retention with bloating.

  13. Breast tenderness.

  14. Decreased libido.

  15. An alteration in the vaginal flora.

  16. Vaginal dryness.

  17. Worsening of existing vaginal infections, especially candidiasis.

  18. The blurring of vision.

  19. Late return of ovulation and hence decreased fertility.

  20. Secondary infertility.

  21. Zinc and magnesium deficiencies.

The Bottom Line:

Your cycles are your internal clock. Every woman and young girl needs to choose if she wants an artificial rhythm or a natural rhythm. Remember, you are choosing health over diseases. Life is about choices. So, choose wisely.

Dr. Sujata Mittal
Dr. Sujata Mittal

Obstetrics and Gynecology

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hormonal contraceptionmenstrual cyclemenstrual bleeding
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