Truth About Hormonal Birth Control & Its Alternatives

 This guest post is courtesy of Regent Law rising 3L and current Family Law student Perri Lembo:

Note: This article is about the use of birth control methods within a committed, monogamous relationship (with marriage being the paradigm). It makes no claims about effectiveness or appropriateness of methods used outside this context. This article and its author do not purport to offer medical treatment or advice. This blog post is meant to be just that - a brief overview of this topic and not an exhaustive treatment. The reader is encouraged to follow the links and expand his or her research on subtopics of interest.

I. Hormonal Birth Control- an Introduction

Oral contraceptives, also known as birth control pills, are medications consisting of synthetic versions of the reproductive hormones estrogen and progesterone (progestin). There are three kinds available: the combination pill, the progestin-only pill, and the continuous use pill. Each formulation has a slightly different risk profile, but all of these pills use synthetic hormones to alter the functioning of the female reproductive system. These pills may prevent the body from ovulating, change cervical mucous to make it difficult for the sperm to reach the egg, and may even change the lining of the uterus to prevent the fertilized egg from implanting.

This last effect is considered a form of early abortion by some, since the egg has already been fertilized by the sperm and has been transformed into a zygote (a single human cell with its own DNA and development trajectory- the very first stage of human development) and has likely even developed into a blastocyst (the next major stage) by the time the pregnancy is “prevented.” In 1965, the American College of Obstetricians and Gynecologists (ACOG) changed the definition of “conception” from the formation of a zygote to the implantation of a blastocyst in the uterus- linguistically avoiding the description of oral contraceptives that prevent implantation as abortifacients. (Despite ACOG’s definition, most obstetrician-gynecologists agree that pregnancy begins at fertilization.)

Oral contraceptives are fairly effective, with a pregnancy rate of 9% with typical use. While this makes them a very popular medication, the physical and psychological effects of hormonal birth control are largely overlooked.

II. Effects of Hormonal Birth Control

A. Physical Effects

1. Cancers

Because hormonal birth control alters the body’s supply of estrogen and progesterone, this drug can increase hormone-affected cancers such as breast cancer. One study showed that current users of oral contraceptives had a 24% increase in breast cancer compared to women who had never used oral contraceptives. That number did decline after use ceased, but did not totally disappear: women who had ever used contraceptives had a 7% increase in relative risk of breast cancer compared with women who had never used these drugs. Another study found the risk of breast cancer in women who were using or who recently stopped using oral contraceptives to be 20% higher than women who had never used oral contraceptives, with the increased risk going up to 60% depending on the type of oral contraceptive used. The risk of breast cancer also increased the longer hormonal oral contraceptives were used.

The risk of cervical cancer is also increased in women who use oral contraceptives. This is because it changes the susceptibility of cervical cells to a common infection that causes cervical cancer. Women who have used birth control pills for 5-9 years have a 60% increased risk of cervical cancer compared to non-users. This risk jumps to a 100% increased risk (double the risk) for users of more than 10 years.

2. Cardiovascular effects- Blood clots, DVT, Stroke, and Heart Attack

Since birth control pills increase the level of estrogen in the body, they promote the formation of blood clots, which can develop in an artery or a vein (a deep vein thrombosis or DVT). Birth control pills increase a woman’s risk of developing a blood clot by 2-4 times, and if the clot breaks off and travels to the lungs, it can cause a pulmonary embolism.

Studies have shown that oral contraceptive use increases risk of stroke, especially when pills with higher estrogen doses are used. The longer oral contraceptives are used, the more significant the risk of total stroke and ischemic stroke (stroke from blood clot). Other risk factors such as high blood pressure, cigarette smoking, and migraine headaches increase the risk of stroke in women taking oral contraceptives.

Blood clots also increase risk of heart attack if the clot blocks flow to the heart. A major study shows that risk of heart attack for women on birth control pills is 50% higher than women not on birth control when women take the combination pill with ultra-low dose of estrogen. Women who take the combination pill with the regular low-dose estrogen have an 80% higher risk of heart attack compared to women not on birth control pills.

Birth control pills also tend to increase a woman’s blood pressure, contributing to cardiovascular risk.

3. Pregnancy problems

Studies show that certain forms of birth control (those containing progestin only) may increase risk of ectopic pregnancy if they fail to prevent pregnancy. Research suggests that use of birth control pills near conception has an increased risk of low birthweight and premature birth. If a pregnancy results from a birth control “failure” (i.e. the woman was taking birth control pills when she became pregnant), it may be impossible for her to avoid these risks.

Although most sources claim that birth control use does not impact fertility once the pills are ceased, one study has shown that use of oral contraceptives for more than 2 years before pregnancy is associated with a higher risk of miscarriage.

B. Mental and Social Effects

1. Depression and suicide

There is a strong link between hormonal birth control use and depression and suicide incidence in women. Use of these drugs, especially among adolescents, is associated with future use of antidepressants and diagnosis of depression. One study found a 70% higher risk of depression among women who used hormonal contraception compared to non-users. A striking study in the American Journal of Psychiatry found that use of hormonal contraceptives doubles the risk of suicide attempt, and triples the risk of suicide. Effects on mood continued years after cessation of hormonal contraception. The study also showed cerebral changes on positron emission tomography as a result of hormonal birth control use. Other neuroimaging studies have revealed alterations in brain functioning and even brain structure associated with oral contraceptive use.

2. Effect on Attractiveness and Attitude Towards Male Partner

A little-known effect of hormonal birth control use is the changes it produces in attractiveness to the woman’s male partner as well as her sexual behavior towards him and other males. Studies have shown that women who choose a partner when they’re on birth control pills and then cease taking them will pay more attention to flaws in their husband’s physical appearance and attractiveness level. This is because being on hormonal birth control tricks a woman’s body into thinking it’s pregnant, causing the woman to have more affinity towards individuals who are genetically similar, rather than being attracted to males who are genetically distinct, which is the normal mating pattern for healthy, non-hormonally-altered women. One consequence of being paired with a genetically similar male (MHC similarity) is that women express lower sexual responsivity towards their partner and report having more extra-pair partners (higher rates of cheating).  MHC-similar couples are also more likely to experience problems with fertility and have less healthy children. All of these problems can impact the spousal relationship and are good reasons to avoid choosing a partner while taking hormonal birth control pills.

Another study found that women who went on or off oral contraceptives during a relationship were less sexually satisfied than women who were consistently using the birth control pill or women who had never used it. This has huge implications both for sexually active women who were on the pill and then go off of it after marriage as well as for chaste or virginal women who never used the pill prior to marriage and then go on it to prevent pregnancy.

Along with decreasing the woman’s sex drive towards her partner, the pill can also make a woman less sexually attractive to him. A preliminary study on primates shows that males become completely uninterested in female monkeys who are on the pill while increasing their interest in unaltered females capable of reproduction. Turning to humans, one study has shown that mate-guarding behavior (behaviors that tend to keep the mate in the relationship such as texting to find out where they are, or holding their hand when around other potential mates in public) decreases when the man is paired with a woman who is on the birth control pill. This could signal less interest or attractiveness to the female partner.

III. A Natural Way for Married Couples to Delay Pregnancy While Avoiding the Pitfalls of Hormonal Contraception

Many couples, for financial or psychosocial reasons, do not want to have a large number of children, even within a marriage setting. Using hormonal birth control may be seen as an attractive option, since many couples see constant condom use as burdensome and see permanent methods such as hysterectomy or vasectomy as overly invasive or unwanted, especially when the couple is not yet “done” with having children. But there is another way - Natural Family Planning.

Natural Family Planning (NFP) is a method of fertility awareness in which a woman monitors her menstrual cycle and other natural fertility signals such as body temperature to learn when her “fertile” days are in her cycle. NFP can be practiced on one’s own or learned with the help of a professional. Many phone apps exist on the market to track one’s menstrual cycle and other fertility cues. Once the fertile days are established, the woman and her husband can choose to avoid sex during those days or use a barrier method such as a condom or cervical cap.  NFP is a birth control method that is free of hormones and avoids the mental and physical health consequences of oral contraceptives. Another benefit is that it can be used to maximize fertility when the couple desires to become pregnant (by making sure to have unprotected sex during the fertile timeframe).

Natural Family Planning is also advantageous for building the marriage relationship since it requires that a woman communicate with her husband about her fertility and work together with him to achieve the couple’s family planning goals. Including the husband in family planning acknowledges that both preventing pregnancy and creating a child is a team effort.

Natural Family Planning is just as effective as oral contraceptives when used properly. When a life-respecting couple cooperatively practices NFP and an “unintended” pregnancy occurs (which can happen with the use of any method of birth control), they are less likely to see the child as a burden or a “failure” and more likely to see him or her as an unscheduled gift.

With many benefits and few downsides, Natural Family Planning is a viable and effective alternative to oral contraceptive use. The truth about hormonal birth control and its options are just one very important path toward family restoration.