How does hormonal birth control work?

For most women, the discussion with their doctor about hormonal birth control often starts and ends with the assertion that hormonal birth control alone can balance their hormones and prevent pregnancy. And most of us eagerly agree to take it, assuming it’s a benign and easy solution to our problems. But what most doctors don’t explain in detail is how hormonal birth control works, or the side effects that might come along with it. 

Today, we’re going to talk a little bit about how hormonal birth control works, and the impact it can have on your body. Before we dive in, we just want to make it clear that we’re big fans of women being able to make their own decisions about their bodies, their health, and their wellbeing. And for some women, that might be the choice to use hormonal birth control. We’re not here to shame or pass judgement, but rather to give some insight into how this form of birth control works. Because while we’re so happy that women have access to a variety of different birth control options, we’re big fans of informed consent too. 

How hormonal birth control works

In this article, we’ll mostly focus on the pill, but Dr. Jolene Brighten has a great article on IUDs if you’re curious about their method of action and potential side effects. 

Though there are a few different options when it comes to birth control pills, the most common option is a combination pill, which contains both synthetic estrogen and progesterone (actually, progestin). 

If you want the cliff notes, hormonal birth control works by stopping the communication between your brain and ovaries, in turn altering the natural function of the reproductive system. And the main way that the pill prevents pregnancy is by preventing ovulation altogether. 

Here’s a great explanation from Dr. Jolene Brighten:

“By taking birth control tablets you send a signal to your brain that there are enough hormones and no need to make more. Your brain in turn does not secrete hormones and the ovaries receive no signal to make hormones.

The pill specifically suppresses hypothalamic gonadotropin-releasing hormone (GnRH) and pituitary gonadotropin secretion. These are brain structures that control hormone production. The suppression of these hormones results in luteinizing hormone (LH) suppression. Without LH your ovaries don't get the signal to ovulate. So, no egg is released.”

And in fact, in suppressing natural hormones, the pill suppresses your period, too. Though you might have a monthly bleed, this is termed a “withdrawal bleed” and not an actual period. Originally, it was designed to make women feel more comfortable not having their period while on the pill.  And while the pill is sold to women as a fix for balancing their hormones, unfortunately it isn’t able to do this, since it suppresses most hormone function.

Common side effects and health implications

The below list isn’t meant to scare you. Even if you’re on hormonal birth control, there’s a lot you can do to support your body, which we’ll talk about in the next section.

Below are a few of the side effects that you will find if you look through the medication package insert, talk to practitioners, or speak to others on the pill. 

  • A negative impact on gut health, including leaky gut, dysbiosis, and the potential escalation to autoimmune diseases thanks to the leaky gut. 
  • Anxiety and depression. If you’ve ever been on the pill, you might know this one intimately. It’s one of the few side effects that’s easy to see in yourself (vs the others that sometimes feel like hidden risks). Here’s an article with more information.
  • Blood clots and increased risk of strokes and heart attack. This is a higher risk for those over the age of 35. 
  • Thyroid issues
  • Nutrient deficiencies, including magnesium, selenium, B vitamins, vitamin C, zinc, and antioxidants like vitamin E. 
  • Metabolic issues, including weight gain and blood sugar imbalances

How to support your body if you are on hormonal birth control
If you are on the pill or another form of hormonal birth control, don’t despair! There is still plenty you can do to support your body even while you’re taking or using them.

1. Love on your liver! Your liver depends on some of the very nutrients that the pill depletes in order to do its job properly. Make sure to eat a nutrient-dense diet (see below!).

2. Eat a nourishing, nutrient-dense diet that’s rich in anti-inflammatory foods. Focus on foods with some of the nutrients that the pill typically depletes. Eat lots of leafy greens, berries, nuts and seeds, eggs, high-quality meat, beans, dark chocolate, seafood and citrus fruit. It’s probably a good idea to take a high-quality multivitamin or prenatal as well. 

3. Seed cycle! Yes, you can seed cycle while you’re on hormonal birth control! 

4. Manage your stress. Hormonal birth control can wreak havoc on the HPA-axis, causing more cortisol to be secreted than is needed. Work on stress-relieving practices like meditation, yoga, acupuncture, massage, exercise, or other things you enjoy. 

5. Get enough sleep. We can all use some work on this one! Sleep is the best option for healing the body and supporting brain and hormone health. 

We hope this info helps you feel empowered to take care of yourself, no matter the path you choose, and to advocate for yourself with your doctor.