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Oral Contraceptives and Hormone Replacement Therapy – The Good, The Bad, and The Ugly



Birth control has evolved from the earliest known methods using acacia leaves, honey and lint to form a cervical cap to modern day hormonal tablets, patches, and vaginal rings. The very notion of birth control became a religious and political battleground that to this day is passionately debated. I am not here to discuss any moral, religious, or political regarding birth control. I would rather explore the physiological changes and micronutrient depletions that occur from taking hormonal therapies like oral contraceptives and hormone replacement therapies and the ramifications of these changes in the body.


An observation was brought to my attention several years ago that many young girls on birth control pills were also placed on antidepressant and anti-anxiety medications within a few years of starting birth control. What was causing this phenomenon? Why are so many young women depressed and anxious? Could it be related to the birth control?


I have personally never been on prescription birth control, so I have no firsthand knowledge, but for years, these questions sat dormant in the back of my mind. I went through pharmacy school and still did not have answers. I practiced as a community pharmacist and saw the same pattern. I took continuing education classes, but there was never a mention of why this was occurring. I worked in community pharmacy practice when hormone replacement therapy was all the rage, to deprescribing HRT because of the dangers of indiscriminate prescribing.


As I was looking for answers for my own personal journey of inflammation, depression, and obesity, I discovered the answer. GUT HEALTH. The key to the connection between oral contraceptives and depression/anxiety was GUT HEALTH. Birth control and hormone replacement therapy wreaks havoc on our microbiome and can lead to estrogen dominance, which causes more systemic issues.


One of the factors affecting our mood is serotonin levels and 90-95% of serotonin in our bodies is made in our gut. If our gut health is compromised, our serotonin levels diminish, leading to depression and anxiety.


Now, there are some research articles that say that the serotonin in our gut is not the same as the serotonin affecting our brain health, but our body is a complex, connected machine. If one system is “failing”, resources will be diverted to improve function. More research is being conducted about the brain-gut connection. Serotonin is one of those neurotransmitters that sends communication directly from the brain to the gut and from the gut to the brain. So, it stands to reason that if serotonin is being depleted in the gut because of poor microbiome health, it will affect other systems in the body, too, like the brain.


Serotonin in the gut is necessary for GI motility (how fast food moves through the system), the mucus lining, and communicating “pain” and “full” sensations from the gut to the brain. So, serotonin can also influence how the gut absorbs other micronutrients.


Birth control and hormone replacement therapies also deplete the body of B vitamins: B1, B2, B3, B6, B12, and Folate. B-vitamins are necessary for energy production, growth, development, and function of cells.


B1: Thiamine –Deficiency can cause confusion, memory loss, muscle weakness, and heart issues.


B2: Riboflavin –Deficiency can lead to skin disorders, sores at the corners of lips, swollen & cracked lips, hair loss, sore throat, liver disorders, nerve issues, and reproductive issues.


B3: Niacin – Deficiency can cause symptoms like a bright red tongue, vomiting, constipation, or diarrhea, headaches, exhaustion, aggressive, paranoid, or suicidal behavior, hallucinations, loss of memory and apathy.


B6: Pyridoxine – Deficiency can cause microcytic anemia (small red blood cells), scaly lesions on lips, cracks at the corner of the mouth, swollen tongue, depression, and confusion, and weakened immune function.


B12: The body does store B12, so symptoms of deficiency can take years to manifest. Deficiency can cause megaloblastic anemia (abnormally large red blood cells), heart palpitations, infertility, depression, confusion, dementia, poor balance, poor memory, soreness of mouth or tongue.


Folate: Folate is necessary to make DNA and other genetic material and help cells divide. Folate is important for women of child-bearing age to take due to the potential for neural tube birth defects like spina bifida if the mother is deficient. Deficiency can also lead to megaloblastic anemia, irritability, headaches, heart palpitations, exhaustion, and shortness of breath. Folate deficiency can also lead to sores in the mouth and on the tongue, changes in the color of skin, hair, or fingernails.


Hormone therapy can also deplete vitamin E, which is a fat-soluble vitamin with antioxidant properties that protect our cells from damage caused by free radicals. Low vitamin E levels can lead to nerve and muscle damage, which can manifest as loos of body movement control, muscle weakness, and vision loss.


Vitamin C and zinc can also be depleted by hormone therapies. Both are necessary for immune function and wound healing. Calcium and magnesium can also be depleted, which are important for bone health. CoQ10 is also depleted by hormone therapy and is necessary for energy production in our cells.


Selenium can also be depleted by hormone therapies like birth control. Selenium is essential for reproduction, thyroid hormone production, DNA synthesis, and has antioxidant properties. Antioxidants help to protect our cells from free-radical damage and premature aging.

Most Americans consume an adequate amount of selenium. However, a selenium deficiency combined with a trigger like a viral infection can lead to Keshan disease (a disease that can affect heart health). A selenium deficiency is also linked to infertility, muscle weakness, fatigue, brain fog, hair loss, and a weakened immune system.


Last, but not least, tyrosine can also be depleted. Tyrosine is an essential amino acid (one of the building blocks of protein). Our bodies can make tyrosine, so it is considered a nonessential amino acid. Low tyrosine levels can affect mood, appetite, and skin pigment because it is used to make neurotransmitters like dopamine, epinephrine and norepinephrine as well as thyroid hormones, certain enzymes and hair and skin pigment.


So, if you take birth control or hormone replacement therapy, I recommend at least testing levels for some of these micronutrients, especially if you are having any of the symptoms listed. I recommend B-Complex, a probiotic for gut health, calcium, and magnesium to reduce bone loss, and vitamin C and zinc to support immune health. Of course, check with your healthcare provider before starting any supplement or discontinuing any medications.



Are you ready to PIVOT to functional health and wellness?


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