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This post is the first of a 2 part series on the birth control pill (“the pill”). I’ll explain how the pill works in your body to prevent you from becoming pregnant and what types of other effects come along with that. Next week, in part 2, we’ll dive into why and how to come off of the pill.
Most birth control pills are a combination of estrogen-like and progesterone-like artificial hormones, called Endocrine Disrupters, that are not human identical. A few (sometimes called the mini-pill) are progestin-only.
When used properly, the theoretical effectiveness of BCP 99% and actual use effectiveness is around 91%. For a refresher on the differences between the two effectiveness rates, go here.
The pill works in 4 different ways called "mechanisms of action" which:
Inhibit ovulation by suppressing the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). These 2 hormones are responsible for the maturity of the egg and ovulation.
Alter the cervical fluid discharge to inhibit sperm transport, making it less likely that sperm can enter the uterus.
Interferes with ovum transport by decreasing uterine and tubal motility. In simpler terms, under normal circumstances, the fallopian tubes perform an action that helps move the egg to move where it can be found by the sperm, the pill interferes with this action.
Lastly, if all the above measures fail and sperm and egg unite to create a new life, the hormonal effects of the pill thin the lining of the uterus so that implantation of the pregnancy cannot occur. This is called an "abortifacient action". Studies are varied in their results on how frequently the pill works in this way, but estimates range from 1.7-28.6% of the time. With the “mini pill”, breakthrough ovulation rates are 33-65%, which means prevention of implantation rates could be even higher with this form of the pill.
Since these hormones have systemic effects, they are not just impacting your reproductive organs. They impact your whole body, including your brain and mood. Common side-effects of the pill are:
Breakthrough or irregular bleeding
Weight gain
High blood pressure
Headaches
Sore breasts
Nausea and vomiting
A diabetic-like state in which carbohydrate metabolism is altered
Decreased libido ("sex drive") - this is ironic because sometimes women will start taking the pill thinking it will free them up to have more sex when, unfortunately, the pill causes them to desire less sex. This effect can last beyond the discontinuation of the pill.
Less common (but very serious) side effects:
Thromboembolism (blood clot)
Pulmonary embolism (blood clot in the lungs)
Heart attack
Stroke
Heart disease
Liver tumors
Gallbladder disease
Hypertension
Infertility
Long term impacts on the cervix’s ability to produce quality fertile mucus discharge necessary for achieving pregnancy
Long term use of the pill can cause aging of the cervix
None of this information is provided with the intention of making anyone feel scared, guilty or upset. Groesbeck FertilityCare Center believes that women have so much value and dignity that they deserve to have all of the information needed to make healthy reproductive choices and it has been our experience that women are often given the pill as a quick-fix “solution” and very rarely (if ever) know all of this information about the short term consequences, long term consequences and moral implications of the birth control pill. Next week we’ll talk about why the pill isn’t a great solution for any health condition and how to discontinue taking it.
Other references: Hilgers, Daly, Hilgers, Prebil. 2017. The Creighton Model FertilityCare System: A Standardized Case Management Approach to Teaching.
Hilgers, TW. 2002. Reproductive Anatomy & Physiology: A Primer for FertilityCare Professionals.
Smith, J. Contraception: Why Not? Audio Recording, 3rd edition. www.janetsmith.org
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