Authored by Gina Lombardo
It is widely believed that hormonal birth control is prescribed for a singular purpose: to prevent pregnancy. Introduced in the early 1950s, birth control, more commonly known as “the pill,” was created to be the first pharmaceutical drug used for contraceptive purposes. This pharmaceutical innovation changed medicine forever, launching a new era of reproductive autonomy for women. Since its inception roughly 75 years ago, clinicians have prescribed birth control for various off brand uses, which rapidly promoted its use among women of all ages. Over the past decades, doctors have prescribed the pill to treat dysmenorrhea, acne, irregular or excessive menstrual bleeding, hirsutism, endometriosis and more [1]. However, with a recent shift towards more holistic health practices and growing public distrust in big pharma, women everywhere have begun to question the safety and long term side effects of the pill and other hormonal contraceptive methods.
Hormonal birth control methods are primarily used in pregnancy prevention and can be taken by mouth, injection, inserted under the skin, or placed on the skin as a patch. Contraceptives work due to their hormonal active ingredients, which are ethinyl estradiol (a type of estrogen) and progesterone. Despite the differences in their chemical makeup, all hormonal contraceptive methods work by slowing ovulation and thickening the endometrium, thus decreasing the chance of pregnancy [2]. But at what cost? Critics argue that despite its use for pregnancy prevention, the pill is prescribed far too often, used as a Band-Aid to mask serious health issues in women, and does not address root causes of illness. While all drugs are not created equal, ingesting synthetic hormones have both short-term and long-term effects that should be seriously considered.
There are a slew of side effects women experience when they first begin to take the pill. Sometimes these symptoms subside after a few weeks or months, but they have also been shown to persist throughout the duration of taking the drug. Side effects such as weight gain, headaches, mood changes, depression, anxiety, acne, nausea, and irregular menstrual cycles have all been reported while on birth control [3]. However, this information is nothing new, as both patients and providers are fully aware of the short-term implications of taking the drug. It is the long-term effects that are becoming a cause for concern.
Various types of cancer, thyroid dysfunction, and blood clots are more prevalent in women who have had prolonged use of hormonal contraception. In a 2019 study conducted in China, researchers found that both pre- and post-menopausal women who had used at least one hormonal contraceptive method were at a significantly higher risk for breast cancer [4]. In another study, a statistically significant relationship between the use of oral contraceptives and the development of cervical cancer was observed [5]. The link between hormonal contraceptives and thyroid dysfunction is also convincing, as scientists were able to identify the effect of birth control on the proliferation of human papillary thyroid cancer (PTC). A 2020 study published in the Galen Medical Journal found that ethinyl estradiol in hormonal birth control increased the proliferation and migration of PTC cells and inhibited apoptosis. This suggests that hormonal compounds may play a role as promoting factors for PTC tumors [6]. Risk of hypothyroidism is also strongly associated with the use of hormonal birth control, especially for more than 10 years [7]. Hormonal compounds in contraceptives have also been proven to be coagulation factors, leading to increased risk of blood clots which can result in heart attack, stroke, and even death [8]. Questions surrounding post-pill infertility are also starting to arise, as recent generations of women have had much higher infertility rates compared to previous generations who did not take hormonal birth control [4].
Although the literature on the long term side effects of hormonal contraception is still growing, it is safe to say that women everywhere should weigh the pros and cons of being on birth control. While pregnancy prevention is a legitimate use for the drug, its prescription for various off label uses should be seriously reconsidered. The overprescription of this medication is potentially harmful for women, and in turn, the population at large.
References
Mishell D. R., Jr (1993). Noncontraceptive benefits of oral contraceptives. The Journal of reproductive medicine, 38(12 Suppl), 1021–1029.
Benagiano, G., Bastianelli, C., & Farris, M. (2008). Hormonal contraception: present and future. Drugs of today (Barcelona, Spain : 1998), 44(12), 905–923. https://doi.org/10.1358/dot.2008.44.12.1299292
Nappi, R. E., Tiranini, L., Sacco, S., De Matteis, E., De Icco, R., & Tassorelli, C. (2022). Role of Estrogens in Menstrual Migraine. Cells, 11(8), 1355. https://doi.org/10.3390/cells11081355
Yuan, X., Yi, F., Hou, C., Lee, H., Zhong, X., Tao, P., Li, H., Xu, Z., & Li, J. (2019). Induced Abortion, Birth Control Methods, and Breast Cancer Risk: A Case-Control Study in China. Journal of epidemiology, 29(5), 173–179. https://doi.org/10.2188/jea.JE20170318
Gierisch, J. M., Coeytaux, R. R., Urrutia, R. P., Havrilesky, L. J., Moorman, P. G., Lowery, W. J., Dinan, M., McBroom, A. J., Hasselblad, V., Sanders, G. D., & Myers, E. R. (2013). Oral contraceptive use and risk of breast, cervical, colorectal, and endometrial cancers: a systematic review. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology, 22(11), 1931–1943. https://doi.org/10.1158/1055-9965.EPI-13-0298
Hedayati, M., Rajabi, S., & Nikzamir, A. (2020). Papillary Thyroid Cancer-Promoting Activities of Combined Oral Contraceptive Components. Galen medical journal, 9, e1648. https://doi.org/10.31661/gmj.v9i0.1648
Qiu, Y., Hu, Y., Xing, Z., Fu, Q., Zhu, J., & Su, A. (2021). Birth control pills and risk of hypothyroidism: a cross-sectional study of the National Health and Nutrition Examination Survey, 2007-2012. BMJ open, 11(6), e046607. https://doi.org/10.1136/bmjopen-2020-046607