Millions of women have used ”the pill” to prevent pregnancy, manage hormonal challenges, and even to control acne. Dr. Jolene Brighten, the author of Beyond the Pill, explores little-known facts about the pill in an effort to empower women to balance their hormones and reclaim their bodies.
Dr. Brighten doesn’t advocate against its use, but she does offer insights on its effect on our health. She discusses little-known side effects like depression, low libido, brain fog, and fatigue. She talks about what it does to our bodies hormonally and energetically, and how it can impact future fertility. She suggests what your diet should look like while on it, and how to best transition off of it.
Listen to the episode here:
Within the below transcript the bolded text is Hilda
The birth control pill was approved for contraceptive use in 1960. Since that time, millions of women have used it to prevent pregnancy, manage hormonal challenges and even to control acne. This is Episode 291. Our guest is Dr. Jolene Brighten. Dr. Brighten is the author of the book, Beyond the Pill, which empowers women to balance their hormones and reclaim their bodies, whether they are on or have discontinued using the pill. Dr. Brighten isn’t against the pill altogether. She simply offers straightforward insights into its effect on our health. She discusses little known side effects from being on the pill like depression, low libido, brain fog and fatigue. She covers the big picture about what it does to our bodies, hormonally and energetically and how it can impact future fertility. She talks about diet and what’s best to eat to support your body while on the pill. She also offers suggestions for how to transition off of it should you decide to do so.
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Welcome to the show, Dr. Brighten.
Thanks for having me.
This is such a critical topic for women now. I am eager to dive into the pill and its effects on our health. I want you to tell us a story of a woman you know who tried unsuccessfully to come off the pill because she kept suffering from acne issues. Can you dive into that a little bit?
Hormonal acne is one of the big reasons women start hormonal birth control. As I’ve seen it, it’s one of the big reasons they feel stuck. They can’t come off. We had a reader write to us. She had been unsuccessful in coming off of birth control three times. She defined it as unsuccessful that every time her face broke out like she was a teenager once again, which was the main reason that she started birth control. After going through the 30-day protocol beyond the pill and implementing that, she took the leap and transitioned off once again. For the first time, she was able to come off of birth control without having deep cystic acne, red and inflamed skin. She did still get a few pimples here and there but she said it was nothing like it was previously. She was feeling incredibly hopeful because now she could enjoy clear skin and prepare her body for a family.
This is interesting to me because I thought most women went on the pill to avoid pregnancy. I didn’t know people got on it to try to rebalance their hormones.
That’s a big reason why women start hormonal birth control. Many of us think, “It’s great for pregnancy prevention. That’s why women are on it.” As it turns out when surveys have been done, women report that their primary reason is for symptom management, heavy periods, painful periods, acne, cyclical headaches. In some cases, my doctor didn’t know what to do so they gave me birth control.
What are some of the issues that the pill can cause that women aren’t told about?
One of the biggest ones is that the pill is associated with nutrient deficiencies. It can lead to deficiencies in folate, B12, magnesium, zinc, Vitamin C, to name a few. When we understand that we require all these nutrients, not only to run the basic systems of our body every day but also to thrive, this can have a tremendous impact on women’s health. We’re also not often told about the connection with autoimmune disease, how it can impact our microbiome. Being on hormonal birth control, that can be a triggering event for some women to develop things like Crohn’s disease, which is an autoimmune condition of the gut. There are a lot of ways that hormonal birth control impacts us. The simplest way to understand is that every single system in your body has receptors for hormones. Whether it’s your natural hormones or the synthetic ones in hormonal birth control, they can influence the performance of every single system of your body.
I was remembering my first experience with hormonal birth control was when I was in my twenties, I was in college and I was having amenorrhea. I was not having my period, I was not menstruating. The doctors didn’t know what to do. They handed me the birth control pill. I took it for a little bit but then I thought, “This is weird because from my understanding, the way it works is it tricks my body into thinking I’m pregnant, which is why I don’t menstruate until I’m off of it.” The cycles that it gives you like it tricks your body. I was like, “That doesn’t seem natural to me.” I got off of it, even though the doctor had given it to me. It’s an odd thing. Is that how it works? It tries to trick your body into thinking you’re pregnant?
When it comes to pregnancy, it’s different hormones. You’re higher in estriol, which is E3, than you are in estradiol and estrone. There are several different kinds of estrogen. The ones that we experienced in pregnancy is very different. You also have higher levels of progesterone. There’s no progesterone in any form of birth control. It’s progestin, which at a molecular level is different structurally and it behaves differently in the body. What you touched upon is an important point in that how does birth control work?
For birth control to stop you from ovulating, it elicits its effect at your brain level. That’s where birth control works. You take enough hormones as a negative feedback loop to the brain and tell us the brain not to talk to the ovaries. If that’s what’s going on, we don’t have a menstrual cycle while we’re on birth control. This is why doctors will say it’s fine to skip your period while you’re on birth control. It’s not a period. It doesn’t matter whether or not you have it because a period comes after ovulation and lack of fertilization of an egg.
There are these ebbs and flows of several hormones throughout your menstrual cycle. When you’re on hormonal birth control, you’re taking the same amount. It’s a static amount all day, every day until you hit that placebo pill. It’s not a real period. We now see that the endocrine society warns against using birth control in cases of amenorrhea because while it can induce a withdrawal bleed, which can be important for preventing endometrial hyperplasia so buildup of the endometrial tissue. If that’s an issue for that woman, it will mask what is going on and even worse, it will mask whether or not she was able to restore her period naturally.
It sounds to me like there are many consequences and we’re still about to go through them or effects from being on the birth control pill that hasn’t been communicated. Are they written on some little ingredient list? When the woman starts taking the birth control pill, is this information in the packet?
Yes, lots of it is contained in the package insert. I shared it in my Instagram stories. I was taking photos of a prescriber’s handbook that talks about how you should counsel women, her thyroid labs are likely going to change, nutrient deficiencies can develop, gas, bloating, constipation, diarrhea, nausea, vomiting, these are side effects as are mood symptoms. When it comes to the mood symptoms, this is something that we often see dismissed. Women are told, “These symptoms are in your head. It’s not birth control.”
That’s largely because we’ve had poor studies for a long time. We’ve never been able to say definitively that birth control does have a strong association until 2016. We had a large study come out of Denmark showing that women who begin hormonal birth control are about 23% more likely to have a diagnosis of depression after initiating it and be prescribed an antidepressant. We now come to understand that teens are at the highest risk. If you look at the package insert of some of these medications, the pharmaceutical companies warn that depression can be a risk.
If there is the onset of depression or the symptoms are severe, that you should consider stopping that particular form of birth control. Sadly, most women aren’t receiving that education, which is what I’m on a mission to do is I want women to know their body, to know their options and to make the best decision for themselves and feel supported in that. We can be pro-access for birth control for women at the same time that we’re advocating for education and informed consent.
Dr. Brighten, how did this issue come to the fore for you? How did this become your mission?
The funny thing is I spent ten years on birth control, the pill specifically myself. I talk about it in my book the slew of side-effects that I had while on it. For me, it’s what I felt was the best tool that I could achieve my goals. I’m a first-generation college student because of it. I look back at birth control and I can say, “Thank you, birth control, for being a tool that helped me personally. It was right for me.” Except that when I came off, I had a whole lot of issues with side effects while I was on it. When I came off, I developed cystic acne. I had never had acne issues before starting birth control. I lost my period. I had regular periods before starting birth control.
My doctor has only answered, “Do you want a baby?” “No.” “You should get back on birth control.” I’m like, “I did it for ten years and I’m ready to transition off.” My big reason is that I was sitting in class, and I’ll never forget sitting in naturopathic medical school and learning about fertility and how we’re only fertile one day out of the month is women. I thought to myself, “I’m not even sexually active. I can only get pregnant one day of the month, yet I take this birth control every single day. I want to know my body now without it.” After losing my period, going through hormonal chaos, the fallout of coming off of birth control, I leveraged my background in nutrition science and what I was learning in naturopathic school.
I restored my period. I cleared my skin. I went on to have a baby, something that my doctor was telling me that, “You likely had PCOS and you would never get pregnant naturally.” It was after I got into clinical practice that I came to observe that I had thought I was the only one but I wasn’t the only one. Before that, I spent two years in a homeless youth clinic prescribing a lot of birth control. When I went into private practice, I had said to my husband, “I’m done. I don’t want to have to manage birth control like this anymore. I’ll support women. They can see Planned Parenthood or see someone else. I am fatigued on all day, every day, birth control.”
I went on to write a book about it. I got the reputation of being the doctor who believed women’s birth control stories. Many years ago, when women were suffering from side effects and having issues when their doctors would tell them that it wasn’t real, they’d come to me. Whether or not I had a study to prove that what they were saying was true, I listened and thought, “How can I support this woman whether she wants to stay on birth control or come off of it?”
If someone reading this and they’re thinking, “I can relate to many of the symptoms that Dr. Brighten has mentioned. I want to get off the pill.” It sounds like you can’t hop off it and hope everything is going to be fine. There almost needs to be some transition protocol. Is that what you mentioned in your book?
As I talk about in Beyond the Pill, if you started birth control solely for pregnancy prevention not for symptom management, then you can stop it. You can get to the end of your pill pack and stop it then. Every woman who is sexually active with a male should have a backup method to protect against pregnancy. That should be step one when you’re considering coming off of birth control. If you did start birth control because you have cystic acne, you have endometriosis, you have heavy periods, you’re going to want to spend some time prepping your body before you make that transition.
That’s what I walk you through in Beyond the Pill is what can you do to be as successful as possible when you come off of hormonal birth control? Much of what you find in Beyond the Pill is right out of my chart notes from working one-on-one with patients who have done this. Having come from a research background, I made observations about my patients. I want to say I am grateful for them trusting in me in this process so that we can develop these protocols together. We found what works, in general, for most women. Knowing that when it comes to hormones, this is individualized that within Beyond the Pill, you’ll find quizzes and other resources to help you choose your own adventure. I set the book up so that you can build the user manual to your body and understand what works for you and what doesn’t work for you.
Everyone is of different ages and stages. What they’re looking for may be different as well. Let’s talk about a few more of the issues that the pill can cause that people aren’t told about. You mentioned thyroid concerns. What about a woman’s libido? Can that be affected by the pill?
Absolutely. Many of my patients joke that’s the real way birth control works is that you get on it and then you’re not even interested in sex. How can you get pregnant if you’re not sexually active? This is the mechanism by which it works. It’s why it can help when we have issues with androgen excess, which is too much testosterone and what gets termed like male sex hormones but women have those too. We see this commonly in conditions like polycystic ovarian syndrome and that can lead to acne, oily skin, hair growth on the chin, chest, abdomen, hair loss on the head. A lot of women will get prescribed birth control for this. That’s because birth control will down-regulate the production of testosterone in your body. You’re going to make less and then it will impact your liver’s expression of a protein called sex hormone-binding globulin.
Sex hormone-binding globulin will then go up. It’ll be elevated. Its job is to bind free testosterone and other free sex hormones. Your production of testosterone goes down. The increase in sex hormone-binding globulin follows and now we’ve got way less testosterone. That can affect our libido but it also can impact our mood. It can impact our muscle mass, our body composition. Testosterone is also a regulator of the immune system. It’s involved in our immune system regulation. This is part of why some experts believe you can see increased inflammation while on birth control. Yes, it can be inherently inflammatory itself to be bringing in exogenous estrogen so estrogen outside of your body. In addition to that, it shifts other hormones that are key players in the immune system.
The other question I wanted to ask you is I’ve heard that some people that go on the pill experienced a lot of fatigue and brain fog. Is that also an effect?
That can be related to the shifts that happen with your hormones overall like cortisol, thyroid and also the changes that happen in the gut. If you look in a drug prescriber’s handbook, this is what licensed clinicians who prescribe pharmaceuticals get to reference, you’ll see that fatigue is listed there and neurological issues like brain fog can be a side effect for some women, by way of shifting the free thyroid hormone that’s available and robbing you of some of these crucial nutrients, that can lead to lower energy production.
In addition to that, we can see brain fog. Some studies have shown that birth control pills specifically can impact COQ10 as part of the mitochondrial pathway and how we create energy. There are a lot of mechanisms at play. At this point in history, for as long as we’ve had birth control, there are a lot of questions that have been left on the answer that generations of women have been asking but science hasn’t come up to speed in answering.
Dr. Brighten, it surprises me that in any way, shape or form, you think it’s cool if people still want to use birth control with all the knowledge that you have of the potential side effects.
That’s what I get a lot. People are like, “How can you think that it’s okay?” I’m like, “I don’t live in her body and I don’t live in her house.” For me, having worked in a homeless youth clinic, this is something that many of us take for granted, the privilege that we have to close and lock a door at night. These women don’t have access to that. They are at higher risk of sexual assault. There are circumstances like that wherein those circumstances, these women elected for the Depo-Provera shot for as long as they could use it. It would shut down their menstrual cycle, which if you’re living on the street and you have to choose between tampons and pads, which are expensive and taxed or eating, you need to select eating.
Many of these women who are without a home are using things like cardboard for menstrual products. The high risk of sexual assault is the other thing that we have to consider as well. That experience has always kept me humble that I don’t know how to live another woman’s life better than her. If she is going to elect for using hormonal birth control, then it’s my job as a provider to support her, to track her symptoms and her labs and to make sure that she’s doing everything she can to stay safe on that.
I appreciate that. It makes me think there may be some folks reading who are like, “I’m not homeless but there are reasons I need to remain on the pill.” If that’s the case, what can they do to offset the effects?
That’s the cool part about being a modern woman is we do have all of these options and we know much more about how to support our bodies. Number one is eating a nutrient-dense diet. You want to replenish what is being lost while on these pharmaceuticals. Eating a nutrient-dense diet including lots of vegetables, getting in high-quality proteins and fats as well and considering taking a multivitamin or prenatal. When we are on medications that deplete nutrients, it’s important to be supplementing as part of your diet. It can often be hard to meet that loss with diet alone but your diet is important because when you’re eating these fiber-rich vegetables, that’s going to be supporting your microbiome, which takes a hit while you’re on birth control.
In addition to that, bringing in cruciferous vegetables and high-quality proteins are going to help you process these hormones through your liver. Your liver does a wonderful job at detoxing natural and synthetic hormones and that requires those certain nutrients happen to be some of the same ones that are depleted by hormonal birth control. Monitoring your symptoms is an important step. Being mindful of has my mood shifted. Are we starting to see changes in your cholesterol? Are we seeing elevations in your blood pressure? Some women are at higher risk for these things happening while on birth control. If you’re on it, you can’t get baseline lab testing like you would before you start it. That’s what I advocate for is track your symptoms for 1 to 3 months, get baseline lab testing.
When you get on birth control, follow-up on that. You live in your body. You’re walking around with some of the best data. You’re going to experience symptoms often far in advance of labs showing up abnormal. Always track your data and advocate for yourself. If issues start to come up, talk to your doctor about is there a formulation that might be better for you to change to? Are there other options that might be a better fit for your personal health history?
The last thing that I would say is making sure that you’re also moving your body, exercising, getting good sleep, doing these basic foundational things. Hormonal birth control is inflammatory. It does lower the risk of some cancers like ovarian and endometrial cancer, but it is associated with the increased risk of other cancers like liver, brain and breast cancer. Some of the most powerful anticancer practices that you can have are exercise and living a lifestyle where you’re happy, you’ve got the community and you are safeguarding your overall circadian rhythm as well.
You’re like I’m preaching to the choir when it comes to some of these things because we are all about nutrient density, movement, sleep and getting aligned with a proper circadian rhythm. We’re all about those things. A lot of our readers are like, “That’s one thing I do.”
When it came to nutrient density, I know with your audience, I don’t have to spend a lot of time talking about a nutrient-dense diet.
These folks are on point with all of that. Let’s say someone’s like, “I’ve been on the pill but I’m ready to come off it and ready to start my family.” How will fertility be affected when they come off the pill?
This is always a big question where we don’t have any research that says that birth control will impact your future fertility. At this place, we don’t have the science to support the notion that birth control could lead to infertility. What we do need to recognize is that when we use hormonal birth control for symptom management without ever asking why we may well be masking an underlying condition that can lead to infertility. If you’re having irregular periods that could be due to PCOS or thyroid disease, birth control isn’t going to address the underlying issues of that. If you’re having painful periods that could be due to endometriosis, birth control may be a great tool for you to help manage those symptoms. At the same time, that’s not going to address the adhesions that could compromise your future fertility. That’s one piece of it.
The other piece is that there have been studies showing there is a delay in regaining your ovulation once you stop birth control. On average, we expect that it can take three months to get your period back after you stopped birth control. If your cycles were predictable and regular before you started, if they were irregular, it could take up to six months for you to start ovulating and menstruating again. Some research has even pointed to as much as eighteen months before women start ovulating. This is important to note because why do we use birth control? There’s the symptom management piece but there’s also to delay pregnancy.
We do see some women who are in their later 30s who come off of birth control and when they were put on it at eighteen, their doctor said, “No problem with your fertility. As soon as you come off, you’ll be able to get pregnant immediately.” Decades later, that may not be true for her anymore. If we know that it could take a year and a half then we want to have that conversation sooner to say, “Maybe we want to transition off at 35, start to support your body. Examine, do we have any underlying issues that could make getting pregnant more difficult or your pregnancy more difficult altogether?” We cannot say that birth control causes infertility but there are ways that it could impact you in terms of how it’s being used and the other variables in your life like how old you are when you decide to come off and start trying to conceive.
If you come off at 39 and you’re expecting to get pregnant tomorrow, most couples on average take around six months to be able to become pregnant. That’s why I always giggle when doctors are like, “You’ll come off of it. You’ll be able to get pregnant the next month.” The average couple with nothing wrong, nothing going on takes about six months. It’s this level of education that we need to provide to women so that when they want to have a family, they can be strategic and planning that. That’s the benefit of being a modern woman. We do have the ability to do that.
I’m grateful that you are informing people about their choices and how to manage them. If they’re on the pill, what to do when they want to come off of it? Dr. Brighten, thank you so much for your time. I want to ask you one more question. If you could offer the reader one piece of advice, one step they could take in the direction of living a healthier life, vibrant, the best possible version of themselves, what would you say?
I would say that you live in your body and you are the authority on what is normal and what is not normal for you. Advocating for yourself and tracking your data so that you know, if you eat this, how do you feel? There’s a lot of great information out there but we always need to be viewing it through the lens of what is true for me. That even happens in a doctor’s office as well. One of the most powerful things that you can do to move closer to a state of healthier being is to understand what is true for you and what is not true for you, so that you can make better-informed decisions every single day.
We’ve got to do some deep listening to our bodies and that’s wonderful advice. Thank you for your time, Dr. Brighten. I appreciate it.
Thank you. It’s such an honor to speak with you and your community.
* Please note one piece of information not discussed in the podcast, but included in the insert of the pill. The hormonal birth control pill ’prevents the implantation of a fertilized embryo’.