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Running head: EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 1

Effects of hormonal contraception on the female body

Misty C. Williams

Midwives College of Utah


EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 2

Abstract

Hormonal birth control options have been available to women since the advent of the first Combined

Oral Contraceptive Pill (COCP) in 1957, approved by the FDA for treatment of menstrual dysfunction

(Buttar & Seward, 2009), (Wikipedia.org, 2018). The following is a review of current literature

concerning the various types hormonal contraception currently available to women, their possible

harmful effects, their likely non-emergent effects in both the long- and short-term with concluding

remarks by the author.

Keywords: The pill, the minipill, ring, IUD, patch, injection, implant, hormonal, progestin,

estrogen, pill, Yaz, Yasmin


EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 3

Contents

Abstract ........................................................................................................................................... 2

Figures: ........................................................................................................................................... 3

Effects of hormonal contraception on the female body .................................................................. 4

Types of Hormonal Contraception .................................................................................................. 4

How they work ............................................................................................................................ 5

Common effects of hormonal contraceptives ................................................................................. 6

Acute health risks related to hormonal contraceptive use .............................................................. 7

Conclusion ...................................................................................................................................... 9

References ..................................................................................................................................... 10

Figures:

Figure 1 Contraceptive Method Choice (Guttmacher Institute, 2017) ....................................................... 4

Figure 2 Natural fertility cycle (generalized) without hormonal birth control. (Triage Method.com,

2017) ........................................................................................................................................................... 5

Figure 3 Fertility cycle with use of COCPs (Amy Meyers, MD, 2015) ..................................................... 5
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 4

Effects of hormonal contraception on the female body

Until the 1950’s there were no options for hormonal birth control available. Birth control was not

a widely supported idea in many ways, and even in 1957 when Enovid was approved for the treatment of

menstrual dysfunction, it was only used off label for birth control, and only for married women. By 1960,

“the Pill” was made available to women regardless of relationship status specifically for the purpose of

birth control. (Buttar & Seward, 2009), (Wikipedia.org, 2018). The availability of COCPs gave women

control over their reproductive health and sexuality like they had never had before, but this freedom did

not come without risks.

Types of Hormonal Contraception

Since the 1950s development of hormonal contraceptives has become a $19 billion-dollar annual

global industry that shows every sign of continuing to expand, with projections of reaching $33 billion

annually by 2024 (Daré Bioscience, 2017).

Once available, use of the “Pill” expanded

rapidly for many years while other hormonal

methods of pregnancy prevention were

developed (The Family Planning

Association, 2016).

The original “Pill”, Enovid was first

FDA approved specifically for contraceptive

use in 1960 (Buttar & Seward, 2009),

although it was still not widely available to

unmarried women. As time went on, other

methods were being tested and made


Figure 1 Contraceptive Method Choice (Guttmacher Institute, 2017)
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 5

available, with perhaps not enough research in advance of release. To date the methods of hormonal

contraception that are most commonly used in the U.S. are oral contraceptives, injections, vaginal rings,

implants, patches, with increasing use of hormone emitting, copper IUDs (Guttmacher Institute, 2017).

How they work

Hormonal birth control functions in the body by introducing

synthesized hormones into the bloodstream that prevent ovulation,

thicken cervical fluid to prevent sperm penetration into the uterus,

and by changing the lining of the uterus to prevent implantation if

an ovum should be released and become fertilized (University of

Washington, n.d.).

The synthesized hormones limit or halt the production of the Figure 2 Natural fertility cycle (generalized)
without hormonal birth control. (Triage
gonadotropins follicle stimulating hormone and luteinizing hormone Method.com, 2017)

(University of Washington, n.d.). These normally work with the natural rise of estrogen, followed by a

sharp drop in estrogen, and a rise in progesterone in the body during the fertility cycle to cause an ovarian

follicle to mature, extrude an ovum, and provide support for a potentially fertilized egg during the luteal

phase (Weschler, 2015, p. 46-48). With the gonadotropin-suppressing levels of synthesized estrogen and

progestin found in COCPs, as well as combined hormone

implants, injections, vaginal rings and patches, ovulation

is prevented, thus preventing pregnancy (University of

Washington, n.d.), (Amy Myers MD, 2018). These

Figure 3 Fertility cycle with use of COCPs (Amy Meyers, MD, synthesized hormones also cause thickening of the
2015)

cervical fluid, which aid in preventing sperm from

reaching the uterus also working to prevent pregnancy. (University of Washington, n.d.)
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 6

In low dose progestin only medications, the mechanism of action is to thicken the cervical fluid to

prevent sperm from reaching the uterus (University of Washington, n.d.).

Common effects of hormonal contraceptives

As with any pharmaceutical, hormonal birth control is not without “side” effects or known effects

of the drugs that are not specific to affecting the condition treated. Some women experience these as mild

others experience them as having a tremendous effect on quality of life. Janssen Pharmaceuticals is the

manufacturer of the most commonly prescribed COCP in the United States, Ortho Tri-Cyclen Lo (NCBI,

2012). On their website, https://www.thepill.com/ they list the following as the “most common” side

effects of regular use of Ortho Tri-Cyclen Lo:

 Headache/migraine  Dysmenorrhea
 Nausea and vomiting  Mood changes/depression
 Breast problems  Acne
o Tenderness, pain, and discomfort  Vaginal infections
o Enlargement and swelling  Bloating
o Discharge  Weight gain
o Nipple pain  Fatigue
 stomach pain

The second most commonly prescribed COCP in the U.S. is Yasmin, manufactured by Bayer

(NCBI, 2012). On their information sheet, retrieved from the Bayer HealthCare Pharmaceuticals Inc.

website (https://tinyurl.com/yccfk8ma) they state that the most common side effects of Yasmin are

spotting between menstrual periods, nausea, breast tenderness and headache. Other less common, but

non-threatening side effects are listed as:

 Acne  Elevated blood cholesterol levels


 Decreased Libido  “Depression, especially if you have had
 Bloating or fluid retention depression in the past. Call your
 Blotchy darkening of the skin, especially healthcare provider immediately if you
on the face have any thoughts of harming yourself.”
 Elevated blood glucose levels especially in  Problems tolerating contact lenses
women with diabetes  Weight gain
Running head: EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 7

Acute health risks related to hormonal contraceptive use

Each of the medications above list more serious as well as more rare effects that pose acute

health risks to some women who take the medications. As of 2013 Bayer has paid out $1.4 billion in

lawsuits related to use of Yaz, Yasmin and Ocella oral contraceptive pills due to numerous pulmonary

thromboembolic events in women using their products (Top Class Actions, 2013). It is believed that the

primary cause of these thromboembolic events is the drug drospirenone (Top Class Actions, 2013).

Drospirenone is a combination drug made up of a synthetic spironolactone analogue and a synthetic

progestin hormone (National Center for Biotechnology Information, 2018). Lawsuits claim that the

exact mechanism of this combination drug in the human body are not well known (Top Class Actions,

2013), in spite of it having gained FDA approval in May of 2001 (Center watch, 2018). The FDA has

updated information about drospirenone several times, and issued statements that reflect incidents of

thromboembolic events in somewhat more strongly worded warnings of this possible effect of the drug.

Bayer and Janssen have similar lists of possible serious side effects of these most commonly

prescribed medications. They are as follows:

Janssen “The Pill” (ThePill.com, 2016) Bayer “Yasmin” (Bayer HealthCare


Pharmaceuticals Inc., 2017)
 Liver problems including rare tumors,  High blood pressure
jaundice, yellowing of skin or eyes
 High blood pressure  Gall bladder problems
 Gallbladder problems  Rare malignant or benign liver tumors
 Changes in cholesterol or glucose levels
 New or worsening headaches or migraines
 Depression
 Possible cancers of breast or cervix
 Swelling of skin around eyes, mouth or
throat
 Dark patches of skin around forehead,
nose, cheeks, or eyes (use sunscreen in
sunlight)
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 8

Each manufacturer also has a list of signs/symptoms that should prompt an immediate trip to a

hospital emergency room:

Bayer “Yasmin” (Bayer HealthCare


Janssen “The Pill” (ThePill.com, 2016)
Pharmaceuticals Inc., 2017)
 Leg pain that will not go away  Persistent leg pain
 Sudden severe shortness of breath  Sudden shorness of breath
 Sudden change in vision or blindness  Sudden blindness, partial or complete
 Chest pain  Severe pain in your chest
 Sudden severe headache not like usual  Sudden, severe headache unlike your
headaches usual headaches
 Weakness or numbness in arm or leg  Weakness or numbness in arm or leg, or
trouble speaking
 Trouble speaking  Yellowing of the skin or eyeballs

Also, each manufacturer includes warnings concerning existing medical conditions that are

contraindications for the use of their drugs. These include women who smoke and who are 35 or over,

women who have ever had a thromboembolic event; have ever had a heart attack or stroke; have high

blood pressure that cannot be controlled with medicine; have heart valve or rhythm abnormalities; have

diabetes with kidney, nerve or eye damage; who have or ever have had breast or other cancers sensitive to

female hormones; have liver problems, including tumors; have unexplained vaginal bleeding; take

Hepatitis C medications; have kidney or adrenal disease and finally if one is pregnant, they should not

take these medications (ThePill.com, 2016), (Bayer HealthCare Pharmaceuticals Inc., 2017).

It is interesting to note that both manufacturers point out in detail that while thromboembolic

events do sometimes occur while taking these medications, each has about the same risk of producing

thromboembolic events as is found in women who do not take these medications, as well as in women

during childbearing. Bayer further asserts that there is a greater risk of thromboembolism during the first

12 weeks postpartum than there is while taking Yasmin consistently over a year. (Bayer HealthCare

Pharmaceuticals Inc., 2017)


EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 9

This paper has specifically examined the two most commonly prescribed COCPs, however it

should be noted that the same synthesized hormones and chemical mechanisms are at work in implants,

injections, patches, vaginal rings, and drug-emitting IUDs. (NCBI, 2012)

Conclusion

There are many chemical methods of birth control available in today’s market (NCBI, 2012),

(Guttmacher Institute, 2017). They all appear to carry the same risks/benefits, irrespective of their mode

of delivery. While dosages almost certainly must be taken into account when one considers risks, this same

consideration must be applied to the effectiveness of the medication over the long term. In the opinion of

this author, for pregnancy prevention, it would be wiser and perhaps safer to rely upon more “old fashioned”

methods of pregnancy prevention. The only 100% certain method of birth control is abstinence. Barrier

methods are quite reliable; for example, condoms have a 2% failure rate, as does the Fertility Awareness

Method of tracking one’s fertility cycle (Weschler, 2015, p. 413). The means to prevent pregnancy without

introducing synthesized hormones or other chemicals that bring with them the possibility of health risks

and allowing the body to function naturally are widely available. These methods do not carry any greater

risk of thromboembolic events than any woman would have on any given day. These methods carry no

risk of worsening dysmenorrhea, headaches, migraines, causing or exacerbating high blood pressure, acne,

bringing mood swings, or depression. It is this author’s opinion, and it is only an opinion, that for all the

ease and convenience chemical pregnancy prevention drugs can offer, they are not worth the risk to health,

well-being or quality of life that may be present while using chemical pregnancy prevention drugs.

However, it is up to each woman to determine for herself which means of pregnancy prevention she will

employ that will fit her own lifestyle and align with her personal needs and choices.
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 10

References

Amy Meyers, MD. (2015). Hormones_BirthControl.jpg [diagram]. Retrieved from

https://www.amymyersmd.com/wp-content/uploads/2015/12/Hormones_BirthControl.jpg

Amy Myers MD. (2018, February 20). What you need to know before taking birth control pills - Amy

Myers MD. Retrieved from https://www.amymyersmd.com/2015/12/birth-control-pills/

Bayer HealthCare Pharmaceuticals Inc. (2017). Highlights of prescribing information. Retrieved from

Bayer HealthCare Pharmaceuticals Inc. website: https://tinyurl.com/yccfk8ma

Buttar, A., & Seward, S. (2009, January 20). Enovid: the first hormonal birth control pill | The Embryo

Project Encyclopedia. Retrieved from https://embryo.asu.edu/pages/enovid-first-hormonal-birth-

control-pill

Center watch. (2018, April 12). Yasmin new FDA drug approval | CenterWatch. Retrieved from

https://www.centerwatch.com/drug-information/fda-approved-drugs/drug/705/yasmin-

drospirenone-ethinyl-estradiol

Conrad Stöppler, M., & Shiel, W. C. (2015, February 2). Hormonal methods of birth control center by

MedicineNet.com. Retrieved from

https://www.medicinenet.com/hormonal_methods_of_birth_control/index.htm#what_are_the_si

de_effects_of_the_pill

Daré Bioscience. (2017). Contraceptive market. Retrieved from

https://www.darebioscience.com/contraceptive-market

The Family Planning Association. (2016, December 1). Contraception: past, present and future

factsheet. Retrieved from https://www.fpa.org.uk/factsheets/contraception-past-present-future

Guttmacher Institute. (2017, September 21). Contraceptive use in the United States. Retrieved from

https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 11

Guttmacher Institute. (2017). Contraceptive method choice [chart]. Retrieved from

https://www.guttmacher.org/sites/default/files/styles/scale_900x720/public/images/contraceptiv

emethodchoicechart.png?itok=kuWZWdW4

National Center for Biotechnology Information. PubChem Compound Database; CID=58. (2018, April

12). Spironolactone. Retrieved from https://pubchem.ncbi.nlm.nih.gov/compound/5833

National Center for Biotechnology Information. PubChem Compound Database; CID=68873. (2018,

April 12). Drospirenone. Retrieved from

https://pubchem.ncbi.nlm.nih.gov/compound/Drospirenone#section=Top

NCBI. (2012, December). Types of combined oral contraceptives used by U.S. women. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469779/

ThePill.com. (2016). Reliable birth control. Daily assurance. Retrieved from https://www.thepill.com/

Top Class Actions. (2013, October). Bayer pays out $1.4 billion in Yaz lawsuit settlements. Retrieved

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billion-in-yaz-lawsuit-settlements/

Triage Method.com. (2017). [diagram]. Retrieved from http://qecosmeticos.com.br/wp-

admin/images/menstrual-cycle-diagram-with-ovulation-

536.jpeghttps://i2.wp.com/triagemethod.com/wp-content/uploads/2017/02/Overview-

ofPhysiology.png?w=500&ssl=1

University of Washington. (n.d.). Hormonal contraception. Retrieved from

https://courses.washington.edu/conj/bess/contraception/contraception.htm

Weschler, T. (2015). Taking charge of your fertility: The definitive guide to natural birth control,

pregnancy achievement, and reproductive health. New York, NY: William Morrow, an imprint

of HarperCollins.
EFFECTS OF HORMONAL CONTRACEPTION ON THE FEMALE BODY 12

Wikipedia.org. (2018, March 13). Hormonal contraception. Retrieved from

https://en.wikipedia.org/wiki/Hormonal_contraception