#106: The Real Truth About Birth Control

Hi, I'm Dr. Tabitha, the gutsy gynecologist. I'm a triple board certified, OB, GYN and Functional Medicine physician. I've embraced the world of functional medicine and wellness through my own personal health journey. And I'm super excited to share my wisdom and unique perspective as it pertains to women's health. After caring for thousands of women, I've come to realize that your gut health determines your gyne health and your overall health. And it's a super gutsy thing for me to go against conventional gynecology practice to bring you the truth. No more band aid medicine, ladies. We're talking root cause resolution on this show. So if you're struggling with hormone imbalance, weight gain, period issues, anxiety, insomnia, you name it, then you've come to the right place. And I want to be your gutsy gynecologist. So welcome. All right, welcome back, ladies. This week we're going to talk about birth control pills and birth control in general. I have gotten asked to do this podcast by quite a few of you, so thank you so much for your DMs and for letting me know what you want to know about, because that is what I'm doing. I'm here for you. So let's talk about birth control today. But first, I just want to share one of my favorite reviews that I got. It's a five star, says an amazing find. So that makes me happy. It's from super excellent. That's cute. So needed this. She is insightful and educational. Thank you so much. Oh my gosh. That just fills my heart. This is why I do this. I am here for you ladies and I want you to be educated. I want you to have the full informed consent when you sign up to take birth control pills or get an IUD or have surgery or whatever your gynecologist is talking you into. I want you to be fully informed before you make that decision. And if you've already made that decision and now you're realizing that you weren't fully informed, that's okay. It's never too late to change and do something different. Sometimes, sometimes we have to deal with the consequences of those decisions. Right? But all we can do is move forward. That's like one of the biggest lessons I've learned in my life is you cannot dwell on the past. Like, literally, I've had a lot of bad stuff happen to me in my life. I've had a lot of struggles. I've made a lot of bad decisions. And literally, you cannot dwell on them. You cannot beat yourself up over them. All you can do is start making better choices going forward and learn from those mistakes. Like that is the key is to learn. I always say fail forward. If you're not learning, you're repeating. And so, you know, I have this unique perspective, you guys, because I used to be a conventional gynecologist and I handed you the birth control pills as a band aid to all your symptoms. I did surgeries that probably shouldn't have been done because other things were the root cause issue and that was not really going to fix the problem. But once you know better, you do better. And so I'm here with my tail between my legs saying, you know what, I did the best that I could at the time with the information that I had. And I think most gynecologists are, I think most gynecologists care about you and want you to do well. Obviously there are doctors who are a little bit ego driven, right. And they're more self concerned. But I'm not saying your doctor doesn't care about you. What I'm saying is they might not be informed because they might be trained, you know, in antiquated medicine. I know I was practicing the same way doctors were practicing 50 years ago. Not a lot has changed in that sick care broken system. And so all we can do is realize the truth and move forward. So I think it's super important for you to be fully informed when you're putting birth control in your body because it is a big deal. There's long lasting consequences for a lot of women. I see this more and more. The infertility rates are through the roof, the hormone imbalances are through the roof. You know, definitely listen to my other episodes for reasons behind all that. But birth control is one of them. So let's get into it. There's barrier methods. There's pills, IUDs, injections, implants, there's permanent sterilization. So let's talk about all of it. Okay, so barrier methods are what is preventing the sperm from getting to the egg. Typically that's condoms, so cervical caps, sponges, spermicides, and IUDs and diaphragms. So one of my favorite barrier methods is a diaphragm. Believe it or not, I was actually given a diaphragm when I was 18 years old. After I had my baby in 11th grade, my doctor gave me a diaphragm and said good luck. And somehow by the grace of God, I didn't get pregnant again. Honestly, I think the diaphragm works really well. So it's a barrier method. It prevents the sperm from getting to the egg. You do need to use it with a spermicide for maximum effectiveness. And it kind of takes the spontaneity out of things because you got to know you're going to be intimate, right? So you have to have time to go put it in and then you have to leave it in for like four to six hours afterward. But say you're having sex at night, you can just leave it in, go to sleep and take it out in the morning. And that gives this sperm ample time to be killed off. So, you know, it's a little bit cumbersome, but I would say it's a really good option if you're trying to avoid hormones. So back in the day, you used to have to have a pelvic exam and they would decide what size diaphragm you would get and then you would get a prescription for that. Now there's something called the Kaya diaphragm. It's C, A, Y, A and it fits like almost all women. So it's pretty cool. You don't need a pelvic exam, you don't need to be fitted for it. So even if your gynecologist doesn't normally prescribe diaphragms and they're not used to that, they can prescribe you the Kaya. It's super easy and they have it at Target and CVS and Walgreens and all those places and you just use it. So it's a super good option. If you're trying to avoid hormones I mentioned you could do the over the counter sponges and spermicides and condoms and all of that stuff. And their effectiveness is very much dependent on the user and are you using it as instructed or not? And so typically you're protected like 85 to 95% of the time. So it's not the most effective, but it's pretty darn good. You can add in cycling like the rhythm method with that. So if you know when your period is, if it's regular, every month, every 28 to 30 days, days, and you know when you ovulate, then you can avoid intercourse during that time. Typically you want to start avoiding two days before you ovulate because sperm can live in the vagina and uterus for up to two days and then you want to wait at least two to three days after you ovulate because the egg lasts for a few days after you release it. And so if you know when you're Going to have your period and you're super consistent. The rhythm method can be very helpful. Putting that on top of a barrier method, you're good to go. So birth control pills, this is probably where I get the most questions. So, you know, birth control pills are great for birth control. They do prevent pregnancy. But I want you to understand what you're signing up for, because so many of us are not on them for a short term. We're on them sometimes our entire reproductive life, you know, 20 years or more. So I really want you to know what you're signing up for. So birth control pills are synthetic hormones and they shut down the communication between your brain and your ovaries. So normally your brain and ovaries talk to each other by the hormones they produce. This is called the HPO axis, hypothalamic pituitary ovarian axis. And that communication is very important to keep your cycle balanced. So the birth control pill does not regulate your hormones. That is a myth. It shuts down their production completely and overrides the system. And so we, what we have come to realize is that you're on this for 5, 10, 15 years and you try to come off of it. Sometimes the brain and the ovaries, they don't talk to each other when you come off of that pill because that system has been down for so long, they don't even know how to communicate. And so often women will come off the birth control pill and not have a period, or they'll have just scant bleeding here and there, or it's super irregular. And what's happening is your brain and your ovaries don't know how to communicate properly. They don't know how to respond to each other. And so you're not getting a consistent regular cycle. Sometimes your androgens can be elevated, your testosterone particularly, and that can cause PCOS induced birth control. So a lot of issues are associated with long term birth control use. I'm seeing fertility infertility just rise because of this. So it's really important for you to understand what you're signing up for. And I recommend only using it for birth control for the shortest duration that you need it. The other main issues with birth control pills and all synthetic hormones that you're putting in your body are it causes gut dysbiosis and leaky gut. So it destroys the lining in your intestines, called your epithelial lining. And if you have leaky gut, that makes you susceptible to turning on autoimmune diseases. If you have the genes for it, like Hashimoto's celiac lupus rheumatoid. And it creates food sensitivities and systemic inflammation in your body. Systemic inflammation is the root cause for cardiovascular disease, cancer, diabetes, all of these things. And so synthetic hormones, long term, are really not safe. I don't recommend them. So if you're on them, I definitely want you just to be aware of what you're signing up for. And I would say, like, focus on good gut health. Make sure you're not eating processed the garbage food. Make sure you're doing everything you can to keep that gut lining healthy. And sometimes that looks like supplementation, managing your stress better, things like that. The other main issue with birth control pills is that they deplete really important vitamins and minerals, namely B vitamins and magnesium and zinc and selenium. So those are super important for energy production and thyroid function. So this is what I see go hand in hand, ladies. A woman is on a birth control pill for 10 or 15 years. She develops a thyroid issue. Her doctor says, oh, your thyroid is just sluggish. And then that woman gets exhausted, she can't function. She's barely making it through the day, she's gaining weight, she's losing hair. And so much of it can be attributed to that birth control pill that she was on for so long. Because that combination of vitamin and mineral deficiencies, leaky gut, autoimmune disease, all of it culminates into this thyroid dysfunction. Picture this chronic fatigue picture all of it. The amazing thing is it's all reversible. So please don't lose hope, okay? But I do want you to be aware that if you don't have enough vitamins and minerals, then your body can't do the processes that it needs to do all day long, every day. And so it's super important. If you are on a birth control pill and you're going to continue, please take a high quality, like nutraceutical grade multivitamin with methylated B vitamins. And that will make so much difference for you whether or not you're gonna like go on to develop this like fatigue picture like so many women are struggling with right now. They're just tired and they're overweight and they can't, no matter what they do, they just can't figure it out. So that is one way to hopefully prevent that if you're on the pill. I honestly think every woman needs a multivitamin, high quality multivitamin, not one from your corner drugstore. Those kinds of supplements are filled with heavy metals and fillers such as gluten and other toxicants. So you need something that's high quality, that's third party tested on the regular. You need good quality supplementation. You're just not going to get it from your diet. So that's my spiel on the birth control pill. So you could do barrier methods, you could do a pill, you could do a vaginal ring. So NuvaRing is essentially a birth control pill in ring form. So those are the same as synthetic hormones. They have the same risks and side effects. They have the same potential for vitamin and mineral deficiencies and leaky gut and hormone imbalance trying to come off of them. There are shots like the Depo Provera shot. Depo Provera is just a progestin. There's no estrogen in it. So progestin only would be a Depo shot or a Norplant implant. It goes in your arm. It looks like a little matchstick. They used to do Implanon and before that it was Norplant. There was six of them. So they've got it down to having less things put in your arm, but it's still just a synthetic progestin that gets slowly released day after day over time. So here's the deal. Estrogens grow the lining of your uterus, and they grow other things. Estrogen is a growth hormone. It grows your boobs, it grows your hips, it grows your uterus lining. It's preparing to get you pregnant. Progesterone is your balancing hormone to estrogen, so it keeps that growth in check. Progesterone prevents the lining from growing too thick. When you use a birth control that is only a progestin. And progestins are synthetic progesterone. There's a huge difference. They don't talk about that in conventional gynecology. Your gynecologist might not even realize the difference, but there's a huge difference when I use those words. Try not to get confused, but either way, these synthetic progestins prevent the lining of your uterus from growing. And without any estrogen to balance that progestin, sometimes the lining gets too thin and you bleed through it because all the little thousands of arteries that are in your uterus, those get exposed and they start bleeding because there's nothing to stop that bleeding, because there's no estrogen. And so it's really common with a Depo shot or Nexplanon rod to have breakthrough bleeding or to have bleeding constantly that just never stops. The goal is for you to have no bleeding. That would look like the lining getting thin enough that nothing is growing, nothing is shedding every month, and that it's not too thin that you're bleeding through, that your arteries are exposed. And bleeding through that is the same idea as in hormonal IUD. Morena, Kylina, Skyla, those are all super popular hormonal IUDs. They have a synthetic progestin in them, just like the depo shot and the nexplanon rod. It gets slowly released day after day. The difference is that with the iud, your synthetic progestin is getting released inside the uterus where that lining is. And the companies will tell you that it only works locally on the uterus to prevent that lining from growing. And so hopefully, you either have super light periods or no periods, because you're not growing any lining to shed. The problem with that is your ovaries are literally 1 to 2 inches away with a big fat artery connecting them. And so that synthetic progestin goes into the bloodstream and goes directly to the ovary, and it tells the ovary, wow, we have a lot of progestin in here. You don't need to make any more hormones. And so it's really common for those IUDs to actually shut down that HPO axis I was telling you about, and you stop making your hormones. Most women notice that they make less testosterone. They have no libido, they're not interested in sex. Same thing when you're on a birth control pill, that testosterone production goes in the tank, and so you don't have any libido. So I just want you to keep that in mind, because a lot of gynecologists tell patients that that IUDs are not absorbed systemically. They don't have any effects on your mood, on your weight, or anything. And that's simply not the case. So here's the deal. The mirena IUD has 52 milligrams of progestin. The Kylina has 19 and a half. The Skyla has 13 and a half. So sometimes, you know, women, they love the idea of the IUD because it is 99% effective. It's like the most effective reversible birth control out there. So if you want to make sure you don't get pregnant, that's a great option. But if you're not handling the hormone aspect of it very well, say you get an A Mirena IUD put in and you are feeling super depressed or, or you're gaining weight, or you're getting acne then sometimes switching that out for a lower dose IUD like a Skyla, which only has 13 and a half milligrams, can make a difference for you. I know personally myself, I could not handle a Mirena iud. It made me actually suicidal. That's how strong it was for me personally. And I have seen that with my patients time and time again. On the flip side, I've seen a lot of women feel amazing on their Mirena iud. It all depends on where you were when you started and how much it's affecting your HPO axis and your thyroid and your adrenal function. So everybody's an individual. And what I want to just get across to you is that as long as you know the truth, you know the risks, the benefits, the alternatives, you should be able to sign up for whatever you want to sign up for. Right? If you want a mirena IUD every five years for 15 years, that's your prerogative. Just know that it might be causing you issues that your doctor isn't necessarily putting two and two together and relating to you. So if you are struggling with things that seem hormonal, but you're being dismissed, then you need to question and consider other options. If you feel amazing on it, good for you and I'm super happy for you. So that is my spiel on hormonal IUDs. So there's another IUD, there's the paragard. The paraguard is a non hormonal, it's made of copper and it simply blocks the sperm from ever reaching the egg. It makes a hostile environment in the uterus, so the sperm dies off. It never makes it to the tube where the egg is hanging out. They never meet and never implants. None of that. So that one, you're not going to have any potential hormonal side effects. The most common complaint from a copper IUD, the ParaGard, is that it causes heavy, painful periods. Here's the key, ladies. Those heavy, painful periods are usually from a hormone imbalance. So usually you're already dealing with estrogen dominance or lack of progesterone to keep that estrogen balanced. There are some women that get the IUD placed, they had great periods before that. They get the Paragard. And it does get worse because you are creating a hostile environment with this foreign object inside your uterus. And some of us have more reactive, stronger immune responses than others. You get a lot of immune reaction. Your immune system is like, hey, that's a foreign object in here. Let's attack. And some women's bodies never stop that attack. And so that can create a lot of cytokine production and prostaglandin production. And those don't feel good. Those cause cramping. They make the period heavier. So it's not for everybody, but there are so many women who absolutely love it because it is the most effective birth control that's reversible. Like I said, 99%. It doesn't affect your hormones. Once it's in, you can leave it in up to 10 years. It's pretty awesome. I mean, honestly, probably leave it in forever, but the company says 10 years. So that is a really great option for a lot of women. There is some talk about copper toxicity. I think that's a very uncommon issue for women. You can measure your serum copper levels. Sometimes that can cause your estrogens to go up, although I have not seen it that often, you know, and I've been doing this for almost 20 years, so that's another issue. So let's see. We talked about the birth control pills and why going on them long term can deplete you and affect your health. We talked about the short shots. I honestly don't know many people who've liked the depo shot. Oh, one last thing. I didn't mention about the depo shot and any synthetic progestin that you're taking systemically long term, like the Nexplanon, rod, the Implanons, the Norplant. So the research is clear. If you are on a synthetic progestin, not progesterone, a synthetic progestin only for more than three years, you are going to thin out your bones. You are at risk for osteopenia and osteoporosis if you're young. The awesome thing is it's potentially reversible. If you get off that synthetic progestin and really support good bone health, you can sometimes bring back some of that, that bone thickening. So that is, there's a black box warning on Depo Provera and that often does not get discussed by conventional gynecologists like you literally should on a depo shot for a decade. You're going to end up with osteoporosis. So if you are listening to this and you've been on depo for more than a couple years, you should get a bone density scan. It's called a DEXA scan, and it will tell you the status of your bone health. That is super important because unfortunately, osteoporosis has a major increase of risk hip fractures for older women. And that's like the number one cause of death for elderly women is a hip fracture. So you fall, you break your hip, and you almost never recover from surgery and leave the hospital. Oftentimes you end up going to a nursing home or dying. So sorry to be the bearer of bad news, but the idea that so much of this is preventable, like, I just need to share the truth with you guys. So definitely get a bone density DEXA scan if you've been on a synthetic progestin only for many years. Okay. The other option is permanent sterilization. You can get your tubes, quote unquote tied. Really? We cut them, we burn them, we remove them, we don't tie them. That's just a nice layman's way of making it sound like we're not doing that big of a thing. I do not recommend the Essure coils. That was a guinea pig situation where we just experimented on women. And some women, they did okay. But a lot of women had major complications from Essure coils. So luckily that has been exposed and is no longer an issue. But if you've had Essure coils, they're little coils that go in the fallopian tubes to scar them shut to prevent pregnancy. They are known to cause cyclical pain, like pain every month. They're known to migrate and leave the fallopian tube and go out into the abdominal cavity or into your uterus. A lot of women end up having other surgeries or even a hysterectomy because of these Essure complications. So if you had Essure and you're having chronic pain or abnormal bleeding, issues like that, you need to get that evaluated because those little Essure coils could be the problem. So I say have your partner get a vasectomy. If you're 100% done. You want to make sure you guys are 100% done having children because that is not usually a reversible decision. You don't want to think of it as reversible. It is permanent. So there's so many non permanent options to choose from. I hope that this really helped give you a better idea of which way to go. And if there's anything I missed, please let me know. Hopefully that was informational and helpful. Just shoot me a DM and let me know if I missed it. I'll just throw it in another episode, right? I'm just trying to answer all of you guys questions so that you can make the best informed decisions despite what your regular doctor may or not may not be telling you. So the answers are out there. There's alternatives. There's other options. That's what I love. Like, you don't have to do what they say. Okay? So use your voice, speak up, always ask why, and come to me if it doesn't make sense. I hope that helps. So if you're finding value in this, please share this with a girlfriend. Shout it out on social media, follow me at the gutsy gynecologist on Instagram and TikTok and definitely hit me up with a five star our review. Let itunes know that you want to hear more of this. So have an amazing week, ladies.