Birth control is often thought of only to prevent pregnancies, but it can be used for so much more. Here we recap the basics of your hormones, and explain how hormonal birth control can be used to alleviate symptoms of various medical conditions.
What Are Hormones and How Do They Work?
Hormones are chemical messengers that transport signals between organs and tissues in our bodies. They influence many areas of life, from growth and development, to appetite and mood. Hormones are produced in the endocrine glands, which include the pituitary gland, thyroid, adrenal glands, pancreas, ovaries, and the testes. Hormones act throughout the body on tissues that have specific receptors for them¹.
A number of hormones are reproductive hormones, which organize fertility and sexuality². Altering the levels and balance of your reproductive hormones is the basis for hormonal birth control methods.
Hormonal Birth Control Methods
As its name implies, the original intended function of birth control (AKA contraception) is fairly self-explanatory — it works to prevent pregnancy before it happens. The many methods of birth control can be grouped into different categories, including hormonal and non-hormonal methods. This post focuses on the hormonal methods and how you can use them as medicines for indications other than preventing pregnancy. Here’s a quick recap of hormonal birth control options.
Hormonal birth control
Hormonal methods contain an estrogen and a progestin or only a progestin. They include:
- Combined contraception pill
- Progestin-only pill (mini pill)
- The patch
- The ring
- The shot
- All other IUDs
- The morning-after pill (emergency contraception)
Just like non-hormonal methods, hormonal birth controls have varying degrees of efficacy³.
Hormonal Contraceptives: More Than Pregnancy Prevention
While birth control can be excellent at preventing pregnancy, it's not only used to prevent pregnancy. In fact, people have been researching and reporting “noncontraceptive uses” for hormonal birth control pills for decades. In some cases, the birth control treats the underlying issue, while other times its mechanism may not be known or it just alleviates symptoms.
58% of people who take the pill use it for a purpose other than pregnancy prevention4 and, of that 58%, 14% take it exclusively for non-contraceptive purposes.
There are many reasons people take birth control pills, from mitigating the side effects of menstruation like cramping and heavy bleeding, to the treatment of acne and endometriosis. Please consult with a physician before diagnosing or treating yourself with hormonal birth controls.
Hormonal Birth Control to Improve Medical Conditions
There’s an (unfortunately) common thought that birth control will inevitably cause bad side effects—and that people who take it should just accept this if they want to reap its benefits. This doesn’t have to be the case, and birth control can be tailored for your medical needs and lifestyle.
Due to hormone differences, genetics, and individual preferences, different birth control methods work better for certain people. This is also true when using hormonal contraceptives for “noncontraceptive uses”. Below are just a few examples of situations in which birth controls can be used as therapies for different conditions.
Endometriosis is a condition that causes the lining of the uterus to grow outside of the uterus. When the lining grows and breaks down, the body can experience swelling and pain, as the tissue is in an area where it was not meant to be. While the exact cause of endometriosis has not been identified⁵, genetics and high levels of estrogen appear to play a role.
Hormonal birth control pills have been used, with questionable evidence of clinical success⁶ ⁷to treat mostly the pain symptoms of endometriosis. However, research suggests that progestin-only pills may be more effective⁸ at treating the pain and bleeding associated with endometriosis than estrogen/progestin combined pills. Additionally, progestin only pills have been shown to reduce the progression of the disease after surgical treatments7.
Although no one type of birth control seems better for patients, multiple hormonal birth control options can improve the quality of life for patients with endometriosis⁷ ⁹.
Polycystic Ovary Syndrome
Polycystic Ovary Syndrome (PCOS), is a syndrome of hormonal imbalance characterized by irregular periods, signs of excessive androgens-- like acne or facial hair growth-- and fluid-filled sacs (immature follicles) in the ovaries. To be diagnosed with PCOS, an individual will have evidence of at least two of these three signs of PCOS.
Symptoms of PCOS can be treated with birth control. Combined estrogen and progestin-only pills can help to reduce hyperandrogenism symptoms such as facial hair, acne and menstrual dysfunction⁷. Therefore, combined hormonal contraceptives are actually considered a first-line medication for PCOS patients.
The best hormonal birth control pill to treat the metabolic symptoms often associated with PCOS is unique per patient--different birth controls are better depending on specific metabolic conditions or risks¹⁰. In some PCOS cases, progestin-only pills are safer than the combined pills¹⁰.
The story with hormonal contraceptives and migraines is somewhat complex. There is evidence that hormonal contraceptive pills that prevent ovulation can prevent migraines caused by decreases in estrogen levels¹¹.
For a select group of individuals, caution should be noted when considering hormonal birth control pills. Older data showed an increased risk of ischemic stroke in ovulatory patients who regularly had migraines with aura and took birth control pills¹¹ ¹². Because strokes can be so devastating, there is a long-standing (and recently upheld¹²) contraindication for patients who experience migraines with aura and combined hormonal birth control pills.
Progestin-only pills have no contraindications related to migraines, and arm implant progestin-only pills may relieve migraine headaches without the hassles of the mini pill¹¹.
Overall, new studies are needed to reflect the major changes in hormonal birth control over the past 50+ years¹¹ ¹².
Acne is one of the most commonly treated skin disorders. One meta-study looked at 31 different clinical trials across the world with 12,579 patients in total and found that oral contraceptive pills with multiple different active ingredients helped alleviate acne symptoms. All nine of the placebo-controlled trials evaluated in that study showed improvement in the number of facial lesions, their severity and patient-assessed overall acne compared to the placebo¹³.
Acne is also a reported potential side effect of hormonal birth controls.
Heavy Menstrual Bleeding
For some people who menstruate, their period comes with constant cramps or pain and excessive bleeding that can lead to fatigue and interference with daily activities. Heavy Menstrual Bleeding is defined as greater than 80mL of blood lost and is common, affecting potentially 30% of menstruating individuals⁷.
Hormonal birth controls are not created equal when it comes to treating Heavy Menstrual Bleeding. The best option is levonorgestrel-containing intrauterine devices-- they are even FDA-approved for Heavy Menstrual Bleeding. They work well because they thin the endometrial lining so there is less to shed (bleed) during a period. A far second, combined oral contraceptive pills can also be used to decrease blood loss during menstrual bleeding⁷.
Hormonal contraceptive use can reduce the incidence of endometrial and ovarian cancers.
For ovarian cancer, the strongest effect was shown with combined oral contraceptives used for over 10 years, starting before age 35. Interestingly, the effect of use can last up to 25 years after taking the pills⁷!
For endometrial cancer, levonorgestrel-containing intrauterine devices reduced the risk the most-- by 78%¹⁴. Combined oral contraceptives also reduced endometrial cancer incidence, again mostly significantly when used for >10 years and when the patient has other risk factors for disease⁷.
The Right Hormonal Birth Control For Your Needs
These are a few examples of how birth control can be optimized to alleviate medical conditions other than pregnancy. Remember, things like genetics, lifestyle factors, access, and individual preference should also be considered when finding the best birth control for you.
At adyn, we work with you to ensure that you find the best possible birth control for you—whether it is for preventing pregnancy, treating acne, or for your own reason to take birth control.