January 10th 2019
Sex & Gynae
Why taking a break from your pill isn’t the “detox” you were promised
May 22nd 2018 / 0 comment
“Clean” contraception and taking a “cleanse” from hormonal contraception is increasingly touted as the natural option and better for your health. We predict a ‘clean eating’ style backlash, and here’s why
The contraceptive pill isn’t for everyone. Its potential side effects, from weight gain to depression, are well documented, have caused misery for many women around the world and have often, until relatively recently, been trivialised in both society and by some in the medical profession. The pill, and other forms of hormonal contraception, are far from perfect, risk-free birth control solutions, however, while symptoms such as low mood, migraine and nausea should be taken far more seriously (it wouldn’t hurt to throw more cash at women’s health research in general either), if you’re not experiencing noticeable side-effects, should you be taking a ‘hormone break’ for your health?
The groundswell of wellness and a preoccupation with all things wholesome, natural and ‘clean’ isn’t just making waves on your local high street or in a smoothie bar near you. Foregoing hormonal contraception for more ‘natural’ alternatives is a stance promoted by a fair few bloggers and contraceptive apps, while the NHS reported that pill use in the UK dropped by 42,000 in 2015-2016, with an NHS spokesperson commenting to The Mail on Sunday that the perceived damage of hormones themselves, rather than any possible side-effects, seemed to be discouraging women from using the pill in particular:
“I’m aware of a feeling among women that they might be worried about using hormones so they are seeking non-hormonal methods.”
Such non-hormonal means of contraception can include condoms, which on paper look like quite the water (sperm) tight solution, with an efficacy rating of 98 per cent and the gong of being the only method of contraception that protects against both pregnancy and STIs, but in practice are easily forgotten or deemed to be a faff in the heat of the moment. There’s also the copper coil, which is 99 per cent effective, but can cause longer, heavier and more painful periods, and the diaphragm or cap, which needs to be inserted pre-sex along with spermicide and is one of the least effective contraceptive methods- between four to eight women using it in every hundred will get pregnant within a year
More recently, contraceptive apps have come to the fore and are heavily advertised as natural, non-intrusive alternatives (any woman in their 20s/ 30s on Instagram will know what I’m talking about), with the clinical research to support their claims but practical hitches leading to pregnancy related lawsuits in some countries. In America, there’s tell of one woman using a potato as a ‘natural’ method of contraception (I’m stumped there), and there are even reports of Diet Coke being employed as a contraceptive, with the logic that acid kills sperm. Harvard University has actually looked into that one according to doctors, women’s health experts and authors of Wonder Down Under Nina Brochmann and Ellen Støkken Dahl, but found that the acid did not in fact kill sperm fast enough to prevent pregnancy, so Diet Coke douching is firmly off the cards (...as if it were ever on them).
Do “clean” living and “clean” loving go hand in hand?
Nina and Ellen would argue, no:
“More and more, we hear people saying they have hormonal contraception intolerance, as if it was an allergy. Others ask whether it’s healthy to take a hormone break, a detox, to flush the unnatural substances out of their body.
“It’s important for us to add some nuance to the scary image that has emerged in recent times. Now and then the media can give the impression that we don’t know about the side-effects linked to hormonal contraception, as if we were playing Russian roulette with the health of young women. Fortunately this is wrong. You can be confident that the pack of contraceptive pills you pick up at the chemist contains one of the most carefully studied medications in the world. The researchers have fantastic amounts of statistical material to examine since many millions of women have taken the pill over vast swathes of the planet from as far back as the 1960s. Serious, unknown long-term effects from hormonal contraception would have been discovered if they existed, particularly when you consider that the first pills that came on the market contained up to five times as much hormone as the ones we have today.”
For many PCOS and endometriosis sufferers, the pill’s capacity to make periods lighter and less painful dramatically improves their quality of life
So, as long as you’re not experiencing any unpleasant side-effects, the pill shouldn’t pose any problems for your health, but how about the idea that we should give out system a ‘break’ every now and again? This has come up in conversation amongst my friends on many an occasion, given that most of us have been on the pill for coming on 15 years, with becoming single throughout this time seemingly opening up a “detox” window where hormonal contraception is concerned, but not so fast with binning the pill packet…
The pill break myth
"In healthy women without medical concerns, there is no evidence for taking a break or detox from hormonal contraception after a period of time. This myth originated after the earlier pills contained higher hormone concentrations. This is not the case for the current generation of hormonal contraceptives.
Sexual health charity FPA is also keen to shut down the idea of a pill “detox” ever being beneficial to health:
“No, you don’t need to take a break because the hormones don’t build up.There are no known benefits to your health or fertility from taking a break.”
Ellen and Nina second this, proposing that staying on your pill is better for your wellbeing than going cold turkey on your contraception:
“Perhaps you’ve heard that hormones aren’t good for you, that they’re unnatural substances. Why subject your body to sinister hormones when you’re not even getting sex as compensation? You think: ‘Let this period of being single be a time for detox, cleansing and health! Time for a break from hormones!’
“Stop right there. This isn’t actually as smart as it sounds. If you’ve found a hormonal contraceptive that works for you it’s plain silly to stop just because you’ve become single. Most people who start taking hormonal contraception have certain side-effects at the outset, but these most often pass or become milder after several months. The body adjusts to a new hormonal balance and settles down. When you stop, it’ll take time for your body to return to a new balancing point, only to experience the same side-effects when you start again.
“Blood clots are, in fact, the main reason we don’t recommend taking a break from hormonal contraception. Some studies indicate that the risk of blood clots is greatest in the first months after you start taking contraceptive pills, and decreases sharply over time. If you use contraceptive pills on and off every time you meet a new man, your body won’t have time to return to balance. The result is that your dream guy won’t just give you butterflies in your stomach, but also a higher risk of blood clots.”
Blood clots aren’t the only risky business when it comes to taking a pill hiatus, as Nina and Ellen report that “one in four girls who take a six-month break from contraceptive pills end up having an unplanned pregnancy within half a year.”
If long-term pill taking preventing your from falling pregnant later is your worry, you can put that one to bed too.
The pill and its effect on future pregnancies
According to a survey of 1000 UK women by life sciences specialists Bayer, 68 per cent of women believe that long-acting methods of hormonal contraception can negatively affect fertility. Nina and Ellen have words of reassurance to debunk the flawed fertility perception:
“Some women are afraid that long-term use of hormonal contraception may make it difficult to become pregnant later in life. Luckily this is total nonsense, although it can take a few months for you to start ovulating again when you come off certain hormonal contraceptives. In fact, the likelihood of infertility is lower among women who’ve used hormonal contraception because they appear to have less chance of suffering pelvic inflammations if they’re infected with sexually transmitted infections.”
The FPA are also keen to quell hormonal contraception vs. fertility fears:
“Once you stop using contraception your periods and fertility will return to normal, often straight away, but depending on the method and your individual cycle it may take a while. If you used the contraceptive injection in can take up to a year for your periods and fertility to get back to normal.”
If you are hoping to fall pregnant soon after coming off hormonal contraception, Dr Ekechi explains why the contraceptive injection could mean you're waiting a little longer, but be reassured that it doesn't affect your ability to conceive:
"Once hormonal pills are stopped, the hormones leave the body after a few days. Mostly, periods return very quickly. After contraceptive injections there may be a longer return to a menstrual cycle, sometimes up to six months. The delay in return to natural cycles is due to the dampened natural hormone release from parts of the brain called the hypothalamus and pituitary whilst taking hormonal contraception. Whilst the hormones that you are taking are cleared after a few days in the case of the pill (or three months after contraceptive injections), it can take a while for natural cycles to return. If the plan is to try to conceive immediately after hormonal contraception, the injection may not be the best choice for you."
If you’re trying for a baby later (post 35), it may also take longer to conceive, and infertility can affect both men and women of any age, but your hormonal contraceptive is highly unlikely to be the root cause of fertility issues.
Hormonal contraception isn’t “unhealthy”
Despite that fact that it’s occasionally portrayed as a toxic chemical invader, while the pill certainly can carry risk, and side-effects as listed above and on the NHS website, it does also bring benefits, aside from the key objective of pregnancy prevention. Bupa highlights that studies of women who’ve been taking the contraceptive pill for fives years or more show that they have almost a 50 per cent lower risk of developing ovarian cancer than those who’ve never used the pill, and it also reduces your risks of womb and colon cancer. For many PCOS and endometriosis sufferers, the pill’s capacity to make periods lighter and less painful dramatically improves their quality of life, while others find that the pill is beneficial for clearing up acne over time.
In our sunlight starved nation, there’s also one other potential unexpected health benefit to taking the contraceptive pill, as nutritionist and author of Getting Pregnant Faster Dr Marilyn Glenville explains:
“It’s been noticed that women can become deficient in vitamin D in particular when they stop taking the pill. It is thought that this change in vitamin D is due fluctuation of the hormone, oestrogen, which is found in the pill. This also means that taking the pill could increase levels of vitamin D by up to 20%.”
Given that the government now recommends that all adults and children take a vitamin D supplement from October until the beginning of March due to widespread deficiency in the ‘sunshine’ vitamin, the news that taking the contraceptive pill could increase your vitamin D levels is particularly pertinent. Whether you take the contraceptive pill, or any other method of hormonal contraception, is entirely personal and dependent on your lifestyle, medical status and personal preferences, so never let anyone but a GP or medical professional tell you what to do, but equally, if you’re hearing that hormones are “nasty chemicals” or being seduced by the idea of a hormonal “cleanse”, don’t be swept up by the scaremongering.
The Wonder Down Under: A User’s Guide to the Vagina, £14.99 (Hodder & Stoughton)