Could the Pill be Messing with your Gut?
Is this you? A young woman, who I have been seeing over the years for PCOS (Polycystic Ovarian Syndrome), came in struggling with terrible acid reflux. She had never had it before and it was even keeping her up at night. There had been no dramatic diet or lifestyle changes in the past few months. The only thing different was she had recently started hormonal birth control. As a naturopathic doctor in New York City specializing in woman’s menstrual issues, I have seen a number of woman struggle with a variety gastrointestinal issues such as IBS, constipation, and acid reflux as a result of birth control pills. Now you might be wondering what exactly is the connection between hormonal birth control and your gut. Believe it or not just like your ovaries and uterus respond to estrogen and progesterone, so does your gut. Why your gut responds so differently to naturally occurring hormones versus their synthetic counterparts found in birth control is that they are not exactly the same and don’t behave in exactly the same way. First they are stronger than their natural counterparts. They also have a longer half life meaning that they stay in our bodies longer and will last longer. Lastly the levels of hormones are kept constant and so is their influence on your digestive tract.
So how exactly is your hormonal birth control messing with your gut?
Disrupts the Microbiome
You maybe familiar with the microbiome which is the beautiful microbiological ecosystem of bacterial cells in such places as the vaginal and digestive tracts. When it is out of balance, a whole host of issues can occur. At the extreme end, we have SIBO (Small Intestinal Bacterial Overgrowth), which is when beneficial flora is crowded out by bad bacteria and yeast. Symptoms of SIBO include those similar to IBS such as constipation, stomach pain, gas, bloating and diarrhea but may also acne, eczema, rosacea, migraines and even restless leg syndrome (yes I’ve seen this in my practice). Studies have shown that use of hormonal birth control alters normal microbiota by increase levels of e coli and candida sp. One of the ways birth control does this is by enhancing adhesion of e coli to mucosal tissues. The beneficial bacteria and one of our natural defenses against opportunistic bacteria, lactobacillus is also reduced. Further more, the synthetic estrogen, ethinyl-estradiol, found in birth control can cause a dysregulation in our immune system preventing clearance of candida.
Slows Down Bowel Movements
Have you ever noticed that your constipation is worse at a certain time of the month? It turns out that our large intestine have receptors for estrogen and progesterone, which alter the timing and strength of gastric contractions. It is these gastric contractions that create the peristalsis to keep us regular. Because the estrogen and progesterone found in hormonal birth control are stronger and they last longer in our bodies, this effect is more pronounced. Progesterone inhibits the contraction of the smooth muscle of the colon which can result in constipation. This can be particularly problematic for women with a genetic predisposition to have more progesterone receptors on their colon and as a result have slow transit time constipation. For those with a history of SIBO, this slowing down can easily make SIBO come back.
Inflames the Gut
Surprising research has shown that women who take birth control for greater than five years, there is a three-fold increased risk of Crohn’s disease. For women with a strong genetic predisposition to the inflammatory bowel disease, it can majorly up the risk and women with Crohn’s disease and ulcerative colitis who take birth control pills require more surgeries than those that don’t. One explanation for this is ethinyl-estradiol can alter intestinal permeability. This synthetic hormone found in all forms of hormonal birth control except progesterone only also enhances TH1 and TH2 mediated inflammatory disease. Another culprit is the synthetic progestin, Drospirenone, found in Yaz and Beyaz which irritates the digestive tract and prevents tissue repair.
Relaxes the LES
Now back to the original story. Why exactly was this woman having acid reflux after starting birth control? The problem is progesterone and is why often pregnant women suffer from reflux besides reduced stomach capacity from a growing fetus. Progesterone relaxes the smooth muscles of the lower esophageal sphincter (LES) decreasing tone which allows stomach contents to regurgitate. Studies have shown significant drops in LES pressure after ingestion of synthetic progestins which further aggravates the problem. The unfortunate reality is that all forms of hormonal birth control contain progesterone and at larger quantities than estrogen.
If you have been hormonal birth control and have been experience digestive problems, the birth control might be the problem. The good news is you have options. For those on the pill or other hormonal contraceptive methods, condoms or natural family planning (also know as fertility awareness) are effective methods to prevent pregnancy. If you have been relying on hormonal birth control to regulate your cycle, reduce cramping and heavy bleeding, clear acne or control fibroids, you might be ready for a naturopathic approach without the use of hormones. In both cases, if you are still having IBS, reflux and constipation after quitting birth control you might also need naturopathic gut repair.
Want to solve to get your hormones under control without birth control? Then schedule a naturopathic appointment with Dr Ivy.