Is your oral contraceptive impacting your gut?

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The oral contraceptive pill (OCP) is one of the medicines great breakthroughs.

Since its introduction in the 1960s, it has liberated women and helped with many issues without a doubt. The OCP is generally regarded as safe and women who are prescribed it are seldom told of any potential risks as a result of taking it.

But they’re aside to the OCP that all women should know about so that they can make an informed choice when taking it. And perhaps looking back some eighty years later, we may have some unwanted effects that you never thought possible.


Estrogen and your gut

Most oral contraceptive pills contain estrogen in varying forms. This oestrogen is metabolised by your gut microbiome, which regulates estrogens through the secretion of β-glucuronidase, an enzyme that de-conjugates estrogens into their active forms. This collection of bacteria is called the estrobolome and it affects circulating oestrogen levels.


Oral contraceptives have been linked to inflammatory bowel disease

This study of over 75,000 women found that those on the OCP had an increased risk of developing both Crohn’s Disease and Ulcerative Colitis, with some studies showing a risk increase of over 30%. The reason behind this is still unclear however these results are quite staggering.


Links between the microbiome, immunity and the OCP

In 2016 gastroenterologist Dr Hamed Khalili published a review of the evidence on IBS and birth control and found a strong link between the microbiome, oral birth control and the body’s immunity.

“This supports the intriguing hypothesis that the gut microbiome lies at the crossroads of pathways linking exogenous hormone use with innate and adaptive immunity,” Khalili concluded. A second study found that if you already have Crohn’s disease, taking the OCP can increase the need for surgery.


The pill and your microbiome

Studies such as this, which look at how antibiotics can make the pill ineffective give clues to how the pill modifies our gut flora, but the truth is we don’t know the exact ramifications yet. This study on mice found that long term use of estrogen and estrogen receptor modulating drugs alters the microbes in the gut. The authors stated “While the overall diversity of microbiota was not changed significantly, we found that the activities of several bacteria taxa were altered by the estrogen therapy. “The levels of several bacteria associated with GUS activity in the gut decreased, including levels of akkermansia,” a family of bacteria believed to have anti-inflammatory properties in humans.”

This is a space to be watched, but what we do know is that the pill isn’t as inert as we once thought.


Taking a measured approach

With anything in medicine, we need to weigh up the pros and cons. If you need the OCP because you’re in horrific pain or have another medical issue then this is one thing. What we are finding though is that women are routinely put on the pill as soon as they are sexually active. What this does to young girls sexual development is an argument for another place, and sometimes the OCP is necessary and helpful, but we need to consider if it is the only option.

Too many times we see clients that have been on the pill for years, no partner, simply because they have just always been taking it. Another reason for the pill is the belief that it will ‘regulate’ your cycle. What it actually does, it takes over your hormonal function, without fixing the underlying issue. This means that at a later stage when you want to have kids or come off of it the issue can still remain.

Think about your options, because what we do know is that long term OCP use has negative effects on your gut.

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