Exploring nonhormonal and integrative options for birth control

In the wake of the United States Supreme Court’s decision to overturn Roe v. Wade, the 1973 ruling which guaranteed federal constitutional protections to abortion rights, conversations surrounding the importance and controversies of birth control have increased.

According to the Centers for Disease Control and Prevention, almost half of women in the U.S. are using some form of contraceptive, the most popular method being the pill, used by 14 percent of women. There are many forms of the birth control pill, but no matter what the brand, they all contain the hormone progestin, or more commonly, a combination of progestin and estrogen, according to Planned Parenthood.

The pill is an easy-to-use medication taken at the same time daily, according to Planned Parenthood, and when used perfectly, it’s 99 percent effective at preventing pregnancy. So, it’s no surprise that the pill is usually conventional medicine’s first-line method of birth control.

However, according to Kaely McDevitt, RD, founder of KaelyRD, a virtual private practice specializing in hormone balance and digestive health based out of Huntington Beach, California, there are a host of side effects that can come along with the pill that often go unaddressed in doctor-patient conversations.

“There's almost never any discussion of potential side effects,” said McDevitt. “That's where I really have a problem with how it’s typically prescribed. Women need to have all the information on the benefits and negative side effects of the pill to be able to make an informed decision.”

Anita Sadaty, MD, IFMP, a board-certified obstetrician-gynecologist and founder of Redefining Health Medical, a woman’s health medical practice in Roslyn, New York, agreed with McDevitt. She said conventional doctors present the pill to patients as a way to “regulate their cycle” when really what the pill does is provide patients with a “fake bleed” or artificial cycle.

There are several forms of hormonal birth control, according to Sadaty. The pill is known as a systemic contraceptive, which works to inhibit ovulation. Systemic contraceptives can also come in the form of injections, implants, vaginal rings, and patches, said Sadaty. There are also intrauterine devices (IUDs), explained Sadaty, that work locally in the uterus to prevent pregnancy.

Most hormonal birth control methods, said Sadaty, effectively shut down the body’s hormone signaling pathway, causing the brain to stop communication with the ovaries, preventing ovulation and halting natural production of estrogen and progesterone. This can lead to several side effects.

“About 20 percent of women have issues with the pill or other hormonal contraceptive agents,” Sadaty said.

Common complaints that McDevitt gets from patients about hormonal birth control include significant mood changes, increased frequency of anxiety or depression, hair loss, insulin resistance, fatigue, weight gain, and low libido.  

According to McDevitt, shutting off the natural production of hormones, and adding synthetic hormones, can cause nutrient depletion, stress on the liver and gallbladder, a shift in the gut microbiome and permeability of the gut lining, and lastly, an alteration to carbohydrate metabolism, which contributes to insulin resistance.

“That's really affecting most systems of the body and therefore also affecting hormones which can contribute to a wide array of symptoms that we see often in our clients,” said McDevitt.

Some of the most common nutrients that McDevitt finds depleted in her clients taking the pill include B complex vitamins, minerals like magnesium, selenium, and zinc, as well as antioxidants like vitamin E and C.

For those taking the pill, Sadaty suggested they take additional nutrients that the body requires to metabolize the medication like magnesium, zinc, and B vitamins such as B12 and folate. McDevitt also recommended patients on the pill consume a diet that includes quality animal proteins, even organ meats, which helps with nutrient depletion, as well as vitamin, mineral, and antioxidant rich fruits and vegetables.

For the most part, Sadaty said, the pill does a good job at preventing pregnancy and relieving certain symptoms that patients may be experiencing. However, blocking hormone production may be ignoring the underlying causes of patient concerns that can sometimes be alleviated through diet and lifestyle interventions.

McDevitt agreed. According to her, the pill is not a cure-all for hormone disorders.

“I have no issue with the availability or recommendation of birth control for preventing unwanted pregnancy; it does that very well and that’s what it was designed to do,” said McDevitt. “But the issue I have is that it’s prescribed to fix really any hormonal complaints that women might come to their doctor with, and it's often said that it will ‘balance their hormones for them’. To say that something that shuts off your hormones is going to balance them is a complete misrepresentation of what's actually happening.”

Nonhormonal options for birth control

There are several nonhormonal birth control methods, explain Satady. There are barrier methods like condoms as well as diaphragms, sponges, spermicidal agents, and the copper-coated IUD, she said. As a last resort, there are also sterilization procedures like tubal ligation and vasectomy. Many of these options however, either come with their own side effects or are less effective than hormonal birth control.

For those struggling with hormonal birth control and who aren’t open to nonhormonal methods like the copper IUD or spermicides, McDevitt said there is a completely natural, side effect free method that’s rarely discussed in conventional medicine: the fertility awareness method (FAM).

McDevitt defined FAM as a method where one learns how to identify and predict their ovulation with accuracy so they can pinpoint their fertile window and either abstain from sex during that time or use other barrier methods to prevent pregnancy.

“The beauty of fertility awareness method is that it's really just a skill and body literacy,” said McDevitt.

According to Nina Boyce, a certified health coach and fertility awareness educator and founder of LUNA: Reclaim Your Cycle, a program that guides patients through the FAM process, when used perfectly, FAM is 99.6 percent effective in preventing pregnancy. FAM involves reading the body’s specific biomarkers or cues to understand when one is fertile and when they are not, she said. In Boyce’s program, the three biomarkers she instructs patients to monitor include cervical mucus, basal body temperature, and luteinizing hormone (LH).

Throughout the menstrual cycle, a female’s cervical mucus will change as estrogen and progestogen levels rise and fall. The menstrual cycle begins on the first day of the individual’s period, explained Boyce, and during their period, hormone levels are low. Right after one stops bleeding, hormone levels are still low and cervical mucus is dry. As estrogen levels rise, cervical mucus becomes “creamier” and may be slightly tacky. As estrogen levels peak, and a female enters ovulation, cervical mucus becomes watery and clear, said Boyce. This is when one is the most fertile. After ovulation, progestogen levels go up and estrogen levels go down, causing cervical mucus to dry up, decreasing the chance of fertility, according to Boyce.

In addition to staying in tune with cervical mucus, Boyce said methods of measuring basal body temperature, which rises after ovulation, with a thermometer, as well as LH with LH test strips, can help an individual better assess where they’re at in their cycle.

“The other tool you're going to need is a charting method,” said Boyce. “You're going to either need a paper chart so you can chart all of this down or an electronic app.”

FAM requires a lot of attention and knowledge of one’s own body, said Boyce. This is why it’s important for patients to be properly educated before trying it out. Working with an instructor, Boyce said, can allow people to gain more insight into their personal cycle.

According to Sadaty, FAM can be a good nonhormonal birth control option, but it’s only reliable for people with regular, predictable cycles, which not every patient experiences.

To McDevitt, it’s important that conventional medicine doctors not only disclose all the protentional side effects of hormonal birth control to patients, but also give them alternative, nonhormonal, and even natural options, like FAM.

Advocates of FAM like Boyce and McDevitt acknowledge that this method may not be for everyone. However, the idea of FAM, which involves being in touch with one’s own body and understanding when they’re fertile through observation, should be a much larger part of sex education, said Boyce. Whether it’s in puberty education in middle school, or in a healthcare setting, young people should have in-depth lessons about the stage of their cycle and when they’re most fertile, said McDevitt.

“Even if someone decides not to use FAM for contraception, there's so much value in understanding your body in that way and being able to troubleshoot any cycle abnormalities by knowing where you are in that cycle,” said McDevitt.