Is Birth Control HRT?

While not really considered hormone replacement or HRT, birth control pills or oral contraceptive pills (OCPs) definitely contain hormones and have multiple hormonal effects on the body. Most birth control pills contain an estrogen (ethinyl estradiol) and one of several synthetic progestins (levonorgestrel, norethindrone, norgestrel, desogestrel, or drospirenone). Birth control pills provide a convenient and affordable way for many women to control of their reproductive path. Although these medications have many actions that decrease the likelihood of pregnancy, the primary mechanism of action is to suppress ovulation via estrogen’s effect on the hypothalamus. This action is further aided by the progestin’s effect on the hypothalamic-pituitary-ovarian axis.
With this alteration of the ovulatory cycle, women taking OCPs usually present with lower estradiol levels combined with a dramatic decline in progesterone levels. These changes in hormones can cause symptoms of estrogen dominance including moodiness, water retention, breast tenderness, tearfulness and foggy thinking. Although women taking hormonal birth control have decreased levels of progesterone, supplementation with progesterone is typically not recommended as progestins bind to progesterone receptors. This competition could potentially result in a lowered efficacy of the birth control method. Most women would not consider the risk of an unplanned pregnancy worth the benefit of alleviating the symptoms. But since there are many different oral contraceptives available, the physician may consider a change in the type of progestin or level of estradiol instead to address these symptoms. For example, changing from LoEstrin 1.5/30 to LoEstrin 1/20 could alleviate breast tenderness or nausea. If weight gain or acne is the issue, the physician may opt for Lessina or Sprintec.
Suppression of ovarian function by birth control often leads to lower endogenous testosterone levels as well, which may contribute to vaginal dryness, fatigue, depressed libido and compromised bone health. Obtaining serum levels of testosterone can often identify this issue. Supplementation of testosterone at conservative doses could be considered for these patients. For patients on oral contraceptives having hormonal issues, contact your physician and talk them about your symptoms and the options available.
by Mary PreFontaine, RPh, FAAFM

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