The use of hormonal birth control is one of the most common and effective ways to prevent pregnancy, as well as manage unwanted symptoms of reproductive health. Hormonal birth control, whether a pill, an implant, or a patch, all function in a fairly similar way. They introduce synthetic hormones into the body to prevent ovulation and increase cervical mucus – a tandem effect that helps prevent pregnancy. Birth control pills are also prescribed to help alleviate symptoms of certain gynecological conditions, like endometriosis, and regulate menstruation. However, if you have been diagnosed with a chronic gut dysfunction disorder and are struggling to treat it, your birth control may be an attributing factor.
Sex Hormones and Your Microbiota Women account for more annual diagnoses of chronic gut dysfunction than men. A growing body of evidence has demonstrated that the fluctuation of the female reproductive hormones estrogen and progesterone have been demonstrated to be contributing factors in the onset of digestive dysfunction. The relationship between hormones and the gut is symbiotic; one affects the other. Evidence shows that women with IBS report a higher incidence of PMS and dysmenorrhea (painful periods)3, suggesting gut dysfunction seems to have a negative impact, at minimum, on the regulation of hormones and perception of pain. Conversely, there is mounting evidence demonstrating the impacts of sex steroid hormones on the gut microbiota. To date, studies demonstrate clear evidence that specific phyla, family and genere variances to the microbiome of rodents result from gonadectomy and hormone replacement4. In adult rats who undergo ovariectomy, shifts in the relative abundances of two major phyla, Bacteroidetes and Firmicutes were demonstrated. Furthermore, we see this demonstrated in humans during pregnancy, and between sexes. Men have higher concentrations Bacteroidetes and Prevotella than women,5,6 suggesting a role for sex chromosomal gene expression or differences in gonadal hormone levels in the modulation of the gut microbiota. Koren et al7 also found a large shift in the gut microbiota from the first to the third trimester of pregnancy women, with an increase in overall diversity and a proliferation of Proteobacteria and Actinobacteria (and resultant changes in metabolism). Lastly, we see exacerbations of pre-existing inflammatory bowel disease in women on oral contraceptives8. This poses an important question – do synthetic hormones, like the ones in birth control, further upend the balance and fluctuations of our microbiome? So what does this mean for someone on a birth control pill? Well, we know that hormones influence the gut microbiota, and an improperly functioning microbiome can lead to several comorbidities, such as:
Increased Intestinal Permeability (what the internet likes to refer to as “Leaky Gut” – undigested proteins, micronutrients, and potentially toxins that pass through the lining of your intestines inappropriately, often triggering an immune response.
Gut Dysbiosis – a general state of imbalance of gut flora that can cause bloating, gas, acne, mental fog, constipation, indigestion, diarrhea, etc.
Small Intestinal Bacterial Overgrowth – the overgrowth of bacteria in the small intestine which can cause cramping, bloating, diarrhea, constipation, indigestion, and gas.
Gallstones – when gallstones develop they can impede the secretion of bile, leading to chronic pain, bloating, and gas. Allopathic medicine often resorts to gallbladder removal surgery to mitigate symptoms.
Rebalancing the Imbalance To improve or eliminate the symptoms of chronic gut issues, switching to non-hormonal birth control may be an option for you. However, if you are using birth control to treat another underlying gynecological condition it may not be in your best interest to simply stop taking it. Always speak to your Doctor and Naturopath before discontinuing any medication to ensure this option is right for you. If non-hormonal interventions are not an option, it is important to focus on rebuilding and supporting a healthy gut microbiome. One of the best ways to support our microbiota is to eliminate foods from the diet that can lead to further imbalance. Cut back or eliminate:
High-fructose corn syrup
Artificial sweeteners like aspartame, sucralose, and saccharin, along with sugar alcohols (xylitol, sorbitol, mannitol, etc)
Processed refined sugar
Foods that are artificially coloured
Pre-packaged or ready-made foods
It is also important to eat a diverse diet rich in whole foods to feed our microbiota and increase the production of a very important short-chain fatty acid, known as butyrate. Butyrate helps to not only improve digestion, but to decrease inflammation, and is increased by the following foods:
Prebiotic foods -- artichokes, asparagus, and garlic (not FODMAP friendly)
Legumes -- green beans or black beans
Fruits – strawberries, mangoes, and melons
Fermented foods – sauerkraut, yogurt, kefir, or kombucha
Prebiotic fibres, like acacia gum and guar gum
For more guidance and help support your gut health, hormones, and achieving a healthy balance, please feel free to schedule an appointment online with Dr. Courtney Homberg, Naturopathic Doctor in Toronto, or by calling the clinic at 647-351-7282 today!  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3569485/  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322543/ 3 https://www.ncbi.nlm.nih.gov/pubmed/16552294 4 https://www.ncbi.nlm.nih.gov/pubmed/27700135 5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1392899/ 6 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4398427/ 7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505857/ 8 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928680/