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Birth Control In Your Body: How It Works and Why You Need to Know Now

You take the pill every day (or wear a patch, ring, or IUD) but do you know how and why it even works? For that matter, do you know how your cycle works? I'm writing this from a slightly disgruntled point of view. I managed to make it almost all the way through my doctorate (IN HEALTH CARE) without actually knowing how my own cycle worked. No one taught me, and if they tried I was in that "4 coffees can't keep me awake after this many exams in a row" zombie haze. Did you know that there's only about 4-6 days out of the month you can even get pregnant? I was spending all 30 days freaking out because I didn't know about 4 days. So I did what I thought was the only option, and I went on the birth control pill during college (later than most of my friends)... because what else do you do when you don't want to get pregnant? Turns out, there's a lot more to it. So here it is: how birth control works, why you need to know, and what other options do you have?

P.s. I recently covered this in a podcast with my friend Alexa at Simple Roots Wellness. If you'd rather listen to this, and use the blog post for reference notes and bonus material, that's ok too!

But first, a few lists... just for fun.

Places that didn't teach me how my cycle worked, or how to know when I ovulated:

- middle school health class

- high school health class

- college biology, anatomy, or physiology

- graduate school anatomy, or physiology

- my former pediatrician or OBGYN

False things I assumed were true because no one told me otherwise:

- The pill regulates my cycle.

- The pill is the most effective way to prevent a pregnancy.

- I have a real period once month when I'm on hormonal birth control.

- There's no need to have a period regularly if you don't want to, and can avoid it with a hormonal birth control.

- When I ovulate is a mystery, so I need a fail safe plan for every day of the month if I'm going to continue to enjoy sex like a normal healthy adult.

The Skinny on Hormonal Birth Control

How Hormonal Birth Control Works (the pill, IUD, patch, ring, or shot)

I wish I could tell you that a magic hormone fairy comes in and precisely regulates your estrogen and progesterone custom to your body's preferred levels. Instead, large doses of hormones (either estrogen or progesterone) suppress your body's natural hormone ebb and flow you would normally have during a 28 day cycle. The ebb and flow of several hormones (estrogen, progesterone, follicular stimulating hormone, and leutinizing hormone) all play off of each other in a delicate balance. Certain spikes and drops need to happen in order for your body to grow and mature an egg, then release it (ovulation). Even if an egg is fertilized and released, if your hormones haven't helped build the lining of your uterus, the egg + sperm combination can't implant itself. 

This chart shows how different female hormones rise and fall during a 28 day time period.


These peaks and valleys of hormones aren't only needed for ovulation, pregnancy, or regular periods. They're needed to help you feel happy and deal with stress. That's right, there's a BIG happy endorphin rush coming at the beginning of your cycle, and tools to help cool your stress hormones. Normal cycling also helps you make smarter, less impulsive decisions, and can make you more productive at work or school. Want to crush your next crossfit work out? The normal rise and fall of hormones can do that too. Let's not ignore one of the most important results of healthy hormones: a healthy sex drive. Many women notice that going on the pill makes their sex drive plummet. This is because that lovely ebb and flow of hormones has a handle on how badly you want it, and how much you enjoy it. 

The endocrine (or hormone) system in your body is really complex. All different types of organs take cues from the female hormone cycle. Thyroid health, bone health, and the way your adrenal glands function are all dependent upon your menstrual cycle hormones. Unfortunately dabbling in hormone suppression in one area, affects the rest of the body too. 

One of the MOST important reasons to have a normal cycle? A regular cycle acts as a "canary in a coal mine." Meaning, it tells you and your doctor a lot about your health. Menstrual cycles are one of the first things to go haywire, alerting your body (and your doctor) that something needs to change. Whether it's stress, diet, nutrition, or other hormones and body systems, a disrupted menstrual cycle is a sign that something else has gone awry. If this cycle is covered up with or completely squashed with artificial hormones, you lose the ability to catch imbalances early. Think about what age most girls go on the pill... 16? 17? So from mid-teens and beyond, these girls don't know what their body's baseline normal function is. They don't know what an unmedicated body feels like, and their doctor has lost an important measurement of health.

A note on the Copper IUD

The copper IUD is toted as non-hormonal, which might make you think "ahh... safer", but let me explain how it works. Your body doesn't like large amounts of copper. In fact, it hates copper so much that once it's in the body, your body starts to fight it like an intruder or illness. It gets hot, red, angry, and mad that copper exists. Eventually enough inflammation is created in the uterus, that a fetus wouldn't want to live there. So that's how copper IUD has no hormones, but still stops pregnancy. It makes such a terrible environment that no one would want to live there. Except you're living there. With that inflamed fire pit sitting in your pelvic cavity. There countless and countless websites, books, diet plans, etc. that are all centered around an "anti-inflammatory" lifestyle. Chronic inflammation leads to disease. Intentionally inflaming our precious lady parts might not be the best solution.

So I'm not having a real cycle, and birth control isn't regulating it?

Not even close. On a hormonal birth control there is no real cycle (ebb and flow of hormones), and therefore no uterine lining is built up. Without a uterine lining to shed, there is no real menstruation. You might have a few days of bleeding, but that's a result of the hormone withdrawal, and it doesn't give you any of the benefits of a real period. That's right, I said BENEFITS of your period. They're real. 

Why having a real period is good (albeit, sometimes annoying.)

The scientists at CEMCOR devote their lives to researching menstruation and ovulation, and proving why a normal healthy cycle is essential. Visit them once a month if you need a reminder of why your period is great. Here's reasons to smile about getting a real, full blown period:

  • It reduces bloating (thanks to a drop in progesterone... so day 2-3 of your cycle is when you can get away with eating the most pasta)
  • It's a natural cleanser. Shedding the lining of your uterus is how your body gets rid of the bad bacteria, and excess minerals (this can even help prevent heart disease)
  • Your metabolism spikes during your period (again... pasta.)
  • It can slow the aging process by getting rid of free radicals (aka, the things that beat up your body from the inside out, like pollution, cigarette smoke, and toxins)
  • Remember all those benefits of the hormone peaks and valleys I mentioned earlier? Sex drive, monster gym sessions, better decision making?

These Side Effects Aren't Your Fault

Here's some possible side effects of hormonal birth control that definitely aren't your fault:

  • depression
  • anxiety
  • lack of motivation
  • irregular bleeding 
  • low sex drive
  • headaches
  • mood swings
  • weight gain or loss

Some of these happen because of that lost ebb and flow of hormones, and some of them might happen because hormonal birth control depletes B vitamins. We've covered this in another post in case you're curious!

Knowing these 4-6 days = FREEDOM.

I teach college anatomy and physiology part time, so allow me to slide into professor land right now (for my awkward hand gestures and PowerPoints of my dog, you'll have to actually take my class). First off, babies can't happen unless a sperm meets an egg, right? We all have that part down? Solid. Moving on.

Day 1 of a female's cycle is the day she starts her period. Typically, periods last from 3-5 days (so days 1-5 of your 28 day cycle). A woman typically ovulates around days 11-14. -- This can vary, as some of you might be early or late ovulators. This is why knowing the signs of ovulation is a huge help. -- When a woman ovulates, an egg is released and finds its way down the fallopian tubes where it may or may not find a friend (sperm). A healthy egg and sperm might decide they like each other enough to nestle into the lining of your uterus and grow into a full human. 

The crucial thing to know about ovulation: an egg only lives for 24 hours (MAX 48 hours), and sperm can only survive for 3 days (5, if you have the world's strongest swimmers). SO, babies can generally only happen if you have unprotected sex 3 days before, or 1 day after you ovulate. 4 days total. Most women use this information only when they want to get pregnant, but it's equally helpful when you don't want to get pregnant. 

My recommendation (and personal preference) has been to track my periods and ovulation on an app called Clue. I picked it because it was the only period tracker that wasn't COVERED in hot pink flower garbage and sparkles. There you can track the major indicators of ovulation: like an increased sex drive, cervical fluid (not as gross as it sounds), cramps, tender breasts, etc. 

What are my non-hormonal options?

1. Using an app to learn your cycle and ovulation days. I got to the point where I would wake up for the day and think "Today's the day." with 100% confidence. Then, if you don't want a baby, don't have sex on those 4-6 days surrounding ovulation as previously described. If not having sex makes you say "NO THANK YOU" in your loudest outside voice, then just have protected sex on these days instead (condoms, diaphragms, spermicide, etc.). If you're not in a committed relationship, or making every guy you date get tested for STDs... you might want to go the "protected" route anyway, right? Learn more about the fertility awareness method here. I swear this isn't your crazy aunt's Catholicism fueled "rhythm" method.

2. Are you in a long term relationship and definitely don't want any (or any additional) kids? All surgery carries risk but getting your tubes tied is very risky (see post tubal ligation syndrome). Having your partner get a vasectomy has shown to be the safer option. It doesn't interfere with male hormones (like an ovary removal would in a female) and it doesn't hurt semen production. It just means the swimmers will no longer be part of the semen.  

How do I get off the pill, or what do I do once I'm off of it?

Now's a good time to listen to this podcast if you haven't yet, OR check out the braniacs over at sweetening the pill. My advice? Find a practitioner who's experienced or certified in functional medicineGoing off the pill can be a bumpy road. You will probably want a friendly provider to guide you through any withdrawal symptoms your body experiences. Don't get frustrated if the doctor who prescribed you the pill doesn't know how to get you off of it. Most of the time they aren't taught how to in medical school. It's more likely that they've been taught to switch you to different hormonal option or intervention. A functional practitioner (which can be an MD, DC, DO, ARNP, etc. with extra training) is more skilled in metabolism, nutrition, hormone testing, etc. to help your body adapt to life after artificial hormones.

I'm not ready yet. I'm going to stay on the pill.

That's ok. It's every woman's right to pick the birth control she wants. Word to the wise: your birth control is depleting your B vitamins. So read this, and get hooked up with high quality B vitamins here. None of that store bought stuff full of folic acid. Here's why we leave folic acid on the shelf. 

Need to know even more about where the pill came from, what it does, and why it's everywhere? Read this book which is soon to be a documentary. 

Hannah Anderson
Hannah Anderson