Guest Post by Dr. Lara Briden, ND
Photo supplied by Lara Briden
The onset of menstruation (menarche) is an important time for girls. It heralds their future fertility, of course, but it’s much more than that. Menarche is also when girls start to make female hormones for the first time.
Making hormones is not easy. It requires regular ovulation, and that can take a few years to become established. That’s why the early years of menstruation are exactly the wrong time to take hormonal birth control. Yet, unfortunately, that’s when more and more girls start taking it. According to a new study [1], this decade has seen a 50 percent jump in the number of young teens (12-15 years old) using medication such as Pills, injection, implant, and Nuvaring. These girls are at risk for many of the side effects of hormonal birth control including:
- impaired bone density [2]
- altered brain structure [3]
- increased risk for depression [4]
- suppressed libido [5]
Side effects occur partly from the synthetic hormones themselves and
partly from lack of girls’ own estrogen and progesterone.
Ovulation is How Girls Make Hormones
Ovulation is not just about making a baby. It’s also the main hormonal event in a menstrual cycle, and the only way to make estrogen and progesterone. When we shut down ovulation with hormonal birth control, we rob girls of the hormones they need for metabolism, bone health, cardiovascular health, mood, and more.
Girls who take synthetic pseudo-hormones via the Pill lose the ability to produce their own hormones. Pseudo-hormones have some similarities to real human hormones, but they also have many differences. For example, the progestin levonorgestrel causes hair loss, but the body’s own progesterone stimulates hair growth. The progestin drospirenone increases the risk of blood clots, but progesterone improves cardiovascular health. Ethinylestradiol, the synthetic estrogen in the Pill, impairs insulin sensitivity [6], but estradiol improves it. These synthetic hormones do not have the health benefits of the human hormones they replace.
Pill Bleeds Are Not Periods
Hormonal birth control is often prescribed to “regulate” periods, but that is nonsensical because a pill-bleed is not the same as a real period.
A real period is the end result of a series of important hormonal events including ovulation. In contrast, a pill bleed is a withdrawal bleed dictated by the dosing regimen of the drug manufacturer.
Newly menstruating girls often have irregular or heavy periods. That can make it tempting for doctors to suggest and for mothers to agree to give them hormonal birth control to mask the problem. But irregular and heavy periods are normal at that age. They occur because girls have not yet established regular ovulation. Hormonal birth control further suppresses ovulation, and that’s why it’s exactly the wrong thing to do. Hormonal birth control won’t promote future ovulation or menstrual regularity, and will probably make it even harder to ovulate in the future.
Better Treatment for Menstrual Problems
Teens have many non-hormonal treatment options for troublesome period symptoms.
Heavy periods: Teens will usually outgrow heavy periods after a couple of years. In the meantime, they can use natural treatments such as a dairy-free diet and the herbal medicine turmeric. Short term use of ibuprofen can also be helpful. I discuss these strategies in this article on Natural Treatment of Very Heavy Periods.
Irregular periods: Irregular periods are common in the first couple of years of menstruation and they usually do not require treatment. If periods do not start to become more regular, then please seek a medical diagnosis. The best treatment will not be the Pill, but rather it will be something to address the underlying cause of irregular periods. For example, the common hormonal condition polycystic ovarian syndrome (PCOS) requires diet and exercise to normalize blood sugar. The Pill is not appropriate treatment for PCOS, contrary to what your doctor might say.
Acne: Teen acne responds extremely well to a dairy-free, sugar-free diet and to the nutritional supplement zinc. Natural acne treatments work more slowly than the Pill, but they’re a better choice in the long term because they’re a permanent cure. In contrast, the Pill’s synthetic estrogen will only mask acne for the duration that it’s used. As soon as the Pill is stopped, acne will typically return even worse than it was before.
Better Birth Control
For those teens who need birth control, there are a couple of good non-hormonal methods. The advantage of a non-hormonal method is that it permits healthy ovulatory cycles and hormone production.
- Copper intrauterine device (IUD): Unlike hormonal birth control, the copper IUD does not suppress ovulation or hormones. Instead, it prevents pregnancy by impairing sperm motility and implantation. It is also highly effective with a failure rate of just 0.6 percent. The September 2012 guidelines from American College of Obstetricians and Gynecologists (ACOG) state that copper IUDs are safe for women who have never had children and for teenagers. This overturns a pervasive—but unfounded—opinion that IUDs should not be used until after childbirth.
- Combination condoms and Fertility Awareness Method: Teens should use condoms on every occasion of intercourse. In this way, they can avoid sexually transmitted disease as well as unwanted pregnancy. Teens can also learn to recognize their peak fertile days (charted according to fertility awareness-based methods), and then abstain on the those few days per month. Strategic, short-term abstinence will greatly reduce their risk of pregnancy in the unlikely event of a broken condom. Fertility awareness also teaches girls body literacy which is important for their future health choices. For Fertility Awareness information and a list of instructors, please visit Justisse Healthworks for Women.
By supporting teens to develop healthy ovulatory menstrual cycles, we put them on the road to better long-term health.
Lara Briden is a board certified naturopathic doctor who qualified from the Canadian College of Naturopathic Medicine in 1997. She currently runs a busy hormone clinic in Sydney, Australia, and posts regularly at Lara Briden’s Healthy Hormone Blog. Early in 2015, Lara released her book Period Repair Manual: Natural Treatment for Better Hormones and Better Periods.
References
- Rashed AN et al. Trends and patterns of hormonal contraceptive prescribing for adolescents in primary care in the U.K. J Fam Plann Reprod Health Care. 2015 Jul;41(3):216-22. PMID: 25398724
- Sholes D et al. Oral contraceptive use and bone density in adolescent and young adult women. Contraception. 2010 Jan;81(1): 35-40. PMID 20004271.
- Petersen N. Oral contraceptive pill use is associated with localized decreases in cortical thickness. Hum Brain Mapp. 2015 Jul;36(7):2644-54. PMID: 25832993
- Kulkarni J. Depression as a side effect of the contraceptive pill. Expert Opin Drug Saf. 2007 Jul;6(4):371-4. PMID: 17688380
- Panzer C et al. Impact of oral contraceptives on sex hormone-binding globulin and androgen levels: a retrospective study in women with sexual dysfunction. J Sex Med. 2006 Jan;3(1):104-13. PMID: 16409223
- Kojima T et al. Insulin sensitivity is decreased in normal women by doses of ethinyl estradiol used in oral contraceptives. Am J Obstet Gynecol. 1993 Dec;169(6):1540-4. PMID: 8267059
What about endometriosis? There are many of us sufferers who benefit from the pill. There are reasons to take it. If it saves my daughter from the pain and heavy bleeding that I dealt with, and it does,she’s taking it. Not for contraception.
Unfortunately THIS young teen needed the pill due to crippling agonising, bent-over-double-and-screaming cramps. Apparently that isn’t something Dr Briden has experienced for herself or even considered. This post has more holes than swiss cheese.
The pill is not a treatment for menstrual cramps, it can hide those symptoms but it will not treat the underlying health condition. Even with conditions like PCOS and Endometriosis the use of the pill to manage symptoms is somewhat controversial, especially for teens due to issues above and ethics of influencing choice.
You mention agonizing cramps but not the cause of your cramps or the other treatment options you were given. There will be some people for whom the pill is the only option, but the problem is with the fact that too often doctors will use the pill as a bandaid rather than investigating and offering treatment options. This culture means that often teens are being prescribed hormonal birth control when it is far from the best option for them in general and means that they are not getting appropriate health care.
Hi Steff,
Thanks for your comment. I should have included a section about period pain in the post.
I have a lot of experience treating teens with severe period pain and teens with endometriosis. They respond extremely well to non-hormonal treatments such as dairy-free diet, zinc, magnesium, and turmeric.
Lara
I was placed on birth control at the age of 14 due to severe cramps, which were later diagnosed as a side effect of sever endometriosis. I was treated two years later for depression (more drugs, which I am still dependent on to this day.) I am 34 now and If someone had told me back then to try changing my diet I would have done it in a heartbeat, especially knowing what I know now. If your daughter is struggling with these types of issues, please at least TRY diet changes and herbal remedies, lots of water and a few warm baths – and maybe prescription strength ibuprofin. You could save her a lot of pain and suffering in the long run.
Thanks for your comment Jen. Yes, endometriosis is routinely treated with oral contraceptives. Not everyone agrees it is the best option. Heather Guidone of the Centre for Endometriosis Care, wrote this in a guest post for re: Cycling in September 2013 about this treatment: “The high rate of recurrence confirms that medications do not adequately treat the disease and may expose patients to side effects that for some are intolerable with the end result being the same: pain returns. Meds also do not improve fertility. All have similar clinical efficacy in terms of reduction in pain-related symptoms and duration of relief and again, none are curative.”
Guidone makes a strong case for the need for more research into all aspects of endometriosis. If you’re interested you can read her entire post here: https://menstruationresearch.org/2013/09/12/if-menstrual-health-is-the-neglected-house-on-the-block-then-endometriosis-is-the-basement/
Re: Cycling is planning to focus on endometriosis as its monthly theme in March of next year.
Hi Lara,
I love your work! I passionately agree with everything you’ve written here, except regarding the copper IUD. I’ve seen this device cause quite extensive copper toxicity symptoms in some women incuding hormonal disruption/paranoia and panic attacks/severe acne/hair falling out in clumps etc, which resolved after removing the device and doing detoxification work. Other women seem to be fine and not have any issues with it. Would you agree that there are some women who are not suitable candidates for copper IUDs/more susceptible to side effects?
Get back to me after you’ve had periods that last 9 MONTHS.
I was given the pill as a young teen. I had horrible side effects from 3 separate kinds I was prescribed to find the right fit. I bleed heavy everyday with each, vomited, felt surges of anger. When I stopped taking them I only had my period once a year for the next 11 years, until I had my child.
I am scared that fake hormones are dangerous.
These comments all suggest the need for mothers, aunts, health-care providers and other significant others in a girl’s life to understand better how to help girls achieve healthy, normal functioning periods from menarche on. There is no reason for any girl, teen or young woman to suffer with serious menstrual problems. Books like Lara Briden’s Period Repair Manual and the information found on The Centre for Menstrual Cycle and Ovulation Research website (www.cemcor.ubc.ca) can be a starting point for many.
Great advice overall, but I was quite surprised that you didn’t mention acupuncture and/or Chinese herbal remedies for helping young women regulate their hormones naturally, especially in the case of painful periods. I hope your readers become aware of how effective acupuncture can be.
hi Amy,
Thanks for bringing this up. I test my patients for serum copper and zinc levels, and I have not yet seen elevated copper with a copper IUD. I have seen elevated copper in many other women, particularly women on the Pill and women with estrogen excess. That’s because estrogen causes the body to retain copper. That’s probably one of the reasons the Pill causes zinc deficiency.
I am not strongly pro-IUD, and I’m alert to any new evidence against it. My first choice is Fertility Awareness Method, but I do think copper IUD is a far better option than hormonal birth control.
Thanks Lara.
To whoever gets this far down the comments, please dig deep in your reading on this subject, and diversify your sources a bit. Do not take articles like this at face value. Of course going on birth control, especially as an adolescent, should be a carefully considered decision. But don’t write off such treatments completely because you hope to go the “natural” path, especially if you’re facing something like endometriosis, for example, which has not been proven to be affected by diet and which, if left untreated, can cause scar tissue build-up that can lead to infertility and a variety of other bowel and digestive issues. More research in women’s health is needed and articles like this that make broad statements essentially writing off an entire area of treatment deserve a skeptical eye (just as articles advocating a medicate-fast-and-furious approach should be scrutinized). Be reasonable.
Thanks, Dr. Briden, for your clear statement that teens need real periods and not artificial Pill cycles. I totally agree with you.
I think it is amazing that are body learns to coordinate the complicated system in which the brain (hypothalamus) gets messages from the rest of the body, talks to the pituitary that sends two signals (both luteinizing hormone [LH] and follicle stimulating hormone [FSH] to the ovary and eventually produces the cyclic normal levels of estrogen and release of an egg (ovulation)and then progesterone levels. It is no wonder that it takes a year or two to get regular cycles sorted. And also not surprising that it may take 10 years before ovulation is secure and mostly predictable.
That is so important that I want nothing to interfere with that “growing up” of our reproductive system in teenagers.
Bri–sounds like you’re having an awful time. Here’s a place to start to get some help https://www.cemcor.ubc.ca/resources/very-heavy-menstrual-flow. No one wants you to suffer the loss of blood, embarrassment, cost and misery of bleeding all the time. That’s not at all what this post is about. It is asking all of us to consider other choices, not just using the Pill for treatment when it is designed to prevent pregnancy.
For Endometriosis the pill does take the pain away because it stops the production of hormones. However this does not treat the root issue, often times endometriosis is due to high levels of cortisol which is stress hormone combined with a diet that’s usually filled with dairy usually causes this. If not this case, I would have to inquire more information, however in my practice I see cases like this often times. There are a lot of things you can do for your daughter while she is taking birth control for her endometriosis, but I really encourage you an exit strategy from birth control to something more manageable.
Hi. My daughter, 15, has been prescribed the pill because she passes out every period, has extreme pain and vomitting too. She is lactose and gluten intolerant so already has low dairy intake. Tried menodoron drops but didn’t help. Has mefanamic acid prescribed for the pain which she still gets, but much reduced, on her week when she is pill free. What other options are there for a girl who just can’t cope with her periods? Also has ASD. Her periods cause so much anxiety, making it worse. If taking the pill means that anxiety reduces and she learns to cope better, then when she is a bit older she may be more able to cope when she goes back to normal periods again.
Can you please post links to clinical studies (not case reports) regarding the efficacy of your suggested dairy and sugar free diet and supplements on reducing cramps and eliminating endometriosis?
On the subject of period cramps…As a teen I had incapacitating period pains for 6 hours each month until I was in my early twenties. It was suggested that I go on the pill, but even as a teen I was highly aware of the big picture and understood that taking drugs was to merely mask symptoms while the underlying imbalance would go untreated, likely get worse and then lead to more deeper health issues…..and I had an aversion to being dependant on drugs and weary to their side effects. And so I tried every herbal remedy on the shelf at the health food store and transitioned mtself to a whole foods diet…lots of good things came of it…like my acne went away, I lost weight, recovered from mono without missing a day of work….but it nothing would touch those period cramps….finally I tried Vitex (Chasteberry) Extract in tincture. After taking it for only 1 week my cramps were only mildly irritating that month (it probably worked so quickly because I had already implemented the diet and lifestyle changes and just need a bit of extra support to recover), the next month the cramps were completely gone. I stayed on the tincture for 9 months to make sure that whatever imbalance was underlying my period issues was completely resolved. Over time my blood clots went away, the colour of my blood went from black to red and my periods stopped being heavy. I’ve never had cramps since. It has been 15 years…..not saying it is the answer for every case of period pain, but if your liver needs support it could be the right herb for you. And if it is, it will change your life : )
Generally, I find teen period pain one of the easiest things to treat. It responds well to magnesium and zinc supplements. In fact, there is a brand new clinic trial using zinc to treat period pain. You can read the study here → https://www.ncbi.nlm.nih.gov/pubmed/26132140. A dairy-free diet can also be helpful, which it sounds like she’s partly doing, but it might be worth trying a few months of no dairy, not even lactose-free products.
If her pain does not improve with dairy-free, magnesium, and zinc, then there’s something more going on than just standard period pain. Please see my post “When pain isn’t normal”. https://blog.kindara.com/blog/when-period-pain-isnt-normal
Hi Kirvin,
As it happens, there is a new 2015 randomised controlled trial of zinc for period pain → https://www.ncbi.nlm.nih.gov/pubmed/26132140. Magnesium has been studies as well → https://www.ncbi.nlm.nih.gov/pubmed/2349410.
To my knowledge, no one has yet trialled a dairy-free diet for period pain, but I hope it will happen soon, and then the research will catch up with a clinical truth. I have seen dairy-free work well for hundreds of girls.
I must say, this article really freaked me out. I first got my period when I was 13. Over time my periods became the opposite of the norm. Within the course of a month I would have a consistently heavy flow for most weeks, then my period would stop for a few days. This cycle continued for months at a time. Naturally, I grew tired of this incessant period so my mom and I decided it was time for a visit to the gynecologist. My doctor prescribed me the pill, and I was so grateful for a solution that would stop the seemingly endless bleeding. I’m 20 years old now, and I have been on the pill ever since. I’ve never really questioned, or realized, that it could cause harm with lasting effects. If you’re right about the information in this article, am I too far gone? Have I already, or is it possible to permanently lose the ability to produce my own hormones or ovulate normally? How would you find out? Is it fixable?
Hi Emily, It’s okay. Hormonal birth control won’t cause you to permanently lose the ability to produce your own hormones. But it is worth now trying to establish regular ovulation and real periods. That means figuring out WHY your periods were like that before. What you describe are typical anovulatory (non-ovulatory) bleeds which occur with polycystic ovarian syndrome (PCOS).
I’ve had many patients with a similar story to yours, and what we do is first (while still on the Pill), test for underlying issues which may be the cause of the anovulatory cycles (such as thyroid and insulin). If there’s a problem, we correct it. We can’t test for female hormones while on birth control, so then my patients come off the Pill, and then we test their female hormones and male hormone (androgens) which are typically elevated in PCOS. Then we treat that with nutrition and herbs. I describe this process in my book, and I also provide some patient stories.
I wonder what are the effects if these pills are taken in late adolescent stage. Like 18 or 19 years old. I had my period and I bleed heavily each month. My period is regular but extremely heavy. It became very difficult to handle, and I went through 10-12 pads a day, for at least 8 days. When I started university it became absolute hell. So, my question is, how about a girl who has had her period for about 4 years before taking the pills regularly? Am I also messing up my hormonal cycle?
Making sure you are adequately hydrated can also cure/reduce cramping.
I totally agree teens need proper menstrual cycles, but in my work I have found IUDs cause chronic visceral irritation. Any foreign body does this. Chronic irritation causes chronic inflammation. Creating a hostile uterus to an embryo means living with a hostile uterus.
Thanks so much for you comment Abi.
I actually agree with you about the chronic inflammation from the IUD. It’s not ideal. In Chapter 3 of my book, I classify contraceptive methods into three categories: 1) 100% safe and healthy, 2) a little bit toxic or damaging, and 3) total hormonal shut-down causing far-reaching physiologic damage. I put copper IUD in category 2. It’s not as good as Fertility Awareness Method and barrier methods (Category 1), but it’s better than hormonal birth control.
Because you have had a chance to establish regular cycles, the Pill won’t harm you as much as it would have if you’d taken it at 12 or 13. That said, there are natural options for heavy periods (discussed in the post). There’s also the Mirena IUD which lightens periods dramatically. As I’ve explained in a few comments, I’m not a huge fan of the copper IUD. I’m even less a fan of the hormonal IUD, but I do think both IUDs are better than the Pill (because they do not shut down ovulation). I discuss Mirena in a couple places in my book. I view it as the least harmful of all the hormonal contraceptives because it permits ovulation at least some of the time. It works locally in the uterus, and doesn’t aim to suppress ovulation. Unfortunately, its low dose progestin does enter the blood, and inadvertently suppress ovulation about 50 percent of the time.
I agree with you, Laura, and have lived through the long term health damages of being put on BCP at a young age and in total for 8 years. (now 39)
We are living in a time where we are over engineering the feminine, taking nature out of the equation….from scheduled periods, conception, and birth while overlooking the long term effects of this dislocation as we’re caught up in the promise of an immediate fix by modern medicine driven by the desires of our culture. (we all play a part, not just big pharma. they simply respond to our collective fears & pain)
I see how some people in this thread are having a visceral reaction to what’s been suggested by this post, citing that the pill is the medicine that saved them or a loved one from pain, and I say to them….great. We are given free will and you have the right to choose what’s best for you. I know medicine has its place and am grateful for it. However, there’s options available for those who are willing and interested.
I went on the pill at 14, partially for heavy painful periods, the other part was a paranoid mother who was pregnant at age 18 herself and wanted to avoid any mishaps with her daughters.
On and off the pill for years, I didn’t think to make the connection at first…but since realize that my mood swings, anger outbursts, debilitating migraines, weak immune system, total loss of periods, hormone imbalances, early menopause (by age 27) frail bones, muscle loss, eczema covering 1/4 of my body, asthma & allergies, digestive issues, depression, anxiety and insomnia were all related to being on birth control pill (in addition to poor lifestyle choices)
I have since turned my health and life around as a holistic healer who has had 15 years of study and application….but it’s not near where I could be, my period will never return (12 years without it, ovaries necrotic) and I can manage just fine with what’s left over for symptoms.
I share this not as a way to gain attention, because truthfully I feel great now. But in hopes that others will see what can happen and make an informed decision regarding their choices.
I understand your passion advocating natural methods and celebrate your ‘ideal world’ point of view but there are issues with the recommendations in this post that you have not covered – it reads more like a magazine article than a thinking woman’s viewpoint. If you wrote more information about the specifics including the agony of IUD insertion in the teenaged cervix (recommended under general anaesthetic in Australia especially for anyone who has not had a pregnancy); as well as the important role of the contraceptive pill in preventing teen/early pregnancy (or teens having to seek abortion) in an emotionally hectic time of school/boys/angst etc, I think your article would be more rounded. It would be wonderful if these sweeping statements you make were true but we live in a time where teenagers are faced with many stressors (for example cyber-bullying, drugs, body image/media to name a few) and this approach will not and can not ‘fit’ all of our young women. Your information is interesting and thought provoking but you need to make allowances for those reading your article who do not embody your target audience with a brief message about how your view is not the answer for every young girl.
It is true there are non-contraceptive benefits and we should support all women’s decisions to choose their own health path. That said, it is equally true that it remains critical to diagnose and definitively treat the underlying source of pain/symptoms which prompted non-contraceptive use in the first place. Simply masking a condition is not a treatment; it is a stop-gap measure. It is also true that many providers are only all too happy to medically suppress patients without offering further investigation, leading to continued delay in diagnosis/effective treatment. In particular, endometriosis is fraught with such pitfalls of underdiagnosis/undertreatment. I look forward to Cycling’s focus on the disease this coming March during awareness month and being part of the dialogue.
My hormones are out of control. I am 25 and I am getting a period every 2 weeks, I have acne worse than ever before, I have joint aches, inability to concentrate, my face is blotchy, agonizing cramps, exhaustion…I have an appointment with a holistic gynecologist in 2 days, took me over a month to get an appointment..my regular Dr gave me birth control last month…Is it okay for the time being?
I don’t do dairy, I don’t do sugar, I exercise, I eat organic
The birth control has given me a little relief, so what do I do??
Hi Hannah, Short term use of the Pill can give relief from symptoms, so of course the decision will be between you and your gynecologist. I expect she will do some testing to try to determine why you were having short 2 week cycles. A short cycle is an anovulatory cycle, which means you had not been ovulating. Your doctor can do further investigation, including blood tests, to figure out WHY you hadn’t been ovulating (for example: insulin resistance, thyroid, or gluten problem).
I do that kind of investigative work with my patients, and if they have severe symptoms, they may choose to stay on hormonal birth control for a few months while we identify and treat the underlying issue.
Thanks for your feedback Gemma. Yes, you are right to point out that some girls are in more difficult circumstances that might the Pill the only option for them.
As regard to IUDs, it can usually be done with local anaesthetic, even for young women who have never given birth.