Hating Hormones: What you need to know about hormonal contraception

Going Hormone Free: Natural Contraception

There is a trend at the moment of people forgoing hormonal contraception in favour of natural contraception alternatives[1] Many health blogs and websites are touting the benefits of hormone-free, or non-hormonal contraception. As with anything that encourages us to take a closer look at our health, this is largely a positive phenomenon. We should always be aware of what we’re putting into our bodies and how it may react with our lifestyles or other medication we’re taking.

For those who are unfamiliar with Natural Contraception you might know it by one of its many other names; the Rhythm Method, Natural Family Planning, the Fertility Awareness Method (FAM) and collectively sometimes referred to as a Calendar Based Contraceptive Methods. These are systems of non-hormonal contraception based on the understanding of when a woman is fertile and can become pregnant.

Studies have shown that that sperm can remain viable for up to 7 days (if you’re curious, there’s a less than 5% chance that it will survive past 4.4 days). Even though it’s unlikely that it will, it’s important to account for the maximum survival rate to ensure the greatest efficacy. This means that a woman is fertile for around 8–9 days before ovulation, and 3 days after ovulation has finished. This provides a fertile window of around a week each month. This can either be used to help conceive or, as is happening now, be a guide on when to avoid sex (or use barrier contraception) to prevent pregnancy.

While FAM have been around for centuries, they have experienced a renewed popularity thanks to our current social focus on “organic” lifestyles. This has also been made easier with the integration of smartphone apps into our lives, making tracking fertility periods much easier.

However there’s also a lot of misinformation out there around natural contraception. Many people don’t realise that FAM is only as effective as the regularity of your cycle. If your body isn’t running like clockwork, it can be very easy to miscalculate your period of fertility. Even in a person with a regular cycle this can be thrown off by things like illness, stress, cohabitation with other menstruating women or medication. For most of us though a completely regular cycle is a foreign concept. In this case use of the Rhythm method requires constant monitoring of cycle symptoms; levels of mucous measurements, basal body temperature checks, cervical changes, breast tenderness, abdominal irregularity and more. Without keeping careful track of these indicators it can be easy to miss your fertility window and risk accidental pregnancy.

When used typically, the failure rate for Natural Family Planning is between 22% — 25%[2]. By contrast the Withdrawal Method or Pull Out Method has a failure rate of 27%[3].

Regardless of the risks of unplanned pregnancy associated with them, more and more people are turning towards non-hormonal contraception methods as an alternative to the hormone based contraception options available.

There is a tendency for people to view anything hormone based as being inherently bad for the body. However, it is interesting at this point to take a moment to debunk some of the myths and to find out exactly how many hormones are in the average hormonal contraceptive.

Synthetic vs Natural Hormones

There is a heavy focus these days on ensuring that what we put into our bodies is ‘natural’ and ‘organic’. While this is a worthy goal, it has meant that there is now a lot of confusion between natural and healthy. For instance, arsenic is both natural and organic but that doesn’t make it healthy or good for your body.

When it comes to hormones a lot of people are concerned about the use of synthetic hormones in contraception, because it seems unnatural. The word synthetic makes us think it’s fake, but in medicine it simply means that it’s synthesised. A synthetic hormone is made in a laboratory, sure, but it is in every way identical to the ones that your body produces. It has to be, otherwise it can’t do its job. In fact the foundation for these hormones is often taken from wild yams and soybeans.

Conversely, an example of a natural hormone is contained in a brand of conjugated estrogens tablets, a medication that combinations natural estrogens often used to treat people with severe menopause symptoms. This naturally occurring estrogen is harvested from pregnant mares. Whilst it isn’t found in the human body, it is typically used in Hormone Replacement Therapy (HRT), which can have some rare but serious side effects[4].

In short, the ‘synthetic’ hormones found in contraceptives are typically going to be identical to the ones your body would be making by itself, they just happened to be made in a lab instead of in your pituitary gland.

How many hormones exactly: The Contraceptive Pill

The Pill, also known as the Combined Oral Contraceptive, is a combination of two synthetic hormones; oestrogen and progestogen. These two work in conjunction to help stop your body from ovulating. This means, rather than using the Rhythm method to avoid having sex during your fertile time, you’re skipping your fertile time completely.

There’s a broad variety of pill types on the market, each of them combining different levels of the two hormones to achieve different results. For example some have higher hormone levels to help combat painful menstrual symptoms.

The median hormone levels found in The Pill are similar to those experienced during ovulation. This means if you’re on The Pill you’re not subjecting your body to hormone levels outside the parameters that it would naturally produce. Even brands of The Pill with higher doses still never exceed hormone levels found in the first 12 weeks of pregnancy.

Meet the Mini-Pill: A low hormone, not a non-hormonal method

The Mini Pill is a progestogen only oral contraceptive. This means it’s similar to The Combined Pill in the way that it’s used, but unlike The Pill it doesn’t contain oestrogen. The mini pill prevents pregnancy by thickening the cervical mucus, which makes it impenetrable for sperm, but it doesn’t prevent you from ovulating.

Most versions of The Pill contain progesterone at around 150 micrograms. The mini pill only has 30 micrograms. That might still sound like a lot, but to help give you some scale, the morning after pill contains 1500 micrograms (1.5mG).

Because the mini pill dosage is so low, it means it’s safe to use while breastfeeding, which is why most women will use it in that context. The downside is, you have to take it within the same 3-hour window every day, otherwise it won’t work.

All the hormones all over the place: Hormonal IUD

When people hear about IUDs, they often assume that it means inserting this hormone generating contraption into your body that’s going to flood you with all the hormones ever. In reality, one type of IUD doesn’t contain any hormones at all, and the other type that does has less hormones than any other method of hormonal contraception. The two kinds of IUDs are considered to be ‘long acting reversible contraception’ (LARC) are commonly referred to as the copper IUD and the hormonal IUD.

The copper IUD doesn’t contain any hormones at all, and so is an effective non-hormonal contraception method. Instead copper IUDs use the chemical reaction of copper in your body to help thicken mucous levels and prevent conception. The copper IUD can make periods a bit heavier and longer so it may not be ideal for women whose periods are already troublesome. This leaves the hormonal IUD.

The hormonal IUD, like the mini pill, is a Progestin-only method of contraception. However, due to its placement in the uterus, it doesn’t require you to do anything (like remember to take a pill each day). This means it has a much higher efficacy rate than any oral contraception. It can also make your periods lighter and shorter or they may stop altogether while the device is in place. Because of this it can be a good treatment for women with period problems.

Because the hormonal IUD is placed in your uterus it also means that the hormones it releases are almost exclusively localised to your reproductive system. With an oral contraceptive, it relies on entering your blood stream via your digestive tract to function. With a hormonal IUD, the amount of hormones reaching your bloodstream will be minimal, meaning hormonal side effects should also be minimised.

The hormone level in a hormonal IUD is the equivalent of between 2 -3 mini pills per week (as opposed to the seven you’d be taking if you were relying on the mini pill for contraception).

Ultimately contraception is a personal choice. It’s up to each of us to decide what we are and aren’t comfortable with putting in our bodies. But part of making that decision requires us to be informed about the efficacy and dosage amounts of the available options. Natural contraception and hormonal contraception are equally valid options for people, depending on their own personal circumstances.

Originally published at www.mariestopes.org.au on February 13, 2018.