If you’ve been taking birth control and feel bloated after eating, or have gained weight that is difficult to drop, or have been set back by sports-related injuries that happened years ago, perhaps this case study on the unintended consequences of birth control on women’s health is for you.

Meet Stephanie — a 24-year-old professional who came to see me with a concern about her digestion. Well, it turned out to be more than that, and as you’ll see, very much related to her use of birth control pills.

Stephanie’s most pressing concern was related to her constant bloating after eating, along with constipation. During her initial consultation, she also told me that while playing sports in high school she suffered a terrible ankle injury that required surgery and months of bed rest. During this time, this 5-foot, 4-inch young woman went from weighing 120 pounds to 183 pounds.

Stephanie’s pediatrician recommended a gluten-free diet to assist her with digestion problems and weight loss. As a result of following her initial doctor’s advice, she did manage to lose a little more than 20 pounds, but still wasn’t comfortable at 162 pounds.

So far, Stephanie’s scenario seemed pretty straightforward to me. This young woman, concerned about her weight, had experienced a setback due to a sports injury a decade earlier as a teenager. Since then, exercise and diet haven’t helped her lose weight, and now she’s stuck at 162 pounds.

More to the Story

One important lesson I’ve learned over the course of my 20-plus years in practice is that there’s usually more to the story leading up to a patient’s primary symptoms, and this was certainly the case with Stephanie. As we explored her medical history, including the information she provided on the functional medicine analysis form she completed prior to her initial consultation, I discovered some interesting and enlightening details:

  • Stephanie had started taking birth control pills at age 12 after two extremely heavy and painful periods that led her to a gynecologist for a checkup (more about this later).
  • She had multiple cases of strep throat as a child, which were treated with antibiotics.
  • She had a history of using Accutane (a derivative of vitamin A) for acne.
  • During college, Stephanie lived in a dorm that had a confirmed outbreak of mold. At the time, she complained of chronic fatigue.
  • She reports that she sweats for no reason throughout the day.
  • She also reports feeling fatigued on most days, especially in the afternoon.

A Hormone Imbalance

One of the root causes of Stephanie’s health issues was a hormone imbalance. Many doctors and patients mistakenly believe that taking birth control pills is the cure for balancing hormones. But it certainly isn’t the best method, it doesn’t always work, and it can actually throw a woman’s natural hormone balance out of whack.

In this case, it completely stopped Stephanie’s menstrual cycles. She had amenorrhea, which means no menses. As you can imagine, amenorrhea is an unhealthy condition, and when it persists for a decade or more, it will likely lead to a hormone imbalance that has a significant negative impact on one’s health. Stephanie was no exception.

When she was 22 years old, Stephanie’s gynecologist decided to try another type of birth control in the form of an implanted intrauterine device (IUD), which also contained hormones. Within weeks, she was having her menses again — a decade late and extremely heavy.

When this occurred, Stephanie reported bleeding for two weeks straight, followed by a four-day break, then bleeding for another two weeks. She had the IUD removed and went back to taking birth control pills. Unfortunately, the bleeding persisted, as did the cramping and bloating. Again, she was bleeding for two weeks, a four-day break, and back to bleeding. It was certainly an unacceptable existence.

At 24 years old, Stephanie was ready to try a different approach — functional medicine — and that’s when she decided to consult with me. At this point, her health concerns were increasing, and she was understandably worried about fertility. Her cycles had not been normal since she was 12 years old, and the only solution that conventional medicine offered her was birth control pills or an IUD.

When I first saw her, Stephanie was bloated, always felt terrible after eating, and wasn’t able to lose weight. She was fatigued, sweating all the time, and had become deeply frustrated because she could find no solutions via diet, exercise, or the conventional healthcare system.

Remember: Birth control pills are not an effective solution for balancing hormones!

The Bucket Analogy

I like to use the bucket analogy when trying to understand what’s going on with a patient. What has filled the bucket over the years causing it to overflow? In Stephanie’s case, the bucket started to fill up as a child, when she was often sick with strep throat. Repeated treatments with powerful antibiotics likely caused an imbalance in gut microbes — the beneficial bacteria that play a key role in digestion.

At age 12, birth control pills began to add to the bucket. Because her hormones weren’t balanced, Stephanie started to suffer from acne, so Accutane was prescribed, continuing to add to the bucket.

Stephanie then experienced a severe ankle injury, negatively impacting her high school athletic career. This probably took a toll on her both physically and mentally, increasing cortisol (a stress hormone), which can contribute to weight gain. Afterward, she moved on to college, tired and living in a moldy dorm.

Over the course of a decade, her bucket could no longer contain all the stressors disrupting her health. It had reached the point of overflowing.

Testing to Uncover Additional Clues

From Stephanie’s medical history, I suspected an imbalance in sex hormones and gut microbes. The microbiome(the community of microorganisms such as bacteria and fungi that live in and on the body), the immune system, and hormones are all interconnected. For anyone interested, a 2016 study titled “Risk of Inflammatory Bowel Disease with Oral Contraceptives and Menopausal Hormone Therapy: Current Evidence and Future Directions” sheds light on the link between exogenous (external) hormone use and gut health.

I suspected that treatment would involve balancing Stephanie’s hormones while restoring balance to her gut microbiome, but we needed to test to be sure what was going on behind the scenes. “Don’t guess. Test.” is a common saying in the functional medicine community, and I ordered a urine test to check for yeast overgrowth, and blood tests for hormones, anemia, and thyroid function.

Test results indicated yeast overgrowth (candida) in her gut and mild imbalances in her sex hormones (heightened estrogen). The yeast overgrowth was probably caused by numerous factors, including repeated courses of antibiotics to treat the strep compounded by mold exposure and a high-carb diet that fed the candida. The result was bloating, poor digestion, weight gain, and symptoms related to PMS.

Treatment: Emptying the Bucket

The most effective approach to treating illness is often the opposite of the process that caused its onset. Stephanie’s illness was caused by poor management of her hormones along with stresses to her gut’s microbiome. So those were the two areas we needed to address.

I let her know that the added hormones from the birth control pills seemed to be impacting her gut health, and that I really thought it was in her best interest to consider a change. I also let her know that if she wasn’t ready to come off the birth control pills (because she was concerned with getting pregnant or afraid of what might happen to her cycle), we could start by working on the gut. Stephanie made the decision to come off the birth control pills immediately, and her initial medical protocol looked like this:

  • Stop the birth control pills.
  • Add a very low dose of natural progesterone to address a slight estrogen dominance.
  • Start natural antifungals to begin killing off yeast in the digestive tract.
  • Add a natural sleep aid supplement to address restless sleep, which often occurs when hormones are imbalanced. (Sleep plays an essential role in the body’s self-healing process.)
  • Start a clean eating dietary protocol. (Note: Stephanie later told me that this dietary protocol was easy to follow and helped her to lose weight for the first time in years.)

Within days, Stephanie started to sleep better, and her energy started to climb. Within two months, the bloating and constipation resolved. Even more exciting is that Stephanie’s cycles have been normal for the last two months — no heavy bleeding, just a normal menses for three to four days without pain for the first time in her life!

It makes perfect sense now that Stephanie’s hormones are balanced and her digestion improved, that her bloating is resolved, her energy is up, she’s not experiencing any random sweating, and her sleep is improved.

A Common Mistake

General practitioners, gynecologists, and gastroenterologists often overlook the complex interplay of multiple factors that can cause imbalances in the body. They focus narrowly on one symptom — in Stephanie’s case, the strep infection or the bloating or the constipation or her menses — instead of looking at the big picture. As a result, female patients often suffer needlessly.

Perhaps worse is that women are often routinely placed on the pill for birth control or to treat suspected hormonal imbalances, without testing and without any follow-up to evaluate the impact on their health. According to the National Center for Health Statistics, a combined 24 percent of women between the ages of 15 and 49 are using birth control in the form of the pill or implant contraception that may contain hormones. These exogenous hormones often create hormonal imbalance, causing more harm than good.

If you’re a woman on the pill and are experiencing health issues that are not being resolved, taking a break from the pill to find out whether it’s contributing to your health issues could be worth it. You can always use something else in the meantime for birth control and decide later to go back on the pill, but taking a short break can help you determine what works best for your body overall.

Of course, some women need to be using birth control for reasons other than balancing hormones (such as birth control), but there are other options, such as copper IUDs that do not contain hormones. Also, digestive and weight issues can be successfully managed, in some cases, while being on hormonal birth control. However, all options should be considered and explored in the context of each patient’s specific needs and preferences with the goal of achieving whole health.

A Story That Is Far Too Common

I penned this case study because I’m troubled by how often we allow women to be mismanaged in the healthcare system, and I am thrilled to see this young woman improve her outcome by deciding to pursue other options.

Based on over 20 years of practice, I can tell you with certainty this scenario is repeated more than a silly dance on Tik Tok! I have two daughters and I would be really upset if this was their experience.

If you or a loved one is having a similar experience, and you’re in the Tampa area (Southern Florida), I encourage you to schedule an appointment with me for a consultation.