The Oral Contraceptive Pill: What You Need to Know From a Nutritional Perspective
While the pill has been a useful method of managing one’s conception, it is increasingly being prescribed for issues other than contraception, such as acne, amenorrhea, pre-menopausal symptoms, painful periods and other issues of hormonal imbalances.
But the reality is, it puts a plaster on the problem and does not address the causes. Whether you choose to stay on birth control, it is a highly personal decision, and every woman is within her rights to choose to take the pill and it is a matter to be discussed with one’s doctor.
It is useful to know how the pill can our nutrient status; one of the negative side effects of being on the pill is nutrient depletion. Synthetic hormones affect vitamin metabolism, potentially exacerbating the problem the pill was intended to address!
Here are a few nutrients that are negatively affected by the pill:
o Vitamin A: the OCP can increase retinol levels in the blood in some, whilst in others, it reduces beta-carotene (the precursor to vitamin A). Vitamin A deficiencies can increase susceptibility to infections, cause dry, scaly skin, pronounce the appearance of wrinkles, cause heavy menstrual bleeding, contribute to defective teeth and gums, and cervical problems. Furthermore, vitamin A is an essential antioxidant.
o Vitamin B1: side effects of a vitamin B1 deficiency include fatigue, insomnia, weakness, depression, irritability, loss of appetite, sugar cravings, constipation, and circulatory problems.
o Vitamin B2: the body uses more vitamin B2 whilst on the pill, therefore requirements are raised. Side effects of a deficiency include dandruff, skin issues, depression and gum infections.
o Vitamin B6: depletion of vitamin B6 has several side effects such as lethargy, anxiety, mood swings, insomnia and fluid retention. Furthermore, vitamin B6 is essential in sugar metabolism, preventing blood clot formation and converting tryptophan to serotonin (a neurotransmitter that affects mood, sleep and sexual desire).
o Vitamin B9/folate (also known as folic acid): levels of vitamin B9 can be depleted on the pill due to reduced absorption and increased excretion through urine. This would be of particular concern if you are looking to conceive soon after stopping the pill; folate is required to facilitate cell division, a process that begins immediately after conception. If levels are deficient, there is an increased risk of abnormal DNA synthesis and congenital abnormalities, such as spina bifida and neural tube defects.
o Vitamin B12: levels have been found to be lower in OCP users in comparison to non-users. This can result in anaemia, weight loss and depression.
o Vitamin C: similarly to vitamin B12, levels of vitamin C have been found to be lower in OCP users in comparison to non-users. This is worsened by poor dietary habits, malabsorption issues, stress, high pollution exposure and smoking. Vitamin C is essential for regulating the menstrual cycle, supporting ovulation and egg quality, clear skin, collagen synthesis, iron absorption and good energy levels.
o Zinc: lower zinc levels are found in OCP users; deficiencies can lead to cravings, weakened immunity and loss of appetite, and can be contributed to menstrual irregularities.
o Selenium: the pill interferes with selenium absorption, an essential antioxidant that is preventative against breast cancer, cardiovascular disease and thyroid conditions.
o Magnesium: levels of this vital mineral are reduced on the pill. Magnesium deficiencies contribute to many PMS symptoms, including breast tenderness, menstrual cramps, sleeplessness, sugar cravings and irritability. Magnesium depletion also alters calcium/magnesium balance, affecting blood coagulation. Hence, it is hypothesised that this may be why the pill increases the risk of thrombosis.
It is important to remember that there is great biological variety in terms of how the pill can impact the body. Everyone’s body is incredibly unique and dietary habits, stress levels, sleep quality, BMI, physical activity, and the environment are factors that affect our biology and nutrient status. Nonetheless, here are actions you can take if you choose to stay on the pill for any reason:
o Eat a whole food diet that includes a variety of vegetables, low glycaemic fruits, complex carbohydrates, organic animal proteins, nuts, seeds, and legumes
o Reduce ultra-processed foods (think sodas, crisps/sweets/chocolates with preservatives and additives, sweetened breakfast cereals, etc.) – it is unrealistic for most people to eliminate all ultra-processed foods completely and that is totally okay! Aim for at least an 80-20 balance (80% whole foods, 20% ultra-processed foods)
o Be mindful of your caffeine intake – caffeine can interfere with absorption of essential minerals such as magnesium, calcium, and B vitamins
o Find a health practitioner to work with to address the root cause of any hormonal balances and to give bespoke guidance on improving overall nutrient status
o Speak to a health practitioner about which multivitamin is the best fit for you
o Get tested! For nutrients like vitamin D, iron, and folic acid, you may want to get your levels tested privately or through the NHS before spending time and money on looking for the appropriate supplement that you may not end up needing.
Oral contraceptives and changes in nutritional requirements