Wednesday, January 4, 2012

Birth Control or Weight Control?

What in this purse may affect your weight? 
Many clients come to see me for the first time when their doctors inform them their cholesterol or blood sugar is elevated. They want to improve their diet in order to avoid going on medication. I totally get this; after all why take something pharmacological if you don’t have to? Every medication can have side effects. What I don’t understand is why millions of young (and not that young) women take birth control pills without a second thought. Whether it’s a pill, injection, patch or “ring”  we should think clearly about this before taking something hormonal every day for years and years.

Then there’s the question of weight gain and certain birth control methods. Many doctors will tell you that the Pill and weight gain is a myth. Katherine O’Connell MD, of Columbia University was quoted saying, “women seem to learn early to blame a lot of side effects on their birth control. But, when women were given placebo (fake) birth control pills in recent studies, they reported the same physical complaints – including weight gain – as women who were popping the real hormone-rich Pill” Many studies echo these conclusions.  There trouble with this research is that it’s hard to determine causal relationships when many women in their 20’s (college aged) and 30’s (childbearing, aging) gain weight anyway.

Doctors also emphasize that the pills of today are innocuous compared to the early versions of birth control. The older generation of pills contained significantly more estrogen and physicians admit these were capable of causing weight gain. I have an issue with this threshold reasoning. You see it often with food ingredient research “at these levels there is no cause for concern.” Concern is concern and my thought is that today’s pills range in their hormone content and who’s to say what dose produces what effects in certain people. The reason studies may not tease out obvious trends is that everyone’s system reacts differently.  A Mayo Clinic piece mentions that estrogen can make adipose cells larger but not more numerous. Larger fat cells = weight gain.

If there’s one form of birth control that clearly produces weight gain it’s Depo Provera a progesterone-only shot (Depo-Provera contains a synthetic form of progesterone called progestin). This was touted for its convenience since it’s needed once every three months and almost foolproof when it comes to pregnancy. However, would you trade convenience for going up a couple of clothing sizes? In a study in the American Journal of Obstetrics and Gynecology in March 2009, 700 women were allowed to choose among various contraceptive methods and then were followed for three years to measure their gain in weight and body fat. Those who chose the Depo shot gained an average of 11 pounds over three years. An interesting theory is that the progestin only birth control (Mirena IUD is progestin only as well as are “mini pills”) may decrease insulin sensitivity which would increase the likelihood of fat storage.

In my work with clients, many women have symptoms when starting a pill that often dissipate at about the 3-month mark. For others, you can tell a pill does not agree with them,  hormonal symptoms do not resolve and their weight continues to rise or not drop despite eating well and exercising. A WebMD article I read stated, “weight gain is an uncommon and temporary side effect to the pill, if you happen to be one of those few women who put on pounds, talk to your doctor. Your doctor may suggest a different type of birth control pill. Why? Because all pills are not the same.” While there are many reasons and motivations to take the pill, there is another option and that’s no pill at all.
Do you take the Pill? Ever had a pill that didn't agree with you? Any concerns about the safely of birth control pills or side effects?

41 comments:

  1. Great post Lauren. This one really hits home with me! I believe the pill is taken way too lightly. The side effects are VERY REAL. Besides weight gain, blood clots are a concern. I had never been on the pill and as a last resort before having surgery I caved and went on LoLo. 6 weeks later I ended up with a superficial blood clot in my right leg that was very painful and if not treated could lead to a more serious clot. I am ok now, but have to be careful and now the vascular doctor is in my contacts going forward.

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  2. This is something that weighs on my mind every day. I'm 36 and have been taking the pill for 18 years. I bring it up every time I visit the doctor and every time she assures me since I've never had any issues, I am ok. I don't know that I believe her but I don't really know what else to do. Children aren't an option. I know my husband can get snipped, but I very much feel "my body, my responsibility" so I am stuck with the pill as most everything else frightens me. I'm close to just tying it all up and calling it a day but surgery scares me too.

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  3. It's crazy how effective the placebo effect can be!! It's like when they say on the news, "the average persona gains 1-2 pounds over the holidays"...then you assume you will gain it and it sort of becomes "true" in your mind. I don't know, maybe that was a bad example. Anyway, I've been on BC for MANY years, but have changed many times. Now I am on a low estrogen version and I have not experienced weight gain (other than that that I have purposely gained). I never understood doing the shot. It's NOT hard to take a pill everyday with breakfast!

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  4. good comments everyone, Gina you're body aware enough to switch and good you seem to tolerate what you are doing. Amber, there are IUS sans hormones and the make "procedure" easier and reversible. Julie agreed people take lightly and MDs are in the medicine business, not sure "everything is fine" is 100% correct but I'm in the food/less medicine business.

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  5. Great post Lauren! WHY take any meds if you it is not a MUST!

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  6. Weight gain is a side effect of so many medications. I suppose that it's the responsibility of the user to weigh the pros and cons of the side effects and decide if it's worth the risk to avoid the condition being treated. Sometimes, like you pointed out, the answer is to find alternative treatments.

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  7. The problem is that once you start taking any pills, the treatment to any further issues or side effects are more pills. The medical industry does not like to go back to nothing and re-evaluate.. before long, people are popping 5,10,15 pills a day. Which is great for the profit of the drug corporations.

    I am no medical expert, but I do believe that in most cases, diet can fix most medical conditions that require long term drug usage. I found Foodmatters and ForksoverKnives films to be interesting for that subject.

    I have never had to take any pills except for a few immediately after a couple of surgeries, but if I did, I would totally be researching other means to remove my dependency on them.

    Sorry, no comment on birth control :) just drugs in general.

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  8. Yes, I believe this is the case with all meds but BC people take without thinking of a med sort of a necessity or even a "vitamin" something you pop and go on with your life. Karen, and in this case I think just investigating alternatives a positive step. Thanks Keri G.

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  9. I used the BC pill when I was younger and had all sorts of little issues. A diaphragm was actually the best solution for me. That is... until my husband got a vasectomy. I am so grateful for that decision.

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  10. Wow I'm embarrassed to say I hadn't thought much about the negative side effects of the pill, not on anything now but definitely fell prey to the doctors "much better than it used to be" talk.

    I took one that did not agree with me, a nice way of saying I was an emotional crazy person and +5 lb real weight gain. Got off and weight came off. Then got on and off Yazmin for a few years; main side effect was positive, improved skin - but caused major emotional rollercoaster if not taking at the same time daily... should have been a hint I was messing with important stuff. Oy.

    Happy for this post; great food for thought -- totally agree that threshold reasoning is crap.

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  11. Carolyn "important stuff" indeed. We trust our doctors and they are trustworthy but also think within a certain framework: these little bitties regulate hormones, improve PMS and prevent pregnancy- viola (not so fast). Caron- I can't advocate surgery while anti meds but thanks for pointing out other options barrier/snipping etc.

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  12. I have been on the pill for years now. I was off of it for some time and just felt horrible. I honestly should try to get off of it again but dread the idea of feeling that crappy when that time of the month rolls around.
    Perhaps my body is so accustomed to it. I don't feel like I have had too drastic changes in my weight.

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  13. I've thought about this a lot since I've been on the pill for (gulp) 22 years. Yet the side effects I've experienced when going off the pill and/or trying other BC methods are far worse than the generally positive side effects of trying something else. When I'm on the pill, my skin is much clearer, my hair is thicker, and I haven't gotten pregnant. But off the pill and on other BC methods, my skin is a disaster, my mood swings wildly. I had a horrid skin reaction to the patch, and the now 12 year old scar on my arm shows that. The Ring did awful things to my husband. Seems like the Pill is my best choice. I'm still on the pill even though I'm pregnancy isn't an issue because I still see positive side effects. My Dr. and I will reassess this path soon.

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  14. I hear you Marie and it's a choice for every woman or maybe even most couples.And thanks to Kristin too for pointing out their are good side effects too. My question is, all these things that are "regulated" or masked by being on the pill are because we're ingesting hormones, what is the upshot of that ultimately?

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  15. I have been on the pill for several years now (minus the year I took off to get pregnant and then the 9 months I was pregnant). I can honestly say I haven't had any negative side effects from it. Granted I use a very low does pill.

    I have been concerned about the negative effects of birth control but due to inconclusive evidence I have remained on it because let's face it...I'm not ready for kid #2. Haha.

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  16. I was on the pill for a few months in my teens -- "secretly." I remember the doctor giving me the pills and me hiding them in my room. Sad because I had no idea what I was doing. But I do remember feeling awful -- weight gain, bloating, mood swings.
    I would be so mad if a doctor convinced my daughter to take the pill in her teens w/o me knowing!
    Since then I never took another BCP. After 3 kids my husband got snipped which I think is the best birth control method when you are 100% certain that you are done having kids.

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  17. Madeline, so glad someone broached the pregnancy topic, yes that's why many people take the pill but without going into detail there are, as I'm sure you know, other methods. Lisa- with teens the worrisome fact is also STDs when you're free to have sex and feel "nothing can happen".

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  18. I do Depo shots and I haven't gained weight. I workout and maintain a healthy lifestyle. I guess I might be an instance where I am the odd ball out but the last time I was on this shot I was not healthy or working out and did gain weight. I would be interested if that study also tracked your workout habits.

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  19. Very interesting comment Amanda. If Depo's pathway for increasing weight is via insulin, exercise improves insulin resistance and would counter this trend. If someone predisposed to insulin resistance or diabetes in family exercise may not be enough to counter this.

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  20. I was on various birth control pills for 12 years and about 3 years ago, decided all the side effects weren't worth it. It really upsets me when OB/GYNs insist that there is no harm in taking hormones for years. What about blood clots, hormonal imbalances, and even more important to me, the higher risk of cervical cancer!?

    My husband and I use non-hormonal methods of birth control that work very well, even though the doctor tried her best to scare me into thinking I would get pregnant before we were ready. Ugh. I just want women to have more knowledge about these things so they can make an informed decision.
    Thanks for the great article!

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  21. Kristen agreed on all points. My hope is that whether it's weight or certain health concerns women think about what they are taking, the options out there and that even "no side effects" can be worrisome.

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  22. This is a great post, and I wonder why we don't see more discussion of hormonal contraceptives in the media. The risk of blood clots is very real.

    That isn't to say that people shouldn't take them...just that they should have a real understanding of what the side effects are.

    I took one brand of pill for a few days and I seriously thought about checking myself into a hospital because I felt very mentally off balance, like I had these racing thoughts that I could not control.

    Then there is the birth control brand that must disclose a potential side effect is that it may raise potassium.....are they educating people as to why potassium out of the normal range might be concerning...certainly not something that would appeal to me.

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  23. I hated being on every single kind of pill I tried. They need to develop one for men. It's their turn to be the guinea pigs. Aferall, they are the ones who want to get it on so bad! In all honesty though, I have always been weary of putting hormones in my body. Our hormonal systems are so sensitive and so crucial to our wellbeing and our health. I've always been scared to mess with mine too much. Though I did have to use the morning after pill multiple times as a result (in my early 20's) and I think doing THAT screwed me up for life.

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  24. See cameo a male pill will not work until men (and not that one weird one) get pregnant.

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  25. Every drug treatment carries some risk of side effects. It’s always a question of risk–benefit analysis, and ends up being a personal issue.

    The benefit of oral contraception pills is very effective prevention of unwanted pregnancies – there are very few options as effective and convenient as the pill – and the risk related with the pill may seem small in comparison to some women, and all too large to others.

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  26. Thanks for your post! you answered a ton of my questions and concerns.

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  27. First off I must admit I am pro-pill. I have seen the side effects of a lot of other forms of birth control...unwanted pregnancies and ectopic (tubal) pregnancy. Every medication has side effects, I went through 3 pills until I found one that I love. I know the risk of blood clots is there so..I don't smoke and am conscious of any signs of swelling in my legs, chest pains or shortness of breath.

    The emotional, social and financial implications of unwanted pregnancies are overwhelming. I think your blog post only addresses educated social upwards woman. Spend one night in the south Bronx and you will be cheering the depo shot. Life up there and in a lot of other places is chaotic and excepting people to take a pill everyday, use a condom or diaphragm is actually asking al ot.

    I have not gained an ounce on the pill, however I am not pregnant (thankfully) and all my PMS symptoms are gone. I have tried EVERYTHING from accupuncture to Zinc to get rid of them but each month I would have 5 days to a week of hell (that is a 25% of my life), I'd rather risk the pill then go through that again.

    Also, some of the options mentioned are only available to people who have had kid or who are done with them. The IUD is only available to people who have had a child and increases your risk of a tubal pregnancy or pelvic infection and getting surgery for you or your partner is only good if you don't want more children. In almost ten years of practice I have seen more complications from the IUD then the pills. Most of the people who get clots from the pills were smokers.

    To Bzybee, I would love to think that diet and exercise cure most things, unfortunately it is just not true. Aspirin has saved the lives of countless people, I have seen marathon runners have heart attacks at 40, non smokers with lung cancer, people whose lives have been given back to them through anti-depressants. I also admitted a 35 year old healthy woman to the ICU last night because she was treating her 2 weeks of pneumonia with ginger tea. I am normally Dr. NO when it comes to giving antibiotics for colds, strep throat and ear infections if your child is over 2 (yeap, you don't need antibiotics!), cat scans for boo-boos and narcotics when not needed. I am not popular!
    However, in responsible good hands medications have there place. I also, as an emergency physician, take time and explain to my patients the dangers of fast food, processed foods, soda , smoking etc but know when even the best life style choices will not prevent certain things.

    Everyone is different, but for millions of woman the pill has literally been a life saver. It gives us choices and control over our bodies and I think many would take the 5-10 lbs that some report to gain over the 30-40 that come with pregnancy.

    Melanie

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  28. Hi Melanie:
    Yes, we come at this from different places and I am a nutritionist on the UWS of manhattan. Aside from weight, what about putting hormones in your body for years upon year?. We learned the hard way with soy supplements that some side effects you don't realize until it's too late. While some BC works post babies there are other non-pharmacological methods that would work for many. The mood swings some say the pill alleviates, others say it creates (makes sense) and some doctors say "it's all in their head." Is the pill right for some, perhaps but many people haven't even thought it over and if weight is a concern or if there's insulin resistance that can run into problems. It depends on the population, it depends on the individual but I don't think everyone should be on the pill or as a MD client once said "lipitor be added to our drinking water" either. I'm not anti medication but anti medication that some people don't need.

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  29. Very interesting discussion. I think the pill is a necessary evil for many but this post definitely makes me wonder if it is so necessary.

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  30. Exactly betty, not necessary for all. Rebecca, waiting for someone to throw the condom word out there.

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  31. The pill came out in 1960, that is over 50 years of data supporting it. Research has shown that is lowers the risk of uterine and ovarian cancer and lowers your risk of stds. While I don't love taking any kind of hormones, the pill these days has significantly lower amounts of hormones then it has had in years. It is, currently, the most effective form of birth control. Far superior to condoms. As for Pms, believe me it has been a wonder drug. I even tried an ssri before hand so if it was all in head I think that would have worked better.

    As for Lipitor in the water... If it didn't have the rare side effect of liver damage and muscle break down I might agree! I would also to slip a few other medications in some people's drink. I agree we come from very different places and experiences and I definitely agree with some of your points and as for the other, I think we should just agree to disagree.

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  32. We can agree to disagree, 50 years of what data? how moody people feel (better or worse) or that it doesn't appear to kill us? Lower hormones to me is like less HFCS don't love idea of either (agree). I will not argue pill is effective for prevention of pregnancy all I'm saying is when people feel poorly on it not "a myth" as some doctors say and for everyone who says it helps mood someone says it makes them moody, a mixed bag. The thing is many people take and stay on pills for years and years, do not necessarily know of think of options and aren't necessarily taken seriously by their doctors (hint hint). Wow my first point of contention with Dr O. Still love you.

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  33. really great post! i recently (6 months ago) got off of the pill after having been on it for 20 years. i never felt bad on the pill but boy do i fell INCREDIBLE off of the pill. it is really powerful and should not be taken lightly!

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  34. So interesting Kalli, one never knows until they experiment.

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  35. Wow! Great discussion here! The last birth control pill I took was before I had my first child. I was on one at that time that didn't have many side effects {that I can recall!}, but I remember taking a progestin only pill once and felt just miserable. I'm intrigued by the role hormones play in weight control...estrogen can cause weight gain in birth control pills, but take it away in perimenopause/menopause and it can lead to weight gain...Since I discovered {after having kids} I have a genetic disposition to having a problem with blood clots, no more pills for me!

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  36. EA I would think omega 3's/green tea good if tendency to clot (unless you're on blood thinners). very interesting what you mentioned about estrogen at different times in live. Yes postmeno it's less estrogen leading to less muscle mass leading to weight gain but estrogen overload premeno leads to weight gain. Hormones!

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  37. This is such a controversial topic. I have been on birth control twice in my life (for only 3-4 month periods and then stopped). While I didn't gain weight, I turned in to the ultimate B**CH! I asked my doctor and she said that some women with low body weight are affected by hormones more severely. I'm thankful I never took them for longer bc I DO believe they are unnatural and I don't like taking any type of drug.

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  38. This topic is very interesting to me as I have been on birth control to regulate my period for too long. I don't have any weight gain issues, but it really does mess with you hormonally. I went off of them for about 3 months and had terrible acne, high DHEA/low progesterone levels. I'm going to see an RD that specializes in hormone abnormalities soon! I am on a low estrogen version now, but I'd like to get off these pills if I can asap. I feel sooo much better off of them.

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  39. Great post and really interesting comments. I think I need to ask my doctor a few more questions. Wish I had read this last week before I saw her!

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