Birth control pills, otherwise known as oral contraceptives, are used by many women for a multitude of reasons in their reproductive years. And while they're a proven form of birth control, there are concerns about chronic nutrient deficiencies related to any prolonged prescription use. Before you toss your pill pack, know that there are ways to reduce your chance of a nutrient deficiency! Let's learn more.

On-going medications such as oral contraceptives are started as early as the teen years, to prevent pregnancy and address hormonal imbalances, and are often taken all the way until a woman reaches menopause. Estimates show approximately 25% of women between the age of 15-44 currently use birth control pills as their contraceptive method of choice. Additionally, an estimated 14% of women take oral contraceptive pills for other medical conditions beyond pregnancy prevention1, for reasons such as:

• heavy or irregular periods
• endometriosis
• hormonal imbalance
• polycystic ovarian syndrome (PCOS)
• acne
• excessive hair growth
• fibroids
• menstrual pain
• menstruation-related migraines

Active agent(s) in oral contraceptive 

There are two main types of oral contraceptives prescribed by doctors, both containing a synthetic form of hormones that mimic the role of the body’s naturally occurring hormones – estrogen and progesterone. Both types have the potential to lead to nutrient deficiency. The first type called “the combined pill” or simply “the pill”  is a blend of the hormones estrogen and progestin (a synthetic form of progesterone).

Common oral contraceptives - Combined Pill (estrogen and progestin): Apri, Junel, Loestrin 24 Fe, Microgestin, Ortho-Novum, Portia, Yasmin, Yaz

The second type, called the “progestin-only pill” or the "mini-pill," provides only one hormone - progestin. Both prescriptions are once-per-day tablets that the user takes orally, preferably at the same time daily.

Commonly prescribed brands for the Mini Pill (progestin-only): Camila, Errin, Heather, Jolivette, Nora-BE

How do oral contraceptives work? 

Whether you are taking the combined pill or the mini pill, both use synthetic forms of hormones you’d find produced by your body. These hormones work together to prevent the release of eggs from ovaries. It does this by signaling to the brain to decrease the production of two vital hormones – FSH and LH. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) help in the maturation and release of eggs (ovulation) during a typical menstrual cycle. Birth control pills work by inhibiting follicular development, which is vital for the production of the ovum. This action prevents ovulation2. Another way progesterone works is by making the cervical mucous unfriendly for the sperm to penetrate. This inhibits sperm activity and prevents pregnancy3. 

Common side effects associated with taking birth control pills

There are several side effects that are commonly discussed during a routine visit with your primary care provider or gynecologist. If side effects from oral contraceptives are concerning you, be sure to bring it up! Oftentimes a simple change in the level of hormones or the type of pill can bring relief from many of the symptoms below.

Nutrient deficiency and oral contraceptives 

Unlike the other side effects listed above, you may notice that nutrient deficiencies can be subtle and most often ignored. Due to this fact, it is least discussed by doctors and lesser-known to women taking birth control pills. Unfortunately overlooking this side effect can lead to serious concerns. This is especially true if you are taking birth control pills for many years. After all, these are synthetic pills. For example, earlier studies have shown that women experience a short-term decrease in fertility soon after they stop birth control pills4. There could be many reasons for infertility, but one striking possibility that cannot be ruled out is a nutrient deficiency(s)4. Synthetic hormones change your body's biochemistry, impacting your natural hormone patterns, metabolism, and inducing nutrient deficits.

The mode of action by which birth control pills alter your body's nutrient levels isn't clearly understood, but research continues to show plausible ways birth control pills may influence nutritional status. One mechanism is that birth pills may alter the small intestine's function, leading to decreased digestion. The disruption in digestion reduces the bio-availability of crucial vitamins and minerals, making it hard for your body to absorb them. Also, to metabolize medications, your body needs some essential nutrients, which could also cause nutrient deficits in the long run.

Although it may seem subtle or trivial, these things can add up and result in deteriorating health. Other factors like unhealthy eating habits, illness, or chronic inflammation could also add to the problem resulting in a full-blown deficiency. The bottom line, longer the intake of birth control pills may lead to a higher risk for nutritional deficiencies.

What nutrient deficiencies are common when taking oral contraceptives?

While oral contraceptives effectively prevent pregnancy, long-term use is found to alter the metabolism of nutrients. In other words, it changes the way your body can process, absorb, and use certain nutrients, which could affect your nutritional status. Studies show that oral contraceptives impact a range of nutrients5 including, 

Vitamin B2 (riboflavin): Research suggests that the need for vitamin B2 is higher for those taking birth control pills. The condition is exacerbated if there is an existing B2 deficiency. Riboflavin is a vitamin that is needed for cellular growth, and overall good health. It helps the body break down carbohydrates, proteins, and fats to produce energy. B2 aids cell turnover and collagen maintenance, which protects the structural integrity of your skin, reduces inflammation, and speeds wound healing. Low B2 levels can also cause deficiencies in other vitamins.

Vitamin B6 (pyridoxine): Your body needs adequate vitamin B2 to convert pyridoxine into a usable form of vitamin B6 6.  Vitamin B6 plays a key role in keeping the brain and nervous system functioning properly. It is involved in the production of hemoglobin (the protein in blood that carries oxygen throughout the body), and the production of hormones such as serotonin (regulates mood) and norepinephrine (helps your body cope with stress). Vitamin B6 also helps the body make melatonin, which is important in helping regulate your sleep.

Tryptophan: It is found that approximately 80% of those using oral contraceptive pills for six months or more experience abnormal tryptophan metabolism7. Tryptophan is an amino acid your body needs to produce serotonin (regulates mood and behavior) and melatonin (for sleep).

Vitamin B12: Studies find that B12 levels drop after oral contraceptive use compared to women who do not use them8 9. Not having enough B12 can lead to anemia, a condition in which your body does not have enough red blood cells to do their job. This can make you feel weak and tired. A B12 deficiency can cause damage to your nerves and can affect memory and thinking.

Vitamin C: Studies find that vitamin C levels are lower in oral contraceptive users, and supplementing with vitamin C is useful10.  Vitamin C is an essential vitamin, meaning your body can’t produce it, yet it plays a major role in your health, such as boosting immunity, improving heart health and blood pressure, even protecting your brain and nervous system from oxidative stress and inflammation.
Minerals: Micro and trace minerals such as zinc, magnesium, and selenium levels are found to drop with prolonged use of birth control pills. Adequate levels of zinc help to support your immune system and muscles. Magnesium plays a role in your metabolism and muscle health, as well as helping to manage sleep.  

Prolonged deficiencies of vital nutrients can lead to many conditions such as anemia, diminished cognitive abilities, fatigue, and in some cases, infertility and depression. Women that are postponing their pregnancy but planning to get pregnant soon are mostly at high risk for nutrient deficiency. Being deficient in the nutrients mentioned above can make it harder to conceive. Plus, a deficient status before conceiving can also complicate pregnancy.

If you take birth control pills and are concerned about your nutrition status, consider using quality nutrient supplements to meet your needs. Blood work can reveal your nutritional status if you're after a targeted approach. Given the evidence from studies, it seems prudent to at least take a multivitamin with B complex vitamins as prevention if you take birth control pills for a long time. Vitamin B supplements in various forms may be a great dietary aid for some women   Besides using supplements, it is also crucial to improve your dietary habits. Include variety in your diet with plenty of fresh, wholesome foods rich in vitamins and minerals. Steer away from processed foods as they will worsen your nutrient deficiency.

The team at CAMFormulas and Local Health Pharmacy are here to help you navigate your whole health picture, from prescriptions to supplements, so you can have the peace of mind and enjoyable lifestyle that your best health provides. To schedule a free consultation with our Pharmacy team, connect with us via chat on the CAMFormulas homepage and click the message button in the lower right corner.

References

1https://www.ncbi.nlm.nih.gov/books/NBK430882/

2https://pubmed.ncbi.nlm.nih.gov/8479492/

3https://pubmed.ncbi.nlm.nih.gov/8479492/

4https://www.mdedge.com/obgyn/article/61299/effect-oral-contraceptives-conception#bib1

5https://pubmed.ncbi.nlm.nih.gov/7400487/

6https://www.researchgate.net/figure/Riboflavin-is-required-for-the-formation-of-Pyridoxal-phosphate-68-Pyridoxine_fig1_318623658

7https://pubmed.ncbi.nlm.nih.gov/7001015/

8https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3410054

9https://pubmed.ncbi.nlm.nih.gov/23852908/

10https://pubmed.ncbi.nlm.nih.gov/7400487/