Exploring birth control with our adolescents
Hormone-based contraceptives were a game changer for women when they were introduced in the 1960s. The pill provided opportunities for more women to enter the workplace, to have control over their bodies, preventing pregnancy if desired, or planning the introduction of new babies into their lives. A whole new era of ‘family planning’ became possible with the birth control pill. But with so many historical benefits, few people today consider the possible consequences of birth control use as we are often not made aware of some of the associated risks.
As the parent of an adolescent, having access to information that considers all perspectives not only gives us credibility when it comes to the ‘sex talk’ but peace of mind when offering advice.
How do oral contraceptives work?
Generally, hormonal contraceptives work by tricking our body into thinking it’s pregnant through various concentrations of synthetic progestins and/or estrogens. These hormones prevent ovulation or change cervical fluid consistency, preventing sperm from travelling up the vagina.
Benefits of the birth control pill
When used as directed, hormone-based contraceptives are very effective at preventing pregnancy. Besides giving women the opportunity to plan their families and reliably prevent unwanted pregnancy, the birth control pill offers women other benefits. Women using hormone-based contraceptives can get irregular periods under control and regulate their length, bringing a reliable measure of predictability to their cycle. Women on the pill may experience lighter periods and have the flexibility to skip periods by continuing to take active pills, avoiding the inconvenience of their period for special occasions if they choose. Hormone-based contraceptives are associated reduced risk of ovarian and endometrial cancers.
Side-effects of the birth control pill
With such widespread use and so many practical benefits, many of us are only aware of a very limited amount of potential side effects. These include some of the more well-documented precautions associated with birth control use: increased risk of breast and cervical cancer, increased risk of blood clots, and the necessity to use a secondary contraceptive method to protect against sexually transmitted infections (STIs). But there are other, lesser-known risks that accompany prolonged use of hormonal contraceptives.
When we take hormone-based contraceptives we stop experiencing the natural harmony between our hormones, essentially removing the cyclic physiology that defines being a woman. Instead of experiencing the natural hormonal fluctuations of a typical menstrual cycle, hormone profiles for both the combined (estrogen and progestin) and progestin only pill, show a flat line across the menstrual cycle. Combined oral contraceptives also affect our other sex steroids, including testosterone which is reduced by 50%.
Our natural hormonal fluctuations have subtle effects on our voice, physical appearance and body odour across the menstrual cycle. These effects are not observed in women taking the oral contraceptive pill. There is even evidence to suggest that oral contraceptive use (and the resulting change to our hormones) influences our partner preference and can negatively affect sexual desire, arousal and pleasure.
Oral contraceptive use also influences the nutrient status of women. The World Health Organisation, (WHO) has recognised that the influence of oral contraceptives on nutrient requirements for women is a topic of high clinical relevance. Vitamins such as folic acid, B vitamins, vitamin C, E and the minerals magnesium, zinc and selenium can be depleted with oral contraceptive use. These nutrients play a critical role in maintaining health and the proper functioning of all our organ systems. When these nutrients are depleted, we can experience a wide range of symptoms.
Of extreme importance is the growing evidence that contraceptive hormone use is associated with an increased risk of depression, anti-depressant usage and in rare cases, suicide. According to research, those at greatest risk are adolescent women. The neuronal plasticity that is still occurring in the developing brains of young women may partially explain how the hormones found in oral contraceptives can induce changes to neurons that directly influence the structure and function of the brain, affecting mental health.
How to deal with the side-affects
If you do decide to use oral contraception, it is a good idea to:
• Be vigilant about monitoring mental health.
• Regularly screen for breast and cervical cancers.
• Carefully monitor diet to ensure it is high in folate, B vitamins, vitamins C, E, magnesium, zinc and selenium or consider a multi-vitamin if dietary intake could be inadequate.
• Use a barrier-based contraceptive to protect against STIs.
Talking birth control
As we become adolescents, we naturally become more inquisitive as our sense of self begins to take shape. Young people naturally seek out more information. The internet is an incredibly informative place but not the ideal forum for sexual health education.
Sharing your personal stories and having informed conversations about sexual health and contraception provides a safe place for young people to get the answers they need.
Talking to the people who love and understand us is often the best way to make difficult decisions. Contraception is a personal choice that requires knowledge of the individual making the decision, the options available and a understanding of the risks and benefits associated with each one.
Everyone has different ideas and values and we don’t necessarily have to conform to societal norms. With so much content out there it’s essential to have access to the right resources or be able to seek help if you need it. Being able to effectively filter the plethora of information and back it up with quality insight will help guide your young person safely through puberty and beyond.
Read more about the stages of adolescence here
When to have 'the talk'
Opening the lines of communication early means you stay ahead of potential issues instead of reacting to situations that you would have been better to avoid. Menarche, or the start of the first menstrual period, is a great time for a meaningful conversation about sexuality, health, wellbeing and birth control. As mothers, aunts, trusted friends or caregivers, we can share our experiences and help empower the next generation of women towards successful and satisfying relationships.
• Ablon G (2018) Phototherapy with light emitting diodes: Treating a broad range of medical and aesthetic conditions in dermatology. Journal of clinical and aesthetic dermatology. 11(2):21-27
• Bryne ML, Whittle S, Vijayakumar N, Dennison M, Simmons JG, Allen NB (2017) A systematic review of adrenarche as a sensitive period in neurobiological development and mental health. Developmental Cognitive Neuroscience 25:12-28
• Dixson BJ, Tam JC, Awasthy M, (2012) Do women’s preferences for men’s facial hair change with reproductive status. Behavioural Ecology, 24(3):708-716.
• Pablo Del Rio J, Alliende MI, Molina N, Serrano FG, Molina S, Vigil P (2018) Steroid hormones and their action in women’s brains: The importance of hormonal balance. Frontiers in public health, 6:141.
• Palmery M, Saraceno A, Vaiarelli A, Carlomagno G (2013) Oral contraceptives and changes in nutritional requirements. Eu Rev Med Pharmacol Sci, 17:1804-1813
• Skovulun CW, Morch LS, Kessing LV, Lidegaard O (2016) Association of hormonal contraception with depression. JAMA Psychiatry 73(11):1154-1162
• Skovulun CW, Morch LS, Kessing LV, Lange T, Lidegaard O (2017) Association of hormonal contraception with suicide attempts and suicides. The Am J Psych 175(4):336-342
• Suleiman AB, Galvan A, Harden KP, Dahl RE (2017) Becoming a sexual being: The ‘elephant in the room’ of adolescent brain development. Developmental Cognitive Neuroscience 25:209-220