Wednesday, September 2, 2009

How it works

It seems sensible to next answer the question of what the pill actually does to your body. That way you'll know, and be able to make an informed decision as to whether that's fine by you or not. If we have how it works straight, we can start looking at the effects in more detail. Rather than be hard-line and say no one should be on the pill - there's a very vocal doctor, Dr Irwin Goldstein, who supports this argument and if you keep reading you might decide that for yourself - I want women to have all the information.

Now, I have no science background to speak of - I scraped through the mid-level science GCSE, but I have managed to get my head round this stuff. I once interviewed Dr Peter Bowen-Simpkins, a gynaecologist and spokesperson for the organisation Wellbeing for Women and asked him why GPs didn't fully explain the pill's workings to their patients and tended to give nonsensical platitudes. He said, 'Why wouldn't you be satisfied with just knowing it stops you producing eggs?'

The pill changes almost every bodily system. In a normal cycle huge hormonal fluctuations occur that have an impact on the whole body, right down to sense of taste and smell. The pill prevents ovulation so all the changes your monthly cycle provokes are altered. Regular hormone production is replaced by a daily dose of synthetic oestrogen and progesterone. This prevents pregnancy by shutting down the ovaries, depleting hormone production from the adrenal gland, and changing the condition of the uterus and cervix. Women are often told the pill mimics pregnancy, but the opposite is true – rather than increasing your hormone levels and fluctutations, the pill reduces and flattens them. Hence, that 'flat' feeling I spoke of earlier.

There are many brands of pill on the market, and each will have varying effects on different women. The pill that works well for your best friend, won't necessarily be right for you. And a pill that worked well for you at twenty-five might cause problems at thirty-five. Although research is dramatically lacking in this area, there are certain facts that it can help to know.

The most commonly prescribed pills are called combined, as they contain both a synthetic oestrogen and progesterone. The level of ethinylestradiol (the synthetic oestrogen) can range from 20mcg to 35mcg. A number of different progestogens (the synthetic progesterone) are used across the brands. Although your doctor will usually recommend pills that are monophasic there are also biphasic and triphasic pills which vary the levels of hormones across the monthly cycle. Also available are progesterone-only pills which have no oestrogen content.

Generally, the lower the dose of hormones, the safer the pill is for your body. Although the difference between doses in modern pills is slight, it is still recommended that the lowest dose be your first choice. Some women will experience unwanted side effects even on an ultra low dose pill, and when this occurs they can switch either to a higher dose pill or a pill containing a different progestogen.

There are two groups of progestogens – the first contains levonorgestrel and norethisterone. These progestogens act on the ethinylestradiol in the pill, and as such counter its impact on the risk of thrombosis development. These progestogens also combat problems caused by the hormone testosterone such as acne and excess hair. The pills containing these elements are progesterone-dominant.

The second group includes desogestrel, gestodene, norgestimate and drospirenone, progestogens used in oestrogen-dominant pills, so-called because the ethinylestradiol is not acted on by the progestogen. These are usually prescribed as a second choice if side effects occur with a pill containing one of the progestogens in the first group.

The progestogen-like element of the brand Dianette is an anti-androgen called cyproterone acetate specifically used for it's suppression of the androgen testosterone. This is an oestrogen-dominant pill.

Of the most popular pill brands Femodette has the lowest level of synthetic oestrogen, Femodene, Microgynon, Ovranette and Yasmin have the next highest dose, and Cilest and Dianette have the highest. Microgynon and Ovranette contain the progestogens in the first group mentioned, and as such are amongst the recommended first choice pills. All the others are in the second group as they contain the other types of progestogen.

Biphasic and triphasic pills mimic women's natural hormone cycle more closely than monophasic pills but there is no evidence this is safer or better for you. They do however produce more natural-like periods and can control more effectively bleeding patterns. Progesterone only pills are most often offered to breast feeding mothers, and women who find they are in a higher risk category for some of the pill's potential serious side effects such as thrombosis due to personal or family history, or as they grow older, or gain weight. These pills don't fully stop ovulation but act more prominently on the lining of the cervix.

Research has shown that the pill's main objective - that is stopping you getting pregnant - is actually more accurately upheld by using a condom and spermicide. Apparently, statistically, women are far better at this than taking the pill every day. Supposedly its 2 in every 100 users with perfect usage that get pregnant, and 8 in every 100 users with typical usage. Perfect usage is taking it bang on time, the same time, each day.

Back to Yasmin - I have looked more thoroughly into the science behind this one pill - it contains a particular, unique kind of progestogen which is what has caused it to produce such severe and specific side effects.

Yasmin is made up of ethinyl estradiol (that's the oestrogen part) and drospirenone (the progesterone). The drospirenone makes this pill what is called a potassium-sparing diuretic. A lot of women will have noticed needing the loo a hell of a lot more than normal when taking Yasmin. As a diuretic Yasmin causes dehydration and dehydration affects the body at a cellular level, interfering with mineral and electrolyte balances. Potassium levels to rise in the blood.

Yasmin suppresses the adrenal gland, as do all pills. The adrenal gland controls hormone production. Its suppression provokes a lowering of serum cortisol levels, which is a hormone produced to guide the body's responses to stress. Changed levels in serum cortisol are connected to depression and psychological stress. When the body experiences stress it provokes heightened adrenalin production. The long term effect of high adrenalin levels is exhaustion. Yasmin, and the pill in general, in its suppression of ovulation and the adrenal gland causes testosterone levels to drop dramatically. Testosterone plays a key role in controlling libido and mental and physical energy.

It is Yasmin's diuretic effect that accounts for the promoted weight loss, which is effectively the loss of water weight. The quashing of testosterone accounts for its clear skin benefits as it is this hormone that controls sebum (the oil in your skin) production.

So, the pill has a whole body effect, every day, for years you are taking a pill that has a extensive, insiduous effect on every bodily function.

There was an article in More magazine earlier this year that showed what days of the month you should do certain things - go to the gym, meet friends, write an essay, have a business meeting - dependent on what your hormone levels were doing at that time. This acknowledged how powerful hormones are in our lives, but I've been wondering if the article was based on the natural cycle of a woman, or on the cycle 80% of women are experiencing at any one time, that is the unnatural pill cycle.


  1. Now I know how the pill works. It is also important for me to know it because my wife is using it.

  2. Hi found this article after researching chin hair and hormone imbalance.

    Im 40yrs old and for the last 4 months have stopped taking the pill ‘cilest’ in order to try to concieve.

    Since then ive been keeping track on my cycle, temperatures and ovulation in order to balance my hormones and cycle post pill.

    Before i started taking the pill my periods were irregular sometimes 7 weeks long, and i had pmt and anxiety. Post pill im gradually re-balancing even though my luteal phase is still quite short.

    In order to try to lengthen my luteal phase and upon researching all of this female health with regards to minimising my pmt and maximising my fertility i take vitamin suplements daily including a pre-natal, zinc, extra B6 aswell as angus castor.

    I feel excellent because of it, and my cycles are more regular than theyve ever been, and my luteal phase has lengthened ive not had any pmt and my skin is improved (i used to get hormaonal acne). All related to estrogen/ progesterone!

    My point is. The main thing ive noticed is the hair on my chin has gone! For the last 2 yrs on the pill ive had unwanted facial hair, i thought it was my age, but since coming off the pill and taking suplements one side effect ive seen is no facial hair, hense why im researching estrogen/ progesterone dominance. Looking for an explanation of why the pill caused my chin hair, or if its the suplements im taking that has got rid of it…

  3. Hi i have had the thirsty symptoms using yasmin and its terrible, needing the loo constantly too, i quit it 2 weeks ago, had a pill free week and then started Cilest, although still thirsty all the time, is this due to Yasmin still being in my system or does Cilest have this affect also? (i was also feeling thirsty on my pill free week too!)
    its driving me mad! thank you