Bye bye PMS? The effect of the pill on your cycle

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What does the birth control pill do to our hormonal cycle? As a woman, this cycle offers you something to hold on to: you know that around ovulation you feel more like having sex or that you are irritable during the week before your period. What about when you take the pill? We ask Professor of Gynecology Hendrik Cammu. “Why would you still feel like having sex when you are no longer ovulating?”

Taking a small dose of hormones every day: if you put it that way, the pill doesn’t sound very attractive. For many women this is no longer the case: the number of women using contraception and using the pill has decreased by 35 percent over the past fifteen years. This is evident from figures from the Belgian health survey 2019. Although the pill is still the most popular method of contraception worldwide, after the condom and sterilization: of all women who use contraception, 16 percent or about 151 million choose the pill. In comparison: 24 percent opt ​​for sterilization and 21 percent for the condom.

It is handy: just swallow a small pill every day and poof, as a woman you can be sexually active without any risk of pregnancy. But as the years pass, more and more women and experts are questioning the effect of those hormones. Yes, the pill is one for a lot of women lifesaver. But does it also make us fat? What does the pill do to our libido? Does it promote depression?

Individual sensitivity

It is a fact that the pill has a major effect on your hormonal balance. That’s just how the pill works, says Hendrik Cammu, professor of gynecology at UZ Brussel. “Every day you get two hormones via the pill, estrogen and progestogen. These are naturally present in your body and influence your cycle. But by adding those hormones extra, the pill completely adjusts the functioning of your cycle. The main effect of course is that ovulation or ovulation no longer takes place, but the pill does more. On the one hand, the hormones also ensure that the mucus production in the cervix decreases considerably, so that the sperm cells have less ‘grip’ on the way to the ovaries. On the other hand, they cause the lining of the womb lining the uterus to thin. For example, an egg that would eventually become fertilized cannot embed itself. ”

The pill takes you hormone balance so over. “Not complete, but still as good as. Especially when it comes to estrogen and progestogen, ”says Cammu. The effect of that? “That is different for every woman. Because every woman has an individual sensitivity to her cycle and to those hormones. That is why some women have premenstrual syndrome (PMS) more than others. Is it true what you read about the side effects of the pill? Yes, everything is correct. But not in the same way for every woman. ”

Goodbye, cycle

But Cammu can be clear about the pill’s effect on the hormonal cycle. “It disappears. Not entirely, because small fractions of male hormones still influence your body, which the pill does not slow down. But if you take the pill – that is, take the same dose of estrogen and progestogen every day – you will get a ‘flat’ hormonal pattern that is the same every day. In principle, fluctuations are no longer an issue. ” More sex drive around ovulation, binge eating in the week before your period: every typical symptom of the classic hormonal cycle disappears. “The fact that a woman can have a lower libido because of the pill is going to make sense. Why would your body still feel like having sex if you no longer have ovulation? ”

So the simple answer is: the pill kills your hormonal cycle. Is that negative? No. Many women take the pill without complaints and are grateful that the pill has released them from PMS, for example. But Cammu has to make an important side note on that. “Some women can still suffer from PMS, in the last week to ten days before the menstrual week, like in a classic cycle. You would think: that syndrome is linked to your ovulation, to those female hormones. But we increasingly believe that the neurotransmitters serotonin (aka the happiness hormone, ed.) And dopamine (the reward hormone, ed.) Play an important role. No conclusive results have yet been published in the scientific literature. So we do know that some women suffer less from PMS because of the pill, that others are completely rid of it and that still others cannot get rid of it. But why that is the case is not yet clear to us. ”

What if you go through the pill? Does PMS also manifest itself? “Yes, even then you can experience symptoms. But when it will appear, it is no longer possible to predict. If you take the pill for three months, you could just as well suffer from PMS somewhere in the middle of that period. ” Furthermore, swallowing the pill has no additional effects, Cammu says. Also not hormonal. “The only thing that can happen is that the mucous membrane on the inside of your uterus becomes so thin that you have very small breakthrough bleeding.”

Welcome back, cycle

Other hormonal contraception does not always have the same effect. The hormone coil, for example, leaves your hormonal cycle largely unaffected. “Except in the first year (you usually keep a hormone spiral for five years, ed.). Then the hormone coil secretes more progestin and some of it ends up in your bloodstream. Therefore, in the first year, some women suffer from oily hair, acne or hair on the chin and the normal cycle is disrupted. But after that first year, the hormone coil secretes its hormones only locally – in the womb – and they no longer enter your blood. Then your hormonal cycle will fully recover. ”

And what if you stop taking the pill completely? Does your hormonal cycle also make a full recovery? “Yes, usually your body is already after one cycle back on track. No matter how long or short you took the pill. Women who do not get pregnant immediately after stopping the pill think that it is due to their hormone balance. But that’s not right. Then your brain is to blame, specifically your hypothalamus causes menstrual disorders. ”

As a final thought, Cammu wants to make some nuances. “It is not because the pill adjusts your hormone balance that the pill affects your health. There are women who experience negative side effects from this, but those percentages remain very small. Yes, the pill is not recommended for some women: women struggling with migraines, obesity or high blood pressure, for example. But at the same time, the pill ranks number five or six in the top 10 of the greatest medical achievements of the past 150 years, according to a survey by the British Medical Journal. ” The bottom line is that you choose a form of birth control that is right for you. And if you’re not very attached to your hormonal cycle, that could perfectly be the pill.





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