Birth control pills are a common intervention in the United States. While pregnancy prevention is the intended use for oral contraception, many adolescents and adult females take this medication for conditions such as painful periods, migraines, PCOS, and acne. With 14% of American women ages 14 to 49 taking birth control pills, we must understand the risks of this intervention. One concern is birth control's effect on a female's stress response. In this article, you learn about the stress response, how oral conception can impact this response, and the avenues in which functional medicine can support this area of your health. 

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What Are Birth Control Pills?

Birth control pills, or oral contraceptive pills (OCP), are synthetic hormone-based medications to prevent pregnancy. OCPs are combination pills containing estrogen and progestin, manipulating the cyclical hormone pattern and avoiding ovulation. Birth control pills also are available in the form of a “mini-pill,” which is a progestin-only oral contraceptive. Both options have benefits and risks, which you should discuss with your healthcare practitioner when considering. 

What is The Stress Response?

Managing the daily and chronic stressors is a part of life. Whether it is a physical or mental stressor, your body has an innate, built way of processing the physiological responses to stress—one of the critical systems of the autonomic nervous system (ANS) stress response. The ANS consists of the parasympathetic (rest and digest) and sympathetic (fight-or-flight) nervous system branches. 

During a stressful event or experience, a cascade of signals is firing between the nervous system, the brain, and the hypothalamus-pituitary-adrenal (HPA) axis. This process increases the hormones adrenaline, epinephrine, and norepinephrine, which ultimately spike a release of cortisol and physiological reactions such as increased heart rate, blood pressure, and respiratory rate. While this response has been vital to our survival as a species, many people are now experiencing an overhaul in the sympathetic state. There are many reasons for this, such as lifestyle, workload, and trauma, to name a few, but there are medications, such as birth control pills, that can hijack this process. 

Do Birth Control Pills Affect The Stress Response?

Research has drawn a correlation between oral contraception and a negative impact on a female's stress response. One area of science found that using OCP during puberty can cause a blunted stress response by altering the working memory area of the brain. This study saw increased prefrontal cortex activation when the brain should be processing negative input through our working memory. The mechanism by which they hypothesize this is occurring is that OCP can structurally change the brain involved in emotional processing and memory, which alters your brain's ability to react to stress appropriately. 

Another study looked at the stress response marker ACTH. Results revealed a stark difference in the decline of ACTH between non-OCP users and OCP users when provided with a fun social activity. Women not taking birth control pills had a decline in ACTH when engaging in a social setting, while women on birth control pills did not have a decrease in this biomarker. Additional studies have shown that hormonal contraception can cause a blunted cortisol response, which occurs alongside weak performance and memory outcomes under a stressful situation, compared to normally cycling women. 

The evidence shows that birth control pills can significantly impact a female's ability to modulate and respond appropriately to stress. Research is continually exploring why this occurs, and hopefully, screening tests for women at risk will be implemented in the future. In the meantime, laboratory testing can provide insight into how your body handles stress. 

Functional Medicine Labs to Help Identify If Birth Control Pills Are Affecting Your Stress Response

Assessing areas of health through functional medicine testing can provide valuable information as to how your body is responding to oral contraceptive use. Here are some key tests your integrative healthcare provider can utilize: 

Adrenal Stress Panel

Looking at the pattern of cortisol release throughout the day can say a lot about how your body modulates this stress hormone. In a healthy response, you want to have cortisol peak in the morning and gradually decline, with its lowest point being midnight. Doing an Adrenal Stress Panel salivary test measures hormones DHEA and multiple cortisol readings for a complete picture of your stress response in a day. The DUTCH Cortisol Awakening Response (CAR) test evaluates peak cortisol and metabolites. This is also a thorough method of assessing HPA axis function. 

Thyroid Panel

The systems of our body do not operate in isolation. For example, the HPT axis connects the adrenal glands with the thyroid gland.

Comprehensive Hormone Testing 

Hormonal birth control pills can cause dysregulation in menstrual cycles and impact cortisol response. Evaluating where your hormones are before starting birth control or after discontinuing birth control can be a helpful tool in regulating your hormones. The DUTCH Plus is a great option that will look at both sex hormones and the cortisol awakening response to reveal a complete picture of how sex and stress hormones operate in conjunction with one another. 

Micronutrient Testing

Oral birth control pills can deplete essential vitamins and minerals important for physiological processes, including stress response. The stress response via adrenal gland hormone secretion also relies on vitamins like vitamin C to optimize function.

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Optimizing The Stress Response With Functional Medicine

Integrative medicine interventions can shift and support your physiological response to stress. Nutrition, vitamins, minerals, herbal supplements, and complementary therapies are all avenues to consider when taking a functional medicine approach to addressing stress. 

Nutritional Considerations for Stress

What you consume on a daily basis can support hormonal pathways and your stress response. Eating food with high amounts of nutrients that OCPs are known to deplete is important. This includes foods rich in vitamin B2, vitamin B6, vitamin B12, zinc, magnesium, and vitamin C. Eating a plethora of seasonal fruits and vegetables, along with moderate seeds, nuts, and quality animal protein, can ensure that you are getting these nutrients from your food. 

In terms of modulating stress through nutrition, eating a balanced and low-inflammatory diet, like the Mediterranean Diet, is a sustainable way of living. Foods in this diet have been shown to support gut health, mental health, and hormone synthesis, which are all important for a healthy stress response. Getting adequate macronutrients- protein, fats, and carbohydrates in a way that works for your unique makeup also helps support these systems. 

Supplements & Herbs For Stress

The stress response can be helped with the use of a number of supplements and herbs.

Ashwagandha

This widely used herbal supplement is great for helping the body adapt to stress and respond. Ashwagandha is a particularly helpful choice for women because it can support both sex hormone and HPA axis processes. For those taking to mitigate chronic stress:

Dose: 600mg daily

Duration: 6 weeks. 

Licorice Root

Glycyrrhiza glabra, AKA licorice, is a great choice for adrenal fatigue and stress modulation. This herb is known to help people in chronic stress states, whether this results in low or high cortisol output. Evidence shows that licorice’s adaptogenic mechanism of action helps regulate the secretion of stress hormones to help balance the body. One main caution with Glycyrrhiza is it’s use for individuals who have high blood pressure. Make sure to consult with your practitioner before starting therapeutic doses of supplements. The recommended dose for licorice root for stress-related adrenal fatigue:  

Dose: 1 to 4 grams, 3 times a day

Duration: Consult with your provider

Vitamins and Minerals

Supplementing with the appropriate micronutrients that your body needs is beneficial. The product OC Companion™ by Vitanica combines vitamins, minerals, fatty acids, probiotics, hormone-metabolizing botanicals, and herbals to support the inflammatory response. The ingredients work in synergy to help women maintain functionality when on OCPs. The company recommended dose:

Dose: 2 capsules daily

Duration: While on birth control

Complementary and Integrative Medicine

Besides nutritional supplements, complementary and integrative medicine options can assist the body in dealing with stress.

Acupuncture

Utilizing acupuncture as a therapeutic modality to support a healthy stress response is highly recommended. Research shows the effectiveness of acupuncture treatments weekly for 12 weeks in regulating one's perceived stress. This study showed that results were maintained for up to 3 months post-treatment. If you take oral contraception to help with hormone regulation, acupuncture may be a great alternative. Studies reveal that acupuncture can help balance hormones in women with various conditions. Implementing this alongside an individualized treatment plan can help balance your anatomy and physiology in a variety of ways. 

Chiropractor

Seeing a chiropractor for manual spinal manipulation can benefit your nervous system. One area that this modality can regulate is the autonomic nervous system, which is composed of the parasympathetic and sympathetic branches. While evidence in the field of chiropractic care is limited in terms of systemic changes, there are some promising results that spinal manipulation can modulate cortisol release. Considering chiropractic care as a way of supporting your stress response may be beneficial to your overall well-being. 

Massage

For most people, getting a massage is a relaxing and rejuvenating experience. Much of this is due to the release of tension in your muscles, which can positively impact autonomic nervous system regulation. A 20 to 30-minute massage can decrease cortisol levels, heart rate, and blood pressure, all of which can assist in regulating your stress response. Incorporating massage therapy is one avenue to explore in managing your body’s ability to process stress.

Mind-Body Therapies

Training the body and brain to engage in relaxation is possible through mind-body practices. Yoga, meditation, and breathing exercises can all help regulate stress. Different variations of yoga can help induce relaxation and improve both physical and psychological stress. Meditation is centered around calming the mind through being present in the moment and bringing awareness to your thoughts. Through this, you are able to self-regulate sensations and emotions you are experiencing. 

Yoga is a combination of breathing patterns and physical postures. It can be an excellent way to exercise but is also known to help decrease stress and improve mental health. While breathwork is a component of yoga, you can also practice specific breathing exercises to manage stress. Taking deep and slow breaths through your nose while expanding your diaphragm and bringing it into your abdomen is the start of mindful breathing. Focusing on a slow and full exhale and then repeating that cycle multiple times can provide a feeling of relaxation and, ultimately, stress regulation. Utilizing these mind-body therapies independently or in conjunction with a holistic treatment approach could assist in your stress response. 

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Summary

There is a widespread use of birth control in the United States, which has been shown to have an impact on the stress response in females. Research suggests a correlation between oral contraception and stress hormone response alterations. Blunted cortisol, altered brain function, imbalanced hormones, and memory processing were discussed.

While conventional medicine utilizes OCPs for various female health concerns, functional medicine can provide an integrative and complementary approach to addressing and correcting the altered stress response. There is hope for restoring optimal physiology through comprehensive laboratory testing and optimizing your health through nutrition, herbal medicine, supplementation, and holistic therapeutics such as acupuncture, chiropractic care, and massage therapy. Ultimately, understanding how birth control may affect your stress response and incorporating these functional medicine strategies can assist women in making an informed decision regarding their contraceptive choices and overall healthcare.