Hormonal Birth Control (OCP) and Pelvic Pain

Jan 03, 2021

I’m going to be completely honest…. This was HARD to write. Hard to write because there are many conflicting opinions out there, hard to write because I spent hours really sifting through the research, and hard to write because I was BAFFLED by how much even I didn’t know…

 

It continues to fascinate me how frequently we are not given the information on a topic that is considered so “mainstream.” I know I’m not the only one, but hormonal birth control has always been a solution to so many things (or so they say). I was prescribed OCP (oral contraceptive pill) at the age of 15 for cramps, acne, and moodiness.

 

Knowing what I know now…. What in the actual heck?! I mean, where was the education on WHY I was cramping in the first place? Where was the nutrition advice, hydration, and not using chemicals on my skin?! How about hormones? What do those even mean?

By this point, everyone knows I am incredibly sold on the fact of finding the cause of why you are having an issue.

I hear every single day about women who have similar experiences. 

 

First, let me say that I do not think OCP is wrong or bad. I think there are definitely situations where it is necessary and effective. One of those cases can be assisting in the pain with endometriosis. There are many other options too, but my clients usually report that OCP helps them tremendously with living with this diagnosis.

 

I am also not here to shame anyone. I am here to provide you with research based information on a topic that goes under-looked quite frequently. Before we dive into the specific question I’ve been getting about whether OCP has a tie to pelvic pain, I want to first share my story and information on the different types of birth control.

This article is not connecting to all types of birth control, but more specifically OCP. There are 3 types of OCP on the market currently:

Combined estrogen and progesterone

Progesterone only

Continuous or extended use pill

 

My Story With OCP and Pelvic Pain

 

The reason I wanted to write this article is solely based on my selfish desire to find a better way to explain the answers to these situations. I was prescribed OCP at the age of 15 and took it until I was 25. Yep, 10 whole years.

 

In that time frame, I was also diagnosed with Grave’s Disease and had recurrent UTI’s (nearly every month), recurrent yeast infections, pelvic pain, extreme pain with sex, lack of libido, lack of lubrication, and depression & anxiety disorders.

That's a whole of things going on for one young female.

Do I think OCP was the cause? Not solely, but I do not feel that it was the right option for me at that time and I do not feel I was given enough information about how to move forward or any information on other options. 

If I knew what I know now, I would not have taken OCP.

 

I was never given any education on what the OCP will do, the long term effects and anything I should consider.

 

I will say this many times: we need more studies on this topic specifically. However what we have gathered, and what I have gathered, will be detailed in this article. 

 

Our hormones affect all aspects of our pelvic region (I am speaking specifically about female pelvic regions). This means that our hormones can affect the way our bowels, bladder, urethra, and muscles function. This is one of the reasons why it is so important for you to find a provider who is going to look at all angles of what is going on with you whether that is urinary incontinence, bowel issues, pelvic pain, or sexual dysfunction.

 

We have also found that hormone imbalance can increase our risk of painful bladder syndrome, incontinence, PID, and frequent UTIs. We are also finding a decrease in lubrication along with difficulty reaching orgasm  which can decrease sexual drive and contribute to sexual dysfunction. 

 

As mentioned before, it does depend on the KIND of birth control you are taking and how it is affecting you. Every one responds to the pill differently. For me, I responded poorly. I had pelvic pain, lack of lubrication, lack of libido, and much more.

 

Note that pelvic floor physical therapy can help you by determining if birth control is the issue by first eliminating bowel, bladder issues or even muscular dysfunction. 

 

Now, one of the most important reasons I am writing this article is because of the questions I get about pelvic pain and OCP. For the entire time I’ve been treating clients, I’ve seen a personal correlation between my clients who experience pelvic pain and having a history of taking the pill. Many of my clients who are reporting pelvic pain have OCP listed as a medication.

 

What we have found, specifically based on research by Dr. Andrew Goldstein, is that there MAY be a link between the use of hormonal BC and pelvic pain. The research has shown that hormonal OCP can suppress our bodies testosterone levels by about 75% and increase what is called an androgenic effect.

For reference, testosterone is incredibly important. It is necessary for proper growth, maintenance, and repair of the tissues in the female reproductive system. 

With decreased testosterone, comes decreased libido, arousal, and ability to reach an orgasm. Fun fact: men have more testosterone than women, which makes sense as to why they want sex more!

 

Dr. Golstein has also found in his research that with taking anti-androgenic birth control pills, the thickness of the labia has decreased, decreased size of the clitoris, a smaller diameter of the vagina, and as mentioned before decreased lubrication.

If you think about that, doesn’t that sound somewhat similar to the symptoms many women express during menopause? So it is my professional opinion that prolonged hormonal birth control MAY contribute to menopause symptoms early on.

 

Now, again, please understand this is not an article to express to you the reasons not to take birth control. More so just to offer you education and information about what it is you are taking.

It is also an article to let you know that if you choose birth control, please be sure to take this information to your healthcare provider and ask the questions you are concerned about.

 

I would also like to express the concern about putting clients on hormonal birth control at an early age, specifically before the age of 17. Dr. Goldstein and his team have found that if clients are on hormonal birth control before the age of 17 are more likely to be diagnosed with what is called vestibulodynia, pain at the vestibule of the vulva. 

 

Most hormonal birth controls have estrogen and progesterone, and refer back to the different types of OCP out there. The different types differ by the amount of progestin and the amount of estradiol that in the OCP. 

OCP prevents the pituitary gland from producing LH (Luteinizing Hormone) and FSH (follicle-stimulating hormone). This lack of production is what prevents ovulation from occurring and also can prevent estrogen, progesterone, and androgens from being produced. 

 

There is not enough time or brain-width for me to describe to you all of the specifics about how hormonal birth control work, but I’ve linked a quick video that I found very helpful:https://www.youtube.com/watch?v=hI2C7TsnSfk

 

I really am hoping that you were able to get some information here. 

 

The summary:

 

OCP are not bad but they do have long term effects that can change your female reproductive anatomy and can increase the risk of having sexual dysfunction.

 

If you choose to come off/change your current hormonal birth control, or are considering beginning birth control, be sure they explain all of your options and all types of birth control. Choose the birth control that is right for you. If you do make a change or start to look at options, be sure you find a provider who does explain all of the risks and also offer a re-assessment at 3 months after beginning.

 

Remember that birth control is supposed to be offered in order to allow you to have the best sex of your life. You deserve to have the information to have that type of sex!

 

Resources and references are below.

 

Resources and References:

S., Lew-Starowicz M., Luria M., et al 2019. Hormonal Contraception and Female Sexuality: Position Statements from the European Society of Sexual Medicine. The Journal Of Sexual Medicine 16:11  1681-91. 



 "A recent study by Battaglia and his colleagues showed that women who took the OCP YasminTM had shrinkage of their labia minora, a reduction in the diameter of the vulvar vestibule, and a reduction in clitoral blood flow as measured by ultrasound after just 3 months of taking this OCP."

 

"Another study by Johannesson et al. showed that women on OCPs develop microscopic structural changes in the mucosa of the vulvar vestibule that makes them more susceptible to tears and fissures when exposed to trauma.2 In addition, a study by Nina Bohm-Starke and her associates showed that “healthy” women without vulvodynia on OCPs sense pain in their vestibules at a much lower pressure (have a lower pain threshold) than women who do not take OCPs."

 

"In a prospective study, Bazin et al. showed that women who started taking OCPs before that age of seventeen were 11 times (1100%) more likely to develop vestibulodynia in comparison to women who had never taken OCPs."

 

"In addition, a study by Bouchard and colleagues in Quebec showed that women who were examined in a vulvar specialty clinic and who were found to have vestibulodynia were 9.6 times (960%) more likely to develop vestibulodynia if they started OCPs prior to the age of 16, and showed an increasing risk of developing vestibulodynia with longer durations of OCP use."

 

"Women with other potential identifiable causes of vulvodynia, such as tight pelvic floor muscles or pudendal nerve injury were excluded from this study. The women were treated by having them stop OCPs and by applying a compound that contained topical estrogen and testosterone to the vestibule. On average their vestibular pain dropped from 7.5 to 2 on a ten-point pain scale after three months of treatment."

 

"Greenstein and colleagues showed that women taking OCPs containing only 20 micrograms of EE were more likely to develop vestibulodynia than women taking OCPs with higher doses of EE."

 

  Questions answered by Dr. Goldstein via researched articles:

If OCPs are he cause of my vulvodynia, won’t just stopping the OCPs allow the vulvodynia to go away?

Unfortunately, for many women, just stopping OCPs does not cause the vulvodynia to resolve. This is because even after stopping OCPs the levels of SHBG frequently do not go back down to the levels they were before stopping OCPs. This leads to persistently low free androgens and the persistence of the vestibulodynia. In our experience, the only way to overcome the persistently low hormones is to apply a compound of topical testosterone and estrogen to the vestibule.

If my vulvodynia goes away after the combination of stopping OCPs and by using the topical hormones, will I ever be able to go back on OCPs?

In our expereience, the pain returns after restarting OCPs. We typically recommend Intrauterine devices (IUDs) for our patients who need contraception after their vestibulodynia has resolved.

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