When you think about the uses of contraceptive methods, what’s the first thing that comes to mind? Most people will say birth control i.e. pregnancy prevention. This makes sense, given that 86% of women using the oral contraceptive pill report birth control as the main reason for the use of the pill. In fact, for 82% of 15-19 year-olds, the main reason for taking contraception is not birth control. 

Let’s take a deep dive and learn more about the 3 most common reasons women and people assigned female at birth take contraception beyond birth control: acne, irregular, heavy or painful periods. 

Acne 

Let's talk about hormonal acne. Acne, particularly severe acne, can lead to anxiety, social isolation, and permanent skin scarring, which according to epidemiological data affects 6-55% of the female population. 

Hormonal acne affects everyone differently. Some women experience premenstrual flare-ups as their oestrogen and progesterone levels shift during their cycle. For others, acne simply persists through the years, even after menopause. This is due to a woman's ovaries and adrenal glands producing a higher level of dihydrotestosterone, the more active component of the hormone testosterone, than normal due to an increase in activity of the enzyme 5 α-reductase. Higher levels of dihydrotestosterone can lead to the body producing excess sebum (an oily, waxy substance), which leads to severe acne. 

You might be asking, how does contraception help with this? Taking the combined contraceptive pill, which contains both estrogen and progesterone (e.g. Yazmin) every day, lowers the amount of testosterone in the body. The pill works to counter hormonal acne by inhibiting testosterone production in the ovaries and adrenal glands. In some contraceptive methods such as Yasmin, the synthetic form of progesterone (drospirenone) actively lowers the levels of testosterone in the body, resulting in less sebum and thus severe acne. Many pills also increase the body’s natural production of sex hormone binding globulin (SHBG), a protein that carries many hormones throughout the body. When SHBG levels increase, more testosterone is grabbed by the protein and this prevents the testosterone from having effects on tissues throughout the body, including the skin. 

Irregular menstrual bleeding (oligomenorrhea) 

Let’s move on to regulating menstrual cycles with contraception. Irregular periods (when the length of your menstrual cycle and the gap between periods keeps changing) are extremely common. Periods could become irregular due to external factors, like changes in environment or stress, as well as medical conditions like Polycystic Ovarian Syndrome (PCOS). 

Irregular periods are a common concern for many women. Some adolescents have had to skip school or miss out on sports activities due to painful and irregular periods. In fact, the committee of the American College of Obstetrics and Gynaecology (ACOG) and the American Academy of Pediatrics (AAP) advises health practitioners to consider periods as the “fifth vital sign”. This means menstruation is as important a health indicator as changes in body temperature, pulse, breathing rate, and blood pressure. 

The hormones (estrogen and progesterone) used in hormonal contraception can help control and stabilize menstrual cycles. The combined oral contraceptive pill can help by releasing consistent amounts of estrogen and progesterone into the bloodstream, creating a “hormonal contraceptive cycle” and thus avoiding the usual ups and downs. This is similar to a natural menstrual cycle, but usually more regular and predictable!

Heavy menstrual bleeding (menorrhagia) 

Finally, contraception can be a saving grace if dealing with period pains and heavy bleeding. Heavy bleeding is defined as losing 80mL (16 teaspoons) or more of blood in each period, having periods that last longer than 7 days or both. In practice, the most important aspect that defines a period as “too heavy” is the perceived impact that it has on a patient’s life! 

Periods are unique, and sometimes, there’s no underlying reason for the heavy bleeding. However, in some cases, it could be a sign of a more serious underlying condition such as endometriosis, fibroids or PCOS. Often, the hormonal Intrauterine Device (IUD) is providers’ method of choice when managing such cases. It has been shown to reduce the need for surgical interventions and provide endometrial protection for both peri and postmenopausal women. The IUD was found to reduce blood loss by 86% after 3 months of use and up to 97% after 12 months of use. 

As well as the IUD, the combined oral contraceptive pill has proven effective at reducing heavy menstrual bleeding too. Over a period of 6 months, the combined oral contraceptive pill has been shown to reduce heavy menstrual bleeding to ‘normal’ bleeding.

Contraceptive pills are mainly used to prevent pregnancy, but more than half of women/users who take them identify other immediate health benefits. Acne and troublesome periods are just some of these medical indications for using contraception. According to Dr Aaron Lazarowitz: 

Contraception is an invaluable tool that healthcare  providers have to tackle numerous medical issues specific to women’s health, far beyond just preventing pregnancy. 

At Dama Health, we believe that it’s important for women and doctors to understand the importance of contraception. Our mission is to ultimately help women, people assigned female at birth and clinicians choose the right contraceptive method for each individual patient, whether it be for purposes of preventing pregnancy or non-contraceptive reasons.

By Dr Paulina Cecula (co-founder of Dama Health)