The question many women ask themselves is whether taking oral contraceptives for a number of years can alter their bodies and affect their wellbeing In many ways, oral contraceptives are one of the best inventions that medical science gave to a modern woman. Not only they prevent pregnancy and make sex more enjoyable, but they even provide many health benefits from improving acne to decreasing risk of ovarian cancer. However, nothing is perfect and the list of their side effects unfortunately is just as long.
Can your birth pill make you tired? There are quite a few risks to increased estrogen and progesterone, blood clots being the most ominous one, but in this post I want to focus on one important aspect of their influence on the body that only recently has become recognized and the one that is directly linked to fatigue. If you are taking birth control pills and feel tired, non-motivated and less interested in sex than you used to be, you might be experiencing a lack of testosterone.
Testosterone is not just a male hormone. Historically, testosterone was considered a purely male hormone, and it was thought that bringing down its level in women could only mean a good thing (since testosterone is responsible for hairy legs and acne). However, the research in the last decade helped us understand that testosterone plays just as important role in women’s well being. Even in small amount it affects such important attributes as energy, drive, motivation, ambition, athleticism and sexual libido.
What happens to your hormones when you take birth control? Oral contraceptives decrease testosterone production by ovaries via hypothalamic-pituitary axis suppression. However, probably even more significant is that over period of time, oral contraceptives induce production of a special protein (called serum hormone binding protein or SHBG) that binds testosterone and inactivates it.. Recent studies proved that women who take birth control have significantly increased levels of SHBG and decreased levels of free testosterone. This is actually the basis behind using birth control as treatment for acne (testosterone is implicated in causing acne, particularly during puberty)
Tip: if you want to have your testosterone level checked, make sure you ask for free testosterone and not total. Also, be aware that many physicians are still reluctant to order testosterone in women and many labs only have reference range of males, as there is still some controversy about what the optimal female levels are.
Is it reversible? It appears that the answer to this burning question is “no” but there is some controversy as to how long it might take for the hormone levels to return to normal, and in some people a mild degree of change may be permanent.
Not all birth control has been created equal. Some women appear to tolerate this birth control effect better than others, and it probably has to do with the initial level of testosterone you have, and how many sensitive is your body to testosterone effects (genetically predetermined). Some pills are less anti-androgenic (meaning anti-testosterone) than others. One of the recently synthesized progesterone analogs called drospirenone (which is contained in popular contraceptives Yasmin and Yaz) is particularly vicious in robbing your body of testosterone effects. While these drugs may be a good choice for women with excess of testosterone, they can be really detrimental to those with normal or already low levels. Also, typically younger women tolerate birth control better than women in the 30s because testosterone naturally begins to decline at this age.
What to do next? In short, if you are taking birth control pills (whether you started them just recently or have been on them for years), they might be linked to your chronic fatigue. On other hand it is just one of many possible explanations. Do not jump to conclusions without talking to your physician first or rush to take yourself off your birth control without having a good alternative plan of contraception- after all pregnancy can make you much more tired than you are now! Sometimes switching to a different brand may be enough. Here is a link to the androgenic strength of different contraceptives (remember the least anti-androgenic will leave you with more testosterone).