birth control

How Do Birth Control Pills Work, Exactly?

Now more than ever, it is vital for women to have options when it comes to their reproductive health. Preventing unwanted pregnancies is essential healthcare, and one of the most important tools we have is, of course, the pill.

Ah, the pill. It’s a drug so ubiquitous that it needs no other introduction. Are you on it? Have you been, in the past? For many of us, and our peers, birth control has become a default solution. Period irregularities? Get on the pill. Pregnancy prevention? Get on the pill. Hormonal imbalances? There’s a pill for that.

This is not to vilify the pill, of course. Those little pills are liberating and powerful tools to have in the reproductive health arsenal. For a drug so commonplace, you think we’d understand exactly how it works, right? Unfortunately, we’ve learned that many women on the pill are still in the dark about how it works, exactly. To give us a thorough rundown, we caught up with Dr. Caitlin O’Connor, naturopathic doctor who specializes in holistic treatment for women.

Read on for our conversation.

How does the pill work?

“When people are taking birth control pills, they’re essentially suppressing the message between the brain and the ovaries. So, the primary purpose of birth control pills is to suppress ovulation,” Dr. O’Connor explains. How does that happen, exactly? “Our ovaries are essentially going into hibernation. They’re not creating a follicle and releasing an egg every month, so therefore they’re not creating their own levels of estrogen and progesterone. When you’re on birth control pills you’re taking a synthetic oral version of estrogen and progesterone. Those external hormones suppress the production of internal hormones,” Dr. O’Connor says.

“There’s also a shift that happens with birth control pills that increases the production of a protein called sex hormone binding globulin. Sex hormone binding globulin attaches to testosterone and inhibits its activity. So people on birth control pills will have lower circulating testosterone activity, which is where sometimes you get that secondary impact of birth control pills decreasing acne or hair growth, and also why birth control pills are considered a treatment for PCOS,” Dr. O’Connor says.

“One thing to remember when people are on birth control pills, is that even though they’re having a uterine lining shedding event–they’re having a bleed every month—they’re not having true menstrual periods because they’re not ovulating.”

What are potential side effects of being on birth control pills?

“Potential side effects from birth control pills are really variable and depend on the type of pill, age and risk factors for the patient.  Like all medications, the pill comes with a risk benefit ratio and that ratio is best examined by the person getting care and their health care provider,” Dr. O’Connor advises.

“That being said, oftentimes the side effects of oral birth control are minimized or overlooked. Some common concerns are nausea, headaches, decreased libido, vaginal dryness, mood changes and changes to weight, hair and skin.”

How soon before you’re ready to conceive should you get off the pill?

“I generally recommend that people stop their birth control at least a year to two years before they want to try to conceive,” Dr. O’Connor advises. “It can take some people up to a full year–even a little longer–for their brain and ovaries to establish a rhythm and a conversation again. Oftentimes we need to be patient,” she continues.

Here’s another consideration: “I certainly see a trend of birth control pills being prescribed earlier, and the biggest challenge with that is that a lot of times it can be masking a potential hormonal issue. You’re essentially treating something you didn’t know that you had,” Dr. O’Connor says, which can lead to a longer road to equilibrium before conception.

Pill or not, it feels good to be armed with this knowledge, doesn’t it?

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Read next: This is why you need to understand your cycle. TTC? Shop OB/GYN-founded vitamins for Conception to boost your fertility.

Written by Jessica Lopez. Jessica Lopez is a freelance writer, digital content creator, and mother. She has covered all lifestyle topics ranging from bridal to beauty for publications including Brides Magazine, Byrdie, THE/THIRTY, and more. Walking wide-eyed into motherhood has inspired her to connect with other parents through her writing and shared experience. You can follow more of her journey @Jessica.H.Lopez.

This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.