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  • Dr. Susan Caldwell

Birth Control in Teens – Why not? Part 1


Hypothalamic-Pituitary-Ovarian (HPO) Axis

In recent years, the birth control pill has become a very common medication prescribed to adolescent girls for a number of apparently good reasons. It appears to help with irregular periods, acne, ovarian cysts, premenstrual syndrome, menstrual cramps, and (of course) pregnancy prevention. I took birth control as a teen and I prescribed birth control to teens – until I stepped back to consider what this medication is actually doing to these girls. In medical school and residency, I was taught that this was a rather innocuous medication that may have some side effects but I was told that the side effects were rare and that the benefits of birth control outweighed the risks. This is simply not true. Let’s take a look at why.


In this post, we will consider the physiology of a teen girl’s developing reproductive system and how the hormones in birth control disrupt this development. This is the case whether we are using birth control to “treat” a symptom or to prevent pregnancy.


Mothers of teens should be well informed before making the decision to allow their daughters to take birth control.


My hope is that this information would be used to help make better decisions.


In the years after a woman’s first period, her body is working hard to establish healthy communication between the brain and the ovaries that is critical to healthy ovulation. There are two glands in the brain – the hypothalamus and pituitary – that are trying to connect to the ovaries via hormone messengers in order to direct the ovaries to make estrogen and progesterone each cycle through the process of ovulation. Think of this as a sort of symphony. Just like an actual symphony, it takes time and practice in order to get it right. This practice can take up to ten years in adolescents in order to establish a healthy system of brain-ovary communication that results in regular periods and healthy hormone production. The idea is that by the time the system is perfected, the woman might have gotten married and then, if everything works well, a baby might be welcomed sooner or later.


As a result of normal process of maturation, it is normal for girls to have irregular periods during their teen years. They may bleed too frequently or too infrequently. Either way, moms get worried and bring their girls to the doctor. Doctors might be too busy to explain the information above so they quickly offer a prescription of birth control to “regulate” the periods. The problem is that the pill does not fix the problem. Instead, it suppresses the “symphony” that simply needs time and practice to perfect itself. In most cases, irregular periods in teens are simply due to an immature hypothalamic-pituitary-ovarian (HPO) axis. In some cases, irregular periods are caused by a disease process such as an eating disorder, thyroid disease, a benign pituitary enlargement, polycystic ovarian syndrome (PCOS) and/or other problems. Either way, the answer IS NOT to shut down the ovaries. We should look for a solution and support the HPO axis in the meantime.


This is my approach to irregular periods in teens:


1. Listen to the teen and her mother. I ask about her diet, sleep habits, stressors and family history of period/fertility problems.


2. If there are any worrisome symptoms – very heavy periods, severe cramps, etc., then I may order tests or I may prescribe natural progesterone to aid the HPO axis as it struggles to get healthy (this really works). We talk about possible causes for her symptoms such as endometriosis or PCOS. Sometimes I recommend supplements or pain relievers that have been researched to be effective for certain symptoms.


3. I ask the teen to start tracking her periods using an app on her phone or paper calendar.


4. I explain to her how her reproductive system works and how she can help it to function well so that she will feel her best.


5. Together with mom, we come up with a personalized strategy to help ease this most beautiful (but challenging) transition from girl to woman.


If you would like to learn more about restoring cycles (and treating other problems) without birth control, I highly recommend the book Period Repair Manual by Lara Briden, ND.


What about using birth control in teens for, well, birth control? I can’t wait to share my thoughts on that in future posts but for now consider this fact:


Hormonal birth control is the only medication in the history of medicine that is given to a healthy person with the intention of making them unhealthy.


Sounds crazy, right? A woman who is ovulating normal is healthy (remember the symphony analogy?). The hormones in birth control are designed to deliberately disrupt this state of health. This disruption causes dysfunction in the woman - physically, emotionally and relationally. Stay tuned for more…

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