Fade in on a sleeping young woman as the light of dawn breaks gently through the curtains. She opens her eyes and slowly unwraps from the warmth of her blanket. With the blare of her alarm in the background, the world begins to come into focus. She opens her mouth to utter her first words of the day, but instead of her voice, out comes a dry, blood-curdling screech, which feels like it should be accompanied by a legion of flesh-eating scarab beetles.
She can taste her breath; it smells like death overcooked in a microwave. As she glides her tongue across the front of her teeth, she realizes that both are coated with a nasty, gelatinous paste. “Just great!” she thinks to herself, “I’m getting sick.”
However, after a few days of this horrid mouth sludge, she doesn’t sense any other symptoms of a cold or flu coming on. Thinking maybe she’s just dehydrated, she forces herself to drink more water, but the bad breath continues.
In a near panic, she buys mouthwash, switches from her favorite toothpaste, and even changes up her diet – all to no avail.
So now the question becomes, at what point in this adventure will she think of questioning her birth control?
Overwhelming Small Changes
Dealing with an extended bout of bad breath may not seem like the end of the world, but it will make you paranoid about every social interaction as it chips away at your self-confidence. Still, that can sound pretty superficial. So, let’s consider what this bad breath indicates at a physiological level.
Like so many of the “small changes” that begin as a consequence of the synthetic steroids in hormonal birth control, these changes point to significant changes in the body at a cellular level. In this instance, our protagonist’s bad breath resulted from microbial changes that began in her gut and ultimately led to gum inflammation.
Years ago, when doctors handed out antibiotics almost as readily as they hand out birth control today, we learned about the importance of a healthy gut microbiome. Culturally, we had made bacteria such a bad word and had focused so much energy on vanquishing this corporeal invader that we lost sight of how anti-bacterial agents (especially in the hands of overzealous doctors) might be throwing our bodies out of balance.
A healthy gut thrives on a proper balance of bacteria, fungi, and viruses colonized within our bowels that help strengthen and train our immune system and support the function of our food metabolization.
Researchers have identified two principle clusters of microbial taxa that inhabit the gut, Bacteroides and Prevotella. As scientists learn more about these “enterotypes,” they better understand how the ratios of the two taxa reflect a health-promoting gut versus a disease-promoting microbial community.
Various species of Prevotella are harmless and can even maintain a mutually beneficial relationship in the gut. However, a few species, including P. intermedia and P. melaninogenica, present as opportunistic pathogens – and those opportunities come when the gut falls out of balance.
What They Say
As you probably figured out by now, hormonal birth control tends to upset the apple cart – or in this case, the Prevotella cart. The synthetic steroids in these drugs perturb the natural state in the gut, which frequently translates into the pathogenic Prevotella flourishing and migrating to other parts of the body, such as the mouth and vagina. Consequently, women can also see an increase in yeast infections, urinary tract infections (UTI), and/or bacterial vaginosis (BV) associated with starting and stopping birth control.
For now, we will focus on what happens in the mouth.
Studying the Mouth
As I begin to dig into a topic, I like to look around and see what the industry is already saying about it. When it comes to hormonal birth control, the answer is usually, “Not much.” However, a surprising number of dentists include information on their websites or blogs about birth control’s affect on dental health. There seems to be no question about the profound impact of hormonal birth control on the microbial flora of the mouth.
Even the Colgate toothpaste website offers this:
The American Academy of Periodontology notes that some medications – including oral contraceptives – can affect your oral health. Certain forms of hormonal birth control work by elevating levels of estrogen and progestin (synthetic progesterone) – in your body to prevent pregnancy. Just as they do during pregnancy, these hormones can affect how your gums respond to bacteria, increasing your risk of gum disease and bad breath.
After overcoming the initial shock of seeing a birth control side effect being discussed so openly, the wording on one of the dentist’s websites jumped out at me. This sentence in particular gave me pause: “As progesterone and estrogen fluctuate, it can result in certain symptoms that replicate gum disease.”
I began to contemplate the difference between replicating gum disease and having gum disease, which led to this tangent.
The Ability to Walk Away
In the first decade of this new millennium, the national media engaged in an intense debate about some of the tactics being implemented to harvest information from prisoners at Guantanamo Bay. As questions arose about whether these tactics were justified; whether they constituted torture; whether they violated the Geneva Convention, much of the dialogue centered around one particular technique known as water boarding.
Eager to put their own personal spin on the conversation, several reporters and activists volunteered to have film crews document them undergoing this gruesome experience that simulates drowning. It’s safe to say that most of them regretted the decision. They frequently described it as being far worse than they ever imagined.
As horrible as it may have been and as accurately as these experiments may have technically replicated actual water boarding, they did not perfectly reflect what the prisoners had gone through because the volunteers maintained the power to stop the experiment the moment it grew too uncomfortable. Another glaring difference was that the people who bound them and poured water over their faces were unquestionably not playing the role of a torturer – or even adversary. The moment the volunteer raised the white flag the tormenters quickly shifted to comforting and consoling them.
In short, the volunteers, as uncomfortable as it may have been, never forfeited the power to walk away on demand.
How many reporters would have agreed to be water boarded if they had been told, “There is a chance that once we begin this experiment, you will become an actual prisoner indefinitely and will lose all rights to end the interrogation”?
Is This Normal?
I cannot help but wonder how many women might fall prey to a similar type of mindset when it comes to birth control. Perhaps she starts to experience symptoms that replicate gum disease (or lupus, or hypothyroidism, or depression, or Crohn’s disease…).
At first, the symptoms may not seem so bad. She wrestles internally with how much she is willing to go through in the name of pregnancy prevention. This debate may grow more intense as the symptoms worsen, but one thing she rarely considers is that the symptoms might not stop just because she raises the white flag and gives up on birth control. Consequently, one of the most common questions I hear from women after they stop birth control is, “How soon will everything return to normal?”
This is precisely why small changes matter.
The Picture Grows Bigger
I doubt there are many women who ever gave up on birth control simply because they couldn’t leave the house without mints or gum, but, just as the changes in the gut microbiome gave rise to gingival inflammation, those same pathogens can progress and lead to a host of other complications and diseases.
Almost like diagramming a family tree, we can connect the dots of subsequent issues as they develop. These problems will vary from woman to woman because of their unique individual body chemistry.
However, in general terms, we know that women who take hormonal birth control experience much higher rates of gum disease and oral ulcers as a natural extension of the previously mentioned inflammation. But, they also experience more disorders with the temporomandibular joint (TMJ) because the synthetic steroids in birth control reduce the concentration of natural estrogens. This creates a problematic environment for inflammation leading to increased joint pressure and decreased pain mediation, which could be even worse among women who receive injectable birth control like the Depo shot.
This is an important distinction for those doctors who tell women that the “hormones” in birth control are just like those their body produces. In fact, the presence of these synthetic steroids that mimic natural hormones cause her body to produce less of her natural hormones, which leaves her more vulnerable to various problems, like TMJ disorder.
If we continue to plot this family tree to which no one would want to belong, we see that women on birth control, who undergo oral surgery, more than double their risk of suffering from dry socket after the surgery. This painful condition occurs when a blood clot fails to form or becomes dislodged, leaving the sensitive surgical area exposed.
So, what happens when we move beyond the mouth?
Branching Out
Unfortunately, the mucosal pathways only represent the problems that can most easily be traced back to the gut. The same immune response and inflammation that can cause problems locally in the mouth and vagina can also become systemic. The uptick in the various species of Prevotella often triggers an overproduction of various cytokines that can lead to more serious complications. So, as the “family tree” of complications stemming from the gut branches out, we see issues like rheumatoid arthritis (RA).
As researchers learned more about the relationship of the gut microbiome to our overall health, they began debating whether Prevotella acted as a pathogen in the onset of diseases like RA, or whether it was merely a biomarker that flourished as a result of the disease. Over time, studies isolated Prevotella infections and linked them to a specific type of T cell known as Th17, which produces the cytokine, IL-17.
This is where you might need to buy some tape to extend the paper for the “family tree” because TH17 and IL-17 induce tissue inflammation in a number of chronic and autoimmune diseases beyond RA, including psoriasis, multiple sclerosis, and the inflammatory bowel diseases: ulcerative colitis and Crohn’s disease.
Furthermore, high levels of Prevotella have been linked to insulin resistance, high blood pressure, non-alcoholic fatty liver disease, and impaired glucose metabolism.
Not coincidentally, ALL of these complications and diseases have also been linked to increased risks with hormonal birth control use.
See the Signs
Clearly, not every woman who wakes up with bad breath from her birth control will go on to develop a chronic inflammatory disease, but that does not mean we should ignore the warning signs.
It takes very little effort in connecting the dots to acknowledge that a relationship exists among these variables:
Hormonal birth control ~ changes to gut flora ~ predominance of Prevotella ~ overproduction of inflammatory cytokines ~ disease state.
We have a history of ignoring warning signs. In the early days of birth control, several leading physicians warned that they were seeing changes in mammary tissue that could lead to an epidemic of breast cancer cases in the future. The drug companies responded to those warnings by marketing that birth control would make your breasts fuller. And, just as predicted, we witnessed a 390% increase in breast cancer cases (from 80,000 cases per year in 1970 to 310,720 cases today), and the numbers continue to rise.
Decades later, scientists are discovering the connection between chronic disease and gut bacteria, which can be triggered by the synthetic steroids in birth control.
So, what should we do with this information?
Well, history has shown that we shouldn’t wait to see how the drug companies respond, nor should we wait for science to settle the debate regarding cause or consequence.
Instead, if you start taking hormonal birth control and find yourself waking up with bad breath, you should probably take it as just that – a wakeup call.
We Need Your Help
More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.
Yes, I would like to support Hormones Matter.
Image by Mudassar Iqbal from Pixabay.
