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Hormones, Birth Control, and Insulin Resistance

Published on December 30, 2025

8.2K views

Little known fact. Your reproductive hormones influence how your body responds to insulin. The artificial hormones in hormonal birth control also play a huge role in how your body responds to insulin. And, your body’s response to insulin determines how well you are able to use glucose to supply your daily energy needs.

In this article, we will discuss the basics of how your body creates energy. In this first section, we will unpack:

How your body creates energy from glucose
Glucose vs. fatty acids as an energy source
How insulin resistance impacts the shift between glucose burning and fat burning
How glucose enters your cells to become fuel for energy
How insulin resistance interferes with the transfer of glucose into your cells

Then, we will tie in how your natural reproductive hormones, estradiol and progesterone, impact your body’s use of glucose as a fuel source and discuss how hormonal birth control disrupts this natural balance.

How the Body Creates Energy From Glucose

Many of your cell types are designed to run on glucose, a metabolic product of carbohydrates, as their main source of energy, and in fact, certain cells that don’t contain mitochondria (or contain very few mitochondria) like red blood cells and cells of certain parts of your eye (lens, retina, and cornea) rely either exclusively (as is the case for red blood cells) or primarily on glucose as an energy source.

The reason for this is that mitochondria are responsible for aerobic (oxygen required) energy creation processes within your body, and cells with no or very few mitochondria rely mostly on anaerobic (no oxygen required) energy creation by glycolysis in the cytoplasm of the cell. As we will discuss in more detail later, when your body uses fatty acids as a fuel source, this pathway is purely aerobic, so it is not possible for fatty acids to be used in anaerobic energy creation processes within your cells.

When you eat a meal containing sugar (sucrose) or carbohydrates, enzymatic processes begin breaking the sugar and carbs down into their basic structures within your digestive tract. The structure of both sugar and carbs contain glucose.

Glucose fuels the creation of ATP in a process known as glycolysis, which happens within the cell, and through oxidative phosphorylation (OXPHOS), which happens within the mitochondria (substructures within the cell). When ATP is broken down within your cells, it releases energy, which is harnessed to power your mitochondria and other important cellular functions. The by-products of that ATP creation (pyruvate and ATP) fuel additional energy production cascades within the cell.

How the Body Switches From Glucose to Fatty Acids for Energy

Even when particular cell types prefer carbs (glucose) as their energy source rather than fatty acids, most cell types are capable of using either of these macronutrients (and also, when necessary, amino acids) as a fuel in order to survive periods of fasting (including overnight fasting).

Insulin plays a key role in regulating whether your body uses glucose (glycolysis in the cell’s cytoplasm and OXPHOS in the mitochondria) or fatty acids (lipolysis in the cell’s cytoplasm and fatty acid oxidation in the mitochondria) as its preferred fuel source. This is because insulin impacts the ratio of two key enzymes (malonyl Coenzyme A and acetyl CoenzymeA) that determine which of these energy pathways is preferred (here and here). The ratio of these enzymes is dynamic, changing throughout the day in response to when and what you eat, and in response to this fluctuating ratio, your body preferentially uses carbs (glucose) or fatty acids as its fuel source.

In an insulin resistant state, your body does not easily shift between glycolysis/OXPHOS (glucose as fuel) and lipolysis/fatty acid oxidation (fatty acids as fuel) and instead remains in a state of using fatty acids as fuel. We will talk about why this is the case in the next section.

How Glucose Gets Inside Cells

The glucose released in your digestive tract from the food you eat is absorbed into your bloodstream, and when your blood glucose levels start to rise following a meal (or any drink containing carbs or sugar), it signals your pancreas to release insulin.

Insulin is the messenger that lets your cells (specifically, your skeletal muscle, fat, kidney, and liver cells) know there is glucose available in your bloodstream. Insulin does this by binding to the cellular membrane, and this activates glucose transporters on the cellular membrane.

Once blood glucose levels start to drop, a healthy body clears insulin fairly quickly so that it can maintain adequate blood sugar levels. Insulin must be cleared so that blood sugar doesn’t drop too low.

What Is Insulin Resistance?

A number of factors influence how your cells respond to insulin. External influences (like stress, diet, and lack of sleep) along with internal factors (hormonal fluctuations) play a role in how the cells respond to insulin. And, different types of cells respond differently to insulin. Skeletal muscle cells are the most sensitive to insulin. Fat cells and liver cells are also sensitive to insulin, and so these cell types (skeletal muscle, fat, and liver) are the quickest to take up extra glucose from the bloodstream.

When your body becomes more insulin resistant, the cells are not as able to respond to insulin. My favorite analogy for this is to imagine that you are at a rock concert. You cannot easily hear the person next to you because the volume in the venue is so loud that your ears are overloaded by the background noise. In order to carry on a conversation, you must move to a quieter place. In this scenario, insulin is the background noise or the decibel level. When you are insulin resistant, your pancreas releases extra insulin to try to get your body’s cells to respond. This would be the same as somebody yelling at you in a concert hall so that you are able to hear them speak.

When you restore insulin sensitivity, it is like taking your body out of that loud concert hall and placing it somewhere quiet. Now, you are able to hear and carry on a conversation without any problems. When you restore insulin sensitivity, the cells are capable of responding to a much lower amount of insulin much more quickly and take the action of absorbing glucose from the bloodstream.

Insulin Resistance Begets Insulin Resistance

With insulin resistance, the cells are used to the high insulin environment (partially deaf to insulin), so they stop responding to insulin’s call. This prompts the pancreas to release more insulin in order to get your cells to hear the message to soak up the extra glucose circulating in the bloodstream. When insulin is unable to be heard because of the high background noise (because there is so much circulating insulin the cells are deaf to it), then glucose isn’t taken up by the cells. This then creates the false message from your cells to key organs to start releasing stored glucose (in a process called gluconeogenesis) to supply the body’s energy needs.

When we are talking about diabetes, this feedback loop often, but not in everyone with diabetes, results in a perfect storm of upward spiraling blood sugar levels.

insulin resistance cycle common in diabetes showing increased insulin resistance triggering gluconeogenesis resulting in higher blood sugar levels which increases insulin resistance — Figure 1. Insulin resistance begets more insulin resistance.

Even in conditions besides diabetes where blood sugar levels are dysregulated, you might have one condition (for example, insulin resistance), without the other (increased release of glucose from your body’s reserves).

With all of that in mind, let us take a look at how reproductive hormones impact insulin resistance and gluconeogenesis, the process of releasing glucose from stored reserves.

Estradiol, Synthetic Estrogens, and Insulin Resistance

Reproductive hormones play a key role in insulin resistance. Most scientific studies agree that estradiol (the endogenous estrogen produced primarily in the ovaries throughout the reproductive years) boosts the release of insulin from the pancreas. While at first glance, this looks like estradiol might contribute to insulin resistance because it prompts release of extra insulin, the opposite is actually true.

Estradiol is widely accepted as a potent compound to restore insulin sensitivity. Whether this is because of upregulation of insulin from the pancreas or whether it is also because of the influence estrogen has on the cells when it binds to estrogen receptors or a combination of both of these is not clear. What is clear, is that estradiol encourages cellular uptake of glucose and more rapid reduction of blood glucose levels after a meal. Estradiol also reduces gluconeogenesis in the liver suppressing the release of free glucose into the bloodstream from the body’s reserves, and this supports healthy blood sugar levels (here and here).

Estrogen Concentrations and Insulin Resistance

How estradiol affects insulin resistance is concentration dependent. Estradiol concentrations in the bloodstream within the normal circulating range (not more than 1 nanomolar abbreviated 1 nM) are associated with healthy insulin sensitivity and healthy blood sugar levels while concentrations higher than 1 nM are associated with insulin resistance. This may be why gestational diabetes is a common condition during pregnancy with up to 10% of pregnant women in America developing gestational diabetes. Progesterone also plays a key role in gestational diabetes as we will discuss in more detail below.

Non-bioidentical Estrogen and Insulin resistance

Ethinyl estradiol, the most common synthetic estrogen used in hormonal contraceptives here in America, also impacts insulin resistance, but like endogenous estradiol, the relationship is not straightforward. Ethinyl estradiol has been shown to impact insulin sensitivity and gluconeogenesis differently depending on:

its concentration in the hormonal birth control
what progestin (synthetic progesterone) it is paired with

Just as high concentrations of endogenous estradiol increase the chances of dysregulated blood glucose control, the synthetic estrogen, ethinyl estradiol, also increases chances of dysregulated blood glucose control. Chemical diabetes caused by hormonal birth control is also well documented in the literature. This is one of the reasons why, since the 1960s, the concentration of artificial estrogens in combined oral contraceptives has been dramatically reduced from upwards of 60 micrograms per pill to as low as 10 micrograms. Currently, most birth control options contain from 20 to 35 micrograms of ethinyl estradiol per pill.

Estrogen Binds to Insulin Receptors Affecting Insulin Resistance

Estrogens, whether synthetic or endogenous, affect blood sugar regulation differently at different concentrations because of their ability to bind to insulin receptors. This concentration-dependent effect of both endogenous estradiol and synthetic estrogens is often overlooked in the conversation regarding the impact of hormonal contraceptives on blood sugar control. Inasmuch as estrogens play a role in insulin sensitivity, insulin secretion, and in gluconeogenesis, and because estrogens are combined in hormonal contraceptives with a wide range of synthetic progestins, the effects on blood sugar regulation are quickly compounded and convoluted.

Progesterone, Progestins, and Insulin Resistance

As with estradiol, the concentration of progesterone also impacts whether progesterone improves or diminishes insulin sensitivity. It is generally accepted that higher concentrations of progesterone during pregnancy are a major contributor to gestational diabetes. Similarly, high concentrations of progesterone, even after menopause, are linked to an increased risk of developing type 2 diabetes.

The actions of progesterone on glucose metabolism is very much related to carrying a pregnancy to term, promoting glucose storage (rather than consumption of glucose for fuel) and promoting ketogenesis (fat burning) within the body. Even when not pregnant, progesterone is the dominant hormone during the luteal phase (second half of your cycle), and this effects how your body uses glucose and its sensitivity to insulin. This ties into common experiences during the second half of your cycle including carb cravings, potentially diminished appetite (if you are like me), and also weight gain.

Unlike artificial estrogens, of which there is only one used in the combined hormonal contraceptives available in the United States, for progestins, the synthetic forms of progesterone, there are four generations of progestins, with each generation containing progestins of different molecular structures. The class of molecules used in synthetic progestins are similar in structure to the endogenous progesterone molecule, but they are not the same. In other words, they are non-bioidentical.

Progestins bind differently to the progesterone receptors within the body (and also bind to a variety of other receptors), than the endogenous progesterone and their specific structure contributes to how much and whether insulin resistance increases. The molecular structure also affects how the body conserves glucose (increases glucose storage) or uses glucose (in the process of gluconeogenesis). It is generally believed that the androgenic nature of progestins determine their role in reducing insulin sensitivity (here and here).

Hormones and Body Composition

An interesting note, whether we are talking about natural reproductive hormones, estradiol and progesterone, or artificial hormones, ethinyl estradiol and the various progestins, these are all fat-soluble hormones. That means, these hormones may be stored in, and thus, impact the behavior of fat cells. One study evaluated the response of fat cells (adipocytes) in the presence or absence of treatment with artificial hormones and found that in the presence of artificial hormones, the adipocytes were more insulin resistant. This suggests that fat cells may serve as a reservoir for artificial hormones and endogenous hormones alike. They essentially soak up circulating hormones from the bloodstream, and these absorbed hormones in turn impact how the fat cells behave.

This finding means that body composition affects how you respond to hormones, whether endogenous or synthetic, and vice versa. It also suggests that, among other things, we ought to consider dosing hormonal contraceptives relative to body composition. Women with higher body fat may store more of the hormones than those with lower body fat and this may initiate or exacerbate insulin resistance.

Summary

In summary, reproductive hormones are intricately intertwined with metabolism, both with how the body creates energy and how it stores fats and carbs to meet energy demands between meals. Hormonal birth control impacts this finely choreographed dance between reproductive hormones and insulin sensitivity, and this seemingly small influence has a dramatic ripple effect. Insulin sensitivity dictates things like weight gain, oxidative stress, and even, as we will discuss in the next article, susceptibility to UTIs and UTI like symptoms.

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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.

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This article was published originally on September 18, 2023.

Profits Over People: Medication Risk and Drug Company Misconduct

by Morgan Statt

Published on December 16, 2025

10.1K views

If you haven’t read Chandler Marrs’ article on the safety of medications, take a moment to do so and understand that no medication is, as Marrs puts it, “perfectly safe.” I’m here to reaffirm this harsh pill to swallow (pun intended) through the telling of my own experience and the showcasing of research that reveals just how much sway Big Pharma has over the safety of medications.

I was 20 years old when I decided to take my doctor’s advice and go on hormonal birth control to help regulate my periods. I remember my mother, a registered nurse who worked in a local hospital, voicing her concerns about the oral contraceptive. At the time, she was seeing quite a few girls my age come in with clotting complications related to the pill.

Thinking I knew what was best for me, I ignored her advice to stay off of the medication. I was comforted in knowing that almost every single one of my close friends was taking some form of birth control, and they were fine. I’d be fine too.

I couldn’t have been more wrong.

Two months later, I was in the emergency room with a bilateral pulmonary embolism or multiple blood clots in my lungs. What I originally thought was a relatively safe medication turned out to be a life-threatening decision. Suddenly gone forever was my notion that any medication I was prescribed would be taken without risk.

After six months on blood thinners to dissolve the clots, I went back to living my life normally, both clot and birth control-free.

Fast forward four years, and I’m reading news stories discussing the thousands of lawsuits that have been filed against the makers of Xarelto, the same blood thinner I was prescribed to help me recover from my embolism. Although I suffered no complications from the medication, I was clearly one of the lucky ones this time. The anticoagulant, which is still on the market today, has no known antidote to reverse its blood-thinning effects, and it has caused so many severe internal bleeding incidents and deaths that legal action has been taken.

Prior to doing any research, my emergency room experience would have made me cast aside the lawsuits as frivolous. There’s a risk with any medication; I can’t deny that I knew the risks before I opted to take birth control. But, didn’t they also know the risks before agreeing to take the blood thinner just like I did?

Drug Company Misconduct

After digging deeper, I realized there was a bigger issue at hand. Drug companies wield an incredible amount of influence within the healthcare sphere that can lead to the approval of medications that should never find their way into patients’ hands in the first place. A major showcase of this influence is seen in Big Pharma’s ability to fund clinical trials.

These clinical trials must be conducted before a drug is approved for market, and funding has typically come from government sources like the National Institutes of Health. But in recent years, more and more industry-funded clinical trials are taking place, meaning that drug companies can sponsor their own medications studies. Critics of this funding allowance point to the fact that the potential for financial gain can lead to a conflict of interests. Companies that have a vested interest in a drug’s approval because it brings a boost in profits could favor positive outcomes while ignoring any negative results.

In the case of Xarelto’s industry-funded clinical trial, it was discovered that Johnson & Johnson withheld information from the FDA that would have highlighted the blood thinner’s inferiority to its comparison warfarin. During the study, 14,000 patients were given an overdose of the traditional anticoagulant due to the use of a faulty blood-testing device, decidedly skewing the results. The design of the company-sponsored trial also limited the distribution of Xarelto to once-a-day dosing that weakened the medication’s effects on participants. With less severe side effects being observed because of the smaller dose, Xarelto’s clinical trial looked favorable for the new experimental drug.

We see a similar story of clinical trial misconduct being told with another blood-thinning medication, Pradaxa. Pradaxa was put through an industry-funded study whose poor trial design led to FDA approval. Critics point out that there was probable cause for bias since it failed to be a double-blind study. Its trial participants were also made up of a demographic of people who were less likely to be prescribed the medication once it hit the market.

The FDA went on to approve the anticoagulant despite the lack of an antidote, but its decision was based on the fact that Pradaxa “wasn’t inferior” to traditional warfarin. This labeling could bring the drug to market, but it wouldn’t be able to give manufacturer Boehringer Ingelheim a leg up in its promotion of the medication. Therefore, the drug company requested that Pradaxa be labeled as “superior” to warfarin in its ability to reduce strokes so that it could make this claim in its marketing materials. The FDA granted the company’s request, decidedly ignoring its original concerns with the blood thinner.

Pradaxa hit the market without an antidote just like Xarelto, and I bet you can guess what happened next. Thousands of patients taking the medication suffered severe internal bleeding complications and even succumbed to the side effects. Like Johnson & Johnson, Boehringer Ingelheim faced a shocking number of Pradaxa lawsuits and created a $650 million settlement fund in 2014 to satisfy the claims.

Profits Over People

We cannot deny that every medication presented to us comes with some sort of risk to our overall health and well-being. I suffered the risks of birth control but miraculously avoided the complications associated with Xarelto. Costs and benefits are just a fact of the pharmaceutical industry.

But, the issue lies in the influence of Big Pharma. If drug companies, who are so clearly focused on boosting their profit margins, can impact clinical trials in such a way that it costs patients more than it benefits them, where do we draw the line?

It will take massive changes in the drug approval process and overall state of healthcare before we can start to see patient lives being placed above profits. But, what we can do is stay informed and educated on the prescriptions we’re taking. There is a lot going on behind the scenes before a medication makes its way into that little orange pill bottle, and it’s up to us as consumers to do our research, look into the possible complications, and voice any and all concerns with our doctors.

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, and like it, please help support it. Contribute now.

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Image by Thomas Breher from Pixabay.

This article was first published in January 2018.

Doctors Say the Darndest Things About Birth Control

by Mike Gaskins

Published on December 8, 2025

9.8K views

A while back, a friend of mine shared a story on Facebook about a doctor’s nonchalant response to side effects experienced by a patient on birth control. I commented that this was one of my least favorite among the common phrases doctors use to gaslight women.

That friend was Sara Harris, who is doing amazing work getting the word out about Fertility Awareness Methods and helping women with hormone issues in Australia with her podcast, Follow Your Flow. Sara knew I was wrapping up work on a new, expanded audio version of my book and recommended I visit her podcast again to promote the audiobook and present my ‘Top 10 Least Favorite Things Doctors Say About Birth Control.’ You can listen to the resulting podcast here.

Lack of Respect

Obviously, I took her up on the offer, burning a lot of energy to get my Top 10 in the proper order – only to change that order and change it again the more I contemplated each phrase. Ultimately, I felt like I could have just as easily said they were in no particular order because each dismissive phrase poses its own set of disturbing problems.

For the purpose of this article, I want to focus on three of these statements, which are particularly egregious in their lack of respect for the potent drugs delivered by hormonal birth control and the detrimental impact they have on women’s health.

And so, here are those three statements… this time, in no particular order.

Localized Hormones

“This birth control option is safer because the hormones are localized.”

Doctors tend to offer this falsehood when speaking about either NuvaRing or the hormonal IUD. It is frequently used to sell a young woman on using the device, but it’s also used later to dismiss questions she may have about side effects she develops after insertion.

I have trouble believing that a medical doctor actually believes that these hormones camp out in the uterus and just manage fertility. Hormones are systemic. By their very nature, they travel throughout the body attaching to hormone receptors that reside on every cell in our bodies.

Now, here’s the kicker – not only are these drugs not localized, but they have the potential to be even more dangerous than hormones that are taken by mouth. Oral contraceptives (as with any drug taken orally) are processed through the digestive system in what is known as first-pass metabolism. This process reduces the concentration of active drug prior to being introduced into the blood stream.

Consequently, drugs distributed via the uterus bypass this first-pass metabolism thereby reaching the bloodstream more quickly and in a more potent state.

It shouldn’t be surprising then that a recent Danish study found that women on NuvaRing were six times more likely to develop a deep vein thrombosis than women not taking birth control, and twice as likely as women taking a combination pill.

Psychotropic Candy

“Don’t worry. I’ll just prescribe an antidepressant to go with your birth control.”

Many doctors seem to think antidepressants can be used to accommodate just about any symptom manifested as a result of birth control. In my book, In the Name of The Pill, I shared the story of a young woman with lupus.

After quitting hormonal birth control, her lupus symptoms became surprisingly manageable. This continued for a few years, until she decided to try a different formulation of birth control. Shortly after starting The Pill again, her lupus symptoms came roaring back. But, when she told her doctor about it, he didn’t think the birth control had anything to do with her flare-ups.

He advised her to keep taking it and prescribed her an antidepressant to ‘help her rest better.’

I believe doctors who pull stunts like this have lost any sense of respect for the potency of the drugs they are doling out. This goes for any drug – not just birth control. As one of the doctors Barbara Seaman quoted in her landmark book, A Doctors’ Case Against the Pill, warned, “It needs to be emphasized that if you give a patient one drug and counteract it with another, there is a rising curve of adverse reactions.”

In my opinion, this warning should be doubled where birth control is concerned because the powerful drug is essentially being used to treat pregnancy rather than some life-threatening disease. As Mayo-trained, Dr. Philip Ball put it at the Nelson Pill Hearings, “I believe that we physicians are so used to administering very potent medications to very serious disease problems, we have not really yet learned, it is a totally different circumstance to administer powerful but nonessential drugs chronically to healthy young women.”

You can read more about specific concerns related to the mixture of psychotropic drugs and hormonal birth control here.

Suddenly Supplements

The third comment deals exclusively with the Depo injection and needs a little setup. The FDA requires a black box warning on this drug’s information pamphlet. A warning in big, bold letters accentuated by a thick, black frame states:

“WARNING: LOSS OF BONE MINERAL DENSITY”

The warning goes on to explain that your bone loss will be greater the longer you take the product and these changes may be irreversible. It reinforces these concerns by stating that Depo should not be used as a long-term birth control solution, even capping its recommended use at no more than two years.

That seems pretty clear and absolute, but many women who have asked their doctors about this warning have been told:

“Just take a calcium supplement, and you’ll be fine.”

Mind you, the FDA warning says nothing about taking a supplement to offset the affects. In fact, it doesn’t suggest there are any measures you could take to avoid the potential consequences.

The FDA is a slow-moving, bureaucratic government agency. It takes a lot of evidence to overcome the inertia associated with issuing such a dramatic black box warning. For a doctor to ignore or deny such a warning and suggest the solution is as easy as taking a calcium supplement is borderline criminal.

Health as a Business

If your doctor ever uses any of these three lines, you should seriously question his/her motivation. Do they care about your health or do they see your healthcare as a business?

One of the things I frequently tell women is to trust your questions more than the answers. If you mention a side effect that concerns you, and your doctor seems more interested in convincing you The Pill had nothing to do with it, don’t assume you’re crazy or you’re the only one experiencing this. Your body is sending you this warning sign for a reason. Keep questioning.

I once had an Ob/Gyn tell me that it’s difficult to get anyone from her specialty to say anything bad about hormonal contraceptives because it represents about a third of their business.

However, if you are a medical professional who recognizes that birth control is much more dangerous than women are being led to believe, be proactive in sharing that information, even if you aren’t an Ob/Gyn.

Women need to hear it. Many feel isolated. They’re afraid to discuss their side effects because they think they’re the only ones having a bad experience. Or worse, they wonder if they may be going crazy.

An eye surgeon recently reached out to me and shared what’s been happening at her practice after she read my book. She said she always takes a complete medical history, part of which includes the patient’s use of hormonal contraceptives. Lately, even though she doesn’t deal directly with menstrual issues, when a woman reports certain ‘mysterious, undiagnosable symptoms,’ this doctor has started recommending they stop taking their birth control. She said a few patients have already contacted the office to thank her because their symptoms have improved dramatically.

I hope more physicians will hop on board and fearlessly tell women about the myriad side effects of birth control. We still have a ways to go, but maybe someday I will be able to compile a list of my Top 10 Favorite Things Doctors Say About Birth Control.

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.

This article was published originally on December 13, 2021.

From DES to the Pill: Are We Doomed to Repeat History?

by Mike Gaskins

Published on October 23, 2025

7.6K views

“The doctor wouldn’t have given it to me if he thought it was dangerous, right?”

My wife asked this salient question as we discussed the pros and cons of The Pill. It sent us both into deep reflection. Everything we read said The Pill was dangerous, but the doctor had acted like they should come in a Pez dispenser. To this day, I’m not sure where the cognitive began and the dissonance ended.

The DES Debacle: Origins of Obstinance

Doctors are generally dogmatic, but their nearly universal laissez-faire attitude toward The Pill seems particularly paradoxical when you study the scope and seriousness of its side effects. How can doctors believe that The Pill is safe, when tomes of studies suggest otherwise? Research links The Pill to everything from breast cancer and strokes, to Crohn’s Disease and lupus. To understand where we are and how we got here, it’s important to study the journey that brought us here.

By 1970, the current dogma that ‘The Pill is safe’ was well rooted in the medical community. However, enough doctors expressed concerns that Senator Gaylord Nelson decided to hold Congressional Hearings on the matter. The big three networks covered the hearings extensively, which caused great anxiety among women taking The Pill — and even greater anxiety among pill proponents, who subsequently demanded more ‘pro-pill’ doctors be included.

Senator Nelson took umbrage with their complaints, noting that all but one of the previous doctors had actually been ‘pro-pill’ to some extent, but all had reservations about its complications. Nonetheless, many of the doctors in the second round of hearings seemed more decidedly ‘pro-pill,’ including Dr. Kenneth Ryan, who stated,

I know of no information that indicates that biological properties of the estrogens used in the contraceptive pill are any different than stilbesterol for which we have at least 30 years of clinical experience…(Competitive Problems in the Drug Industry, Ninety-First Congress, Second Session, Page 6541)

Very reassuring… Unless you were actually familiar with the 30-year history of stilbesterol, also known as diethylstilbestrol (DES). Sir Charles Dodds discovered DES in 1938, and rushed it to market in the public domain. The English doctor bypassed the patent process hoping it would discourage the Nazis from further tests on women prisoners in their development of ethinyl estradiol (Barbara Seaman, The Greatest Experiment Ever Performed on Women; page 36).

From DES to the Pill

Despite his noble intentions, Dodds soon regretted the decision. Without a patent, drug companies around the globe were free to produce DES. He never expected that synthetic hormones would be given to healthy women, and was horrified that doctors were prescribing it as hormone therapy for natural menopause.

You Can’t Put the Hormones Back in the Tube

Even worse, Dodds soon learned that an American doctor named Karnaky had begun blazing a new trail – doling out DES to ‘prevent miscarriages’. Alarmed by the news, Dodds sent him a study he had personally performed, which showed that the drug actually caused miscarriages in animal subjects. It didn’t deter Dr. Karnaky or the many doctors who followed his lead. (Robert Meyers, D.E.S. The Bitter Pill; pp. 56-73)

Dodds began to feel like he was fighting a monster that he himself had unleashed. He was most concerned about how his discovery could affect certain cancers. He sent DES samples to the newly formed National Cancer Institute in the United States, and urged them to conduct tests and notify doctors.

Dodds wasn’t alone. The Council on Pharmacy and Chemistry warned,

…because the product is so potent and because the possibility of harm must be recognized, the Council is of the opinion that it should not be recognized for general use at the present time…and that its use by the general medical profession should not be undertaken until further studies have led to a better understanding of the functions of the drug. (Barbara Seaman, The Greatest Experiment Ever Performed on Women; page 44)

The concerns sent murmurs through the medical community, and many doctors began experimenting with lower doses of DES. By 1940, the editors of the Journal of the American Medical Association (JAMA) felt compelled to add theirs to the litany of warnings:

“It would be unwise to consider that there is safety in using small doses of estrogens, since it is quite possible that the same harm may be obtained through the use of small doses of estrogen if they are maintained over a long period.” (JAMA, April 20, 1940)

In 1959, the FDA determined the link to side effects (including male breast growth) was sufficient to ban poultry farmers from using DES as a growth hormone. However, the widespread use of DES in humans continued. In fact, it had become standard medical practice by the time Dr. Ryan assured Congress that The Pill was just as safe as DES – showing how medical dogma often trumps scientific evidence.

The greater irony of Dr. Ryan’s statement materialized one year after his testimony, when researchers first linked a rare vaginal cancer to the daughters of women who received DES during pregnancy. The FDA reacted strongly, listing pregnancy as a contraindication for DES use.

Consumer Groups Take the Lead

You would expect this to be the beginning of the end for DES. Shockingly, the medical community responded with indifference, continuing to prescribe DES for a variety of ‘off label’ uses, including as a morning-after pill, to catalyze the onset of puberty, and the old faithful, hormone replacement therapy. (Robert Meyers, D.E.S. The Bitter Pill; page 185)

It took nearly a decade of passionate effort from consumer movements like DES Action to convince doctors to (mostly) abandon DES. Dozens of lawsuits were filed; some were settled; and some are still pending. There is evidence that the harmful consequences could now be affecting a third generation of DES victims.

The current Director of Epidemiology and Biostatistics at the National Cancer Institute, Robert Hoover, M.D. oversees the DES Follow-Up Study to track the ongoing repercussions. With identifiable problems now affecting the grandchildren of women who took DES, the disaster hasn’t yet moved into the past tense of our nation’s history. Despite that, Dr. Hoover says:

There’s essentially a whole generation of medical students who don’t know the story. The story has such powerful lessons that I think that’s a tragedy…For about 20 years now, when I standardly ask in my general epidemiology lecture… how many of you have heard of DES, nobody raises their hand.

Sidney Wolfe, M.D., who headed up Ralph Nader’s Health Research Group offered this perspective,

DES is an excellent example of how drug companies behave, how they take advantage of the ways doctors act, and how they make millions of dollars by ignoring evidence of a drug’s harmfulness, by failing to get evidence that it is effective, and then by marketing a product that plays on fears and misconception. (Robert Meyers, D.E.S. The Bitter Pill; page 208).

In just 20 years, the American Medical Association moved from “It would be unwise to consider that there is safety in using small doses of estrogens…” to embracing the release of insufficiently tested hormones as birth control for millions of women. I’m leery of trusting a dogma founded on such an erratically moving target. In their defense, the dogma really hasn’t moved much in the decades since.

Today, the medical community assures us The Pill is the most researched drug ever. Sorry doc, that reassurance just doesn’t ring true. At this point, it feels more like a phrase learned by rote than a statement based on any kind of empirical evidence. Unfortunately, it’s not the only hollow mantra that should raise a red flag when it comes to hormonal contraceptives. I will discuss how the medical community responds to scientific studies in my next post, The Spin Doctor’s Prescription for Birth Control.

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This article was published originally on Hormones Matter on August 31, 2016.

Stroke, Birth Control and the Nelson Pill Hearings: What They Knew Then

by Kerry Gretchen

Published on October 16, 2025

13.4K views

birth control side effects nelson pill hearings

I had a stroke from hormonal birth control at the age of 28. Prior to my stroke, I didn’t think much about the side effects of hormonal birth control, or any other medication for that matter. Like many of us, I took for granted that if a doctor prescribed the medication, it must be safe. Especially one as widely used and as cavalierly prescribed as birth control pills. I was so wrong. Nearly dead wrong.

Since that time, I have become increasingly aware of how little we know about the side effects of many medications and how many are under-researched before being “approved.” We can see that in the number of medications that get taken off the market. The pressure of the pharmaceutical companies to make a return on their research investment and their exorbitant advertising budget is putting human safety, and especially the safety of women, at great risk. I wrote my master’s thesis on risk communication, how women are informed of the risks of hormonal birth control, and what they know about blood clots. I’ll write more on that later but suffice it to say, the results were not promising. It appears that we are intentionally misled where drug risks are concerned. “Well, of course,” the cynic in me says. “After all, who is writing the risk communication in the first place?” The very people that need to minimize risks in order to maximize profits.

As mentioned in previous articles, I’ve recently begun a research project involving the Nelson Pill Hearings. Senator Gaylord Nelson scheduled these hearings back in 1970 after a number of reports, books (especially Barbara Seaman’s “The Doctors’ Case Against the Pill”), and studies brought up concerns about the safety of the birth control pill. Feminist groups and women’s health advocates attended the hearings demanding that women who had taken the pill be allowed to testify. To which Nelson responded, “I stated in advance of the hearings that every viewpoint would be heard on this issue… There will be women who testify… I will give you all the time—if you ladies will come to see me—would you girls have a little caucus and decide which one will talk one at a time, we can then decide what ladies will testify. Your viewpoints will be heard, don’t worry about that.” Then they were kicked out. And much of the testimony was never made public.

After a great deal of work from Karen Langhart, with the help of Senator Bernie Sanders’ office, and perhaps an invocation of the Freedom of Information Act, we were able to get a near complete copy of the Nelson Pill Hearing transcripts. (I say “near complete” because I have already found at least one instance of a page missing. But more on that later.)

A Massive Experiment

As someone who has survived a stroke directly related to the birth control pill, you can imagine how strange and challenging it is to read these hearings. Here I am pouring over 1500 pages of testimony from countless doctors who are describing problems, side effects, and dangers of hormonal birth control and as far as I can tell right now, they all seem to agree on two things. One, that putting women on birth control pills was (and I would say, still is) a MASSIVE experiment with millions of healthy women. Two, that there simply wasn’t enough research to understand even the short-term effects, let alone the long-term effects. Though these hearings were 46 years ago, I believe we have yet to discover all the ramifications of this experiment.

They Knew: Pill Induced Stroke

From a personal standpoint, one of the most frustrating discoveries I have made so far was found in the testimony of Dr. David B. Clark, a professor of neurology. Imagine my shock as I read him describing the exact symptoms of my stroke. This was particularly frustrating as my doctors indicated that the reason I was misdiagnosed and left untreated for so long was because my stroke was so highly unusual. And now I’m reading testimony from 1970 that says they knew strokes in young women on hormonal birth control occurred this way. Over forty years ago, these risks (and many more) were identified and, for the most part, ignored. Here is some of his testimony:

“It has been thought for a great many years that spontaneous cerebral vascular accidents are quite rare in healthy, nonpregnant women, especially the younger ones.”- Nelson Pill Hearings, page 6137

So seeing an increase in these should tell us something…

“Further, it was rapidly found, which was embarrassing, I think to all of us, that we did not have a really accurate idea of the incidence of spontaneous cerebral vascular accidents, spontaneous strokes, in young, healthy, nonpregnant women. We did have some comparable information comparing incidence in women with that in men.” -Nelson Pill Hearings, pages 6137-6138

This really isn’t surprising given that women were often excluded from medical research and are still vastly underrepresented in clinical trials.

“In looking at this group of strokes, it seems their time of onset is often prolonged, for days, and even weeks. In a considerable portion of the cases, the onset was marked by premonitory migrainous headache. The patient may have attacks of double vision, they may have transitory weakness in various parts of the body, which recovers for a time: they often report giddiness and fainting attacks, and this finally develops into a full-blown stroke.”- Nelson Pill Hearings, page 6140

These symptoms are almost identical to mine.

He goes on to say that these types of strokes do not appear to be related to arteriosclerosis (hardening or thickening of the arteries) or hypertension (high blood pressure), two normal precursors for stroke. I also had neither arteriosclerosis, nor hypertension.

“So I think it is possible that such premonitory symptoms for days or weeks before the full-blown stroke develops may be a reason for assuming a seeming association with the pill.”- Nelson Pill Hearings, page 6140

Expletives and Indignation

Needless to say, when I got to this testimony, I let fly several loud expletives that served no purpose but to release a decade of frustration and scare my dog. This was 1970! My stroke was in 2006. Where did this information get lost? Why didn’t my doctors know to check for stroke when I presented with an ongoing headache and transitory weakness? Maybe my OB-Gyn wouldn’t have thought I had a migraine and a pulled muscle. Maybe the doctor at the local health clinic wouldn’t have suggested an appointment with a neurologist a week later. Maybe I wouldn’t have been sent home from the emergency room twice. Maybe I wouldn’t have had to suffer the fear and pain of massive seizures. Maybe I wouldn’t have had to relearn how to tie my shoes and relearn how to walk and relearn how to do math.

And as if reading a near-textbook list of my stroke symptoms that no fewer than four doctors misdiagnosed wasn’t maddening enough—the very next doctor to testify at these hearings, Dr. J. Edwin Wood, said the question of whether strokes are caused by hormonal birth control is debatable. He goes on to say that there is “a definite hazard to life while using these drugs because of the side effect of causing blood to clot in the veins” (Nelson Pill Hearings, 6156). Now, I’m definitely not a doctor, but I do know that the majority of strokes are caused by blood clots. More cursing ensued.

So where does this leave us? For my part, I’m going to keep digging. And I’m going to keep telling you what I find.

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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.

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This article was published originally on April 18, 2016.

Iatrogenic Illness and Pharmaceutical Side Effects

by Mike Gaskins

Published on September 30, 2025

8K views

Are you familiar with the phrase “iatrogenic illness”? An affirmative answer is more likely among the readers of this website than the public at large, but I would argue that even we (those of us who frequent this website) don’t give it the attention it deserves. In fact, if we changed the way we looked at iatrogenic illness, it could reframe the way we look at the entirety of medicine.

The Effect of Side Effects

Iatrogenic means an ailment that is actually caused by a medical examination or treatment. Perhaps the reason it receives less attention than it should lies in the fact that the classification would usually require an admission of guilt from the person most likely to identify it. Most doctors aren’t inclined to draw attention to the fact that something they did caused a new problem.

Consequently, we tend to associate iatrogenic illnesses with things like infection after a surgery, where it happens despite the medical team’s best efforts to prevent it. And, the only time we weigh the iatrogenic effect of pharmaceuticals being administered comes in extreme cases, like chemotherapy, where the patient and their family often weigh the quality of life versus the quantity.

However, we really should start considering the quantity of effect versus quality much sooner in life.

The Primary Effect

Think about the early development of a new drug and then consider this old phrase:

“There are no side effects, only effects.”

When a new drug is in development, the chemical engineers have a sense of what the desired effect will be, largely because most new drugs are variations on existing medications. But, this focus on a primary effect can lead us to discount the other effects on the body. It’s as if simply labeling an effect as a ‘side effect’ trivializes it in our minds.

What we must keep in mind is that by introducing these compounds into our bodies, we open ourselves up to the potential to experience any and all of the various effects. The doctor may give it to us to treat a specific ailment, but the reality is we’re susceptible to the entire array of effects.

Granted, these other ‘side’ effects may not happen as frequently as the ‘primary’ effect, but are drug makers still failing to give them proper attention as they weigh the benefit-to-risk simply because of how they may negatively impact marketing?

Creating a Drug Market

Let’s look at a couple of examples to see how marketing ultimately determines which is the ‘primary’ effect of a drug. We will begin with a brand so familiar it has almost become a generic term for analgesics.

In the late 1800s, an inexperienced pharmacist mistakenly sent acetanilide instead of naphthalene to a couple of French doctors who were experimenting with treatments for intestinal parasites. By chance, the doctors soon discovered the new compound reduced fever in some patients and later realized it offered some level of pain relief.

While unexpected, the ‘side’ effects were marketable. That’s why nearly 150 years later acetanilide, which metabolizes in the body to become acetaminophen, is still marketed under the brand name Tylenol, and has become synonymous with its ‘primary’ effects of pain relief and fever reduction, rather than its effect on parasite motility.

What about the other effects – the less marketable ones? Liver damage would probably fall into that category, And, despite the long history, researchers didn’t really start looking into the impact of acetaminophen toxicity on livers in both adults and children until this millennium. It makes one wonder how many people suffered severe liver damage before it caught researchers’ attention.

To some extent, the failure to notice the negative effects can be chalked up to human nature. As we look for the hook to hang our hat, we aren’t likely to notice the corner of the dresser until our little toe ultimately discovers it at a most inopportune time.

One Effect Stands Out

Drug makers aren’t completely oblivious to ‘side’ effects as they develop a new drug. In fact, they become acutely aware of secondary effects when they provide the potential for more profits.

It is a well-known story that the makers of one new drug being developed for high blood pressure and angina discovered that the drug also effectively induced erections in many of their male patients. Once they stripped away the labels of primary effect versus side effects, it probably didn’t take Pfizer’s MBAs long to recognize Viagra’s potential.

Rather than join the crowded, competitive field of blood pressure drugs, they had the opportunity to essentially create a new market catering to those suffering from impotence.

Of course, erectile dysfunction sounds much more like something that needs to be treated so they put their ad budget toward branding the ‘ailment’ as much as the new drug and it paid off in spades. Viagra managed to stay in the range of $2 billion in each year of its patent protection.

Don’t Take Your Eye Off the Ball

The drug and medical industries, which are so clearly on top of the ball when it comes to drug outcomes and profitability, have an abysmal record when it comes to drug outcomes and actual patient experience. It is precisely this focus on profits that clouds their vision, and turns side effects into new symptoms.

This is problematic with any drug, but none more so than with birth control because the patient is typically young and healthy. Plus, I can think of no other drug that is designed to be given to a healthy patient with the intent of stopping a natural process.

Given the disease-free state of so many patients who begin birth control, you would think this is one drug where it would be easy to identify an iatrogenic effect when side effects begin to arise. However, this is rarely the case, and the story of a young woman who recently contacted me provides a perfect example.

A Pattern of Side Effects

After seven years of taking birth control pills, Alexa changed over to the Mirena IUD. She began to notice facial hair growing and mentioned it to her doctor. He ran some tests and discovered her DHEA-S levels were high. A subsequent ultrasound revealed the classic string of pearls on her ovarian tissue, and she was diagnosed with PCOS.

When she questioned her birth control, the doctor insisted that she NEEDED to be on birth control or she would likely end up with endometrial cancer. She felt almost like he was using cancer to threaten her into continuing with birth control. He began to discuss other medicines she would also need to treat her condition.

But, she knew that her ovaries had been fine before starting on Mirena, and just couldn’t accept what the doctor was telling her. She searched online and found the patient information pamphlet for her IUD and learned that the documented side effects include “cysts on ovaries” and “facial hair.”

Alexa opted to take supplements to help balance her hormones and began charting her cycle after removing the IUD. Her cycle normalized quickly, her mood stabilized, and her energy rebounded.

It was the first time she began to realize how much the synthetic hormones had dragged her down over the years. She began to take inventory of all the “symptoms” that she encountered after starting birth control that might have actually been “side effects.”

Not only had the doctor recently missed that the two symptoms (facial hair, ovarian cysts) he used to diagnose PCOS were clearly listed as side effects of the contraceptive device he inserted, but she began to question previous interactions.

The IUD contributed to multiple vaginal infections, which in turn, led to several antibiotic prescriptions, but her doctor never acknowledged that the IUD could have played a role, even though these types of infections had never been a problem prior to the IUD.

She could see a pattern developing.

Then, she remembered when she first started taking The Pill at age 15. She experienced her first bouts of depression, which triggered new scripts for Paxil and then Lexapro.

Depression and anxiety represent some of the most common side effects of hormonal birth control. Yet, they are treated as mere symptoms of a new, unrelated disease by a vast majority of doctors.

A Cascade of Symptoms

I wonder how many young women have lived a similar experience? They unwittingly trade in their health for a cascade of symptoms.

When you hear a story like Alexa’s, you begin to understand why 131 million people in the US take at least one prescription drug, with the average being 4 prescriptions. We lead the world, spending $1,376 annually per capita on these drugs, nearly 50% more than our nearest competitor, Germany.

I don’t mean to insinuate that these new symptoms aren’t in fact new diseases. The subsequent effects of birth control often manifest as long-term, even chronic, new diseases. It isn’t uncommon for synthetic hormones to trigger an autoimmune disease, nor is it uncommon for depression to linger long after a woman stops taking birth control.

These long-term consequences are precisely why the next time your doctor casually hands you a prescription and you feel compelled to bite your lip and not ask the questions bouncing around in your head, ponder the phrase “iatrogenic illness” and don’t be afraid to start questioning the doctor.

After all, you will be the one living (or dying) with the consequences.

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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.

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This article was originally published on September 26, 2022.

Blood Clots, Birth Control and Female Athletes: Are We Missing Important Risk Factors?

by Chandler Marrs, PhD

Published on March 10, 2025

17.2K views

birth control, blood clots and female athletes

Over the last several years, stories of young women, many of them athletes (here, here), suffering from dangerous and sometimes deadly blood clots have filled the press and academic literature (here, here, here). Often mentioned in passing is the fact that these women were taking hormonal contraceptives at the time of the event. As a mom of a female athlete, a lifelong jock myself, and a researcher, I cannot help but wonder if we aren’t missing critical connections between some very common real life variables that predispose young women to serious health risks. Are athletic women more at risk for hormonal birth control-induced blood clots than other women? I think they might be.

We all know, or at least should know, that hormonal contraceptives increase the risk of blood clots for any woman who uses them. We often don’t pay attention to those warnings, especially when we are young, consider ourselves healthy, and when we are athletes. We ignore the warnings because taking birth control is, in many cases, a practical decision. Hormonal contraceptives, whether in the pill, patch, implant, vaginal ring, shot, or IUD, regulate if and when we bleed. That is, we bleed on a schedule, controlled entirely by synthetic hormones.

Scheduling is wonderful for female athletes. With no control over the scheduling of competitions, the ability to schedule one’s period is a great advantage. Let’s face it, competing while bleeding and cramping is never fun and near impossible for women with painful periods. Who wants to spend years training for that one event, only to have her period start? No one.

Optimal athletic performance requires that we control extraneous variables to the extent possible. Controlling one’s period takes care of a major variable in the life of the female athlete. And since it prevents pregnancy, hormonal birth control is a win-win.

Or is it?

Aside from the fact that hormonal contraceptives impact athletic performance (a topic of great debate and conflicting research), induce a variety of unwanted side effects, and that pill bleeds are not periods, hormonal contraceptives increase the risk of blood clots, quite significantly. Conservatively, birthcontrolsafety.org, estimates that out of the nearly 11 million women who use hormonal contraceptives (pill, patch, or ring), approximately 20,000 will develop blood clots and about 600 women will die, every year. There are no data on how many of these women were athletes or exercised intensely; however, it is likely that the numbers are pretty high given the high rate of hormonal contraceptive use in the general population.

Intense exercise, which is the foundation of athletic training, increases the risk of blood clots independently of gender or birth control usage. Indeed, some research suggests that the risk for deep vein thrombosis, blood clots in the legs, may be significantly higher for athletes than the general population. An interaction between hormonal contraception and exercise is likely to increase the odds of blood clots rather significantly. As women, the combination of those two variables alone should give us pause, but when we consider all of the other real world variables that also increase blood clotting and that just so happen to be prevalent in the life of the female athlete, the risk becomes quite concerning.

When Clots are Formed: Virchow’s Triad for the Athlete

When we look at the mechanisms involved in clotting and bleeding, we should remember that blood clotting itself is a necessary and protective mechanism against injury. Without the ability to clot, all sorts of complications can arise from everyday activities. Equally important are the body’s compensatory mechanisms that are designed to prevent too much clotting and to clear out clots once the immediate danger has ceased. The balance of power between the factors that promote clotting and those promote bleeding must be maintained within a fairly narrow window. Disruption to either side creates problems. Hormonal contraceptives shift that balance towards clotting and the normal components of athletic training and competition, shift the balance even further. When we add a few more variables, in any combination, synergies develop and the cumulative effects make female athletes using hormonal contraceptive at risk for serious, and sometimes deadly, blood clots.

Blood Clots and Athletes: The Basics

Blood clot formation is more likely when there are disruptions in blood flow. This can happen with:

Injury to the blood vessel wall (even microinjury induced by a medication or chemical exposure)
Depression of blood flow dynamics
Changes to blood constituents (clotting factors)

These factors constitute what is called Virchow’s Triad, after the German pathologist Rudolph Virchow who developed a framework in 1884.

Off the bat, by using Virchow’s triad, we can identify several potential risks for clotting that are likely more prevalent for athletes, male and female. For example, periods of intense exertion increase blood pressure, heart rate and the shear stress on the vascular walls (inducing damage and inflammation), which increases clotting propensity for athletes; while conversely, the athlete’s slower resting heart rate and lower blood pressure when not in competition, makes clearing those clots efficiently much more difficult. Similarly, periods of dehydration increase blood viscosity, slowing blood flow, as does inflammation and muscular hypertrophy via venous or arterial compression. Injuries and surgeries damage the vascular and arterial plumbing and slow blood flow. Extended travel compresses leg vasculature (and sometimes arm vasculature depending one’s sleeping position) and slows blood flow. Heck, even repeated movements can compress veins or arteries in different regions of the body and slow blood flow. What is athletic training if not repetition, hours upon hours of repetition?

Now consider these variables occurring against the backdrop of hormonal birth control, which changes the very balance of power between clotting and bleeding, effectively overriding many of the systems in place to ensure that clots don’t persist and causes problems. Throw in a few other decidedly female variables that also increase clotting, like monthly NSAID use to stave off menstrual pain, a propensity towards headaches and migraines, a latent genetic disorder or two, maybe even a less than optimal diet, and we have a recipe for disaster.

A Deeper Dive: Common Clotting Triggers for Athletes

Injury to the blood vessel wall

Injury to the blood vessel wall can develop by a number of mechanisms. The most obvious are those that result from direct injuries that occur over the course of training or competition. Surgery falls into this category. The rate of blood clots that evolve into pulmonary emboli after shoulder surgery ranges from 0.17% – 5.1% depending upon the type of surgery. Deep vein thrombosis after knee surgery, however, complicates some 2-13% of cases and upwards of 60% with some procedures. We cannot forget, also, that women are apt to have surgeries related to reproductive health issues, e.g. those related to endometriosis or ovarian cysts.

Less obvious are the micro-injuries or insults to vascular endothelial cells. Micro-injuries are surprisingly easy to induce over the course of athletic training and even in everyday living. They are not commonly recognized as risk factors for blood clots and there are few data that address these types of injuries; perhaps because their effects are likely part of a more complicated set of variables that combine to initiate and/or prolong the clotting, and are not immediately identifiable. I would argue that we ought to consider these risk factors especially in female athletes who use hormonal contraceptives because they are likely quite common. Here are just a few.

Contrast Dyes used for Imaging

Before any injury is surgically managed, imaging studies are common. The contrast dyes used for these studies induces micro-injuries to vasculature where the dye is circulated and are known to induce clots.

Vaccines and Medications

A number of medications and vaccines induce varying degrees of vasculitis or vascular microinjury. The most recent evidence of this is the HPV vaccine. For female athletes, something as simple as this or other vaccines, could initiate a clotting cascade that becomes difficult to end when hormonal contraceptives are involved. Similarly, the most commonly prescribed class of antibiotics, the fluoroquinolones (Cipro, Levaquin, Avelox and others), induce vascular microinjury among other side effects (tendon rupture, rhabdomyolosis, and neuropathy to name but a few).

Nutrient Deficiencies

Nutrient deficiency can induce vascular injuries via mitochondrial cascades. This one is a little bit more complicated and often a longer term process but one that adds to the overall propensity to clot. Briefly, mitochondria are responsible for and/or involved with a long list of functions ranging from bioenergetics (ATP production), to inflammation, steroid synthesis and cellular apoptosis, even platelet aggregation (an important variable in clot formation and dissipation). Mitochondria need several core nutrients to power enzymatic reactions. Most folks, even athletes, are deficient in several of these nutrients, especially if on hormonal contraceptives. Hormonal contraceptives deplete vitamins B1 [thiamine], B2 [riboflavin], B6, B9, B12 (worse if one is a vegetarian/vegan), C, E, magnesium (many athletes are magnesium deficient regardless of contraceptive usage), zinc, and CoEnzyme Q10. Simultaneously hormonal birth control may elevate vitamin K concentrations (which increases clotting), and also, increase copper and iron (too much iron favors hypercoagulation). Nutrient deficiencies and abnormalities cause mitochondrial dysfunction (and a whole host of other problems). Mitochondrial dysfunction leads to cell dysfunction, leading to molecular changes in the vasculature (and elsewhere), injuries, and a propensity for clotting ensues. Mitochondrial damage would also lead to changes in blood flow dynamics and blood constituents. So mitochondrial damage, though more subtle, can affect the entire triad of variables.

Blood Flow Dynamics – The Plumbing

Compression

Like the pipes in our houses, anything that blocks or compresses or otherwise slows the fluid through the pipes can induce a clog or, in this case, a clot. The most obvious of these factors is compression, as occurs on long plane/train/bus trips to and from competitions. According to AirHealth.org:

About 85% of air travel thrombosis victims are athletic, usually endurance-type athletes like marathoners. People with slower resting blood flow are at greater risk of stasis, stagnant blood subject to clotting. Also, they are more likely to have bruises and sore muscles that can trigger clotting. No other risk factor comes close to this. Age over 60 is supposed to be a risk factor, but these victims are younger, 82% of them under 60 [47% of air travel thrombosis cases are between the ages of 20-44].

According to some reports, the increased risk for clotting continues for up to 24 hours post competition, making the long trip home after an event particularly risky.

These are staggering numbers which are likely under-reported and under-studied. Imagine the risk for compression induced clotting to the female athlete who uses hormonal contraceptives. If she’s had an injury that required imaging with a contrast dye, or experienced any of the aforementioned other vascular insults, the risk increases.

May-Thurner Syndrome. Twenty percent of the population is believed to have a narrower than normal left iliac vein leading to blood clots in the pelvic region and left leg. May Thurner Syndrome, Pelvic Clots Most do not know this until they end up in the hospital with a blood clot. For these women, the risk for deep vein thrombosis, particularly in the left leg is even higher, especially on birth control (most especially, I believe, though this is pure speculation, when using a cervical ring like the NuvaRing). Again, add long sit times, an injury perhaps, and we can begin to see how the risk for blood clots in the female athlete using hormonal contraception can be much higher than for her teammates who do not use hormonal contraceptives.

Paget-Schroetter Syndrome, an anatomical narrowing of the subclavian vein (just under the clavicle or collarbone) and repetitive use trauma either alone or together can initiate clotting from this region. Sports with high upper-body repetition such as swimming, gymnastics, rowing, tennis, baseball/softball, and others, are at most risk.

subclavian vein effort thrombosis It is believed that the repetitive trauma that these sports require imposes strain on the subclavian vein leading to microtrauma of the endothelium and activation of the coagulation cascade. This alone is a risk factor for developing a blood clot, but when we add a few more variables, an intense competition, dehydration, a long flight home with upper body immobility and perhaps compression (sleeping on one’s arm), and enter these variables into an system primed for coagulation by hormonal birth control, the risk for dangerous blood clots increases significantly.

Viscosity

Sludgy matter doesn’t move through pipes too well. All manner of variables can affect the viscosity of blood. The most common in athletes is dehydration.

Dehydration

Dehydration is common in athletes, especially after a long competition. Dehydration increases the viscosity of the blood, slows the movement through the pipes. Put a dehydrated female athlete, who uses hormonal birth control on a long bus trip home, and clot risk increases. Add some past vascular damage, even minute and unrecognized, plus an injury or two, and the risk increases even more.

Blood Constituents – Changes at the Molecular Level

We can change the intrinsic clotting factors by a number of mechanisms: genetic, epigenetic and via medications (like birth control, NSAIDs and others) or environmental chemicals. There are over 20 proteins involved in maintaining the balance between clotting and bleeding and each of them can be altered towards a pro-clotting state by a myriad of variables (for a full list see here).

Genetics

Beginning with the genetic variables, 3-10 % of the population have heritable genetic mutations that increase their risk of developing blood clots quite significantly, absent other variables. Upwards of 50% of patients who have develop a clot carry one or more of these mutations. Unless there is a known family history of clotting disorders, most women who carry these mutations are unaware of their genetic risks. When these women utilize hormonal contraceptives, their risk of blood clots increases significantly by as much as 35x according to some data. I think all women should be tested for these genetic variables before being given hormonal birth control. Unfortunately, none are, until they end up in the hospital fighting for their lives. Now consider a female athlete who carries one of the mutations and is on hormonal birth control, travels, uses NSAIDs, has had an injury or two, and the likelihood of her developing deadly blood clots is very much increased.

With both genetic and acquired components, antiphospholipid syndrome (APS or APLS), also increases blood clot propensity. In fact, it is the most common cause of excessive clotting, and affects women more than men. APS is autoimmune condition that causes hypercoagulability of blood through unknown mechanisms. APS can occur on its own, or in conjunction with lupus and other rheumatic disease processes like Sjogren’s. Neither of these diseases is uncommon in female athletes, though hard data are difficult to come by. Anecdotally, Venus Williams has struggled with Sjogren’s and case reports abound of female athletes with Lupus (here, here).

Epigenetics

Epigenetics is a fancy term for events that happen above the genetic level. It is an emerging science where investigators look at variables that don’t directly alter the DNA, but rather, aberrantly turn on or off a particular gene. Environmental factors play a large role in epigenetics, medications, vaccines, other chemicals, diet and nutrition. So, just as a woman can carry heritable genetic mutations, she can also carry heritable epigenetic changes that turn on the genes controlling the clotting proteins or turn off those that prevent clotting. We can inherit these epigenetic changes from parents and even grandparents, but also, induce them via every day exposures and activities. I suspect that there are epigenetic components of one’s risk for blood clots.

Medication Induced Clotting

Here’s the big one that we don’t pay nearly enough attention to – medications and vaccines can induce clotting via multiple mechanisms, including changing the balance of power between clotting and bleeding. Briefly, and most importantly to female athletes are hormonal birth control and NSAIDs (ibuprofen and the like). The chemistry is a bit complex, but let us take a stab at it, because when these variables are combined with the normal activity of a female athlete, I believe her risk for blood clots shifts from the ‘if’ category to the ‘when’ category. For more information on the clotting cascade, here is a simple Khan Academy video.

Hormonal birth control increases all of our coagulation factors, but most especially, clotting factors VII and X, where plasma concentrations have been measured at 170% of normal. Fibrinogen (responsible for initiating the fibers that form the clot) is increased by 20%. Hormonal contraceptives also stimulate platelet aggregation (the initial plug that covers the injury), while simultaneously decreasing an anti-clotting factor called antithrombin III. Sit with that for a moment. This is the biochemical foundation that the female athlete is working with. Without doing anything else, her body is primed to clot.

Pro-clotting factors are increased to almost 3X their normal levels, while anti-clotting factors are diminished.

With this biochemistry, a body can only forestall excess clotting for so long. In fact, early reports suggest that clotting risk increases with time used. That is, clotting factors increase over the months and years one uses these medications. This may be why some of the most deadly clots, the pulmonary emboli and cerebral venous thrombi develop in women who have used contraceptives for years.

I have to add one more poorly understood hit to the coagulation system. NSAIDs alter platelet aggregation in some pretty complex ways and the mechanisms by which NSAIDs induce bleeding or clotting are just beginning to be understood. It is well known that NSAIDs like aspirin and ibuprofen can induce excessive bleeding. Gastric bleeds are one of the most common side effects of ibuprofen use. NSAIDs also carry with them increased risk of venous thromboembolism. Excessive bleeding but also excessive clotting–how is that possible? Certainly, it depends upon the formulation and which pathways the drug targets (Cox 2 inhibitors), but the emerging theory is that platelet aggregation may increase over time and become difficult to dissipate, because these medications block the enzyme responsible for keeping injured vessels free of clots while the damage is being repaired.

Another mechanism by which NSAIDs influence coagulation is via heart rhythm irregularities, like atrial fibrillation (at least for older populations, no data are available for younger athletes). With atrial fibrillation, we have a good chance of blood pooling which can result in clot formation. Finally, there is some evidence that NSAIDs increase vasoconstriction, which would impact blood flow. NSAID use is very common in the life of the female athlete and non-athlete alike with regular use both monthly, to stave off menstrual pain, and over the course of training to manage pain and injuries. It is possible that NSAID use may not only impact the post-injury healing process, but also, increase an athlete’s chances of developing a blood clot.

Now What?

Birth control is a personal choice. If pregnancy prevention is the only reason for using these hormonal contraceptives, there are non-hormonal options, including the old stand-bye, the condom, and newer devices for tracking. If scheduling is the primary consideration, I would consider whether or not the opportunity to schedule overrides the risks associated with using these products. Blood clots are a very real danger for athletic women without the additional risks that come with hormonal birth control. Are those risks worth taking?

Share Your Story

If you are a female athlete and have developed blood clots while using hormonal contraceptives, consider sharing your story. Contact us via this link: Write for Us.

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.

Photo by John Arano on Unsplash.

This article was published originally February 23, 2016.

Hormonal Birth Control Plus Poor Diet Is a Recipe for Disaster

by CB

Published on February 17, 2025

7.1K views

I am a 29 year old female who began experiencing a decline in my health at 25 years old. This was in 2020. At that point, I had been on hormonal birth control for nearly 10 years. I suspected the birth control was contributing to my ill-health but my doctor disagreed and continued to prescribe different forms to alleviate my symptoms. That did not work and only made things worse. When Depo-Provera was added, I completely crashed and have not recovered, nearly two years later.

When I first began to experience extreme fatigue, abdominal bloating, irritability, restlessness, and massive amounts of hair falling out, I went to my primary care doctor who could find no reason for it on basic bloodwork, except for a low vitamin D level (27mg/mL). They checked CBC, CMP, autoimmune markers, B12, a complete thyroid panel, Lyme titers, mono titers, and iron levels. Since everything was basically normal, my primary care doctor blamed it on my stressful job. At the time, I was working in the emergency room on the night shift. I was not getting the best sleep, and not eating that well either. I was lucky to eat one meal a day and then maybe a snack especially on my busy shifts. On my days off, I was so exhausted that I would eat maybe twice a day. My diet consisted of easy meals like grilled chicken, salads, granola bars, processed cereals, pizza, chicken nuggets, chips, bananas here and there, and overall not a lot of fruits or vegetables.

Enter Depo-Provera

Fast forward to the fall of 2021, after these symptoms persisted, my doctor decided to switch my birth control to the Depo-Provera shot. After taking this shot, havoc was wreaked on my body and brought me down to a level of non-functioning that I never knew existed. Over the next couple months and after taking only one depo shot, I began to experience debilitating symptoms of headaches, fatigue, achy joints/all over body pain that eventually progressed into episodes of heart-racing anytime I would change position. I also experienced shortness of breath, chest pain, difficulty swallowing, a complete loss of appetite, GI issues, brain fog, severely decreased ability to concentrate, severe restless leg syndrome, insomnia, and neurological symptoms so extreme it felt like my brain was “short circuiting” for lack of a better word.

One side of my body would become extremely numb, tingly, and feel weak without any clear deficits. I experienced severe muscle weakness, where it would feel like my body was doing everything it possibly could to keep me upright and breathing. It was so bad, I felt as though I couldn’t even grip my phone and just talking on the phone to family felt like I was dying. I could barely concentrate. I developed severe visual issues, a condition called visual snow syndrome, and still am dealing with it with no improvement. I also developed tinnitus and have a constant high pitched ringing in my ear. I am unable to handle any type of stress, multi-tasking, or any emotional upset without truly feeling like my body is dying from severe neurological symptoms. I became scared to leave the house alone because of these debilitating symptoms. I lost over 30 pounds from feeling so awful and a complete loss of any desire to eat. I would have to force myself to put in fluids or food.

Over the course of many months, I saw multiple neurologists, neuro-ophthalmologist, cardiologist, electrophysiologist, primary care doctor, ENT, TMJ specialist, otologist, binocular vision specialist, rheumatologist, had numerous ER visits, two hospital admissions. I even participated in vestibular/neurological physical therapy over the course of several months. I had multiple head MRIs and CTs of my head and neck, MRIs of my spine, and so much bloodwork looking for autoimmune causes. I had a colonoscopy, a camera down my nose to look at my throat, an audiogram, a sleep study, a tilt table test, an echocardiogram, a stress-echocardiogram, and they even attempted a lumbar puncture on me as well. Conditions such as blood clots, multiple sclerosis, any type of cancer or tumor, etc., were ruled out and the only thing they came up with was a diagnosis of Postural Orthostatic Tachycardia Syndrome (POTS), a suspicion for “some type of migraine variant” and a deficiency in vitamin D and phosphorus on my bloodwork.

Could This Be Thiamine Deficiency?

Fed up and worsening, I paid out of pocket to go to a natural medicine doctor who did heavy metal and mold testing on me along with hormone testing. Nothing really turned up there and so I took it upon myself to order a full vitamin and mineral panel paying over a grand out of pocket. This panel revealed that my serum thiamine was one point away from being flagged as low (8 nmol/L). I then returned to my primary care and two different neurologists to ask if a thiamine deficiency could be the problem or at least part of it, especially after my own research and the known research that birth control depletes many B vitamins. All of the doctors told me that there was no possible way I could have a thiamine deficiency since it is added to so many foods in the United States. They also told me that I could just take a B complex vitamin if I was worried. Even after I told them I was hardly eating because I felt so sick and that when I was eating it was mostly foods like processed toast, frozen chicken nuggets, cans of soup, and other things of that nature, they still dismissed the idea of thiamine deficiency.

May-Thurner Syndrome

On top of all of the debilitating POTS and neurological symptoms, throughout my time on birth control I had complained to my GYN about persistent left sided pelvic pain. It felt like my labia was swollen and at times like something was bulging into my pelvic area. In 2019, I had a CT scan of my abdomen and pelvis done due to some GI symptoms I was having. An incidental finding on it was suspicion for pelvic congestion syndrome (PCS). The report stated that I had very prominent peri-uterine vessels and a dilated left gonadal vein. I took these results to my GYN at the time who clearly stated “PCS is a fake diagnosis and you don’t need to do anything with that.” Since I was young, in my early 20s, I didn’t take it too seriously. Again as time went on, I continued to have the pain and over the years my GYN kept changing my birth control and mentioned endometriosis and small ovarian cysts as possible causes. The birth control would help a little bit for a while but then I would have irregular bleeding and the pain would always come back. It wasn’t until after I took the Depo shot and came off of the hormones that things became worse.

I began to have severe left pelvic pain that persisted for months. I had transvaginal ultrasounds every 6 to 8 weeks to monitor recurring small cysts that they swore were not the cause of my pain. I was tested for PCOS and was negative for that too. It wasn’t until the end of 2022, that I had another transvaginal ultrasound and this one read as having a hydro-salpinx. I had a new GYN at the time who referred me to get an MRI done of my pelvis. This MRI came back as also showing “likely hydro-salpinx” on the left. Since I was having such severe pain, I was referred to a GYN surgeon who said in extremely painful cases it is recommended to take out the tube and it was pretty much nonfunctional when it was as swollen as mine. I elected to proceed with the surgery, as the pain was so extreme. Funny enough, after the surgery when the pathology came back there was no hydro-salpinx and my surgeon said he did not see any endometriosis when he performed the laparoscopy. He said he believed my MRI may have been misread since he did not see any indication of hydro-salpinx during the procedure.

As if that wasn’t enough, after the procedure I had a severe neurological reaction to the scopolamine patch they put on me during the procedure. I had so much testing for this. I was even in the hospital for 5 days with what they thought was “scopolamine patch withdrawal” even though I only had the patch on for 3 days like they told me to wear it.

Fed up and still in pain, I let it go for a few more months thinking it was just “scar tissue” from the surgery or some other easy explanation. It wasn’t until my POTS doctor recommended me to wear an abdominal binder/compression device around my stomach that things worsened so much that I was forced to figure this out. I began having severe left pelvic, hip, and leg pain after wearing this device for only 3 days. I went to the ER because the pain was so bad, but they could only find a small ovarian cyst on my left ovary. They didn’t even consider doing any other work-up. I was then sent to an orthopedic to look at my hip and back to my GYN. Neither could really give an explanation for this pain. Finally enough was enough, I went to a vascular doctor on my own accord to get this PCS, which no one seemed to take seriously, looked at.

At the vascular surgeon’s office, they did a vascular scan of my pelvis and abdomen and were quickly shocked to find that my left iliac vein was almost completely compressed causing my peri-uterine vessels to get almost no blood flow. They diagnosed me with something called May-Thurner Syndrome and said that they usually only see severe cases like mine in women who have had “5 or 6 babies.” I was 28 at the time with one previous ectopic pregnancy many years ago. They quickly scheduled me to get a stent of my left iliac vein placed, as my left leg had begun swelling bigger than my right due to the limited blood flow.

On the day of surgery, my left leg was 2 inches bigger than the right and I was in severe pain. They did a venogram with internal ultrasound and were able to tell me my left iliac vein was 85% compressed. So basically, I was getting no flow through it and hardly any return through that vein up to my heart. They also informed me that the birth control was probably masking the problem but also could have been worsening it when I was on estrogen-containing birth control. They said I was extremely lucky that I did not develop a blood clot, especially when I had taken Beyaz for several years. Now, I am on blood thinners for several months post stent, while waiting to see if this helps with my POTS symptoms at all. So far, I have not seen any improvement except that my leg is no longer swollen.

Still Seeking Answers

I don’t know if thiamine deficiency could be causing my issues, but I have not received any answers other than POTS and my recently discovered May-Thurner Syndrome. I have seen so many doctors and spent so much money with no improvement in my health. This all severely worsened after I took the Depo shot. I have been unable to work for months, was bed bound for a long time, and was completely unable to eat during the worst of my symptoms. Now, I am at least able to move around more than I was and leave the house for doctor appointments, but I am still not working and I am still searching for answers. I would like to feel better and get back to some type of semi-normal life.

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.

Photo by Kelly Sikkema on Unsplash.

This article was published originally on August 14, 2023.

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Enter Depo-Provera

Could This Be Thiamine Deficiency?

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