Can Birth Control Pills Cause Pelvic Pain?
A note from the author:
At a time where reproductive rights are being stripped and bodily autonomy is being challenged and revoked, a discussion about any form of birth control cannot be taken lightly. Accurate information regarding reproductive health, contraceptive options and the impact those options have on our overall health is more important than ever before. I believe deeply in the importance of informed consent and fully support anyone in using whichever form of birth control is best for them.
-Dr. Rebecca Maidansky, PT, DPT
Oral contraceptives are prescribed for a variety of reasons including painful periods, PMS, relief of symptoms associated with endometriosis, a desire to have a more predictable period and even as acne treatment. For many of us, that means we started using oral contraceptives in our teenage years and continued through our 20s and even into our 30s. In our pelvic health clinic in Austin, TX, it’s not uncommon for my patients to report a 10-15 year history of oral contraceptive use.
But oral contraceptives, like all medications, can impact systems they never meant to touch. If you have a history of using oral contraceptives, even if you stopped years ago, understanding how the pill may have impacted your pelvic health can help you find the best treatment option for your pelvic pain.
So, here we go.
There are two types of oral contraceptives:
The mini pill: this is a progestin only pill.
Combined hormonal contraceptives (CHCs): This pill includes estrogen and progestin. This blog post is going to focus on CHCs.
People with vulvas have testosterone and it’s important to our health. Testosterone is not just a male hormone and we need to dispel this notion because it’s important for the health of people with vulvas, too. We have two types of testosterone: bound and free.
Low testosterone levels can lead to these common symptoms:
low libido
weight gain
mood changes
unexplained fatigue
changes in cognition
bone loss
decreased muscle strength
Combined hormonal contraceptives reduce testosterone levels in two ways:
They trigger a reduction in ovarian testosterone production, reducing total testosterone.
They stimulate production of Sex Hormone Binding Globulin (SHBG) which binds and thus reduces free testoterone.
This 2014 systematic review looked at a total of 1,495 young women ages 18-40 using CHCs and found a significant increase in SHBG with a significant decrease total testosterone levels and a 61% mean decrease in free testosterone. Besides the previously mentioned reasons regarding the importance of testosterone, testosterone is also important for pelvic health. The vestibule (vaginal opening) has testosterone receptors making it hormonally dependent. The vestibule is dependent on estrogen AND testosterone. Decreased testosterone has been associated with vestibuloydynia, or pain at the vestibule. Click here to learn more about how lactation impacts estrogen levels and thus vulvovaginal health.
The pain is often multifactorial, and so are the treatment options:
Vestibuloydynia and pelvic pain are often multifactorial, with common contributing factors including hormones, the musculoskeletal and nervous system. If you have a history of using oral contraceptives and are experiencing pain with sex, talk to your provider about your choices to address the pain. Treatment options can include but is not limited to:
manual therapy performed by a trained pelvic floor physical therapist
modifications to habits like incorporating a lube or home exercise program to address underlying soft tissue restrictions
the use of a topical hormone cream
sex therapy
vaginal moisturizers
A 2013 review found reductions in vestibular pain following discontinuation of CHC use along with initiating a combined topical hormone therapy including estrogen and testosterone, often referred to as ET cream. It’s important to note that discontinuing CHCs is not always enough and some folks continue to experience low testosterone levels beyond the discontinuation.
If you’re experiencing pain with sex, consider pelvic floor PT. A trained pelvic floor PT can help you navigate your pain and determine the best course of treatment for you.
To learn more about how pelvic floor physical therapy can help you reduce pain and improve pleasure during sex, contact us here!
This post was written by Dr. Rebecca Maidansky, PT, DPT, owner and founder of Lady Bird Physical Therapy. Rebecca is a pelvic floor physical therapist in Austin, TX and founded Lady Bird Physical Therapy in 2019. She is the creator of Birth Preparation and Postpartum Planning, Baby Steps Fitness and the head writer and editor of The Pelvic Press.
Rebecca is a passionate writer and vocal advocate for pelvic health and the importance of improving access to perinatal care. She believes strongly that many common pregnancy pains and postpartum symptoms can be eased or even prevented with basic education and care.
She created this blog to help all birthing people manage common pregnancy pains, prepare for birth and recover postpartum.