How to Optimize Your Cycle on a Contraceptive Device

Nov 12, 2019

Dr. Ashley Margeson

Dr. Ashley Margeson


Did you know that you can optimize your hormonal cycle for better memory, focus and productivity EVEN WHEN you’re using a contraceptive device like the IUD, the Birth Control Pill or the Depo-Provera Shot? You definitely, 100% can. 
This episode we deep dive into “how to figure out where the bloody hell you are in your cycle” when you’re using something that can sometimes make that difficult. 
Along the way, I’ve dropped in a few fun science nerd facts, like the original research on the Birth Control Pill was done in the 1920’s on rabbits. Yes. Rabbits. Make clllllll of the jokes you’d like about pregnancy and rabbits now; I can guarantee that I’ve made them all already. 
As promised on the podcast, I’m including all of the fun research that we found while researching for this episode. And let me just say, some of this research is OLD. And I’m talking 1970’s old. But, turns out, we haven’t tracked women’s hormones during their cycles since about 1983 (and if you can find a more recent research paper to that regard PLEASE send it to me!), so I’m working with a limited research database here. 
Let’s dive in! 
Part One: The Birth Control Pill
The story of how the Pill was engineered to suppress ovulation is one of the first examples of researchers using naturally occurring hormones to re-direct normal human biology. As far back as the 1920s, scientists had determined that transplanting ovaries from pregnant rabbits into other fertile rabbits prevented pregnancy, and by the mid-1940s it was known that the hormone Progesterone was responsible for this effect. Researchers then wondered: What is the role of Progesterone and other hormones in regulating normal reproductive biology, and could this knowledge be safely used to suppress ovulation in humans?
The hormones estrogen and progesterone drive the rise and fall of two other hormones, FSH (follicle-stimulating hormone) and LH (luteinizing hormone). To trigger ovulation, FSH rises slowly in response to an Estrogen rise over the follicular phase of the cycle; and then an LH surge releases the off that FSH developed. Progesterone and Estrogen then rise after that surge, prepping the uterine lining for implantation of an embryo. If no implantation occurs, both hormone levels drop sharply, triggering menstruation. If fertilization and implantation do occur, levels of P and E remain high throughout pregnancy, suppressing the spikes of FSH and LH that drive ovulation.(These cycles are also outlined in the Hormone Optimization Planner (you can download your free copy here) with a little bit of extra information about how to plan your cycles for true optimization!)
Because FSH and LH are required to trigger ovulation, artificially blocking these two hormones would therefore suppress ovulation. Why then are progesterone and estrogen commonly used in the Pill instead? It is generally easier to add something to a biological system than to remove something, and since progesterone and estrogen suppress the release of FSH and LH these are logical choices for halting the sequence of events that lead to ovulation. Some people describe taking the Pill as “tricking the body into thinking it’s pregnant” and while not entirely accurate, this statement is not completely false. [PMID: 6225622]
Because of the estrogen and progesterone in birth control pills, they effectively deliver the same levels of hormones on a daily basis, before the “sugar pill” part of the cycle triggers a withdrawal bleed. Yes, that is correct, you do not get a period while on the Birth Control Pill. This means that you need to, in a way, “shrink” your monthly cycle into a 24-hour cycle to optimize it; as the curve dictating your productivity now relies on a hormone called cortisol. You are your most creative in the morning, a better planner in the morning; and then you get sh*t done in the afternoon (providing your cortisol doesn’t bottom out causing that awful mid-afternoon crash!). Don’t worry! I’m going to deep dive into the amazingness of cortisol in the coming episodes 🙂 
Turns out, this effect doesn’t change if you’re taking a 28-day Pill or a 90-day Pill like Seasonale. In fact, the research shows that there is little to no difference in your day-to-day hormones [PMID: 24453511] [PMID: 19209272], but there is a difference in how quickly your hormones return to their normal fluctuating levels. The longer you continuously take a birth control pill with no break, the longer it takes for your FSH and LH to regulate afterwards. This is very important if you’re thinking about timing for baby making! 


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Part Two: The Intrauterine Device (IUD)
Probably the most interesting medical device on the planet (in my opinion), an IUD has a local effect on your uterus. And we know this from research on healthy women in their early 20’s with a regular menstrual cycle in the 1970s and 1980s. I’m pointing that out on purpose, because we also know that some women react with no issues to an IUD, while other women react very differently. This is something you want to talk about with your local medical professional! 
Back to the research. What these research papers show, and subsequent papers as well, is that ovulation is not suppressed while you are on an IUD. Hormonal or Copper, it doesn’t matter, your ovulation is NOT suppressed. This means that, you still release an egg. WHICH IS GREAT when it comes to optimizing your cycle! 
Hormonal IUDs decrease the chances of pregnancy by thickening cervical mucus (which makes it very hard for both sperm and an egg to pass through) and through thinning the endometrial lining (which makes it very hard for a fertilized egg (highly unlikely in the first place) to implant. This is why you may only experience a light period or spotting or no period while on a hormonal IUD. The copper IUD has a nickname in my office of being the “sperm killer” as it is just toxic to sperm 😉 [PMID: 27789925]
In order to optimize your cycle and discover where you’re at, you want to look for a change in your vaginal discharge. it will get a bit more watery and egg-white discharge-y in the few days around ovulation. You’ll also be able to pick up on slight cues in your PMS before your cycle, but mostly the break in your sluggish and emotional feelings to clarity again. If you go from “feeling off” to “feeling like yourself again”, congratulations, you just approached day 1. If you’re one of the people who experiences spotting on an IUD, you’ve got it easy – you know exactly where day 1 is of your cycle! 
[PMID:4820609] [PMID:7554977] [PMID:1165881]
Part Three: The Depo-Provera Shot 

The contraceptive injection is given intramuscularly every 12 weeks. The injection works in a very similar way as the IUD, and many of the effects are the same. While it can be used by most women, it’s not generally recommended as first line for women who are under 18 or over 45, as there is some evidence of a small decrease in bone density. However, this decrease appears to be regained on cessation and has not been shown to increase fracture risk. [link]

The Depo-Provera does have a few side effects consistently, and that includes weight gain and that return to fertility can take 12–18 months so a woman’s pregnancy plans need to be considered [PMID:4419530]. It does take upwards of 12 months for a complete loss of period to occur, so you should be prepared for spotting initially as you move onto the shot. This can be very effective for those of you who don’t want to take a pill everyday and can’t use an IUD for various reasons (such as a diagnosis of endometriosis, let’s say). While it takes a little bit longer for your body to get used to it, you can optimize your cycle as your estrogen fluctuations do continue. However, your progesterone levels stay consistent through your period due to the shot… so you’ll have to work a little harder in accomplishing all those cool ideas you come up with! [PMID: 27789925]

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