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Does birth control cause bloating?
Posted 3 years ago by Clare
One of the most frustrating aspects of bloating is that it can seemingly happen for no reason. And sometimes we can think we are putting on weight when in fact we are merely bloated. Not only that, but the abdominal swelling may be water retention caused by hormonal imbalance due to birth control, such as the pill or coil. But how, when, and what can we do about it?
This is a huge question and a complicated area. The answer is down to a woman’s individual metabolism and there are a myriad of factors at play here.
Let’s try to take these apart a little
Firstly, let's look at some physical responses our body has when we go into our menstrual cycle. Clare Blake, from Fertility Massage, explains that, "There are a couple of other reasons that women experience bloating during their menstrual cycle. First, the higher levels of progesterone also cause a slowing down of the peristaltic action, which means that women get constipated in the luteal phase (from ovulation to menstruation). Secondly, constipation is made worse due to the womb increasing in size, doubling in weight from its non menstruating to menstruating weight. If the womb is misaligned and leaning against the rectum, then this increased pressure will cause a bowel disturbance, as the womb impinges the freedom of movement in the rectum. This constipated feeling will make a woman feel fuller and more bloated as they are holding more waste products within."
This gives us a great idea as to why we may bloat during our cycle, but many of us try hormonal contraception to avoid this, so why doesn't it always help? It is worth thinking about what happens to our hormones during our menstrual cycle. Levels of oestrogen rise in the first half of the cycle, after which they drop. Progesterone goes up in the second half, and when this drops, our period starts. It is thought that rising oestrogen levels cause the body to retain water, which might explain why many women start to feel bloated when they ovulate (when oestrogen is at its highest). However, some women bloat just before their period which is not when oestrogen is at its highest but when progesterone drops. At this point oestrogen is dropping too, but crucially, not as fast as progesterone. The gap between the two hormones closes. This causes a rebound effect of increased water retention. This suggests that it’s not simply to do with what level each hormone is at separately, but rather how both hormones are in relation to one another1. Either way, your hormones can affect water balance in your body2. Fundamentally though your weight will rise and fall in a fairly predictable pattern whilst your hormones are balanced. This is a crucial point and brings me on to the issue of birth control and bloating.
We can’t assume that each woman has the same genetics, metabolism, lifestyle, diet or ways of handling stress! All these variables will have an influence on how the pill or IUS coil may affect a woman.
Birth control is meant to smooth out the natural fluctuations of one or the other hormone, depending on the type of birth control you are taking. Progesterone must always be present to suppress ovulation. Both oestrogen and progesterone have different effects on the endocrine system in our body. Theoretically oestrogen in birth control would cause women to retain water (it acts on receptors in our kidneys, changing the way they excrete water3) or even put on weight, but many women experience neither of those. Progesterone is in fact meant to be a diuretic so should help women lose water. However, there is too much anecdotal evidence suggesting birth control does cause bloating to close the door on this question. So how can this be?
Firstly, it is suggested that anything we take which changes our hormone levels may affect water retention. Our bodies need to adjust to the new levels of hormones before they can find balance again. This is perhaps why doctors suggest a three month period of adjustment when having a coil inserted, or taking a pill.
Secondly, and this is key, this adjustment period won’t always result in a flat tummy and even moods because we may not have ‘balanced hormones’ in the first place. Women go through several phases of hormonal transition – puberty, pregnancy, pre menopause, menopause, not to mention a menstrual cycle every month! In fact it’s a miracle any of us remain sane!
Compounding this is the possibility our hormones have been adjusted and unbalanced by exogenous sources such as xeno-oestrogens, found in non-organic meat and plastic bottles. This issue is too complex to go into here, but it is becoming commonly known that this can seriously affect our hormonal health (as well as men’s).
Stress is another external issue that seriously affects the production of our sex hormones. Hormones are all made from the same orginal building block, cholesterol. When we are stressed and pumping out cortisol in an effort to counteract the adrenaline, we use up much of the building block which is required for our sex hormones, as it's being used to make cortisol instead. Simply put, when stressed our body runs out of the materials needed to keep our sex hormones balanced. Add birth control into the equation and who knows what we get!
Does the coil or pill make us bloated or gain weight?
A recent study4 concluded that the injection and either coil (hormone or copper) caused a significant amount of weight gain over the years. The injectable more so than the coils but all had an effect. Another study suggests that oral contraceptives slightly help prevent bloating but were shown to increase weight gain5. Conversely, another recent study suggests that the hormone coil will help alleviate some of the bothersome pre-menopausal symptoms including bloating6. However, other authors have underlined the importance of taking an individual approach to administering contraceptives, suggesting that it depends very much on the individual, her symptoms and present balance of hormones7.
Some advocate natural birth control as a way to avoid complicating our hormones further. Amy from Red Tent Sisters says
"Weight gain and water retention are common reasons why my clients come to me seeking natural birth control options. Hormonal contraception is shown in studies to increase nitrogen retention, which leads to weight gain, and decrease sodium excretion, which leads to fluid retention and edema. Furthermore, hormonal contraceptives have a huge impact on mood regulation, which is by far the number one reason women come to me seeking non-hormonal contraceptive options8."
No wonder we can turn into stressed out, grumpy, weepy, bloated messes rather than the strong, sexy women we have the potential to be! Although it varies according to each individual, it is very possible that your birth control may be causing that bloating you are experiencing. Every woman is unique and therefore there is no hard and fast rule. However, if you suffer from too many fluctuations, there are things you can do to help rebalance you hormones.
Tips to alleviate hormonal bloating
1) Discuss your contraception with your doctor, and whether or not it is the right one for you. They all have different levels of oestrogen or progesterone or are combined, and your doctor may be able to help you work out which one will suit you better. Just be clear about your symptoms, age and how you are feeling before taking the birth control.
2) Drink more water – this seems counterintuitive but when your bloating is caused by fluid retention it is vital to drink more water. Strange as it sounds, the water you drink will help to flush out the retained water, by helping you get your kidneys working optimally again.
3) Cut the salt – if you have high levels of salt in your diet, your body will retain more water to dilute it, as in high levels salt is a toxin.
4) Consider your liver – we all know that our liver is a detoxifying organ and therefore if we go on a drinking binge, our liver is one of the organs that is most stressed. However, it is less well known that our liver has to process our hormones before they are excreted from our body9. Therefore when we have a surge in hormones, our liver can be under pressure. On the flip side, if we have a sluggish liver, it can mean that our old hormones do not get broken down and excreted properly which can cause a build up and therefore an imbalance. Looking after your liver is therefore important when rebalancing hormones. Cutting down on refined carbs, processed foods, sugar, coffee, and your wine will all contribute towards keeping liver function healthy. The herb milk thistle is very good at helping keep your liver clean. Drinking dandelion tea can help too. Read this blog post on liver detoxification.
5) Exercise is also vital. Keeping the blood pumping and your limbs moving helps remove pockets of water from your lymphatic system or elsewhere. It is also great for digestion and expelling waste, again helping to keep your liver functioning well. Not to mention the positive effect that exercise has on stress and the mind.
6) Eat plenty of greens, and potassium and magnesium-containing foods, as this will help regulate liver and kidneys.
7) Take a long, relaxing Epsom salt bath. Epsom salts contain magnesium and sulphate which are absorbed through the skin when you bathe in them. Typically epsom salts are believed to help detox your body and remove toxins which in turn helps remove excess fluids. Magnesium is also needed by the liver and kidneys.
Eating a cleaner diet, drinking water and managing stress will go a long way to helping you regulate your hormones. Birth control is obviously vital but if it’s having unpleasant side effects such as bloating, the one you have chosen may just not be for you. It’s worth trying some of the suggestions above, or perhaps finding one that is.
You may also like to read Do we bloat more as we approach the menopause?
Do you feel that birth control is causing you to feel bloated? Please share your experience by leaving a comment below - what birth control are you taking, when and how do you experience bloating, and are there any other factors that might be interlinked?
Please note that anyone with kidney disease should seek advice from a doctor on this matter.
1.Stachenfeld, N. S. (2008). Sex Hormone Effects on Body Fluid Regulation. Exercise and Sport Sciences Reviews, 36(3), 152–159. http://doi.org/10.1097/JES.0b013e31817be928
2.Wenner, M. M., & Stachenfeld, N. S. (2012). Blood pressure and water regulation: understanding sex hormone effects within and between men and women. The Journal of Physiology, 590(Pt 23), 5949–5961. http://doi.org/10.1113/jphysiol.2012.236752
3.Graceli, J.B., Cicilini, M.A., Bissoli, N.S., Abreu, G.R., & Moysés, M.R.. (2013). Roles of estrogen and progesterone in modulating renal nerve function in the rat kidney. Brazilian Journal of Medical and Biological Research, 46(6), 521-527. Epub July 02, 2013.https://dx.doi.org/10.1590/1414-431X20132666
4.Modesto W, et al .2015, Weight variation in users of depot-medroxyprogesterone acetate, the levonorgestrel-releasing intrauterine system and a copper intrauterine device for up to ten years of use. European Journal of Reproductive Health 2015 Feb;20(1):57-63. doi: 10.3109/13625187.2014.951433. Epub 2014 Aug 27.
5.Berenson, A. B., Odom, S. D., Radecki Breitkopf, C., & Rahman, M. (2008). Physiologic and psychologic symptoms associated with use of injectable contraception and 20 µg oral contraceptive pills. American Journal of Obstetrics and Gynecology, 199(4), 351.e1–351.12. http://doi.org/10.1016/j.ajog.2008.04.048
6.Santoro N et al. 2015.Use of a levonorgestrel-containing intrauterine system with supplemental estrogen improves symptoms in perimenopausal women: a pilot study. Menopause 2015 Nov 13.
7. Cianci A, De Leo V. 2007, Individualization of low-dose oral contraceptives. Pharmacological principles and practical indications for oral contraceptives]. Minerva Ginecol. 2007 Aug;59(4):415-25.
8.Source: Reproductive Endocrinology: Physiology, Pathophysiology, and Clinical Management, by Yen and Jaffe.
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