Q: Why do I keep getting zits?Isn't birth control supposed to improve my skin?
A: Yes and no. There are two hormones in most birth control pills: estrogen and progestin (synthetic progesterone). Estrogen's intended role is to maintain tissue in the uterus to prevent bleeding, causing a period when you take the placebo pills. Progestin is the actual contraception -- it prevents ovulation and thickens cervical mucus to stop sperm from entering the uterus.
In the skin, estrogen decreases sebum production. Sebum is produced by glands in your skin and is made up of fats and dead cells. Appealing, no? Less sebum means fewer zits. Conversely, progestin increases sebum production. Progestin's structure resembles that of testosterone, and testosterone stimulates the sebaceous glands. Whether your skin improves or not is largely an individual response to various formulations (the amount of each hormone in a particular brand of pill). The best way to find the pill that's right for you is trial and error. The higher the estrogen:progestin ratio, the more likely the pill will improve your skin.
Q: I thought birth control was supposed to help with PMS.Why is it making me nuts?
A: Once again, estrogen and progestin play opposing roles. Though it was once believed that estrogen causes depression in women, later studies have shown estrogen at the low doses contained in modern oral contraceptives does, if anything, improve mood. Progestin, on the other hand, can cause depression, mood changes, nervousness and fatigue.
Q: All my friends said oral contraceptives made their breasts grow.Why am I still an A-cup?
A: One study showed certain formulations of birth control cause an increase in prolactin, which is the hormone that increases the size of glands in the breasts to prepare for lactation. Even if lactation doesn't occur, the glands still grow, and so will your breasts. The other hormone that can affect breast size is progesterone. The synthetic progestin causes your body to decrease its level of production, and lower levels of natural progesterone correspond to larger breast size.
Another factor that can increase breast size is water retention and all-around weight gain. The water retention is caused by estrogen stimulating the production of yet another hormone, aldosterone. Aldosterone causes the body to retain sodium, and when the body retains sodium, it can retain up to three or four pounds of water to equalize the sodium concentration.
Lastly, because testosterone can cause weight gain, hormones that resemble testosterone, such as progestin, can make you gain weight. So breast changes depend partially on the particular brand of pill you take. Or it can be, like a side effect of any medication, partially a matter of sheer dumb luck.
Q: Now that I'm not ovulating, why am I not interested in sex?
A: Prolactin, the same hormone that can cause breast size increase, can also decrease your sex drive. High levels of prolactin feed back on a number of hormones and, long story short, libido drops. Also, vaginal dryness can occur, which contributes to decreased enjoyment of sex.
Q: Birth control?How come I got pregnant?
A: Mixed estrogen-progestin pills are more than 99 percent effective when used correctly. So, a vanishingly small number of women do get pregnant, even with perfect use, which requires taking every pill from every pack at the same time every day. Realistically, birth control pills are about 95 percent effective because of user error, leaving them still one of the most reliable and easy forms of birth control. This means there are some things you can do inadvertently that decrease the effectiveness of the pill. The package insert contains strident warnings about missing a pill mid-cycle, but the worst pill to miss is actually the first one. After seven days of placebo, your body starts to revert back to producing normal cyclical patterns of hormones. Not a problem, if you start back up after a week. But ovulation can occur even on that eighth or ninth day.
Antibiotics, most notably the drug rifampin,can also cause oral contraceptive failure. The failure rate of other classes of antibiotics is less clear. If you're on antibiotics, particularly rifampin, sulfonamides or penicillin-type drugs, use a second method of contraception or wait until you've started your next pack.
Anna is a Health & Sexuality columnist and a University Medical student. She can be reached at asedney@cavalierdaily.com. This column should be used for educational purposes only and is not meant to substitute advice from your doctor.
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