I was recently at a barbecue with some other parents when the topic of teenage daughters and birth control came up. “I plan to just put her right on the pill when her period starts,” said one mom. Other moms nodded in agreement, “Yes, my doctor said she needed to be on the pill so her periods would regulate.” Another chimed in, “It also helps with all of that acne! Cleared it right up. Plus, now, we don’t have to worry about pregnancy.”
On the surface, hormonal birth control for teens makes sense. Teen girls often have menstrual issues, which birth control appears to help. Most moms don’t hope for the prospect of pregnancy for their teenage daughters, which birth control mostly prevents. In a nutshell, hormonal birth control appears to be a catchall solution for period problems (which, by the way, is often an off-label use) while also preventing the specter of teen pregnancy. Wham bam two-for-one. So what’s not to love? Why would you even think twice when considering putting your teen daughter on birth control?
Research increasingly shows there is reason to pause before jumping to the pill pack for your teen girl. Cycling naturally (which hormonal contraception prohibits) during the critical years of puberty has been shown to be imperative for long term hormonal health. Hormonal birth control use also comes with many potential risks and side effects. Not only does hormonal birth control during puberty have potentially lifelong health impacts, but it also delays the diagnosis and treatment of endocrine disorders, because it largely masks their symptoms without actually treating them. For the most part, hormonal birth control does effectively prevent pregnancy, but this comes at a high cost—perhaps especially for teen girls.
Abnormal vs. normal menstruation: The signs to look out for
In 2015, the American College of Obstetricians and Gynecologists (ACOG) put out a statement that said, “It is important for clinicians to have an understanding of the menstrual patterns of adolescent girls, the ability to differentiate between normal and abnormal menstruation, and the skill to know how to evaluate the adolescent girl patient. By including an evaluation of the menstrual cycle as an additional vital sign, clinicians reinforce its importance in assessing overall health status for patients and caretakers.”
It is encouraging to see a major health organization like ACOG emphasizing that a teen girl or adult woman’s menstrual cycle is truly a fifth vital sign, however, what is left out of ACOG’s statement is a simple, yet important fact: The menstrual cycle cannot be properly observed when someone is on hormonal birth control, because one no longer has a menstrual cycle while on hormonal birth control. So, when a teen girl is placed on birth control, monitoring whether her menstruation is normal or abnormal (which is of enormous benefit to determining her overall health and wellbeing) becomes impossible.
But let’s define some terms now. What exactly is normal and abnormal menstruation? In the first 10 years after menarche, some irregularity is to be expected. In fact, irregularity is a normal progression of the adolescent menstrual cycle [1]. The progression towards normalcy/regularity over time is more important than any individual cycle—which is why cycle charting for teens is not only helpful, but arguably essential. Cycle charting allows girls (and their mothers and doctors) to monitor if and how their periods are regulating. When symptoms are stagnant and not progressing towards regulation, even slowly, it can be a red flag and worth getting a restorative reproductive practitioner involved. A certified fertility awareness educator along with a restorative reproductive medicine practitioner is a perfect healthcare team for your daughter or teen girl as they journey through the 10 year trek of puberty. (Yes, puberty and maturation of cycles can take up to 10 years!) Keep in mind that excessive period pain and/or very heavy bleeding is less normal, and almost always worth looking into.
Parents, naturally, don’t want to see their teen struggle with any period issues, which can be painful, embarrassing, and disruptive of schooling and extracurricular pursuits. It’s therefore understandable why a pill pack seems like fulfilling due diligence, when hormonal contraception can alleviate endocrine disorder symptoms like irregular and painful periods. But as we’ve discussed at length here at Natural Womanhood, hormonal contraception of any kind doesn’t actually fix the reason behind the symptoms.
Caring for your daughter’s fertility now means safeguarding her future ability to conceive
Sometimes a teen girl’s irregular period symptom can be a perfectly normal part of pubescent progression, as we’ve just discussed. Other times, the symptoms are expressive of deeper hormonal issues. There are many of these hormonal conditions, but the most common are polycystic ovary syndrome (PCOS) or endometriosis, both of which can have implications for your daughter’s ability to conceive later in life, especially if they are not treated early on.
A woman who starts hormonal contraception as a teen may spend years, even decades, without a second thought. Then, when she comes off it—perhaps to start a family—she may find that the same issues she once faced pre-birth control still persist (although, not always, if those original symptoms were part of the natural progression of puberty, as discussed above). But if her symptoms were due to an underlying reproductive issue or endocrine disorder, she’s lost time that could have been spent navigating (and hopefully treating) those issues—and her reproductive system might have a rude wake-up call after spending all that time inactive. This may lead to an increased use of fertility treatments that could potentially have been avoided if those reproductive issues had been treated earlier on in life. Therefore, a teen who is working toward restorative care as an adolescent not only repairs current hormonal issues, but safeguards her ability to conceive someday.
For healthy bones later in life, teen girls need to ovulate
Still not convinced that birth control might not be the best option for your teen? Natural Womanhood featured a series a while back on Reasons Women Need Periods, which focuses on why women and teen girls need to experience healthy ovulation and menstruation for maximum health and wellness—which is even more true during the years of puberty. Those reasons include proper immune system development, current and future bone health, brain condition, and vascular and cardiac function. Turns out a period serves some pretty important purposes that aren’t just about making (or not making) babies.
The first 10 years after menarche (a girl’s first period) are critical in how the rest of a female’s reproductive years unfold. Endocrine maturation can affect breast development (which in turn affects future lactation), future fertility, and general wellness as a teen girl progresses through the various stages of life.
The subject of bone mass, in particular, does not get nearly enough attention, especially concerning the prevalence of osteoporosis among older women in the United States and elsewhere. Bone mass is finished building by a female’s early twenties. After that, bone mass can only be maintained, not formed. The primary way to build bone mass is by ovulating. A teen on hormonal contraception isn’t ovulating, and therefore her body is not stimulating maximum bone mass formation, while losing out on a critical window of time.
Protecting your teen’s brain
The final glaring reason not to put a teen on hormonal contraception is how it changes the structure and function of the developing brain. These changes include areas involved in affective and cognitive processing, such as the amygdala, hippocampus, prefrontal cortex and cingulate gyrus [2]. According to a 2014 paper, “Synthetic steroids not only cause a structural reorganization of the brain, but—even more importantly—induce changes in neurochemistry and brain function” [3].
The years following menarche have been called an “organizational window” for neural pathways to cement. These neural pathways are responsible for the way we process emotions, develop relationships, calculate risk, and make decisions. It is not an understatement to say that hormonal contraceptive use during these years can precipitate permanent organizational brain changes, with lifelong consequences on adult behavioral patterns [4]. It could even affect the partners they choose. We also know that hormonal contraceptive use during teen years is correlated with increased risk of depression during adult years.
Your daughter deserves better than birth control
If all of the above doesn’t have you reconsidering a carte blanche pill prescription for your teen, the final reason to pause is the actual FDA-approved use of hormonal contraception—which is for pregnancy prevention. It is true that when used correctly and consistently the pill has fairly high efficacy rates at preventing pregnancy. But being on the pill can induce a form of moral hazard in a teen girl, possibly pressuring her into risky behavior before she is ready (“C’mon, you’re on the pill now, you won’t get pregnant.”) and it can increase her chances of contracting sexually transmitted infections if it makes a teen boy less likely to use condoms if he knows a girl is on hormonal contraception. Hormonal contraception can effectively prevent pregnancy about 93% of the time with typical use, but it comes at the high cost of stunting brain, cervical, endocrine, and gut health.
Let me put this another way. Would you put your teenage boy on a drug that shuts down his endogenous hormones, stunts his reproductive maturation, shrinks his testes, increases his risk of depression, and changes his brain structure, potentially permanently? Teen girls on birth control are subject to these same effects (although, it won’t shrink their testicles, of course—but their clitori), and their developing brains and bodies are made to bear the unequal brunt of pregnancy prevention. It’s time to reconsider that. Teen girls—and boys—deserve better.
Comprehensive fertility education for teens that includes access to restorative reproductive care makes for good health care, but also frankly, just common sense. Open communication in homes about sexuality, menstruation, and fertility is good. But it can’t just be from the family that teenagers hear about these things. They need to hear about them from other adults and role models around them. Programs like TeenFEMM, Guiding Star, and the Couple to Couple League Mother Daughter program offer such education, which empowers teens to take ownership and safeguard their sexuality.
With all of the incredible resources available today for teaching teens about authentic, healthy sexuality, I urge mothers to rethink the paradigm of birth control-as-default for their teen daughters, even if they were placed on birth control as teenagers themselves. Our daughters’ brains, bones, and so much more are on the line.
References:
[1] Adams Hillard PJ. Menstruation in adolescents: what’s normal?. Medscape J Med. 2008;10(12):295. [2] Front. Psychol., 27 October 2020 | https://doi.org/10.3389/fpsyg.2020.556577 [3] Pletzer BA, Kerschbaum HH. 50 years of hormonal contraception-time to find out, what it does to our brain. Front Neurosci. 2014;8:256. Published 2014 Aug 21. doi:10.3389/fnins.2014.00256 [4] Vigil P, Del Río JP, Carrera B, ArÁnguiz FC, Rioseco H, Cortés ME. Influence of sex steroid hormones on the adolescent brain and behavior: An update. Linacre Q. 2016;83(3):308-329. doi:10.1080/00243639.2016.1211863Additional Reading:
Signs that your daughter will be getting her first period soon—and how to prepare her for it
Why I’m teaching my daughters how to chart their menstrual cycles
Busting the 4 Biggest Myths about Teens and Fertility Education
Study Shows Link Between Teen Birth Control Use and Adult Depression
The Links between Irregular Cycles, Birth Control, and Early Death
Birth Control, Blood Clots, and the Untimely Death of Alexandra Williams
Thank you for this. I would encourage parents and young women to take the part about endocrine maturation, breast development, and lactation very seriously. There isn’t anything peer reviewed yet, but the lactation community is noticing that there is a connection between women who simply don’t make milk, for none of the usual reasons, and having been on hormonal contraception before completing puberty. The inability to breastfeed can be quite devastating for women who planned on it, and if the baby is unable to tolerate ordinary formula, it can be even more difficult.