Medications Affecting Hormones
When I get a patient’s history, I’m trying to figure out why they are hurting. I’m not interested in why they have their current symptoms, I’m interested in why this whole spectacle of pain started in the first place. Questions that I ask most all women are:
1. Have you ever been on birth control?
2. Have you ever been on Spironolactone?
3. Have you ever been on fertility drugs?
4. Have you ever been diagnosed with endometriosis?
5. Have you had a hysterectomy?
6. Have you ever breastfed?
All of these scenarios can affect the level of sex hormones in the body. Sex hormones in the body affect so much more than your ability to have sex. The main sex hormones I discuss are estrogens and testosterone. Birth control, Spironolactone, fertility drugs and hysterectomies can affect sex hormones, though this isn’t a complete list, it gets the big hitters.
Birth Control
Combined hormonal contraceptives (CHC’s) are primarily prescribed as a form of birth control, but sometimes prescribed to clear up skin, change the menstruation experience or help with cramping. They can be very beneficial for a lot of women. However, there are effects that happen with every person that takes these medications. It is a fact that in all women, CHC’s reduce the ovaries’ production of estrogen and testosterone. It is a fact that in all women, CHC’s increase a protein from the liver called sex-hormone binding globulin (SHBG). A drop in estrogen and testosterone and an increase in SHBG will actually create an environment ripe for several symptoms, one of which is painful sex. Not all women experience symptoms from having CHC’s, but they do all experience changes in sex hormones. Sometimes this is reversed when getting off the CHC’s, but sometimes it is not. That is why I always ask about any history of birth control use. Even if birth control is used for six months, it still makes changes in the sex hormones. I do understand that not all birth control involves a CHC. “Pulling out” is a form of birth control. Using a condom is a form of birth control. Not having sex is a form of birth control (am I right or am I right?).
Spironolactone
This is typically prescribed for acne or excessive facial hair. And it affects the sex hormones. Again, not all people who use Spironolactone end up with symptoms of painful sex or other vulvovaginal issues, but there is a relationship.
Endometriosis
It is extremely common to get a prescription for CHC’s in order to reduce the discomfort of endometriosis. However, it is not lost on me that endometriosis and Interstitial Cystitis are called “The Evil Twins” in much of literature. I’m highly suspicious that the CHC’s used to help the experience of endometriosis actually help cause Interstitial Cystitis symptoms because of the way they affect sex hormones and SHBG. When you alter sex hormones directly or indirectly, it is not uncommon to develop bladder symptoms. This can be confusing because patients usually think that their newfound bladder issues have nothing to do with any other symptoms they have. Patients start to think they are just falling apart. But, they are not falling apart. They are actually wholly making sense.
Hysterectomy
Without a doubt, removal of the uterus affects the function of the sex hormones, regardless of whether or not the ovaries are intact. If the one or both ovaries are intact, the blood supply to the ovaries is diminished with removal of the uterus. This ends up affecting estrogen and testosterone production from the ovaries. With less blood supply, there is less output. So many doctors tell patients that removing the uterus, but leaving in the ovaries doesn’t affect hormones, but it absolutely does.
Breastfeeding
It’s extremely common for sex to feel drier and less comfortable after childbirth. One part of this picture is actually from the hormone changes that take place during lactation. Lactating does cause a drop in sex hormones at the genitals. It can take a while for sex hormones to level off after stopping breastfeeding.