Originally Posted by Mommyof3
Are there bioidentical hormone options for birth control? In the past I have used a lot of the synthetic brands along a span of many years and I am coming off my third pregnancy and would like to go another route this time. I conceive very easily so the option of no birth control is not high on my list.
Thanks in advance Dr. Mariano.
What stops ovulation is progesterone. This is why progestins - artificial versions of progesterone were developed for use in birth control pills.
Progesterone can be used in high enough dose to prevent ovulation. This dose may need to be as high as 1200 mg a day depending on the patient. The problem is that this can be very sedating. Up to 90 percent of the progesterone becomes converted in the liver to Allopregnenolone, which acts similarly to a benzodiazepine on GABA receptors. Progesterone can also metabolize into estrogen or testosterone or other downstream signals, which if excessive can cause problems.
There is a literature for using high dose melatonin for birth control. As I recall, the doses were around 75 mg a day. I do not recall how effective it is compared to using regular birth control pills. The studies were done in Northern Europe. You would have to look up the studies. Apparently, Melatonin was not sedating at this dose.
Here is one study I found on medline for the use of melatonin as a contraceptive: http://www.ncbi.nlm.nih.gov/pubmed/8365512?
Regarding regular birth control pills, much of the problem occurs from the use of a very high strength estrogen - ethinyl estradiol. This contributes to weight gain, mood changes. The progestin, itself, blocks natural progesterone.
In some patients who experience the estrogen side effects of birth control pills, a consideration is the mini-pill - a progestin only pill. This has to be taken every day without missing a dose - unlike the estrogen-containing birth control pills were missing a dose often doesn't cause problems. The effectiveness may be improved and the side effects reduced by adding additional natural progesterone to help reduce the progesterone blocking effects of the progestin-only birth control pill. So far, in the few patients I have tried this with, it has worked well with much fewer side effects than regular birth control pills. The dose of added progesterone doesn't have to be high in this case. It augments the progestin, while also reducing the progestin's side effects.
Romeo B. Mariano, MD, physician, psychiatrist
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