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Is the hormonal birth control mini pill better than the regular pill?

If you have been following along, this is the third part of our hormonal birth control and vulvodynia series. First, we covered how combination methods of birth control (containing synthetic forms of both estrogen and progesterone) could lead to vulvodynia. We then explored if there is a risk of developing vulvodynia after the insertion of a hormonal intrauterine device IUD). In this post, we will delve into the relationship between the progesterone only birth control pill, also called “the mini pill,” and vulvodynia. As a quick refresher, vulvodynia is pain on the vulva, or external genital tissue. For more information about vulvodynia, check out this post on our website.

Similar to the hormonal IUD, the mini pill works as a contraceptive by thickening cervical mucus and thinning the lining of the uterus to prevent a fertilized egg from implanting. Similar to the IUD, it is an expected side effect to experience spotting in the first few months of use1. Interestingly, some women will no longer ovulate, while some will continue to, about 4 in 10, according to the American College of Obstetricians and Gynecologists1

When considering how the mini pill impacts the vaginal environment, we can think about the fact that the mini pill contains progestins (the synthetic form of the naturally occurring hormone progesterone) that are also in the combined methods of birth control, which we know can lead to undesirable effects on the vaginal and vulvar tissue from decreased circulating androgens (sex hormones)2,3,5,6,10,11. However, this becomes more complicated as there are several different types of progestins that can be used in your hormonal birth control that have different effects on the body depending on its estrogenic, androgenic, or antiandrogenic activity4,5,10.

What does this mean? All oral hormonal contraceptives will lower the overall amount of circulating free androgens- but to what extent varies, and has not been studied well. There is more to this story that science is still trying to understand, so in the meantime, if you start a new hormonal birth control and start to notice any vaginal dryness, irritation, or vulvar/vaginal pain, reach out to your referring provider to discuss another option as soon as possible in order to stop a chronic pain cycle from beginning.

As the theme has been for this entire series, research is lacking on quantity and quality of studies researching the impacts specifically of progesterone only pills and vulvodynia. While some studies have not found any negative effects on sexuality, including pain with sex, with the mini pill compared to the regular pill4,7,8, newer studies specifically looking at vulvodynia have found associations. A recent study of over 2,000 women found an increased risk for development of vulvodynia in women taking combined hormonal birth control pills, as well as progesterone only pills, compared to controls who were not using birth control. The association was stronger with the combination pill compared to the progesterone only pill9 (also sometimes referred to as POPs). Until science has caught up to what many patients have already experienced when starting a new hormonal birth control method, it is best to treat your symptoms as soon as they come on and prevent the negative impact vulvodynia can create on your quality of life and interpersonal relationships.

At Femina Physical Therapy, all of our physical therapists have specialized training to address the musculoskeletal components of your vulvar pain and will work with your other healthcare providers in a collaborative manner to maximize symptom-relief and improve your quality of life. Reach out to our team to get started.

Interested to learn more? Click here to read Part 1 and Part 2.

Resources:

  1. https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection#:~:text=How%20do%20progestin%2Donly%20pills,does%20not%20do%20so%20consistently.
  2. Aerts L.,Pluchino N., Hormonal contraception and vulvodynia: an update, GREM Gynecological and Reproductive Endocrinology & Metabolism (2021); 03/2021:156-161 doi: 10.53260/GREM.212034
  3. Bohm-Starke N, Johannesson U, Hilliges M, Rylander E, Torebjörk E. Decreased mechanical pain threshold in the vestibular mucosa of women using oral contraceptives: a contributing factor in vulvar vestibulitis?. J Reprod Med. 2004;49(11):888-892.
  4. Caruso, S., Palermo, G., Caruso, G., & Rapisarda, A. M. C. (2022). How Does Contraceptive Use Affect Women's Sexuality? A Novel Look at Sexual Acceptability. Journal of clinical medicine, 11(3), 810. https://doi.org/10.3390/jcm11030810
  5. Casado-Espada NM, de Alarcón R, de la Iglesia-Larrad JI, Bote-Bonaechea B, Montejo ÁL. Hormonal Contraceptives, Female Sexual Dysfunction, and Managing Strategies: A Review. J Clin Med. 2019;8(6):908. Published 2019 Jun 25. doi:10.3390/jcm8060908 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6617135/
  6. Casey P.M., MacLaughlin K.L., Faubion S.S. Impact of Contraception on Female Sexual Function. J. Women’s Heal. 2017;26:207–213. doi: 10.1089/jwh.2015.5703
  7. de Castro Coelho F, Barros C. The Potential of Hormonal Contraception to Influence Female Sexuality. Int J Reprod Med. 2019;2019:9701384. Published 2019 Mar 3. doi:10.1155/2019/9701384
  8. Graham CA, Ramos R, Bancroft J, Maglaya C, Farley TM. The effects of steroidal contraceptives on the well-being and sexuality of women: a double-blind, placebo-controlled, two-centre study of combined and progestogen-only methods. Contraception. 1995;52(6):363-369. doi:10.1016/0010-7824(95)00226-x
  9. Kiesner J, Bittoni C. Vulvodynia: Risk Associated with Vulvar/Vaginal, Psychological and Physical Side Effects of Oral Contraceptive Use, The Journal of Sexual Medicine, Volume 21, Issue Supplement_2, March 2024, qdae002.046, https://doi.org/10.1093/jsxmed/qdae002.046
  10. McMahon L, Handy A, Jones A, Mijares S, Noon A, Meston C. The Effect of Oral Contraceptive Pill Type on Vulvovaginal Atrophy, The Journal of Sexual Medicine, Volume 20, Issue Supplement_2, May 2023, qdad061.096, https://doi.org/10.1093/jsxmed/qdad061.096
  11. Traish AM, Vignozzi L, Simon JA, Goldstein I, Kim NN. Role of Androgens in Female Genitourinary Tissue Structure and Function: Implications in the Genitourinary Syndrome of Menopause. Sex Med Rev. 2018;6(4):558-571. doi:10.1016/j.sxmr.2018.03.005 https://www.sciencedirect.com/science/article/pii/S2050052118300465#bib18 

More Articles in This Series

Hormonal Birth Control and Vulvodynia Part 2: Hormonal Intrauterine Devices (IUD)

Hormonal Birth Control and Vulvodynia Part 2: Hormonal Intrauterine Devices (IUD)
Image courtesy of Reproductive Health Supplies Coalition on Unsplash https://unsplash.com/photos/white-plastic-tool-jEE5SQ47JHo

Hormonal Birth Control and Vulvodynia - Part 1: Combined Hormonal Methods

hormonal birth control and vulvodynia
Image courtesy of Reproductive Health Supplies Coalition on Unsplash https://unsplash.com/photos/a-medical-device-is-laying-on-a-blue-and-yellow-surface-hFphI8Zx_E4

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Testimonial by A.M.

Months after giving birth, it was difficult for me to go from a sitting or lying position up to a full standing position without feeling that I had to remain hunched over until a bit of time had passed to get fully upright. However, after taking Heather’s course, I learned exercises to get my body back to normal. She also showed me correct ways to lift and carry my son as well as put him in/take him out of the carseat and stroller. This class was really beneficial and Heather is a wonderful teacher who made me feel very comfortable.

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Testimonial by Julie T.

Femina PT (née Fusion Wellness & Physical Therapy) has honestly changed my life. Before receiving treatment at Femina, I was going doctor to doctor to try and find the answer to my pelvic pain. It has taken me YEARS to find someone that can help fix this. It wasn't until my gynecologist recommended your clinic that I finally felt relief. My pelvic pain is almost gone, and granted I still have a lot more to work on with Laureen (my PT), my original problem is nearly cured. I am so grateful to her.

What is even better is she gave me practical exercises to do at home that were not tedious and provided instant (and lasting) relief. Although I mainly work with Laureen, my interaction with the owner (Heather) has been great. She is very generous, kind, and committed to her business.

It hurts to know there are women out there suffering who will never know or have the opportunity to work with women like Laureen and Heather because this issue is hardly talked about and this field is so rare. I hope more doctors and physical therapists see the value in this work and can relieve more woman of their pain.

-- Julie T., 12/4/16 via Yelp!

Testimonial by M.M.

My husband and I were married for 5 years and unable to have intercourse, but I never knew why. After numerous awful experiences at doctor’s offices (where many doctors told me I “just needed to relax”), a surgery that didn’t fix the problem, and a year of owning dilators that didn’t get me anywhere, someone finally referred me to Heather for Physical Therapy. I finally had answers and information from someone who knew exactly what I was dealing with!

Read more: Testimonial by M.M.

Testimonial by J.H.

My last appointment with Heather was over 6 years ago but I still think of her every day. I don’t take for granted that I can easily get out of bed, care for my two active and busy young boys, run, play tennis, clean my house, or sit at a desk for several hours at a time. None of these tasks were easy for me before meeting Heather. Eight years ago my car was struck from behind by a tractor trailer that was estimated to have been speeding. I spent 3 years working with different PTs and Drs trying to heal and move on with my life. When I became pregnant and the hormone relaxin that “relaxes” all the joints of the body and the additional weight gain erased all my progress and I was suddenly in a lot of pain again. My OB sent me to Heather for one last try.

Read more: Testimonial by J.H.

Testimonial by T.H.

I started seeing Heather in October 2014. For more than two years, I had been suffering from painful urinary tract infection type symptoms after my bartholins gland surgery which included constant burning and urinary frequency sensation that led to more and more painful intercourse. I had made multiple visits to internist, obgyn and urologist's offices, went through a range of treatment with UTI and bladder frequency medication that included antibiotics, vesicare, estrogen cream, but nothing worked.

Read more: Testimonial by T.H.

Testimonial by J.B.

My husband and I were having problems with painful intercourse. My therapist recommended that I go and get a pelvic floor evaluation from a physical therapist. Having never been treated by a physical therapist, I wondered how this really was going to help me. My husband who is a physician was very supportive and agreed that a PT evaluation would be a great idea. So i made the appointment and was blown away by what I learned. I had no idea that pelvic floor muscles could get tight and have trigger points just like any other muscle in the body. I'm a massage therapist and very familiar with tight muscles, and this new thought really amazed me. Heather's program to help relax and strengthen these muscles made such a difference. I can say that I am 100% pain free during intercourse now. Yippee! Going to the PT appointments and doing the at-home exercises was definitely a discipline, but it's 100% worth it! The rewards are amazing.

-- J.B.

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