This blog post is part of an ongoing series on hormones and migraines:

Hormones and Migraines Part 1: Glutamates and HIstamine
Hormones and Migraines Part 2: Copper / Zinc Balance

A few months ago, I wrote my first blog post on hormones and migraines.  During my 1.5 year old’s nap, and leaving the dishes and laundry to languish, I wrote about how estrogen and progesterone interface with histamine and glutamates, influencing migraine. Many women have written to me expressing appreciation for sharing this angle on migraine and especially why migraine often occurs for them at ovulation or on their moon time.

But what was left out of that blog post is the very important fact that exogenous forms of estrogen and progesterone used in hormonal birth control are playing a big role in women’s migraines as well. This is because most forms of birth control raise women’s copper and deplete their zinc stores. More on that later.

What I’ve found in my coaching practice is that women who have a history of hormone replacement therapy whether during their fertile years or post-menopausal years, have a harder time healing from migraine, for reasons I will soon explain.

Heads up! This will not be a feel-good blog post. As you can probably tell, I’m quite worked up about this issue. The detrimental effects that hormone replacement therapy of all kinds (yes, even bioidentical) are having on women’s health is a tragedy of immense proportions. It’s a tragedy that I wasn’t really aware of until recently because I was never on hormonal birth control for very long – only 6 months of my adult, sexually-active life, and I felt so terrible on them that I promptly stopped. I have used natural birth control methods in the 20 years since then.

Why is this a social justice issue?

I believe that the increased prevalence of migraine among women is not just a biological feature inherent to women, but a symptom of our pill-based, profit-driven medical system. Hormonal birth control and hormone replacement therapy are a huge industry, and fertile women who don’t want to get pregnant provide an almost endless supply of revenue through hormonal manipulation.

The global market for oral contraceptives alone is estimated at over $13 billion, and it’s expected to rise to over $22.9 billion by the year 2023. In other words, there’s a multi-billion dollar industry that depends on you not fully understanding how your body works. (Source: The Fifth Vital Sign, Lisa Hendrickson-Jack)

Because women can bear children, and men cannot, our fertility is very much manipulated and controlled in ways that men’s is not. Most women today use hormonal contraceptives at some point in their fertile lives. Socially, women tend to carry the burden of managing fertility to a greater degree than men do, for obvious reasons.

While controlling fertility is necessary, and many would argue rightly that hormonal birth control has contributed to women’s sexual liberation, the question is always: at what cost, to whom, and what are the alternatives?

After you’ve finished reading this blog post, I think you’ll agree that the costs are great, women have been bearing the costs, often in the form of migraine, and that there are alternatives to hormonal birth control.

Because so many women are on hormonal birth control (in the hundreds of millions worldwide), any and changes in physiology and mental health as a result of this hormonal manipulation will have a huge impact on society, many of them unknown or unstudied:

Although, endogenous female sex hormones have been convincingly associated with changes in brain structure and physiology, . . . the neuronal targets of synthetic steroids are almost unknown. Changes in brain structure and chemistry cause changes in cognition, emotion and personality and consequently in observable behaviors. If a majority of women use hormonal contraception, such behavioral changes could cause a shift in societydynamics. (Source)

But Hormonal Birth Control Has Contributed to Women’s Sexual Liberation!

This is indeed true. Certainly, women wanted hormonal birth control because any kind of control over fertility was preferable to the slavery of having endless children. But this freedom also belies the realities that women experience every day on hormonal birth control.

If the health effects and negative effects on mood and libido are great, it begs the question what is sexually liberating about a substance that dampens sex drive and compromises health. Perhaps more appropriately we should recognize that these methods liberate women from the fear of pregnancy, and in that they are effective, but freedom from fear is not the same thing as sexual liberty.

I like what Lisa Hendrickson-Jack has to say about it:

Althought the pill has been associated with women’s liberation, numerous issues associated with HCs need to be put out in the open. After all, the heart of the women’s liberation movement is freedom. For me, freedom is the right to exist in the world exactly as I am – as a woman. I recognize that there’s more to being a woman than simply having a uterus and being able to menstruate, but as a biological woman with a menstrual cycle, I don’t want to be part of a feminist movement that doesnt’ allow me to cycle naturally. (Source: The Fifth Vital Sign, Lisa Hendrickson-Jack)

The good news is that women are starting to wake up to the negative effects of hormonal birth control, at the same time that more and more efforts are underway to offer birth control options to men. Reversible, non-hormonal forms of male contraception like Valsalgel are poised to become available.

And none too soon. As Holly Grigg-Spall points out in her book “Sweetening the Pill“,

When the pill was released women had to stand up to their doctors to get it, today they must fight to get off it.

Hormonal Birth Control and Migraine

We can get insight into solving the riddle of copper, estrogen, and migraine by taking a look at women on hormonal birth control and what happens to their migraines.

Many forms of hormonal birth control list migraine and headache as a side-effect. As an example:

The packaging label indicates that doctors should consider removing the Mirena if the patient develops migraines or migraines with vision problems, which could indicate a condition called “transient cerebral ischemia.” (Source)

But women are also sometimes given hormonal birth control in an attempt to curb migraines.  If indeed it’s true that migraine is caused in part by sudden drops in estrogen, it would make sense that taking the pill and getting a consistent stream of estrogen could help to reduce migraines.

And in some cases it does – but not always. Dr. Jelena Pavlovic of the Albert Einstein College of Medicine in New York City points out that:

In those who had preexisting migraine, and who are then started on exogenous hormones, particularly exogenous estrogen products, their headaches can often improve with steady levels of estrogen, but sometimes they can worsen or become more frequent . . . In those in whom it worsens, that should be considered as a red flag. (Source)

Some women develop migraine for the first time after starting an oral contraceptive with estrogen. In this case, Dr. Pavlovic says she would suggest taking that patient off oral contraceptives and switch them to a progesterone-containing contraceptive in order to avoid exogenous estrogen.  (Source)

Why would one woman’s migraine would go away with hormone replacement therapy, and another woman’s would get exacerbated? The researchers don’t illuminate this most important question, but an understanding of copper/zinc balance through the lense of hair tissue mineral analysis does.

Synthetic Hormones Cause Copper/Zinc Imbalance

Contraceptive pills, IUD’s, and hormone replacement therapy are commonly employed by women in the general population – but because of how they deplete important minerals, especially zinc, and raise other minerals, especially copper – they exacerbate migraine symptoms. 

I would like to share here a lengthy excerpt from the “London/FPA Oral Contraceptive Trial”, in which 800 women were given over 50 combinations of seven progestogens and two oestrogen.

The most important mineral abnormalities caused by exogenous progesterone and oestrogen hormone use are lowering zinc and elevating copper levels, as first reported in 1968. I have confirmed this fundamental finding in numerous patients since the 1970s. Abnormally high copper levels in my patients are invariably due to exogenous hormone use, except for occasional acute infections. Since the start of the London oral contraceptive trials in the1960s, very few women consulting me have never used hormones. Often past users have residual zinc deficiency or copper store deficiencies after stopping OCs or HRT because of side- effects.

Current hormone takers had significantly higher copper levels in sweat, serum and hair compared with either men or past hormone takers (all significant at p < 0.0001). Among hormone takers abnormally high copper values were found in 90% of sweat samples, 80% of serum samples and 60% of hair samples. Hormone takers and past hormone takers had lower serum zinc levels than men (p< 0.001). The mean sweat zinc for the women was below the female reference range and all were or had been exposed to exogenous hormones. There was little or no overlap in sweat, serum or hair in copper/zinc ratios in the three groups, with current hormone takers having the highest copper/zinc ratios.

Low doses caused bleeding and pregnancies; high doses caused depression and amenorrhoea. Peak dose effects, for venous changes and thrombosis, headaches and migraine, and aggressive moods, matched dose-dependent changes in endometrial blood vessels and enzymes. (Source)

I’m going to recap some basic info below about copper and zinc from part 2 of my Hormones and Migraines blog post on Copper Zinc Balance, so we can piece together why some women’s migraines go away while on synthetic hormones and other’s are exacerbated.

Copper and zinc compete for absorption in the intestine and are very close in atomic weight, so are easily swapped out for each other in various metabolic functions. This is why too much of either mineral can cause a deficiency in the other, and why maintaining a good balance and harmony between them is crucial for physical health. 

There are four common migraine mineral imbalances that I see in my coaching practice: 1) copper deficiency migraines, usually seen in a fast metabolic type, 2) copper toxicity migraines, usually seen in a slower metabolic type 3) migraines caused by heavy metal toxicity, and 4) migraines caused by both heavy metal and copper toxicity. The first type is the easiest to remedy, the second type, which is usually caused by hormonal birth control, requires much more time and is much more difficult, as the copper must be dumped from the system, and the third and fourth types are often caused by dental amalgams or other sources of heavy metal exposure like vaccines. The presence of these heavy metals in turn will dys-regulate all copper-dependent enzymes even in the presence of adequate copper or zinc, and removal of the heavy metals through nutritional balancing is the main strategy.

By understanding these mineral dynamics, we can understand the differences in response between women on hormonal birth control and their migraines. A copper-deficient and therefore estrogen-deficient woman with a fast metabolism and migraines who goes on hormonal birth control will probably experience her migraines going away (at least initially), because the hormones will replenish her supply of copper.

On the other hand, a woman with a slower metabolism, a higher natural estrogen load, a high copper diet, a history of hormonal birth control and high tissue copper load, or a lot of heavy metal contamination is much more likely to experience migraines from a form of hormonal birth control that is adding to the copper and estrogen load.

Back in the 70s, Karl E. Mason, PhD, already knew and warned that:

The continued use of oral contraceptives has been, and will continue to be, an important factor in influencing copper homeostasis in women.  

Copper / Zinc Imbalances and the Copper IUD

Many women who opt for the copper IUD do so because they are told it is a nonhormonal form of birth control. This is not the case, because copper raises estrogen – in some women, quite significantly. This elevated copper can be a huge risk factor for migraines and stored biounavailable tissue copper, aka, “copper toxicity” – sometimes even years after the IUD has been removed.

This “copper toxicity” can even be passed down congenitally (through the placenta) to male and female children, so it is not just a women’s issue. I have a friend in Australia who had chronic migraines who was conceived with his mother’s copper IUD in place!

Many women report feeling crazy on the copper IUD, with extreme health effects. This is not surprising, because copper increases adrenaline. If these women already have a high copper burden from estrogen-based birth control pills and are depleted in zinc, the effects of the copper IUD can be very detrimental to women’s emotional, mental and physical health.

Just a few studies here illustrate the effects of copper IUD’s on health:

The Cu concentration was higher in women with IUDs, concomitantly with time-dependent increases in the main oxidative stress biomarkers (TBARS, protein carbonyls, glutathione and nitrates + nitrites), hepatic enzymes (LDH and transaminases), MTs and CRP. We concluded that the use of Cu-IUDs for more than 2 consecutive years should be avoided in order to prevent oxidative damage. (Source)

The observed higher blood Cu levels among T380A user stands out in sharp contrast to previous reports of other types of Cu IUDs. Further research should evaluate if the observed levels are associated to toxic effects with the general population or special groups. (Source)

If you’re interested in reading more about women’s experiences on the copper IUD, over 100 stories are collected on the Copper Toxic website.

Dangerous Effects of Hormonal Contraceptives

Hormonal contraceptives are the only drug designed specifically to shut down a normal bodily function in a healthy individual.

In her book The Fifth Vital Sign, Lisa Hendrickson-Jack writes about menstruation as a gauge for overall health status. Our menstrual cycles, and indeed the health of our entire cycle, can tell us very important information various aspects of our health. In other words, by tuning in to our menstrual health, we have access to an amazing diagnostic tool in evaluating our health in general, allowing women to detect thyroid disorders, polycystic ovarian sydrome, amenorrhea, and other issues sooner than later.

Her book also outlines the side-effects of hormonal contraceptives, noting that these very serious (and even potentially fatal) side-effects are often couched in more pleasant language to downplay their seriousness with more obscure wording like “important safety information” and “prescribing information.”

This “important safety information” does not fully represent the actual research on the dangers of hormonal birth control, so Lisa created her own label, pictured below. Unfortunately, most women are not often counseled or notified of these effects prior to being put on hormonal birth control.

Most women are also not informed that hormonal birth control pills, often prescribed to “regulate” a woman’s periods, do no such thing – they actually stop ovulation alltogether, the equivalent of chemical menopause. The breakthrough bleeding that occurs while on the sugar pill days is not a real period.

A Little Glimpse into the History and Development of Oral Contraceptives

The history of oral contraceptives is eye-opening and sobering, to say the least. For a substance credited with giving women sexual liberation, it’s beginnings are sketchy at best.

The first oral contraceptive pill, Enovid, was developed by John Rock and Gregory Pincus. They discovered that exposing women to synthetic hormones suppressed ovulation.

Enovid was the first drug ever developed to shut down a perfectly normal bodily function in healthy individuals. The women who participated in the first round of testing stopped getting their periods and quickly became convinced they were pregnant . . . The creators of the pill needed to answer two key questions: How could they convince women to take medication every day when they weren’t sick? And how could they convince women to take a pill that stopped their menstrual cycles? Presenting hormonal birth control in a way that mimicked a woman’s natural menstrual cycle was the solution. From the very beginning, women were lied to about what hormonal birth control was doing to their bodies: the creators of the pill quite literally added in a fake menstrual bleed to the original design to get women to go along with it. Without that fake monthly bleed, the women of the 60s wouldn’t have agreed to take the pill in the first place. (Source: The Fifth Vital Sign, Lisa Hendrickson-Jack)

Pincus had originally wanted to make birth control for men, but this was rejected due to the side effects – which included testicle shrinking.  “It was believed women would tolerate side effects better than men, who demanded a better quality of life”. (Source)

By the 1950s, Rock provided test subjects by giving the pill to his patients in Massachusetts under the guise of a fertility study. He did not inform his patients that the pill was designed to prevent them from getting pregnant. Many women dropped out of the initial Massachusetts study because they couldn’t tolerate the side effects: bloating, potentially fatal blood clots, and mood changes. At first, Rock and Pincus again had trouble finding women who would tolerate the pill’s side effects. “Women in Puerto Rico dropped out of the study, too, and so they started looking for women they could force to participate, both at home and in Puerto Rico'” writes Ann Friedman in The New Republic.

“Women locked up at a Massachusetts mental asylum were signed up. Women enrolled in medical school in San Juan were told they had to take part in the medical test or face expulsion.” Again, these women weren’t told what the pill was for.  (Source)

Five years after the pill was developed, 6.5 million American women were on it, making it the most popular form of birth control in the U.S (Source). In 2003, 100 million women worldwide were on the pill, chemically removing their fertile cycle, in a years-long state of induced menopause. This success is quite incredible when we consider that women can only get pregnant a total of 24 days out of the 365 days in a year, whereas men are fertile all 365 days, and can theoretically impregnate multiple women in a given day.

A sobering side-note: the Depo Provera shot is used to sterilize male sex-offenders and is incredibly effective as it greatly diminishes their sex drive. It is also equally effective at diminishing a woman’s sex drive. Sexual liberation? I’m not so sure. (Source: The Fifth Vital Sign, Lisa Hendrickson-Jack.)

The Alternative to Hormonal Birth Control

What is perhaps most profound about Lisa’s “The Fifth Vital Sign” is that it offers women a viable and highly effective form of birth control that does not involve the use of hormones. It’s called Fertillity Awareness.

Fertility Awareness is distinctly different than the rhythm method in that it is not an estimate of when a woman is likely going to ovulate based on previous cycles (which is not an effective form of birth control). It is based instead on tracking three signs of fertility to understand when ovulation has occured: cervical mucous, cervical position, and basal body temperature.

Hormonal birth control is a social justice issue because alternatives DO exist, but women are not educated about them.

“We could easily compare the practice of preventing women from developing a complete understanding of their fertility to the historical practice of preventing women from learning to read and write.” (Source: The Fifth Vital Sign, Lisa Hendrickson-Jack)

Resources

If you would like to learn more about Fertility Awareness, I reccommend visiting Lisa’s website and listening to her excellent podcast, Fertility Friday.

For more information about Copper Toxicity, visit the Copper Toxicity Website.