The more I learn about the human microbiome, the more I realize I don’t know. I was listening to a podcast the other day, and they were talking about birth control and emerging research suggesting that the pill may adversely affect women’s bodies, hormones, and the microbiome — specifically the estrobolome — in ways we are only beginning to understand.
As I listened to the podcast, I got a little sad. Then a little mad. I wondered why no one told me then what I was hearing now about the effects of taking birth control pills long term.
I am one of those women who was on Ortho-Novum for over 20 years, back in the 1980s and beyond, and learning what I’m learning about the microbiome and the significance of our hormones, I couldn’t help but wonder how my long-term use of “the pill” contributed to some of my health and weight challenges.
I felt sad because at the time, I didn’t understand that by taking the pill, I was disrupting normal functions of my body that could impact me later in life. It seems so clear now — and of course, like most women do, I blamed myself for not knowing. How could I do this to myself?
Then I got mad that the people I trusted — my doctor and my mother — didn’t tell me. But then I realized they probably weren’t asking the right questions either. I now understand that the reality is that no one in America was even studying the human microbiome in a meaningful way until around the time I was getting off the pill in the 1990’s. My emotions relaxed. How could I blame anyone when they didn’t know either? We don’t know what we don’t know until we know it. Obvious, right? So I let it go, leaned in, and wrote this article.
I took the pill for decades because that was the path in front of me, and at the time, it seemed to make sense. I am not writing this to pretend one prescription explains every weight or health issue I ever had. But I do think this conversation matters.
I went on the pill when I was a young woman and stayed on it for over 20 years as a means of “family planning.” I came off the pill because my doctor thought it was best given my high blood pressure. I moved into perimenopause a few short years after coming off of the pill. That means I spent two decades using synthetic hormones during one major phase of my life, then entered another major hormonal transition early only a few short years later. Coincidence? Maybe.
Certainly, I was too trusting of the pamphlet handed to me at Planned Parenthood. Or maybe that is just what most young women did at the time. We trusted the adults, trusted the medical system, and trusted the thin little piece of paper that supposedly explained everything we needed to know. I do not say that with bitterness. I say it with hindsight. Ok, and maybe a little bitterness.
What I wish I had understood then is that a pamphlet is not the same as a whole-body conversation. It may tell you how to take the pill, what side effects to watch for, and when to call a doctor. But it may not help you understand what long-term synthetic hormone use could mean for blood pressure, insulin, triglycerides, gut health, liver processing, inflammation, mood, libido, metabolism, or the hormone shifts that come later. None of that was even in the fine print of the prescription, where they outline the dangers and cautions of taking the drug.
The Reproductive System Does Not Have Its Own Zip Code
For a long time, birth control was presented to me mostly as a reproductive decision. It prevented pregnancy. It regulated cycles. It made things predictable. End of discussion, apparently.
But the reproductive system does not live in its own little zip code, quietly minding its own business while hormones, the gut, liver, brain, immune system, metabolism, blood sugar, and cardiovascular system carry on elsewhere. The body is connected. Hormones are messengers, and messengers travel.
That does not mean birth control pills are automatically bad (although these days, I’d strongly encourage any young woman considering them to think twice before taking them). What it does mean is that the conversation should be bigger. Oral contraceptives do not only interact with the ovaries. They move through the body as systemic medications and involve hormone signaling, liver processing, metabolism, blood pressure, and other whole-body functions. That is the part I wish I had understood earlier. The pill was not just a pregnancy switch. It was a hormonal intervention in a connected body.
Formulations Change, But Hormone Questions Still Matter
Birth control pills have changed since I first went on Ortho-Novum in 1979. The formulations used decades ago are not necessarily the same as what many women are prescribed today. Some modern pills use lower doses of estrogen, different progestins, different schedules, or different delivery methods. That matters, but newer does not automatically mean better.
So I am not interested in making a simple old-pill-versus-new-pill argument. The better point is this: even when formulations change, taking pills that disrupt normal functions of the human body deserve whole-body questions. What type of hormones are being used? What dose? How does it work in the body? If it stops normal body functions from occurring, what are the short term and long term risks? What should a woman understand about the long term effects of the drug on the human body? What is a safe amount of time to be on these drugs? What are the trade-offs and alternatives?
And this does not apply only to birth control pills. Hormonal birth control, emergency contraception like Plan B, and hormone therapy in midlife are not all the same thing, and they should not be treated as if they are. Different purpose, different dose, different timing, different stage of life. But they all belong in the larger conversation about how synthetic hormones interact with the whole body.
Plan B, for example, is intended as emergency contraception, not a regular birth control plan. HRT may be helpful for women navigating difficult menopause symptoms. Both deserve real information, clear purpose, and a conversation about the whole body. The point is not that every hormone option belongs in the same category. The point is that women deserve to understand what they are taking, why they are taking it, how long they may be taking it, and what their body may need along the way, and how to wean off of it. These are not fear-based questions. They are informed-consent questions.
The Metabolic Piece
The research does not support the simple claim that birth control pills directly cause major weight gain in every woman. That is important. I do not want to turn curiosity into a slogan just because it makes a punchier headline. The better question is whether long-term combined oral contraceptive use may influence the internal terrain that makes losing weight harder for some women later.
That terrain is not limited to just reproductive hormones. When we talk about hormones and metabolic health, we are also talking about the body’s relationship with insulin sensitivity, glucose handling, triglycerides, inflammation, liver processing, gut health, and the hormonal shifts of perimenopause and menopause.
Research has connected oral contraceptives with reduced glucose tolerance, insulin resistance, higher triglycerides, inflammatory markers, and later metabolic risk in some women. Reduced glucose tolerance, more formally called “impaired glucose tolerance,” means the body is not clearing glucose from the bloodstream as efficiently as it should. Blood sugar may stay elevated longer after eating, even if fasting blood sugar still looks acceptable.
Insulin resistance means the cells are not responding to insulin as well as they should, so the body has to work harder to move glucose out of the blood and into the cells. That matters because blood sugar and insulin affect energy, hunger, cravings, fat storage, inflammation, and long-term metabolic health. So no, I am not saying the pill made me gain weight. I am saying long-term use of the pill may have influenced some of the metabolic conditions that made losing weight harder.
Estrobolome: The Gut-Hormone Connection
One of the most interesting pieces of this puzzle is the estrobolome, which is the part of the gut microbiome involved in estrogen metabolism. In plain English, the gut helps regulate estrogen.
The liver processes estrogens and packages some of them for elimination. Those processed estrogens can move through bile into the intestines, where they are supposed to leave the body through stool. But certain gut bacteria produce enzymes that can reactivate those estrogens before they leave. Once reactivated, some estrogen can be reabsorbed back into circulation instead of being eliminated.
Reabsorption itself is not automatically bad. The body is designed to recycle certain compounds. The concern is excessive or poorly regulated reabsorption, especially if the gut microbiome is disrupted, bowel movements are sluggish, fiber intake is low, or the gut-liver system is not keeping up.
This is where oral hormones become part of a bigger conversation. Hormones taken by mouth have to be processed through the body. They involve the liver. They involve metabolism. They may interact with the gut-hormone recycling system. So when we only talk about birth control pills in terms of periods and pregnancy, the conversation is too small. Again, the reproductive system was never separate from the rest of the body.
What Was My Body Trying to Tell Me?
This is not about my body betraying me. I do not feel that way. If anything, I feel very strongly that my body was (and is) communicating the whole time. I just did not know how to hear it at the time, or understand what was happening.
I did not have the language for insulin resistance, glucose intolerance, the estrobolome, hormone clearance, inflammation, or metabolic risk. I had symptoms, patterns, and questions, but I did not know how to connect the dots.
That is the part that feels important now. Not blame. Not panic. Not “the pill ruined everything.” More like: what systems were involved, what was my body trying to communicate, what do I understand now that I wish I had understood then, and where do I go from here?
So What Do Women Like Me Do Now?
We start where we are. We cannot go back and untake the pill. We cannot rewind to those years and ask better questions with everything we know now. But we can stop treating symptoms as random inconveniences and start looking at the systems underneath them.
For women like me, that means learning how to understand labs and metabolic markers instead of waiting for someone else to tell us everything is “normal” while our body is clearly waving a tiny flag. Fasting glucose, A1C, fasting insulin, triglycerides, HDL, liver markers, blood pressure, and other metabolic markers can all offer useful information when we learn what they mean and how they fit together.
It also means looking honestly at the daily inputs that shape the body’s terrain now. For me, that includes getting off ultra-processed foods, ditching sugar and flour, avoiding artificial sweeteners, moving away from poor-quality oils, and paying closer attention to digestion, bowel regularity, fiber intake, protein intake, carb intake, hydration, stress, sleep, strength training, and how my body responds to food.
None of this is glamorous. There is no dramatic theme music when you start caring about triglycerides and bowel movements. But these things matter because hormone clearance, blood sugar regulation, metabolism, and gut health are not separate systems. They are part of the same body.
This is also something I have learned to do in my own life, and it is something I care deeply about helping other women understand if that feels right for them. Not because everyone has the same history, the same body, or the same answers. But because learning how to read the body’s signals changes the whole conversation.
A Caution, Not a Scare Tactic
For future birth control users, my concern is not that the pill should never be used. My concern is that women deserve to pause, think twice, ask better questions, and understand what they are getting into before using synthetic hormones for years or decades. They deserve to understand that synthetic hormones may affect more than periods and pregnancy. They deserve conversations about insulin resistance, glucose tolerance, triglycerides, mood, libido, blood pressure, gut health, liver processing, inflammation, and what to pay attention to over time.
They also deserve to know their options. Birth control can be a difficult decision because it involves health, relationships, pregnancy risk, medical history, access, safety, lifestyle, and values. Women do not need shame. They need better information.
The Bigger Lesson
I cannot prove that taking Ortho-Novum for more than 20 years caused my health and weight challenges. There is not enough research to say that conclusively, and I would not make that claim because it is too simple. I care too much about truth to turn curiosity into a slogan.
But I also no longer believe those years were biologically meaningless. I do not believe synthetic hormones only affected my ovaries while the rest of my body politely minded its own business. The gut, liver, metabolism, immune system, blood sugar system, cardiovascular system, and hormone receptors were all part of the story.
Maybe the pill was the right choice at the time. Maybe it was the most practical choice. Maybe it helped in some ways and came with trade-offs I did not fully understand. More than one thing can be true at the same time, even though that is terribly inconvenient for tidy little opinions.
The point now is not to blame the past. The point is to understand the body with more honesty in the present. That is the heart of The Awakened Body for me. The body is always communicating, but sometimes we need better information before we can understand what it is trying to say.
The work now is to listen better, ask better questions, and support the systems that were connected all along.