Should You Test A Woman On The Birth Control Pill?

by Mark Newman, MS

To the point : Women on birth control pills have suppressed estrogen and progesterone. If you wonder why their progesterone and estrogen levels are low - they are supposed to be when you're on the pill!

One of the most common questions we receive at the lab involves testing a woman on the birth control pill (or the birth control ring or birth control implants). We have been asked if someone on the pill can just stop their pill on day 19 and test, if they can test during the sugar pill week, how long after stopping the pill until they can test, and how to treat a woman's hormones while on the pill.

The short answer is...you can test the Dutch Adrenal while on the birth control pill however testing the sex-hormones has diminished value.

Why?

The birth control pill (ring and implants) stops the FSH and LH surge from the pituitary to prevent an estrogen rise and ovulation (thus progesterone production) from the ovary. If you hormone test a woman on the pill, her estrogen and progesterone should be quite low. That means the pill is doing its job and she is not likely to become pregnant.

Having a woman stop her pill on day 19-22 will not induce ovulation AND it WILL likely bring on an early menstrual cycle or increase her risk of becoming pregnant. We do not recommend stopping the pill for a few days just to test her hormones.

Testing during the sugar pill week when she has her withdrawal period will also result in predictably low estrogen and progesterone numbers.

Be very careful in 'treating' women while on the pill as any liver support or detoxification supplements may render the pill less effective as it too gets processed through phase 1 and phase 2 clearance which may increase her chances of break-through bleeding, worsen symptoms, and increase her chance of becoming pregnant.

If your patient wants to stop the pill (or ring or implant) and test her hormones, we encourage she have 3 full menstrual cycles without any pill, ring or implant use before testing to ensure the hypothalamic-pituitary communication with the ovary is back on track as best as it can be. Make sure she uses alternative methods to prevent pregnancy such as condoms! If she plans to get right back on the pill, this doesn't serve much purpose.

Don't the estrogens and progestins in the pill "show up"?

No! We use very accurate testing (LC-MS/MS) and these are synthetic hormones (different chemical structures) so they will not show up on our test.

Notes

• Mirena IUD (with hormones) can suppress ovulation but not always. They don't tend to suppress estrogens like oral birth control, so if ovulation is not happening (thus no progesterone production) you may have an estrogen dominance situation.
• Copper IUDs shouldn't affect hormone levels
• Patients on birth control pills are obviously exposed to synthetic estrogens and progestins. They are not actually estrogen deficient, but their hormone picture is somewhat complicated since these synthetic hormones share some properties of bio-identical hormones, but not all.

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