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A Functional Medicine approach to birth control is a new alternative method of providing safe and more conscious protection from pregnancy. There are various types of birth control used all over the world, which may vary depending on the user, their health history, the side effects, and the effectiveness. Synthetic hormones are commonly the most prescribed protocols in Western medicine. However, with the rise of hormonal imbalances today, Functional Medicine is an approach that looks at the patient more holistically, and chooses the most effective birth control method based on weighing the positive and negative health effects.

Functional medicine involves a switch from traditional disease-centered focus of medical practice to patient-centered approach. Although it often involves a more natural approach to birth control, it also integrative, in which it uses evidence-based science and diagnostic testings. Functional Medicine practitioners mostly do not support the use of hormonal methods, such as the birth control pills or hormonal IUDs, due to the presence of negative effects, such as risk of cancers, dysfunction, and nutrient depletion. Functional Medicine practitioners may instead support the use of copper, non-hormonal IUDs. With women with regular periods, the fertility awareness method is advised, especially when used with new technological devices and applications. The difference with Functional Medicine approach versus conventional approach or a traditional natural family planning is that it is not fully against hormonal methods or unnatural methods. Although highly advised to reduce synthetic hormones as much as possible, a core principle is that they dedicate more time to patients. It considers the body as a whole, interconnected system when choosing the right option, and aims to create an individualized plan, which is what distinguishes Functional Medicine from conventional Western medicine. Thus, some functional medicine practitioners may still advice lower dose formulations of birth control pills. For women who are using hormonal methods for non-pregnancy issues, the Functional Medicine approach aims to address the underlying hormonal imbalances, such as by using herbal supplements.

However, there is still a need for more research to be done not only on Functional Medicine as a whole, but also its stance on hormonal methods to birth control.

What Makes Functional Medicine Different
Functional Medicine is seen as another form of alternative medicine. Its approach utilizes aspects from Holistic, integrative, and natural models of care, but claims to add another dimension. It looks at the patients health holistically by considering the mind, body, and spirit. While Functional Medicine may use natural products predominantly, it is not used only exclusively to help the patient reach the optimal state of health. It manages the patient's health in an integrative fashion, involving both "alternative" and conventional modalities. It considers both the body's complex genetics, and environmental influences, such as chemicals, toxins, and stresses.

In conventional medicine, a strong emphasis is creating categories of diagnosis as a reflection of the symptoms, rather than the root cause. It involves standardized protocols, such as synthetic medications, and invasive procedures. On the other hand, Functional Medicine heavily considers the interconnectedness of the organ systems, and the individuality of the patients, such as their unique genetics, environment, and lifestyle. It uses these same principles of biology and physiology to understand the primary cause of the disorder, protocols to disable these drivers, and ultimately resolve the symptoms. While Conventional medicine may be stronger with emergencies, acute diseases, infectious disease, and surgical interventions, Functional Medicine claims to have greater strengths in chronic disease management, nutrition and preventative medicine.

Functional medicine practitioners aim to be primary care physicians that complement conventional MDs. They generally spend more time with patients than in the conventional medical system. Patients are usually interviewed at length and asked a variety of topics. The laboratory tests may be more extensive and includes less conventional tests. These tests help Functional Medicine practitioners determine the underlying imbalances and understand the biological processes that are functioning normally or not.

When it comes to contraception, while Functional Medicine aims to use natural methods, it does not completely dismiss the use of hormonal methods. Functional medicine aims to treat patients as individuals, and according to their needs. Thus, it may also include conventional therapies such as birth control or IUDs, as long as it still aligns with the Functional Medicine philosophy. Instead of prescribing a standardized treatment, it considers the effects on the individual, and the way it may affect their hormones, liver, thyroid, and the brain. Functional Medicine doctor make an effort to tell their patients about the negative risks of birth control pills, which is what differentiates them than conventional medical doctors. They will often work with patients to safely stop the pill and fix any underlying hormonal imbalance symptoms.

Similarly to conventional medicine, functional medicine practitioners uses evidence-based science and advanced diagnostic testing.

Fertility Awareness Method
The Fertility Awareness method, is a non-hormonal approach that some Functional Medicine practitioners may also recommend. It is a method based on research of a women's physiology during ovulation, and overlaps with aspects of the Rhythm Method and the Natural Family Planning, but with some differences. The Rhythm method is where the fertile phase of the cycle is calculated according to the lengths of previous menstrual cycles. Because of its reliance on regular menstrual cycles and long periods of abstinence, it is often not widely accepted as a modern method of natural family planning. Unlike Natural Family Planning, this method also doesn't mean abstaining from the use of contraceptive barriers, such as condoms, during the fertile phase.

Based on the idea that during the ovulatory stage, the egg is only vital for no more than 24 hours, and the sperm is vital in the uterus for five to six days, a women's fertile days is about seven to eight days out of her cycle. The Fertility Awareness method teaches women to educate themselves on what factors to track so they know when they are in those seven to eight fertile days. It also considers that a women's menstrual cycle may be delayed or affected by stressors, and thus relies on other factors as well. The Sympto-thermal method, which is a sub-type of the fertility awareness method, checks two things: the body's basal body temperature and the cervical fluid. For example, the cervical fluid starts getting wetter, and often stretchy, like egg whites, before ovulation. After ovulation, the cervical fluid dries up.

If a woman does not want to be pregnant, Functional Medicine practitioners would advice women to use another means of contraception or to abstain from sex during the ovulatory window. However, PCOS, breastfeeding women, or women who have irregular or absent periods, are not advised to use this method as there may be a greater risk for pregnancy risk. Functional medicine practitioners may advice to use this method in conjunction with fixing the underlying hormonal imbalance that is causing the irregular periods.

The fertility awareness method requires that patients learn the details well and follow the rules very closely. This may cause the method to be commonly dismissed, as there are claims that women may be easily confused by their own bodies or are too lazy to successfully use this method. But research shows that when women are able to follow it with consistent use, it has a failure rate similar to that of the contraceptive pill. However, since only a small percentage of women have used it, there still needs to be more research done. With new technology, this method is often used in conjunction with the Daysy ovulation tracker to provide more accuracy.

The aim of this method is to also empower women to learn how their body works and have true body literacy, in which they become in tune to the subtle cues that come from their body. While it may not be the primary and only main use of birth control recommended by Functional Medicine doctors, it is still seen as a valuable method to helping women be educated about their body.

Birth Control Pills
Aside from preventing pregnancy, birth control pills may be a cost-effective for many medical disorders in women. Although oral contraceptives can be used as first-line treatment, Functional Medicine practitioners believe they may only treat some of the symptoms. For example, since the pill suppresses ovulation, birth control users do not have true menstrual periods. It is only during the placebo days that causes the withdrawal days to bring reassurance of not being pregnant. Since it is not a definitive treatment, the symptoms may come back when women stop taking the contraceptive pill. This may be why some Functional Medicine practitioners aim to target the root cause of the symptoms. Popular books that dive deeper into a Functional Medicine approach to getting off the pill, or treating their hormonal dysfunction, such as PCOS (Polycystic ovary syndrome), are The Women Code, Period Repair Manual, and Beyond the Pill. Although most Functional Medicine practitioners are usually against birth control pills due to the risks that still exist, depending on the patient's case, some Functional Medicine may still think oral contraceptives may be a good choice for some women. However, a Functional Medicine approach would choose the new formulations that have lower hormone levels of both progesterone and estrogen, which lowers the risk of side effects and complications, such as blood clots. Functional Medicine practitioners stresses the importance of contraceptive counseling to the individual’s needs and goals can also assist with the risks and side effects.

Functional Medicine practitioners do not give synthetic hormonal recommendations primarily due to their knowledge on the interconnection of hormones and the systems in the body. According to Functional Medicine, excess hormones can be stressful for the liver to break down for elimination. This chronic stress may cause the liver to be sluggish and congested, which would increase the risk for inflammation. Furthermore, excess estrogen may cause the hormone to go back into the bloodstream in a more toxic form, raising the risk for certain cancers and dysfunction, such as breast cancer, cervical cancer, liver dysfunction, or thyroid dysfunction. However, there needs to be more research on this since there are also some studies that state absolute increases in risk were small, and would disappear once the use of oral contraceptives was stopped within 5–10 years.

One of the biggest concerns about contraceptives for Functional Medicine practitioners is the effect of nutrient depletion, such as folic acid, vitamins B2, B6, B12, C, and E. These nutrients are studied as they play crucial metabolic roles, especially during the reproductive years for women. To counteract this, Functional Medicine practitioners advise supplementation of some vitamins to counteract the depletion caused by the contraceptive pill.

IUD
While Natural Medicine may not be supportive of IUDs, Functional Medicine practitioners still support the use of Intrauterine devices (IUDs), which are commonly used as a long-term contraceptive method due to its high success rates. In fact, the American College of Obstetricians and Gynecologists(ACOG) recommended the IUD as a first-line option for all women of reproductive age.

There are two types of IUDs, which are non-hormonal copper IUD (Paraguard) and the hormonal IUD (Mirena).

Non-hormonal IUD
This type of IUD, which lasts for 10 years, does not contain hormones that interrupt the menstrual cycle so patients are still able to ovulate regularly. This is usually preferred for women who do not want to add any unnatural hormones to their systems. This may also be a choice for breast cancer patients, or those sensitive to hormone medications. However, it may have a common side effect of heavy bleeding and cramps. Another concern is that excess copper also severely depletes other nutrients, such as zinc. Thus, Functional Medicine practitioners would also help patients manage their nutrient levels.

Hormonal IUD
This IUD, with the Mirena being the most popular type, lasts for 5 years, and releases less than 20 micrograms of synthetic hormones, such as progesterone, from the device over time. There are also newer devices, such as the Skyla, Liletta, and Kylenna, which may be smaller, and last different amount of years. The hormones, such as progesterone, are meant to help women with heavy menstrual bleeding. However, this can also lessen menstruation or eliminate menstruation altogether. The loss of menstruation is often a concern for Functional Medicine practitioners.

Herb Supplements and Addressing Hormone Imbalance
One prominent consideration Functional Medicine practitioners look into when deciding the right contraception and treatment choice for patients is looking at the interconnection of the hormones with other health systems.

Functional Medicine practitioners take into account the effects of unnatural amount of hormones that are also synthetic, and how it may cause imbalances in the body. The human hormonal balance depends on the communication between the brain and the hormone glands. The brain monitors the hormone activity in the body, and then controls how much hormones that glands should produce. When a large amount of hormones enters the body, it may create a “feedback loop” of communication between the brain and the hormone glands to slow down or lower the body’s natural production. This may create symptoms for women who go off the pill. Due to these hormonal imbalances, Functional Medicine practitioners may not put birth control pills on the top of their recommendations.

Conventional medicine may use the birth control pills to aid the symptoms of hormonal dysfunction. For example, if PMS is causing pain, it aims to suppress the normal monthly cycle using birth control pills. However, once the birth control pill is stopped, the symptoms may continue. Functional Medicine would aim to fix any underlying hormonal imbalances that may cause the symptoms to be alleviated.

Herb supplements in Functional Medicine is not used alone to prevent pregnancy, but rather as a complement to the contraceptive method. It is used to manage women's cycles better, and treat the same symptoms that birth control pills may be used for in non-pregnancy related issues. Some examples of supplements that are used for hormone balance or counteract negative effects of hormonal methods are Maca, Chasteberry tree extract (Vitex), or Evening primrose oil. It is also important to discuss with Functional Medicine practitioners any herb supplements being taken, as they might also conflict with hormonal contraceptives.

Using Technology to Improve Birth Control
With technology advancements, there has also been an emerging health technology market with new birth control apps being created. For example, Natural Cycles is the first mobile fertility app that was approved by the FDA as a digital contraceptive device. By studying data from 15,000 women who used the app for approximately eight months, the FDA found that if used correctly, 1.8% of women would get pregnant over one year. When accounting for the human error of not using the app consistently, it had a "typical use" failure rate of 6.5%.

Since there is still a failure rate, there is still research needed to study the quality of these fertility awareness method applications, and how reliable the functions are. In one study, 95 fertility applications were examined. After accounting for only including applications that had technology that centered around evidence-based methods, and also included a disclaimer that it may not fully avoid pregnancy, there were 40 applications left. Only four of these 40 remaining apps accurately used the Fertility Awareness Symptothermal Method, and only one was found to use the Standard Days Method. This may demonstrate that it is important not to rely solely for preventing pregnancy and for predicting the user's menstrual cycle, but rather as a complement and while educating oneself about one's body's rhythms.

Another device that has been used is the Daysy fertility monitor, which monitors women's body and predict their fertility window. It predicts ovulation by learning about the user for the first few cycles, and then uses a complex algorithm that compares the cycle to the data it has already collected from millions of other users. For example, it Once it has collected enough data, the user would take their basal body temperature every morning, and it would give a colored light that indicates the user's fertility. It uses a complex algorithm to determine when the user's temperature spikes, which accompanies ovulation. Daysy has a Pearl Index of about 0.8.