words by Dr Louise Newson, leading female hormone health expert

Over a hundred million women across the world use the contraceptive pill (and that’s not including the many others who opt for the injection, the implant or perhaps the patch). Whichever of these contraceptive choices is selected, one thing is recurrent –  all of these options contain synthetic hormones and, since synthetic hormones have different chemical structures compared to natural hormones, they inevitably have an impact upon your hormone health. But what if there was a form of contraception that was, biochemically and biologically speaking, more like your own hormones? 

What many women don’t realise (because often their doctor doesn’t tell them!) is that there is in fact a more natural type of contraception available that is more likely to align with your natural hormones. This is called body identical contraception, and it’s well worth taking the time to understand this type of contraception and why it could be the right choice for you.

All other types of contraception that contain oestrogen are made from ethinylestradiol which is a chemical type of estrogen which has a completely different structure than estradiol. 

All types of contraception that contain “progesterone” actually do not contain any progesterone – they contain a synthetic version, known as a progestogen, which all have different chemical structures than progesterone.

What body identical contraception is available in the UK?

Currently, the most body identical form of contraception offered in the UK is called Zoely. Zoely is a combined oral contraceptive that contains body identical estradiol (estrogen) and a newer type of progestogen, called nomegestrol acetate (NOMAC), meaning it works to replace your natural hormones in a like for like way. However, even Zoely isn’t a completely body identical contraception (since it contains a synthetic progestogen) and there isn’t yet a completely body identical form of contraception even in existence. 

Why might body identical contraception be a good choice?

Frustratingly, the women I speak to often don’t know about the advantages of body identical hormones in contraception and merely just accept the negative impacts that synthetic hormones can have upon their symptoms and their future health.  The more well known, and commonly prescribed, forms of hormonal contraceptives I mentioned earlier have a wide range of potential side effects and risks, despite the dose of hormones in them having been significantly lowered since they were first available. These include: headaches, weight gain, acne, mood changes and nausea as well as small increased risks of clot, stroke, heart attacks and cancer.  Thousands of lawsuits have been filed alleging serious adverse outcomes, including blood clots, strokes, and heart attacks, all linked to the use of hormonal contraceptives.

The combined pill can also reduce your testosterone level, which can cause low libido and lead to symptoms such as low mood, reduced motivation, poor stamina and joint pains.

Many women discontinue taking hormonal contraceptives due to side effects and also concerns about health risks. Research has shown around a quarter of women quit contraception in the first year (rising to 42% for injectables). The most common reason for this is significant side effects, with abnormal bleeding and weight gain being the most common reasons cited.

Women know the impact that these side effects can have but, in my experience, many women report that when they talk about the detrimental impacts of hormonal contraception with their doctors, they are often dismissed or ignored, and this is why it is so important for women to track their hormones and any symptoms, which may be from contraception. I created the Balance app so women can understand the impact of hormones across their whole body. It allows you to track your periods, and any symptoms you may be experiencing such as headaches, bloating, mood swings and weight gain. You can share this information with your healthcare professional to help identify the impact of your contraception and to choose the method that’s most suitable for you. 

I’d like to challenge that women have to accept side effects like this, especially when a more body identical alternative could be offered? 

This seems an especially important question to raise when the risks involved in taking the most body identical form of contraception, Zoely, are much lower than other synthetic formulations. For instance, a review of five studies involving more than 560,000 women found a significant 33% reduction in venous thromboembolism (clot) risk among users of estradiol-based COCPs compared to synthetic ethinylestradiol-based COCPs. 

And it’s not just the statistics that make body identical contraception more appealing, I remember seeing a stark difference in my own daughter when she moved away from a synthetic hormone to taking Zoley. Her mood was better, her energy was better and she was  simply easier to live with. There was definitely a change and not one I put down to coincidence. It’s something I see a lot in my clinic too – having something that is biochemically and biologically more like your own hormones has a positive influence on the hormone health and quality of life of women. So why isn’t every woman considering body identical contraception?

In the main, it comes down to cost. Zoely is more expensive than other combined contraceptives, like Microgynon or some of the other contraceptives that have been around for a long time.  As a result, many women and girls are not offered it or are refused a prescription for it. I’d argue that while expensive in the short term, it’s not really expensive in the long term and if it’s really improving quality of life, so making people more able to function, to work, to contribute to society then surely it’s worth the additional cost? Also having less risks needs to be considered too.

The cost of the medication should not be considered in isolation; we have to take into account the cost of all the consultations going back and forth to the GPs, with the bleeding, with the bloating, with the side effects, with the more synthetic hormones.

It’s infuriating that despite so many women using hormonal contraception, there’s been little investment in improving the options or reducing side effects. The focus has largely been on developing new contraceptives for men or non-hormonal methods, while women’s needs remain overlooked. Pharma companies have little incentive to improve existing products, even though a significant proportion of women stop using them because of unwanted side effects. This leaves many women with no truly body identical hormonal options, and their voices are still not being heard.

Body identical hormones – progesterone and estradiol – are cheap and not subject to any patent whereas every time a new synthetic hormone is made then there is a patent associated with it which is the way the pharmaceutical companies make money. 

What does the future of body identical contraception look like?

So, as it stands, Zoely (the most body identical form of contraception) is exasperatingly not accessible for many women who take hormonal contraception and so many women are left dealing with being prescribed contraceptives with more side effects and risks. Of course, I’d like that to change, but I’d also like to challenge how nonsensical it is that there is not a single contraceptive available in the world which completely contains body identical, natural hormones!

Current trends show that women are becoming increasingly aware of the differences between natural and synthetic hormones and opting for a copper coil or barrier contraception such as condoms as this will usually lead to better PMS or PMDD symptoms, rather than bearing the side effects of synthetic hormones.  What’s clear is that women deserve to have a form of contraception that helps rather than hinders their health and I think more development of body identical contraception would be the key to this.