In light of the changing political climate, specifically with the recent overturning of Roe v. Wade in the United States, the rate of birth control prescriptions is on the rise (Langmaid, 2022). The most common form of birth control remains oral contraceptives (OCs), with 75% of Canadian and 88% of American females taking OCs at some point in their lifetime (Government of Canada, 2015; Barakat et al., 2020; Britton et al., 2020). While OCs effectively prevent pregnancy, recent studies have discussed the potential for the hormones found in these contraceptives to leech into local waterways, causing detrimental effects on an ecological level (Britton et al., 2020).
OCs are a hormonal form of prescription birth control taken every 24 hours to prevent pregnancy, regulate menstrual cycles, treat acne, endometriosis, and ovarian cysts, as well as reduce the risks of endometrial and ovarian cancers (Government of Canada, 2015; Barakat et al., 2020; Britton et al., 2020). There are two main types of hormonal OCs — progesterone-only and estrogen-progesterone, also known as the combined oral contraceptive pill (COC), which is the most widely used form (Cooper, Patel and Mahdy, 2022). Progesterone is a hormone formed during pregnancy by the adrenal cortex and gonads (Cable and Grider, 2022; Cooper, Patel and Mahdy, 2022). Progesterone is also the primary hormone present responsible for preventing pregnancy by suppressing ovulation, thickening cervical mucus, lowering fallopian tube motility, and thinning the endometrium (Britton et al., 2020). Estrogen, on the other hand, is the female reproductive hormone responsible for the control of menstrual bleeding (Cooper, Patel and Mahdy, 2022; Delgado and Lopez-Ojeda, 2022). Estrogen prevents irregular bleeding and prevents follicle development (Britton et al., 2020).
While beneficial for their intended purpose, these hormonal OCs make their way into local waterways due to a combination of factors (Figure 1). Estrogen’s presence in waterways is partially due to the incomplete removal of the hormone during the water treatment process (Caldwell et al., 2010). Individuals on OCs release significantly higher concentrations of estrogen in their urine which cannot be fully filtered out by current water-treatment systems. While research has found that the concentration of estrogen in our drinking water is small enough to have no significant effect on humans, many aquatic species that survive in waterways are facing detrimental effects (Caldwell et al., 2010; Gonsioroski, Mourikes and Flaws, 2020).
Figure 1: Estrogen levels in waterways and subsequently filtered drinking water are the result of a combination of factors including landfill runoff, agricultural (pesticide) runoff, livestock excretions, industrial production, and residential waste. Estrogen levels from hormonal OCs fall under residential (home) waste, as estrogen is released through urine and carried to wastewater treatment plants. EE2 is the type of estrogen found in many OCs. From there it is treated and the remaining estrogen is released into waterbodies or filtered as drinking water (Wise, O’Brien and Woodruff, 2011).
Prolonged estrogen exposure impairs the development and reproductive function of species. One example of this is the feminization of fish (Gonsioroski, Mourikes and Flaws, 2020). Estrogen exposure beyond normal limits impacts gonad development by interacting with estrogen receptors (Figure 2). This causes an inversely proportional relationship between the number of fish with normal testes and the number of intersex fish (Gross-Sorokin, Roast and Brighty, 2006). Since intersex male fish have decreased sperm production and mobility, their reproductive success is reduced (Kidd et al., 2007). Female fecundity, or the ability to produce many offspring, was also reduced (DeQuattro et al., 2012). With prolonged exposure to estrogen in waterways, the male and female reproductive systems of fish populations are greatly impacted.
Figure 2: Biological section of minnow gonadal tissue. Tissue sample A is a control ovary sample from a minnow residing in a lake without added estrogen. Tissue sample B is from a female minnow in a lake with high estrogen levels. The arrow points to a follicle that has failed to develop due to estrogen exposure. Tissue sample C is a control testes sample from a minnow residing in a lake without added estrogen. Tissue sample D is from a male minnow in a lake with high estrogen levels who has become intersex. The arrow is indicating developing ovaries in the intersex male minnow (Kidd et al., 2007).
While birth control has great benefits for those electing to use it, the negative effects of hormonal OCs on aquatic species ensure that it is not a perfect solution. Further research needs to be done to identify birth control options that are safe, effective, and environmentally friendly for all.
References:
Barakat, M., Al-Qudah, R., Akour, A., Al-Qudah, N. and Bashi, Y.H.D., 2020. Unforeseen uses of oral contraceptive pills: Exploratory study in Jordanian community pharmacies. PLOS ONE, 15(12), p.e0244373. https://doi.org/10.1371/journal.pone.0244373.
Britton, L.E., Alspaugh, A., Greene, M.Z. and McLemore, M.R., 2020. An Evidence-Based Update on Contraception. The American journal of nursing, 120(2), pp.22–33. https://doi.org/10.1097/01.NAJ.0000654304.29632.a7.
Cable, J.K. and Grider, M.H., 2022. Physiology, Progesterone. In: StatPearls. [online] Treasure Island (FL): StatPearls Publishing. Available at: <http://www.ncbi.nlm.nih.gov/books/NBK558960/> [Accessed 4 December 2022].
Caldwell, D.J., Mastrocco, F., Nowak, E., Johnston, J., Yekel, H., Pfeiffer, D., Hoyt, M., DuPlessie, B.M. and Anderson, P.D., 2010. An Assessment of Potential Exposure and Risk from Estrogens in Drinking Water. Environmental Health Perspectives, 118(3), pp.338–344. https://doi.org/10.1289/ehp.0900654.
Cooper, D.B., Patel, P. and Mahdy, H., 2022. Oral Contraceptive Pills. In: StatPearls. [online] Treasure Island (FL): StatPearls Publishing. Available at: <http://www.ncbi.nlm.nih.gov/books/NBK430882/> [Accessed 4 December 2022].
Delgado, B.J. and Lopez-Ojeda, W., 2022. Estrogen. In: StatPearls. [online] Treasure Island (FL): StatPearls Publishing. Available at: <http://www.ncbi.nlm.nih.gov/books/NBK538260/> [Accessed 4 December 2022].
DeQuattro, Z.A., Peissig, E.J., Antkiewicz, D.S., Lundgren, E.J., Hedman, C.J., Hemming, J.D.C. and Barry, T.P., 2012. Effects of progesterone on reproduction and embryonic development in the fathead minnow (Pimephales promelas). Environmental Toxicology and Chemistry, 31(4), pp.851–856. https://doi.org/10.1002/etc.1754.
Gonsioroski, A., Mourikes, V.E. and Flaws, J.A., 2020. Endocrine Disruptors in Water and Their Effects on the Reproductive System. International Journal of Molecular Sciences, 21(6), p.1929. https://doi.org/10.3390/ijms21061929.
Government of Canada, S.C., 2015. Oral contraceptive use among women aged 15 to 49: Results from the Canadian Health Measures Survey. [online] Available at: <https://www150.statcan.gc.ca/n1/pub/82-003-x/2015010/article/14222-eng.htm> [Accessed 4 December 2022].
Gross-Sorokin, M.Y., Roast, S.D. and Brighty, G.C., 2006. Assessment of Feminization of Male Fish in English Rivers by the Environment Agency of England and Wales. Environmental Health Perspectives, 114(Suppl 1), pp.147–151. https://doi.org/10.1289/ehp.8068.
Kidd, K.A., Blanchfield, P.J., Mills, K.H., Palace, V.P., Evans, R.E., Lazorchak, J.M. and Flick, R.W., 2007. Collapse of a fish population after exposure to a synthetic estrogen. Proceedings of the National Academy of Sciences, 104(21), pp.8897–8901. https://doi.org/10.1073/pnas.0609568104.
Langmaid V., 2022. Contraception demand up after Roe reversal, doctors say | CNN. [online] Available at: <https://www.cnn.com/2022/07/06/health/contraceptives-demand-after-roe/index.html> [Accessed 4 December 2022].
Wise, A., O’Brien, K. and Woodruff, T., 2011. Are Oral Contraceptives a Significant Contributor to the Estrogenicity of Drinking Water? Environmental Science & Technology, 45(1), pp.51–60. https://doi.org/10.1021/es1014482.
Comments
11 Responses to “Birth Control – But for Whom?”
Hi everyone!
I chose this blog post topic after learning about an interesting example of the effects of estrogen in waterways in one of my elective classes last semester. This post was extremely fun and interesting to research, connecting topics of biology, ecology, drug discovery, and ethics. I hope you enjoy reading this post and I encourage any and all feedback!
I look forward to seeing all your comments,
Sarah 🙂
Hi Sarah,
This was an incredibly well-written blog post. I didn’t know that birth control could have such a harsh environmental impact. Here are my suggestions:
– The first sentence could have greater relevance to the rest of the post, as you don’t really get into the political climate. Conversely, you can detail what “changing political climate” means.
– In the second paragraph, you mention estrogen and progesterone as hormones multiple times, making it feel repetitive. You can state that they are the two major steroid hormones and omit sentence 3.
– It would be interesting if you had information about non-hormonal birth control options or new developments in birth control technology. You suggest the need for “safe, effective, and environmentally friendly” birth control options, but don’t provide any specific alternatives.
You brought up some great points in this post. I hope this issue gains more awareness.
Best of luck editing,
Ayushma
Hi Ayushma,
Thanks for your comments! I made some of the changes you suggested to help increase flow, specifically with the redundancies and lack of clarity on the political climate sentence. While I would love to compare the hormonal birth control options to others, due to the word count limitations of blog posts I do not have room to do so.
Thank you for all your comments 🙂
Sarah
Hi Sarah,
Great blog post! It’s always interesting and thought-provoking to consider how the drugs we take affect the environment. A couple of suggestions for your post:
– Your title should be capitalized as “Birth Control – But for Whom?”.
– “three-quarters” would be better represented as 75% to match the 88% statistic you stated right after.
– The “overall” at the beginning of your fourth sentence is unnecessary, and I think your writing would flow better without it.
– How do estrogen levels in the urine of people taking OCs compare to those who are not? It might be useful to include that comparison to represent the impact of OCs on aquatic life.
Overall, this was a very interesting post, and I look forward to reading the final result!
Happy editing,
Andrew Graham
Hi Andrew,
Thank you for your comments! I made some of those minor comments you had regarding the consistencies of statistic formatting and title capitalizations. I also attempted to clarify the comparison of users and non-users, however, in my research I found little numerical data to specifically represent it.
Thank you for all the notes,
Sarah 🙂
Hello Sarah,
An interesting and cohesive blog post! Birth control was actually the pharmaceutical I tackled in RP2 with my group, so it was nice to have some deja vu. Here are some suggestions to aid your editing process:
1. Intro: strong start!
2. Figure 1 is excellent, however cites EE2 as the form of estrogen that leaches into the environment. I’d recommend either modifying the figure for omission of EE2, or providing context within the prose/figure caption to keep the audience informed.
3. Consider defining ‘fecundity’ in P4 and combining the sentence with the one prior, for flow!
4. Great depth of figure caption, for the second figure!
5. I’d recommend swapping out ‘extreme’ in the concluding paragraph for something more contextual. Considering that the second half of the sentence focuses on negative effects, you could say “while birth control has positive effects for those intentionally consuming it, the negative effects are yet applied unintentionally to aquatic species.” or something along the lines.
6. General: you maintain a firm and logical tone and I find it approachable to read. Great author voice!
Overall, you really hit the nail on the head with this blog post and I hope my suggestions are of benefit. Best of luck with the editing process, Sarah!
Sincerely,
Prutha
Hi Prutha,
Thank you for all your comments and kind words! I applied your notes to the paper and I believe it aided with clarity and understanding, thank you!
– Sarah 🙂
Sarah! Another great post! For my IP, I’m reading a lot about how estrogenic contaminants destabilize aquatic ecosystems right here in Southern Ontario, so this is a super-relevant topic. Good choice! I have some minor suggested edits, mostly to cut down on some unnecessary words:
P1: “While these pills are effective for preventing pregnancy…” -> “While OCs effectively prevent pregnancy…”.
P2: I noticed that you wrote “Progesterone is a hormone primarily formed during pregnancy” followed by “Progesterone is the primary hormone present responsible for preventing pregnancy”. I have some background knowledge on how OCs work so I understand what you mean, but some readers might find this contradictory. Is there any way you could clarify progesterone’s (and estrogen’s) role when produced endogenously vs when taken through OCs?
P3 and Figure 1 caption: No need to write “different” in “A combination of different factors” -> “A combination of factors”.
P2: “The hormone assists with preventing irregular or unscheduled bleeding, as well as preventing the development of follicles” -> “Estrogen prevents irregular or unscheduled bleeding, and prevents follicle development.”. I’m tempted to even remove “unscheduled bleeding” -> “Estrogen prevents irregular bleeding and prevents follicle development” because to me that’s encompassed in irregular bleeding, but if they mean two different things to you then that is a-ok.
Conclusion: Omit “Thus” – your conclusion is strong and logical enough without it 🙂
Once again, great work & thanks for an interesting read!
-m
Hi Maya,
Thanks for all your notes – they were extremely helpful! I applied your notes and they definitely helped the post, can’t wait to hear more about your IP soon!
– Sarah 🙂
Hi Sarah,
I thought your post was very interesting! Your figures were helpful for understanding the concepts discussed and you incorporated several captivating ideas throughout your post.
I have a few suggestions:
1. In your second paragraph, when you are describing the two main forms of hormonal OCs, I think it would be very helpful to compare their effectiveness. For example, are progesterone-only OCs more effective than estrogen-progesterone OCs? This would be useful as you describe how each OC works but do not compare them to one another.
2. The first sentence of your third paragraph seems a little awkward. To improve clarity, you could reword it to say “While beneficial for their intended purposes, these hormonal OCs make their way into local waterways through a combination of different pathways”
3. In your fourth paragraph, you write “This causes an inversely proportional relationship between the number of fish with normal testes and the number of intersex fish”. This sentence seems to be a little unclear, I think it would be helpful to explain this a little more.
4. In your fourth paragraph, when you talk about decreased sperm production and female fecundity, it would be more impactful if you had a concluding sentence to this paragraph, such as “With prolonged exposure to increased estrogen levels in waterways, the fish populations are greatly impacted as the reproductive systems of both males and females are negatively affected.”
Overall very interesting post and good luck with your final version!
Cheers,
Keira
Hi Keira,
Thanks for taking the time to read my post and provide some comments. As for your first note, given that my paper is focusing on the effects of OCs outside of the body and not on their effectiveness overall, I do not believe that there is a reason to discuss which of the two forms is more effective. However, I did apply some of your other suggestions. Thanks
– Sarah 🙂