Dr. Mary Claire Haver

So when the liver sees estrogen, it starts pumping out different types of proteins, and it also pumps out clotting factors.

And so the early birth control pills had about three to four times as much ethanol estradiol.

And so that was when we started seeing all the blood clotting.

And we start saying, well, all estrogen causes blood clots.

No.

Ethanol estradiol is going to do that.

And then we start talking about things like testosterone in our body, because if your body sees estrogen, it's going to make a protein to bind some of it up.

That protein is sex hormone binding globulin.

Well, it's going to make more of it in response to ethanol estradiol just because of how potent that molecule is.

And when SHBG goes up, guess what?

Testosterone gets bound up and your testosterone goes down.

And there's so many different things that ethanol estradiol does.

It's not actually as good in the bones for promoting bone health as natural estradiol.

So there is some evidence in younger women that if they're taking ethanol estradiol birth control compared to those that are just having normal cycles, their bone mineral density looks different by the time they get into their 20s.

I really appreciate you saying that because it's actually something that I've addressed, I would say, on social media.

And I think about as someone who's also board certified, subspecialty certified in complex family planning, I am someone who very much supports the use of birth control for many different things.

It is incredibly valuable, including for preventing pregnancy.

And, you know, if we're worried about blood clots and birth control where there is nothing that's going to give you a blood clot more than a pregnancy, right?

Right?

Right.