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Birth Control Ain’t Right (But Neither Should It Be Left)

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I’m writing this article with all the trepidation of someone walking into a Thai restaurant with a peanut allergy — knowing it could go horribly wrong.

I want to discuss politics. More precisely, I want to talk about a political fight by apolitical means. When it really comes down to it, hormonal birth control and women’s health transcend politics – or at least they should. It’s easy to lose sight of that in today’s political climate.

Lupus and Birth Control

An item came across my news feed this morning that caught my eye. It wasn’t a news story, but a letter to the editor of a coastal newspaper. The writer mentioned the increasing incidence of lupus in young women caused by hormonal contraceptives (the keywords that landed it in my newsfeed). Wow! That’s a connection very few people have made. I wanted to read more.

But when I opened the letter, it was a political diatribe from a woman who was all over the map. She talked about Republicans using the Honduran caravan to get votes. She blamed the caravan on overpopulation caused by poverty stemming from a Latino machismo perpetuated by the Catholic Church. She accused conservatives of trying to outlaw birth control. I was with her when it came to the facts (or fact), but she lost me in her rhetoric – and it’s not even about whether I lean Right or Left. Let me explain:

  • The increased incidence of lupus in young women on birth control is a fact. We should all be concerned about this and be engaged in dialogue on how to fix it.
  • Politicization of the Honduran caravan is opinion. In fact, the rhetoric has gone both ways. Depending on where you get your opinion-news, you could believe the caravan was likely being funded by either Donald Trump or George Soros.
  • The overpopulation-poverty-machismo-Catholic theory is opinion. I don’t even know where to begin, but I guess there’s always a way to blame the Catholic Church when you’re talking about birth control.
  • Conservatives trying to outlaw birth control is opinion. I know some will argue that it’s a fact, but I haven’t seen any evidence of this. Living in Texas, I have a number of ultra-conservative friends, and I have never had anyone approach me with the suggestion that we outlaw birth control – and that’s with knowing how much I hate The Pill. To the contrary, I’ve actually been accused of being anti-capitalism because of my attacks on the drug industry and birth control.

Divided We Fall

Women’s health is worth the fight! Lupus induced by birth control is not only the lede; it’s the story. If we can agree on that, then I really don’t care who you think funded the caravan. If we can unite in agreement that birth control is harming women by means of breast cancer, blood clots, Multiple Sclerosis, suicide, infertility, Crohn’s Disease, diabetes… should it really matter to me whether I’m linking arms with a Republican or a Democrat?

I know it may be pie-in-the-sky to think we can rise above political affiliation in this day and age, but we should. This has been going on for far too long.

As far back as 1970, the Nelson Pill Hearings revealed many of the horrible complications linked to birth control. The news coming from the hearings was so devastating that women across the country began to call their doctors asking to be taken off The Pill. If you view politics through a lens of only the past decade or so, it might seem hard to believe that it was a Democratic senator who chaired the hearings, and it was a young Republican senator from Kansas who defended The Pill. Sen. Bob Dole virtually attacked every doctor who testified about troubling side effects.

Ben Gordon, who was Sen. Gaylord Nelson’s lead staffer said, “Dole was on our committee, and when he came, there was no question he was representing the industry.”

The industry has always been organized in promoting and defending its product. Unfortunately, the era surrounding the Nelson Pill Hearings is as close as the opposition has ever come to being organized and unified.

United We Stand

The hearings brought together doctors from all different specialties who felt The Pill had been forced upon them despite insufficient testing. Suddenly, the media was paying attention to doctors, journalists, and authors who had been expressing serious concerns about birth control safety. Perhaps most important, women (many of whom were hearing about these serious side effects for the first time) began to unite.

Alice Wolfson became the face of the hearings after bringing them to a brief halt. Along with several other young feminists, she had come to the hearings with plans to protest the senators, who she felt weren’t really listening to the voices of women. However, after hearing the testimony of several doctors, she famously stood up in the chambers and shouted, “Why are 10 million women being used as guinea pigs!?”

She became fast friends with Barbara Seaman, whose book, The Doctor’s Case Against the Pill, helped launch the hearings. Ms. Seaman later wrote about the hearings saying it brought the “uptown” and “downtown” feminists together on the issue of birth control safety. She and Ms. Wolfson would go on to found the National Women’s Health Network. To this day, it is one of the nation’s top women’s health advocacy groups.

Shouldn’t Be Left (Alone)

With all of this organized opposition to The Pill, what did the hearings accomplish?

Well, The Pill became the first drug ever required to have a patient information booklet included in each pack. I suppose that would be pretty significant if it had been written in laymen terms so people could actually understand it.

And, the drug industry responded by releasing new, lower-dose formulations, which they claimed were safer. Unfortunately, their testing was even less stringent than it had been in the original trials. In fact, none of subsequent generations of hormonal birth control have been proven to be safe.

Clearly, what we as the opposition have done thus far hasn’t been enough. It’s time for more hearings. It’s time to hold the drug companies accountable for the sad state of women’s health. It doesn’t serve you or me – it doesn’t serve the Republicans or Democrats to have women suffering with chronic ailments or even dying in the name of birth control. In the end, it only serves the bottom line of Big Pharma. Maybe that’s what they’re referring to when they keep telling us ‘the benefits still outweigh the risks.’

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More Side Effects From Birth Control- The Liver and the Gallbladder

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This time of year, the holiday season, can be a time of overindulgence for many of us. And how can we talk about overindulgence without taking a look at the liver? To say the liver is important is an understatement. It is the body’s largest gland and while estimates of the number of functions of the liver vary, many textbooks generally cite around 500. Nearly everything we ingest, from drugs and alcohol to vitamins and nutrients, is metabolized by the liver. The vital role it plays in the functioning of our bodies makes the testimony from the 1970 Nelson Pill Hearings about the effects of oral contraceptives on the liver that much scarier.

Research Presented at the Nelson Pill Hearings

Dr. Victor Wynn was one of the first physicians to testify about the effects of hormonal birth control on the liver.

On page 6341 he states, “if you will take cells out of the liver and examine them under the electromicroscope of women taking oral contraceptive medication, you will find some extraordinary changes.” Of these and other changes caused by the pill, he says: “When I say these changes occur, I mean they occur in everybody, more in some than in others, but no person entirely escapes from the metabolic influence of these compounds. It is merely that some manifest the changes more obviously than others.”

Later to testify was Dr. William Spellacy who was specifically called upon to speak about the metabolic effects on the liver. His testimony about the liver begins, “The biochemical effects of the sex hormones on the liver are legion.” Below is a list of liver functions that, based on the research presented in Dr. Spellacy’s testimony, are altered or impaired (NPH 6427):

  • Lowering of total plasma protein level
  • Decrease in the albumin and gamma globulin and increases in other fractions
  • Tests may be abnormal in women on oral contraceptives without disease being present
  • Estrogen (including that in oral contraceptives) interferes with liver function and varies with dosage
  • Some women taking oral contraceptives have abnormally high blood bilirubin levels
  • 1/3 of women who have jaundice on oral contraceptives will get it when pregnant
  • Discontinuation of oral contraceptives “cures” jaundice

He summed up his thoughts on the liver damage caused by hormonal birth control:

“The immediate effects include the alteration of several of the laboratory tests used in medical diagnoses. Aggravation of existing liver disease, if present, to the point where jaundice may be seen has also been shown. There is no answer to the query of will permanent liver damage result from the use of the oral contraceptives.”

The honorary Chairman of the Population Crisis Committee, a “pro-pill” organization focused on population control added his two cents about the effects of oral contraceptives on the women using them. “While metabolic alterations affecting the liver and other organs do result from use of the pill, there is no evidence at this time that they pose serious hazards to health;” General William Draper, Page 6705.

Of course, we shouldn’t assume that just because a medication causes a “legion” of biochemical effects on the livers of otherwise healthy women that there will be any lasting problems, right?

Research Since the Hearings

“Women more commonly present with acute liver failure, autoimmune hepatitis, benign liver lesions, primary biliary cirrhosis, and toxin-mediated hepatotoxicity,” according to a 2013 article in Gastroenterology and Hepatology.

Like I mentioned in my piece about rheumatoid arthritis, whenever a health issue affects women disproportionately, there is often a connection with hormonal birth control. While this study doesn’t specifically mention that, it does call for further studies assess the role of sex hormones and other behaviors on liver problems in women.

These connections were well-documented at the 1970 Nelson Pill Hearings but the subsequent research gets more confusing.

Timeline of Liver Research

1980: Lancet published an article showing the connection between malignant liver tumors and women using oral contraceptives.

1989: The British Journal of Cancer found “confirmation in this population of the association between oral contraceptives and hepatocellular carcinoma” and “the relative risk was significantly elevated in long-term users [of oral contraceptives].”

1992: “This study, the largest to date, adds to the number of investigations demonstrating an increased risk of primary liver cancer with use, particularly long-term use, of oral contraceptives.”

2006: “Long-term use of oral contraceptives (OCs) and anabolic androgenic steroids (AASs) can induce both benign (hemangioma, adenoma, and focal nodular hyperplasia [FNH]) and malignant (hepatocellular carcinoma [HCC]) hepatocellular tumors.”

Yet a 2015 meta-analysis concluded that “oral contraceptive use was not positively associated with the risk of liver cancer.” However, the analysis also conceded that “a linear relationship between oral contraceptives use and liver cancer risk was found.” And the authors noted the need for further research into specific formulations of oral contraceptives and the duration of usage.

It makes you wonder how we went from pretty convincing and highly damning connections between oral contraceptives and liver cancer to no positive association at all. Did all the scientists from the 1960s to 2006 get it wrong? Or is something else going on here?

What About the Gallbladder?

Perhaps we can look at the liver’s little buddy, the gallbladder, for some more information. The two are intimately connected in that the liver is constantly making bile and sending it to the gallbladder for storage and dispensation. Like problems with the liver, women are more likely to develop gallstones than men. According to the National Institute of Diabetes and Digestive and Kidney Diseases, “Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.”

This was proven shortly after the Nelson Pill Hearings. According to the revised edition of The Doctors’ Case Against The Pill by Barbara Seaman:

“The Pill also has serious adverse effects on the gallbladder, and women who take the Pill face an increased risk of someday facing surgery for gallstones. Pill use causes higher levels of cholesterol saturation in the bile, according to a study reported in the New England Journal of Medicine in 1976. This high level of fate in the bile is considered ‘an early chemical stage of gallstone disease,” according to Dr. Donald Small of the Boston University School of Medicine… The risk of gallbladder disease rises with the length of time a woman has been on the Pill… In some studies, Pill users are two and a half times as likely to suffer from gallstones as comparable women.”

A meta-analysis conducted in 1993 found “Oral contraceptive use is associated with a slightly and transiently increased rate of gallbladder disease” and “Considering…the rapidly changing formulas of oral contraceptives, the authors suggest that the safety of new oral contraceptives be evaluated by studying bile saturation and biliary function rather than by waiting for gallbladder disease to develop.”

A much more recent study (2011) found that there was even more risk of gallbladder disease with the newer formulations:

  • Long-term use of an oral contraceptive is associated with an increased risk of gallbladder disease compared with no use
  • There was a small, statistically significant increase in the risk of gallbladder disease associated with the use of desogestrel, drospirenone and norethindrone compared with levonorgestrel
  • Both estrogen and progesterone have been shown to increase the risk of gallstones
  • Estrogen has been shown to increase cholesterol production in the liver, with excess amounts precipitating in bile and leading to the formation of gallstones
  • Progesterone has been shown to decrease gall-bladder motility, which impedes bile flow and leads to gallstone formation

The gallbladder shows us that these hormones are damaging the body.

What Now?

So what do you do when you have a gallbladder that’s not functioning properly? The current practice is to take it out! Of course, removing the gallbladder is not the quick fix many think it is and often leads to other health complications like irritable bowel syndrome, acid reflux, and Sphincter of Oddi Dysfunction.

What about when your liver isn’t functioning properly? That’s not as simple. You can’t just take a liver out. How can the gallbladder, an organ so fundamentally connected to the liver, experience drastic and dangerous changes from hormonal birth control but the liver is supposedly unaffected? Have we researched ourselves out of that problem by declaring that it isn’t a problem? Has there been some spin-doctoring going on when it comes to the liver?

As Dr. Wynn said at the hearings, “There are more than 50 ways in which the metabolic functions of the body are modified, and to say therefore that normal physiological function has been demonstrated in the years of oral contraception is to overlook a very large amount of information.”

I think a very large amount of information has indeed been overlooked.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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Laboratoires Servier, CC BY-SA 3.0, via Wikimedia Commons

This article was first published December 15, 2016.

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It’s Not All In Your Head: Mental Health and Hormonal Birth Control

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Mental Health Birth Control

Once upon a time, a 26-year-old woman went to her doctor and asked to be put on the new birth control pill that allowed women to only have four periods a year. She had seen it advertised on television. Four months later, 15 pounds heavier and suffering from mild depression, she returned to the doctor feeling miserable. The doctor told her the weight gain and depression were not from the pill because those were not side effects of hormonal birth control. Wait, does this sound familiar? It’s the same story I told in my article about hormonal birth control and weight gain. Only this time, I’m talking about mental health.

The truth is that I gave my mood changes and my mild depression very little thought. Once the doctor told me they were not a symptom of my new birth control pills, I figured it was my fault I was sad and not dealing with things very well.

What They Knew in 1970

I remembered the connection between my birth control pills and that bout of depression when I began reading the Nelson Pill Hearings. One of the first doctors to testify pointed out that there had been a suicide during the original pill trials in Puerto Rico. Neither the suicide, nor the other three sudden deaths (of five total deaths during the experiments) were investigated. But what really got my attention was that the page after the mention of the suicide was the only one missing in the nearly 1500 pages of testimony. I have since been able to get a copy of that page and while the testimony doesn’t seem that damning given the laundry lists of risks, concerns, and dangers with hormonal contraceptives that are examined at the hearings, it does bring up an interesting point.

Doctor Edmond Kassouf’s testimony answers questions from Mr. James Duffy, minority counsel at the hearings (page 6112):

Mr. Duffy:  One of the five deaths was suicide.

Dr. Kassouf:  Yes.

Mr. Duffy:  So what I would like to understand is how does one take a suicide and link the case of death to the pill?

Dr. Kassouf:  Very simply. It has been of current concern. Many physicians and psychiatrists are concerned about depression and the pill. If this is true, suicide may well be the end result of that combination and, therefore, a reasonable suspect, a reasonable link.

Suicide Attempts While on the Pill

“I’ve really got to look into this more,” I thought. Well, I had to look no further than page 6447 and the testimony of Dr. Francis Kane, Jr., Associate Professor of Psychiatry at the University of North Carolina. To sum up his testimony about the studies conducted with regard to mental health and oral contraceptives, he says this (page 6457):

“There is considerable incidence of mild to moderate psychiatric morbidity [disease] associated with the use of combination oral contraceptive agents… In three of the four studies, there seems to be agreement that those who have required psychiatric care in the past will be more at risk for the development of morbidity, including psychosis. One study also suggests that there may be some increase in the depth of illness the longer the medication is taken.”

Dr. Kane describes a study conducted in England of 50 women on oral contraceptives who were compared to a control group of 50 women who had not used hormonal contraception. There were no differences in socioeconomic status, age, or history of past depressive episodes. But in the group taking the pill, 14 women “had depression of mild to moderate proportions, while only three of the control group reported this.” The pill users also reported greater depression as well as particularly high scores for “guilt, self-absorption, and loss of energy.”

He goes on to say, “Two suicidal attempts in the pill sample were found, which had not been disclosed to the general practitioner. Since completing the study, another depressed pill-taker had made a serious suicidal attempt.” Three suicide attempts in a study of 50 women? That seems incredibly high to me. Ludicrously high. Especially given that there are other methods of contraception.

But Wait, There’s More!

But that’s just one doctor testifying about a few studies, right? Sure. But the next person to testify was Dr. John McCain (not the senator). One of the first things the doctor points out is (page 6471):

“The contraceptive pills are potent steroid hormones. Alterations of the anterior pituitary function are produced by them… the potential endocrine and systemic disturbances are almost unlimited. The effects produced through the anterior pituitary may be so indirect that years may elapse before a correlation is established between the abnormality and the administration of the contraceptive pills.”

You know what else is a hormonal medicine? Anabolic steroids. “Roid rage” is pretty well documented. Is it really such a leap to think that hormones in birth control can also cause changes in mental health?

Dr. McCain spent years documenting the patients in his practice who suffered serious side effects from hormonal contraception. In that time, he recorded episodes from 52 patients. And per his own testimony, his largest concern was mental health (page 6473).

“The emotional or psychiatric problems are the complications which seem to me to have the most serious potential danger. Three patients have stated that they were desperately afraid that they were going to kill themselves… After the pills were omitted, the depression and suicidal fears of the three patients disappeared, as did the depression of the other patients.”

He also points out (page 6473):

“It is disturbing to consider the patients on the pills whose depression may have ended in suicide and/or homicide with no recognition of any association with the contraceptive pills… Personality changes could be a factor in other conditions such as automobile accidents and divorces.”

Is it really so much of stretch to think that a potent steroid could cause personality changes that could lead to the damaging of personal relationships that are beyond repair? Plenty of other potent substances can and do.

What They Say Now

Dr. Kane and Dr. McCain, as well as every other expert who testified at the Nelson Pill Hearings, agreed on one thing. More research was needed.

So what does the research say now?

Medscape published an article from the American Journal of Epidemiology with the claim that “Hormonal contraception may reduce levels of depressive symptoms among young women.” Yet when you read further into their conclusions, they say that nearly one-third of women discontinue hormonal contraceptives within the first year, many because of mood changes, and those women are unlikely to restart hormones. Therefore, “hormonal contraceptive users at any time point may be overselected for less depression than nonusers.”

The study also points out that:

“Existing literature on hormonal contraception and depression has been primarily confined to small, unrepresentative samples. Among these smaller studies, few cohesive findings have emerged.”

And:

“Little research has examined the role of exogenous hormone use in suicidality, and existing research has focused on mortality from suicide rather than suicide attempts.”

And according to WebMD, there are a laundry list of medications that can cause depression. What is not included on this list? Birth control pills. The only hormonal contraception included is Norplant. Interestingly enough, the active ingredient in Norplant is levonorgestrel, a progestin found in many birth control pills as well as hormonal IUDs. So am I supposed to believe that when injected into my arm, synthetic hormones can cause me depression but when taken daily as a pill or sitting in my uterus for 5 years, they won’t? Does that make any sense at all?

It doesn’t make sense to Dr. Kelly Brogan. That’s why when she has patients that complain of depression, anxiety, low libido, mood changes, weight gain, etc. she recommends they stop using hormonal contraception.

What Have We Learned?

  • Hormonal contraceptives can cause mental health issues
  • Women who suffer from mental health issues are much more likely to suffer from increased symptoms when on hormonal contraception
  • Often the longer hormonal contraception is used, the greater the symptoms
  • Discontinuation of hormonal contraception can usually alleviate mental health symptoms
  • The research promised from the Nelson Pill Hearings has never materialized

Why, if they knew in 1970 that hormonal contraception was deeply connected not only to depression but also to suicide, has it not been further researched? It’s been nearly 50 years since Dr. Philip Ball (page 6493), a specialist in internal medicine, testified before congress. Which makes what he says all the more chilling.

“It is not considered reasonable that there be any mortality or morbidity in a pill used purely for contraception purposes. Medical research has got to offer something better than this. Physicians will probably look back on the contraceptive pill era of the past 5 years with some embarrassment.”

Exactly.

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This post was published originally on Hormones Matter on June 22, 2016.

 

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Birth Control Pill and Your Fertility

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Let’s face it; if a girl’s period is irregular, heavy, or painful when she goes to her family doctor, the first line of treatment will be to go on the pill.

Her well-meaning conventional medical doctor may tell her that the pill can minimize acne, even out moods, regulate menstrual cycles and optimal health seems to be restored!  Almost like magic?

She may receive a very minimal amount of information about the potential risks of the pill and led to believe that the benefits far outweigh the risks.

These risks include blood clots, higher blood pressure, gall bladder disease, infertility, increased risk of cervical and breast cancer.

But, hey this young girl is not worried about all these diseases, let alone her fertility, she simply wants to regulate her cycle and feel and look good!

Fast forward 10-15 years later and she now wants to have a baby.

She decides to come off the pill and while some women are able to have regular menstrual cycles relatively quickly, for others it is simply not the case.

They struggle with the same health issues they had before they went on the pill and in many cases these symptoms are now worse.

Achieving Fertility After Hormonal Birth Control

Birth Control Impacts Nutrient Levels

There are studies that indicate the birth control pill can decrease certain nutrients in the body.  The pill is found to lower vitamin B6, B12, B2 levels, including folate, vitamin C, copper, magnesium, selenium and zinc.

Plus due to the depletion of our soil and consumption of the standard western diet (which includes a heavy reliance on processed foods) our nutrient levels can already be low.

All of these nutrients play a vital role in the menstrual cycle and can contribute to irregular periods, no periods (amenorrhea), no ovulation, alternating cycle length or bleeding for long or short length of time. They also play a role in fertility and conception.

How Do We Restore Nutrient Levels?

The best suggestion is to eat a nutrient dense diet with targeted supplementation when needed!  I always recommend switching to the fertility diet! It’s low in inflammatory foods and high in nutrient dense foods, which help prepare your body for baby.

  • It’s best to take a professional grade prenatal that has methylated folate and not folic acid. Research indicates that as much as half the population may have impaired methylation via the MTHFR gene and need a more bioavailable form.  Always opt for folate with “5-methyltetrahydrofolate” (5-MTHF)
  • Add in foods rich in B vitamins such as dark leafy greens, poultry, shellfish and eggs
  • Consume foods with vitamin C such as dark leafy greens, citrus fruits and berries (plus they are great for your immune system!)
  • Don’t forget to have foods that are high in magnesium such as brazil nuts, poultry, eggs and grass fed meats
  • Make the switch to organic produce and grass fed, wild caught, antibiotic free meats and fish. If the cost is prohibitive opt for the dirty dozen or clean fifteen.

The Pill Disrupts Your Gut Flora

We are just beginning to understand the role of the microbiome and our health.

Essentially when we come out of our mother’s womb our microbiome starts to take shape. The first microbes are acquired through the vaginal canal and breast milk contains beneficial bacteria too.  So if you were born via C-section or bottle-fed you are slightly behind from the beginning.

The microbiome represents the number of microorganisms and their collective genetic material present in the human body or environment. The Human Microbiome Project is developing research resources to enable study of the microbial communities that live in our body and the role they play in human health.

There are huge benefits to having a healthy microbiome, from improved skin health, joint health, mood issues, digestive health and autoimmune disease.

However, stress, antibiotics, poor diet and chronic medications like the pill can negatively alter the microbiome, which can potentially impact your fertility.

How Do I Restore My Microbiome?

  • Consume a good quality probiotic.
  • Consume more probiotic rich foods such as probiotic drinks, bone broth, kombucha, sauerkraut and kimchi which can all help to restore the beneficial gut bacteria
  • Add more living plants into your diet, such as cilantro, parsley, basil and lemon balm

What to Do Next?

It may take some time to restore your cycle after taking oral contraceptives, or your cycles may be restored right after stopping the pill.

Since I deal exclusively with women trying to conceive I typically find that symptoms such as irregular periods, no periods, heavy periods and painful periods are quite common.  And yes, many of these women have recently come off the birth control pill.

It’s the classic chicken or the egg. For many women they were prescribed the birth control pill because of symptoms with their menstrual cycle. When they come off the pill these issues are typically still present. Others find that they now have other health issues and their menstrual cycle is disrupted after coming off the pill.

Preconception health is so important, but many women rush right into trying to have baby without fully preparing their body for pregnancy.

Remember it only takes 90 days for the egg to renew itself and the life cycle of the sperm is 70-80 days, so in a very short period of time you can dramatically improve your health and impact the health of your future child.  If you have been on the pill for any substantial amount of time, it may take longer to restore your health. Do not worry, however, it can be done.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Image credit: CC0 Public domain.

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The Birth Control Blind Spot: Stop Letting Politicians Dictate Women’s Health

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Access Versus Safety: It’s Not Either Or

In February 2012, five years ago to the week, I wrote:

“In the US women seem too scared to criticize the pill as they think anything less than zealous enthusiasm will be seized upon by the Right and used as fodder in their bid to ban birth control. This situation means there is very little accurate information getting through to women about the risks of hormonal contraceptives — from the quality-of-life-threatening to the truly life-threatening. Those on the Right that are looking to ban birth control or limit access are manipulating information, this is true, but so are those who claim to be working for women, who claim to have women’s best interests at heart. The silencing of honest discussion is letting many women suffer unnecessarily as a result of using the Pill.”

This statement was part of an article for the Society for Menstrual Cycle Research’s blog, re: Cycling. My book, “Sweetening the Pill,” was still in the proposal stage, yet to find a publisher. However, as I’d written for a few major publications by that time, I was asked, by a reporter at the Washington Post, whether I thought the political debate around access to birth control was “distracting from” discussion of the side effects and safety of hormonal contraceptives. The article became an extrapolation of my answer.

In the same week, I published an article with Ms. Magazine about the serious and life-threatening risks associated with newer, drospirenone-containing, oral contraceptives. One of these kinds of birth control pills, Yasmin, I had taken for over 2 years and my experience set me on the path to becoming a “birth control critic” (as the Washington Post then labeled me, in 2016). Due to a misleading marketing campaign, Yasmin became one of the most popular and profitable brands in the mid-2000s. Yet, drospirenone-containing pills had significantly higher risk of blood clots than older brands of pill (a fact known to the pharmaceutical company). This was not front page news, nor taken up as a feminist cause – which is why I was writing about it.

Politicians Putting Safety On Sidelines Again

Five years later, at the start of 2017, has the situation changed? Well, no, and yes. Last week I received this email in regards to the upcoming “Sweetening the Pill” documentary, which will look at the safety and side effects of hormonal contraceptives and issues of informed consent. This woman voiced her concern:

“I wanted to get a sense of your thoughts about releasing it in this rather terrifying new political climate, and all it means for women’s rights. Of course, I’ve long been in favor of looking at the downsides of the pill—and I still am—but there was always a small concern in the back of my mind about unintentionally aiding the right-wing agenda.”

Reading this, I felt a sense of déjà vu and disappointment. In the past year or two, people had stopped asking me this question. More women were talking about side effects and more support was being given to those women, including myself. When my book came out, it was not well-received by all, to put it mildly, but I’d seen the tide change and talking about the problems with the pill had become mainstream. 2015 was the “year of the period” (as decreed by NPR), increased honesty around menstruation was leading to body literacy, including a reexamination of the impact of medicalizing menstruation and fertility. Now, it seems, that this developing conversation might once again be hushed up.

The political climate the email-er was referring to, is, as you likely know, that Donald Trump’s administration looks to defund Planned Parenthood and dismantle the Affordable Care Act, both of which have made some birth control methods accessible to more women. While he hasn’t explicitly said that he doesn’t agree with the use of contraceptives as a whole, as Rick Santorum did back in 2012, it’s clear the result of his proposed policies will be less accessible, less affordable hormonal contraceptives and devices. On top of that, Trump has stated a desire to further limit access to abortion, even outlaw the procedure.

And We’re Falling For It

In the wake of Trumps’ election the internet was flooded with articles demanding women seize the opportunity to get a subsidized or “free” IUD, with headlines quite literally stating, “Get An IUD Before It’s Too Late.” None of these articles mentioned side effects to watch out for, few distinguished between the IUD options (hormonal or copper), or mentioned alternatives for preventing pregnancy.

Access concerns were centralized, side effects and safety issues were relegated to the sidelines – along with any concern for the informed consent of the women who would inevitably take action. In fact, Planned Parenthood widely publicized a 900% jump in IUD requests. We can assume a significant number of those women did not want an IUD, but felt they had to get an IUD. The suggestion that the IUD is the one-size-fits-all fix to the problem of access is a willful avoidance of many complexities – from the high discontinuation rates associated with IUDs, to the serious side effects, to historical and current experiences of coercion, especially for women of color and women of lower economic status. Getting the IUD was presented as the responsible, politically-aware, thing to do. Of course, there was no headline stating, “Men, Now’s The Time To Get A Vasectomy” or “Men: Commit To Condoms For The Next Four Years.” If the majority of women want their IUD removed before the expiration date, I hope health practitioners are ready for this.

Demand Access and Safety

Faced with an attack on access to birth control and abortion, the response from liberals, Democrats and feminists is understandably, to fight for access. The equation is drawn that less accessible birth control means more unplanned pregnancies; higher rates of unplanned pregnancy without access to abortion means more unsafe abortions and/or more women having those unplanned children. While five years ago the emphasis was on the pill, now the emphasis is on the IUD – effective birth control that is inserted and removed by a health practitioner, bypassing the autonomy of the woman almost completely.

My own response to an attack on access is the same today as it was five years ago. I believe in taking an offensive and not a defensive position (pun intended). I support full access to all forms of contraception – pharmaceutical drugs and devices, and non-hormonal methods, by which I mean OBGyns trained in diaphragm-fitting, accessible classes in fertility awareness, and insurance coverage for fertility monitors. As a British person, I’m obviously an advocate of a nationalized healthcare system. But I also, simultaneously, believe we need to address head-on the real problems with the pill and other hormonal contraceptives, otherwise we cannot claim to truly care about women.

Allowing politicians to dictate whether we can discuss side effects and safety issues benefits the pharmaceutical industry, which funds representatives on both sides of the aisle. Bayer AG, the makers of both Yasmin and the hormone-based IUDs (Mirena, Skyla), is one of the top contributors to senators and political campaigns. Bayer AG recently merged with Monsanto, another high level backer of politicians. We cannot let the conversation be co-opted by the men, or women, of any political persuasion, but that’s what can happen when we keep quiet.

One month after I published my piece for re: Cycling, I co-wrote (with Laura Wershler) a “guide to coming off hormonal contraceptives.” The introduction went:

“As politicians, pundits and priests whip the nation into a frenzy over access to birth control, it’s understandable that women of every political affiliation may have had just about enough. If women are fed up with this furor over contraception, this daily demonstration that their rights to sexual and reproductive self-determination are vulnerable, then maybe now is the time to do something about it.”

The answer was to seize the means of reproduction. Dependence on decision makers, or making choices from fear, is not the way forward.  What we needed then, as we need now, is a birth control rebellion.

“One way to take back power from those who would deny, bully or browbeat you is to not need what they are fighting over.”

That guide can now be updated with the many more resources that have become available in the past five years for women who want to reject pharmaceutical birth control.

Encouragingly, I see sparks of this rebellion today – in women sharing books wherein this perspective originated, like “How To Stay Out Of The Gynecologist’s Office” and “A Woman’s Book of Choices;” in renewed interest in herbalism and plant medicine; in women sharing knowledge of fertility awareness, and those teaching informed consent and body literacy. This is the kind of grassroots movement that could bring about important change for future generations of women.

We need to take back control of the conversation from those who will happily kick this political football down the field for decades to come, always centering their agenda and not women’s health or autonomy.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Photo by Lauren Mitchell on Unsplash.

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A Pain in the Leg: Blood Clots on Birth Control

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My experience with blood clots started in 1980 as a 16 year old after Family Planning recommended the pill to me. At the time, I played sport – sailing and ice-hockey, was lean and fit, didn’t drink alcohol nor smoke. I grew up eating mostly home-cooked meals; no junk food or soft drinks.

Within 6 months of going on the pill the only obvious side-effects were weight gain and possibly the migraine headaches that I would sometimes get. Then, at some point, I had leg pain that felt like muscle cramping. I didn’t think or know that this was a side-effect of the pill. I don’t remember being advised about this as a known problem with the pill.

Calf Cramp or Blood Clots?

My right calf muscle would seize with pain and feel very tender. I couldn’t flex my ankle and it became difficult to walk up and down stairs. The pain grew worse over the following few weeks, so mum and I went to the hospital. The doctors in the ER insisted I had pulled a muscle, even though I was certain I had not. At the same time the doctors suggested I return if I felt tingling or if my foot felt cold.

I returned the next day with a cold foot. Again, the doctors measured my calf muscles with no difference between the painful leg and the other leg. A student doctor suspected deep vein thrombosis and after much debate with other doctors, ordered a venogram for the next morning. I was admitted to the hospital. The result was positive and I was bed-bound in hospital for twelve days while taking heparin and warfarin.

While I was in hospital, another teenage girl arrived in my ward. She was flown to Sydney by helicopter from Mudgee with the clots under her upper arm.

Six years later in 1986, after trying several other contraceptive devices, like the diaphragm which popped out of place when I moved, family planning suggested that I go on the ‘mini pill’ as it was a very low dose. After some time, I don’t remember how long, I had the same leg pain, in the same calf muscle.

I knew what it was. After two weeks of hoping it would go away, I went to the hospital ER closest to where I lived. The registrar there would have none of it, even with my history, and refused to check using venogram. Again, there were no visual signs of a blood clot. Just the pain.

So, I traveled over an hour on a train to go to the hospital where I was previously treated. They admitted me straight away and performed a venogram the next morning. The treatment was the same as before.

I’ve not used chemical contraceptives since then. I found naturopath Francesca Naish and followed her natural fertility management program for the rest of my fertile life. I have never had any further issues with blood clotting, even with two pregnancies.

Because of this history, the obstetricians tried to label me as a high-risk pregnancy when I was pregnant, prohibiting me from a natural birth in the birthing centre. After I strongly insisted, they signed me off. I agreed to take a shot of anticoagulant when my baby was born. I had no sign of clots during either of my two pregnancies and delivered both naturally, without pain medication.

I realize I was a very lucky woman.

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

We need your help.

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Yes, I’d like to support Hormones Matter.

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Birth Control and the Fifth Vital Sign

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From March 2nd to May 30th of this year, we drove 15,000 miles across the US, from New York to California, on a reproductive health education tour. We offered 60 free classes in 43 states in order to share accurate, fair information about the menstrual cycle and hormonal health. We dubbed the project The Fifth Vital Sign, because we consider the menstrual cycle to be a vital sign, as indicative of our health status as blood pressure, heart rate, respiratory rate, and temperature, with the potential to give us information about thyroid issues, endometriosis, PCOS, infections, cancers, fertility and infertility, pregnancy, miscarriage, menopause and more.

By sharing information about how our bodies work, we hope people are better equipped to make fully informed choices about their health care and contraception in particular. If we’re not aware of the benefits of ovulation and menstruation, can we really make an informed choice about hormonal birth control, which prevents ovulation and menstruation? Beyond body literacy, without knowing or being presented with all of our contraceptive options, and the risks and side effects of each, how can we make an informed decision, which is our right, about our preferred method?

Informed choice in the context of contraception is one of our favorite parts of The Fifth Vital Sign curriculum, because we realize how critical it is. We were able to initiate our project, thanks in large part to a generous donation from Informed Choice for Amerika. Karen Langhart founded the organization after her daughter, Erika, died at the age of 24 from a double pulmonary embolism as a result of the NuvaRing. From then on, it became Karen’s life’s mission to catalyze research and communications that lead to informed contraceptive decisions for women. She didn’t want anyone else to lose their lives because they didn’t know the third generation progestin in NuvaRing is associated with a higher risk of blood clotting (between 3 and 12 women using combined hormonal contraception out of out of 10,000 will develop a serious blood clot, according to the NuvaRing website).

Body Literacy and Hormonal Contraception

So, how can you make an informed choice about contraception, both hormonal and non-hormonal? We always preface this section of our class by saying: our opinions do not belong in this space, and we are here to provide you with information so that you can make the best decision for your body, which you are the authority on.

We wrote about how body literacy is an important part of making an informed choice. Our recommended resources for menstrual cycle knowledge are listed on our website, but it’s a long list! A good place to start menstrual cycle 101 is Appleseed Fertility’s blog.

Know your rights. When you are speaking with your health care provider, you have the right to say no; the right to ask more questions because you have the right to informed consent; and the right to a second opinion. Depending on where you live and your personal, financial situation, a second opinion is not always available or accessible. If this is the case, know that you can always bring a patient advocate with you to an appointment, a trusted friend or support person who can help you advocate for yourself. Bring as much information with you to the appointment as possible. We will share some of our go-to resources for contraceptive information below. Also, request a long appointment time, so that you don’t feel rushed, and write down any questions you have.

Know why you want birth control. Ask yourself what’s important to you about contraception: STI protection, price, convenience, pregnancy prevention, inconspicuousness? Making what you want and need in contraception clear to yourself will help direct your choice. If you’re considering hormonal contraception for reasons other than contra-conceiving, like acne, decreased menstrual cramps or flow, be aware that hormonal contraception is not a treatment for these issues but a temporary relief. In Women’s Bodies, Women’s Wisdom, Christine Northrup compares taking hormonal contraception for these reasons to putting a piece of duct tape over the check engine light in your car and continuing to drive. There’s still a problem under the hood, but for the moment, you’re not aware of it. These issues can be indicative of hormonal imbalances, and treatment may be found in diet and lifestyle changes. This is one of our favorite questions to ask in order to make a fully informed choice: what are the alternatives to X option? In other words, if I’ve been on the pill for six years to decrease my acne, and I’ve just come off the pill and my acne is back, what are alternative treatments? Some of our favorite diet and lifestyle resources for hormonal balance and health are Nicole Jardim’s blog, Alisa Vitti’s Flo Living and Woman Code, Lara Briden’s blog and Period Repair Manual, other members of our health care team, including abdominal massage therapists, and of course the Hormones Matter blog! Also, if your cycle is irregular, hormonal contraception won’t regulate your natural cycle; instead, the synthetic hormones will induce an artificial one. An irregular cycle may signify hormonal imbalances, or it could just be your normal.

Research and ask for a comprehensive list of contraceptives. We use a combination of Scarleteen, Bedsider, Planned Parenthood, and ACOG to learn about contraceptive options prior to speaking with our health care providers. Once you’ve narrowed down your options, we also recommend looking at the pharmaceutical companies’ websites for more information. To facilitate an effective conversation with your health care provider, ask them three main questions about each option: what are the benefits, risks, and side effects?

Know your health history and your family’s history. Communicate this information to your provider. For example, does your family have a history of blood clotting disorders? Risks of combined hormonal contraceptives include blood clots.

Make sure you understand the instructions for how to use the contraceptive. Repeat what you understand back to the health care provider in order to verify your understanding.

Be sure to know what your insurance will and won’t cover. For example, some insurance companies will cover the insertion of the implant but will not cover the cost of the removal.

 

Real Risk Study: Birth Control and Blood Clots

Lucine Health Sciences and Hormones Matter are conducting research to investigate the relationship between hormonal birth control and blood clots. If you or a loved one have suffered from a blood clot while using hormonal birth control, please consider participating. We are also looking for participants who have been using hormonal birth control for at least one year and have NOT had a blood clot, as well as women who have NEVER used hormonal birth control. For more information or to participate, click here.

 

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It’s Time to Man Up on Birth Control

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Part I – Being There

I can’t think of another instance where men have so eagerly shirked their responsibility as with birth control. This is my first installment in what may become a recurring series addressing some of the ways men need to change their approach to reproductive discussions.

Women experiencing problems with hormonal birth control need advocates, not because of any inherent weakness, but because of the herculean resistance they’re likely to encounter from their doctor. Beyond migraines, strokes, or even cancer, birth control’s biggest danger may be overconfident doctors – those medically trained men and women who either don’t know about or refuse to acknowledge the robust science linking The Pill to devastating complications ranging from depression to death.

A Father Takes Charge

As a father, I know how much we long to protect our daughters from all pain and suffering. So I understood the distress and helplessness when my friend posted this on Facebook, “Sitting with my daughter who has been dealing with a migraine and blurry vision for several weeks…Asking for prayers. We all need relief. If you are not a praying person, eat a bacon cheeseburger and think good thoughts.”

Knowing him, I would have been really concerned if he found a way to include vegan atheists. As it was, my concern led me to message him immediately, “If your daughter is on any kind of hormonal birth control, have her stop right away!”

He thanked me, and said they were looking at that. Doctors had inserted a progesterone-only IUD three months earlier to help with her PCOS. She began experiencing the migraines about five weeks after the IUD was inserted.

They ended up admitting her to the hospital. My friend told me a couple of days later that the doctor, “who seems to be really on top of things,” decided her problems weren’t caused by the synthetic hormones at all. Instead, he gave her Topamax, the off-label cure-all (to be read with more than a hint of sarcasm), and sent her home. Oddly, the doctor didn’t offer an alternative suggestion as to what else might have caused the sudden, unrelenting bout of migraines.

One week later (still seeing no change in the brutal symptoms), my friend and his daughter returned to the ER, and he demanded they remove the IUD. The doctors complied and she began to feel better, although the improvement was gradual. As an interesting aside, it was daith piercing that ultimately provided instantaneous relief. Her father later told me, “The piercing took away her headaches, but I still have no doubt that the IUD caused them.”

Women Need Health Advocates

Fathers naturally advocate for their daughters, but in other relationships, we men forget that women sometimes need our advocacy. I’m not talking about limiting a woman’s reproductive rights, or taking away her voice. I’m talking about adding more voices to the choir. Too many men translate the women’s health movement as a complete abdication of responsibility. They are more than happy to allow women to bear the entire burden. I’m challenging men to be there when a woman in your life needs you to be.

We can easily carry the “it’s her body” mentality to a comfortable end, and remain completely disinterested. But, even the most fiercely independent woman may want to share with you her frustrating experience with a stubborn doctor who didn’t want to hear about her side effects. She may need encouragement to trust her instincts when she runs into what Barbara Seaman called the ‘don’t worry your pretty little head’ mentality.

You can also encourage her to empower other women by sharing her story. The Real Risk Study, currently being conducted by Lucine Health Services, would be another great way to expand the message. (Men, if you’ve lost a loved one, and suspect it might have been caused by hormonal contraceptives, I urge you to click here and share that story as well.)

Think Different

“To the crazy ones. Here’s to the misfits. The rebels. The troublemakers. The people who see the world differently.”

Apple Computer’s iconic ‘Think Different’ campaign reignited the brand with a salute to ‘the people crazy enough to think they could change the world.’ Outliers willing to fly in the face of conventional wisdom are especially rare in the overly dogmatic medical industry. However, a few courageous doctors are beginning to question Western medicine, and their numbers may be growing.

In my recent article on migraines, I linked to a document posted on the University of Virginia student health services website. Afterwards, I decided to track down Zach Bush M.D., the doctor who originally created that migraine warning 15 years ago. He told me that he created the document around the time the National Institutes of Health halted the women’s health initiative study on hormone replacement therapy because of safety concerns.

“I think the industry as well as practitioners were overwhelmed by the idea that maybe we were doing the same thing with birth control pills… We didn’t even have the first clue what the long term ramifications were of women being on birth control for 9, 10, 20 years. I think the long-term consequences are definitely going to be cancer and heart disease. The issue is it’s hard to measure those long-term consequences. Whereas with migraine and stroke, that risk factor is real within a year of use. So, in some ways, that was a much easier tackle”

Actually telling women about the risks they faced with hormonal contraceptives could very well have been Dr. Bush’s first venture outside the walls of the medical norm. He explained the typical thought process:

“I understand the fear of it. What doctor has not prescribed progesterone and literally told the woman, ‘This is the same hormone your body makes. Therefore, it’s completely safe, and there’s no reason you shouldn’t take it.’ That line comes out of a doctor’s mouth probably five times a minute in this country… The reality is we are not delivering these hormones like the body would deliver them, either in dose, delivery curves, or location. The small intestine is not where you want high progesterone levels, and these hormones in the wrong place can be just disastrous.”

I won’t split hairs because I’m ecstatic to find a medical professional willing to say these things. But since he didn’t point it out, I would like to add a reminder that this is a common fallacy. Synthetic hormones are not the same as your body’s natural hormones. The very fact that they are synthetic has disturbing consequences of their own.

Dr. Bush continued unpacking his thoughts on prescription hormones:

“There’s a huge misunderstanding among physicians about the hormones estrogen and progesterone. These are steroid hormones.

“We have a healthy respect for prednisone and Medrol dose packs and all these steroids that we are willing to call steroids… Doctors keep telling the patient, ‘These have really bad effects on your bones, your skin, your brain. These are damaging steroids, but the only reason we’re using them is a last ditch effort to help you out of your pain’ or whatever it is.’

“We could give exactly that same pitch for estrogen or progesterone because they are steroid hormones. “This is a female steroid hormone. I’m going to give it to you, but my gosh, it screws up your liver metabolism. It’s going to screw up the way you manage insulin. It’s going to affect the way cancer cells can grow. It’s going to screw up all kinds of things in your body, but we’re going to use it as a last ditch effort for your hot flashes or to prevent pregnancy until we find a better solution.” That way, at least the woman has an understanding of what she’s getting into.”

Shifting the Paradigm

Dr. Bush no longer resides on the faculty at the University of Virginia. The triple board certified practitioner also broke away from academia in the way he set up his practice. At his new facility in Charlottesville, they treat patients with a foundational approach to medicine – focusing on health and nutrition rather than illness and pharmacology. His break from traditional medicine (at least in the Western sense) is rooted in the belief that we are not born with a pharmaceutical deficiency. He explained:

“[Doctors] are definitely trained by the pharmaceutical industry these days. We have completely departed from any understanding of physiology outside of the pharmaceutical realm.

“When we designed women’s health, we did it from a complete disease management standpoint. At no point did we really ask what would be healthy for women. We started managing birth and pregnancy as disease, and that really hasn’t stopped. Probably most obviously, we turned a child into a surgical procedure with C-Sections. It’s just an unbelievably slippery slope that we hit from the 1960s on. Women got burdened with the brunt of the experimentation and disease management mentality, and I think they’ve really suffered enormously from a health standpoint.”

Bringing Outliers into the Fold

Dr. Bush frequently receives invitations to speak at medical gatherings around the country. At these conferences, he encounters numerous doctors from varied backgrounds who express discontent with the medical industry, and are receptive to his paradigm-shifting message.

We could be on the cusp of a major shift. If enough of these seeds of discontent catalyze a new breed of doctors willing to think different, it could lead to a groundswell of fresh new women’s health advocates on the other side of the stethoscope. For now, all we can do is pray – and maybe eat a bacon cheeseburger.

A Simple First Step

Woody Allen famously said, “Showing up is 80 percent of life.”

Women have been schlepping the entire reproductive burden for nearly six decades. Until and unless more doctors acknowledge the dangers of synthetic hormones as both contraceptives and hormone replacement therapy, men need to get off the La-Z-Boy and do more to pull their weight. I’m suggesting a pretty simple first step – be there.

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We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

Photo by Amanda Sixsmith on Unsplash.

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