December 2012 - Page 2 of 2

Over the Counter Birth Control Pills

Published on December 10, 2012

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Should birth control pills be available over the counter? In an unexpected and likely controversial position statement, the American College of Obstetrics and Gynecology (ACOG) announced its desire to see birth control pills sold over-the-counter (OTC). Stating that “oral contraceptives are very safe, and data show women can make these decisions for themselves.” Dr. Kavita Nanda who co-wrote ACOG’s paper, suggested that OTC birth control pills could reduce the rate unintended pregnancy significantly and save the nation $11 billion annually.

The bold move from prescription birth control pills to OTC is sure to remove barriers, provided the to-consumer pricing doesn’t skyrocket as is often the case when medications are sold OTC. Given the ongoing politicization of women’s reproductive health, returning the control of women’s health to women’s hands would be a laudable move and might even turn the volume down on current debates.

Imagine if birth control decisions were entirely personal and unhindered by political whims. Consider that greater access to birth control might be the key to reducing unintended or unwanted pregnancies. The availability of OTC birth control pills could be a very positive development for women’s health.

Are Oral Contraceptives Safe Enough to be OTC?

Unlike other over-the-counter medicines like ibuprofen that represent a single compound to be used for specific ailments – pain and inflammation – there are dozens of different birth control pills. Birth control pills are prescribed for an ever-increasing list of female ailments beyond simply preventing pregnancy. The question of whether birth control pills are safe must take into consideration the specific compound, dosage and woman. Some oral contraceptives have better safety profiles than others and some are quite dangerous (See Here).

Within the current market, determining which pill works best for which women, even in the doctor’s office, is a trial-and-error process. Much of the medication safety information is provided through the marketing channels of the product manufactures and–as has been reported here–those data are frequently biased and sometimes fraudulent. In that light, letting women self-select the appropriate birth control pill may be no worse than the current sub-optimal process.

Over-the-Counter Birth Control in Other Countries

In other countries where for-prescription regulations are not enforced, oral contraceptives and other medications may be purchased over the counter already. Numerous studies suggest women are capable of self-screening for the contraindications or risk factors associated oral contraceptives. This supports the argument that women can manage their own oral contraceptive use, at least for its intended purpose of preventing pregnancy. Whether women would continue to utilize oral contraceptives for the myriad of other conditions for which these pills are currently prescribed, remains unclear.

Though no data exists for oral contraceptive usage, ease of access to non-prescription medication shows a direct relationship to the use and abuse of prescription medications and mortality by overdose. That is, countries with strictly enforced prescription drug laws (the US, Canada) have higher prescription use rates and higher mortality from overdose with no concomitant decrease in morbidity or mortality by disease or really any overall improvement in health. These data suggest that as prescription requirements loosen, use of more potent medications decreases. In the case of oral contraceptives, it is possible that OTC access could reduce the current trend of utilizing oral contraceptives as the magic pill that treats all reproductive disorders. This could be good thing for women, but it may not be a good thing for industry.

The Economics of Birth Control

Social and political benefits aside, women’s reproductive health is a market. Unlike other markets affected negatively by the economic downturn, the birth control market appears untouched, even bolstered. Sales of oral contraceptives are expected to reach $17.2 billion worldwide within the next few years. As one of the most commonly (over)prescribed medications in women’s health, oral contraceptives are used as a first line of treatment for a range of conditions unrelated to birth control. One has to wonder why the organization that controls access to this medication in the US would want to lose such a lucrative cash cow.

For millions of healthy women, the annual exam to renew one’s birth control prescription is the only reason to visit a physician. For the millions of other women with endometriosis, PCOS, PMS, and a host of other common conditions, oral contraceptives remain the first and sometimes only line of treatment. Selling oral contraceptives OTC would effectively remove those business segments from the gynecologist’s bottom line. When combined with other market segment encroachments on the business of obstetrics and gynecology (midwifery for healthy birth and maternal-fetal medicine for complicated birth), from a purely economic and albeit cynical standpoint, it is perplexing that that this organization would give away the largest remaining revenue stream of its members.

The economic drivers from the pharmaceutical industry’s perspective are no less perplexing. If priced correctly, over the counter oral contraceptives could increase sales–especially to lower income women who were previously locked out of the market by lack of insurance or access to healthcare providers. However, OTC access might also reduce the growing percentage of ‘off-label’ uses. For an industry unaccustomed to R&D in this sector, (why develop specialized therapeutics for the array of women’s health conditions, when birth control pills can be prescribed for all), the move to OTC could have serious financial ramifications.

There must an economic upside for these organizations, but for the life of me, I cannot figure it out.

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.

Reflections on Becoming a Woman

by Jordan Davidson

Published on December 7, 2012

2469 views

Endometriosis Symptoms began with Menstruation

I remember that day perfectly. I was eleven, in the sixth grade, 4’8 with brown frizzy hair – in the midst of that awkward transition from girl to woman. It was the first time that my Dad had taken me to the doctor (the pediatrician to be exact). My dad – a sympathetic and caring man – quite naturally hated seeing his daughter in so much unsubstantiated pain. Usually both he and my mother would accompany me to the doctor, but today that responsibility was left solely to him. As we sat in the examination room, him in a plastic chair and me on the examination table – feet dangling off the side, I remember hoping not for an answer but for validation, validation that my pain was real.

When I was ten I started getting these mysterious ‘stomach aches’ they’d come and go and with each one I’d go to the nurse and the nurse would tell me I had to stop avoiding recess, or gym, or whatever activity I decided to skip that day. To be somewhat fair, I would usually go to the nurse during gym. My doctor sent to the gastroenterologist several times, with no luck. The gastroenterologist suggested that maybe I was lactose intolerant and that I should take lactaid. No tests were ever run – I was told; “take lactaid and if it helps, your problem is solved.” My problem wasn’t solved but I still took the lactaid hoping that eventually it would work.

So there I was – at the doctor, missing yet another day of school, with my Dad in his suit, missing yet another hour of work. The door opened and in walked my pediatrician, disapprovingly muttering my name at the sight of me yet again, in her office. We went through the steps, her feelings my abdomen, asking me about my eating and bathroom habits, the works… Except this time she seemed more exasperated than usual “Jordan” she said emphatically “You are like the little girl who cried wolf, there is no reason for you to be in this much pain. If you keep ‘crying wolf’ one day you might actually be very sick and no one will believe you. Don’t make me send you for a sonogram!”

How I wish I wasn’t 11 years old at the time and absolutely petrified of a sonogram; which I assumed to be some gigantic needle that would be placed through my forehead or some other awful place. Needless to say, I never got that sonogram until about a year later, when I rushed into emergency surgery for a problem that a sonogram could have picked up a year earlier.

Endometriosis

The average endometriosis diagnosis takes 7 years; fortunately, mine only took 2 ½. The day I found out I needed surgery I had an appointment with an endocrinologist to discuss why I was so short. I was born with a Ventral Septal Defect (VSD) – a hole in my heart- which took longer to close than expected. For some reason, unbeknownst to my doctors, I failed to thrive as a child. I was mentally advanced but physically I was in the 1st and 3rd percentiles respectively for height and weight. I was very small.

I had gotten my period for the first time 6 months prior to that appointment. My period would come every 7 days and last for about 11 days. When I did have my period, I would be incapacitated for the first several days, writhing in pain, unable to move from fetal position. My doctor told me “Welcome to being a woman, you must have a very low pain tolerance; it should get better within a year.” Well, it didn’t. So there, at the endocrinologist, I laid on the examination table, curled up in more pain than usual. I was sweating and barely coherent. My mom stood there wiping my forehead with a cold paper towel. The doctor walked in took one look at me and her face contorted with horror. “What’s wrong” she exclaimed as she made her way over to examine me. As she made her way towards me I jumped up and ran across the room, barely making it to throw up in the sink. My mom followed after me; “she has her period” she nonchalantly conveyed to the doctor, since this had become the normal routine in my house. My doctor took another look at me, shook her head at the insistence that I had been lead to believe this much pain was normal and called for an orderly to escort me to the emergency room.

Uterine Didelphys: Two Uteri

Less than three hours and one morphine shot later, I was being prepped for surgery. Turns out my periods were so out of sync because I have uterine didelphys – two uteri (aka the plural of uterus). One of my uteri, was blocked and so when I would get my period, the blood wouldn’t drain, rather it would collect in my uterus. Every time I got my period my uterus would contract and try to push out the 6 months worth of blood that had collected in my uterus – to hold all of this blood and uterine matter my uterus had filled to what was analogized as the equivalent of being 3 months pregnant. They removed the blockage and told me that was it, the pain would be over.

Except the pain wasn’t over and six months later, I was back in the hospital for exploratory surgery to try and find the cause of my pain. After an hour long procedure, it was discovered that I had mild endometriosis. My surgeon told me they removed all of the endometriosis and that was it, the pain would be over.

Except, the pain wasn’t over and still isn’t. There is no cure for endometriosis. While surgery has alleviated some of my pain, it has not cured the disease. I am 21 now; I have had 5 surgeries for what is now stage IV, recto-vaginal endometriosis that is working its way up towards my liver. Altogether I have had 15 surgeries – 9 for my eyes and one to remove a cyst unrelated to my endometriosis. I know pain better than I know my best friend but not once have I let pain get in the way of my life. I went to prom with a 103 degree fever, half delirious from morphine, with my clutch overly stuffed with pads and tampons. In addition to my endometriosis, I have a lot of auto-immune and digestive issues. I am highly sensitive to yeast, I have thyroid disease, glaucoma, and I suffer from migraines.

I have a secret though, a secret for dealing with my pain. Even though on paper, I might not be healthy; I live my life as if I were healthy. I decided that I wasn’t going to let myself (or rather my body) stop me from doing the things I love to do. Some days that is harder than others but it is all about positive thinking and motivation. Your body is your temple; you need to take care of it. I am a vegetarian, I do yoga and I try to love my body, even when it doesn’t love me back. My rough road to womanhood has taught me strength and has given me the ability to stand up for myself and what I know to be right; and for that I am thankful.

Eating and Endometriosis: My Story

by Angela Wice

Published on December 6, 2012

5387 views

I have suffered from endometriosis for as long as I can remember. I am sharing my story so that others may learn from my experiences, and be encouraged to share their own. By sharing our stories, our voices can make a difference in the lives of other women struggling with hormonal issues.

This is my story about food, an eating disorder and my battle with endometriosis.

For as long as I can remember, food has always been a big part of my life–and often a challenging part. When I was a baby, I started to have severe reflux from infant formula and Pablum, a precooked infant food made from wheat, oats and corn. Was my reaction an early indicator of a food intolerance?

I remember the food we ate growing up because it was the same thing every week. Chicken sprinkled with salt, pepper and garlic powder or meatloaf with mashed potatoes some green string beans. Another day we’d have spaghetti with ground beef or hamburgers with brown beans and a nice glass of cold milk. I would always have seconds. On rarer occasions, we would have cabbage rolls, liver, chef Boyardee ravioli, Kraft Macaroni and cheese or Campbell’s Tomato soup with grilled cheese.

For breakfast we would have corn flakes, rice puffs or toast with cinnamon spread. I remember having Jell-O, candy and popcorn but for the most part we ate healthier than other families.

When I was in middle school I would get home starving and would heat up some ravioli or whatever was on hand. Most of the time I would be too full to eat dinner, but I would still have to eat.

In High school for the most part I didn’t eat. I would be in a hurry to catch the bus so I wouldn’t eat breakfast or bring a lunch because I had to make it. By the time I got home I would eat Kraft dinner then go back out. I weighted only around 100-110 lbs. I was a very active teenager, and sometimes forgot to eat. If I was on my period, I lost my appetite for a week and if I did have a bowel movement the pains were so intense.

I started to have a love/hate relationship with food.

After high school, I continued to struggle with my eating patterns. I had a friend who kept saying she was fat and she was a size 0. I have never been a size 0 and all I could think was ” if she is fat then what am I?”

I began to starve myself. Living in a constant state of hunger went on for around 7 years and then turned to binging and purging, the classic cycle of bulimia. I continued to purge up until 2009 when I realized that I needed to stop. I was able to stop purging, but I continued to binge. It was a vicious cycle.

I was also in pain from the Endometriosis rectally. I had generalized pelvic pain as well. I remember being nauseated and seeing stars all the time as well as blacking out.

In 2002 I became pregnant and started to eat 3 times a day while gaining over 70lbs but I wanted to make sure she was healthy and after I gave birth to my daughter I wanted to make sure she ate the best food possible. I became interested in avoiding processed foods for myself and my baby. When my daughter was 6 months old, I started making homemade pureed foods such as spinach, peas, carrots, applesauce and sweet potatoes.

My friend was a vegetarian and she introduced me to a whole new way of eating. She made me see how important food is encouraged me to focus on healthier foods like fish and quinoa.

My focus on eating whole foods changed my life.

I eventually decided to experiment with going gluten-free. I was on and off for so many years because it was really hard for me to do. In Nov 2010 I saw a naturopathic doctor who told me I had food intolerances to Wheat, Spelt and Dairy and that I was not fully absorbing any nutrients vitamins or minerals. She also said that I had Candida in my large and small bowel. She put me on a Gluten free and dairy free diet as well as many supplements. I succeeded in following the diet for 3 months then was put on Amitriptyline for the Endometriosis. The make me crave every single bad food out there. I felt really upset that I didn’t have the willpower to walk away. My cravings grew in intensity.

Even just eliminating gluten for 3 months, the Chronic Dermatitis on my toes went away for the first time in 3yrs and has not returned. Also all of my painful perineum fissures went away for awhile. Unfortunately they have since returned.

I have now embarked on a new Journey that started Nov 1^st 2012 and I have been gluten and dairy free. I plan on continuing and not giving up. I mentally feel better but I still struggle with stomach pain.

There is so much confusion and conflicting information about diets to follow. It is difficult to learn what is actually best for my body.

I know that I experience positive changes when I maintain awareness of how foods affect my digestion and mood.

I am devoted to continuing to learn which foods to avoid and to nourish my body to alleviate my endometriosis symptoms.

What affects have eating and dietary changes had on your endometriosis symptoms? Share your story.

To read more about my struggles with endometriosis, click here.

Nevada Receives F in Women’s Health and Reproductive Rights

by Chandler Marrs, PhD

Published on December 4, 2012

1594 views

According to the Population Institute’s 2012 Report Card on Reproductive Health and Rights, Nevada, my current home state, received a failing grade. That’s right, the state that depends upon women for its thriving tourist industry does nothing to care for those women while they are here.

Nevada was only one of nine states receiving the F in women’s health.

The most striking statistic:Nevada spent only $44,000 on family planning clinics for low income women in 2010. That equals about $0.08 per woman. Way to go Nevada!

To learn how your state ranks: The Population Institute 2012 Report Card on Reproductive Health and Rights.

Vitamin D3 and Lupus

by Susan Rex Ryan

Published on December 4, 2012

3415 views

The untimely death of 23-year-old Sasha McHale, daughter of professional basketball’s Hall of Famer Kevin McHale, recently shocked the world.

Sasha inherited her father’s athleticism, energy, enthusiasm for life, and love of the northern U.S. state of Minnesota. An insidious disease called lupus prematurely snatched Sasha from her family, friends, and life.

Lupus is a chronic autoimmune disease that attacks the body’s cells, tissues, and organs, and results in severe inflammation, fatigue, and, in some cases, death. The medical name for the most common form of the lupus is “systemic lupus erythematosus” (SLE). According to the Lupus Foundation of America, about 1.5 million Americans, and over five million people globally, suffer from a form of lupus. Ninety percent of persons diagnosed with the disease are women, many of whom are in their child-bearing years.

Mounting evidence suggests adequate vitamin D3 in the body may protect against the development of autoimmune diseases including lupus. Genetic and environmental factors including vitamin D3 deficiency have been linked to lupus. Sensitivity to sunlight, the primary source of vitamin D3, is common among SLE patients. Scientific research indicates a high prevalence of vitamin D3 deficiency among people suffering SLE:

Researchers at the University of Toronto Lupus Clinic studied 124 female SLE patients to understand, inter alia, their circulating vitamin D3 levels. Eighty-four percent of the women had vitamin D3 blood serum levels less than a sub-optimal reading of 32 ng/mL.

The Medical University of South Carolina conducted a study of vitamin D3 blood serum levels of 123 individuals who had been recently diagnosed with SLE. The findings suggested vitamin D3 deficiency as a possible risk factor for SLE.

Researchers studied 25 Canadian women diagnosed with SLE and found that over half of these patients had less than 20 ng/mL of vitamin D3 circulating in their blood. The research also suggested that hydroxychloroquine (HCQ), a drug used to treat SLE, may inhibit vitamin D3 production.

A study published in a 2012 edition of the journal Dermato-Endocrinology not only documented the prevalence of low vitamin D3 in SLE patients but recommended oral vitamin D3 supplementation for SLE patients. The researchers lauded the safety, low cost, and wide availability of vitamin D3 supplements as well as their potential effectiveness against SLE progression.

Maintaining adequate vitamin D3 levels may forestall the development of autoimmune diseases including lupus. In addition, vitamin D3’s capability to reduce inflammation may alleviate lupus symptoms. Further research is required to confirm the extent of vitamin D3’s connection with lupus.

December 2012 - Page 2

Are Oral Contraceptives Safe Enough to be OTC?

Over-the-Counter Birth Control in Other Countries

The Economics of Birth Control

Real Risk Study: Birth Control and Blood Clots

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