Mike Gaskins

Mike works as a writer/producer in all forms of media.
His new book, In the Name of The Pill, examines the powerful forces that gave us birth control before it was proven safe, exposes the deceptive tactics used to keep us in the dark, and explores the numerous chronic and deadly ways women’s health has been sacrificed In the Name of The Pill.

Birth Control’s Breast Cancer Curveball

2336 views

Hormonal birth control is bad. It just is.

I know there are women who say they took it for decades and it didn’t do any harm to their bodies. It’s possible that’s true for a very small percentage of women. Maybe it didn’t cause any noticeable harm, but I can guarantee it didn’t do anything good for their bodies.

Some new studies have convinced me that you can simply never let hormonal birth control off the hook when it comes to assessing its side effects.

Basics of Breast Cancer

The link between hormonal birth control and breast cancer has been pretty well established over the past few decades. A quick look at the types of breast cancer and a pinch of common sense help us grasp a better understanding of their association.

When a patient is first diagnosed with breast cancer, doctors test for three primary receptors within the tumor to help them identify it. Two of the three receptors are closely related to hormonal contraceptives. The most prolific type of breast cancer contains estrogen receptors (ER-positive). Nearly 80% of breast cancers are ER-positive. The presence of these receptors in a tumor indicates that it will grow more quickly in the presence of estrogens.

The high percentage of ER-positive tumors provides a stark reminder of the warning issued by Dr. Roy Hertz at the Nelson Pill Hearings in 1970:

“[Estrogens] are to breast cancer what fertilizer is to the wheat crop.”

No Safer Birth Control

You might think the safer solution would be to switch to progestin-only birth control. Unfortunately, about 65% of breast cancers contain progesterone receptors (PR-positive). Tumors containing one or both of these two receptors are known as hormone-receptor positive.

Knowing the tumor contains hormone-receptors helps the doctors create a plan of attack. For example, after the initial treatment, doctors will frequently prescribe a drug like tamoxifen to block hormone-receptors and hopefully prevent future metastasis.

The third of the three principle receptors in breast cancer isn’t as easily connected to hormonal birth control. About 20% of breast cancers test positive for human epidermal growth factor receptor 2, commonly called HER2. This protein receptor normally helps control breast cell growth, but when too much of it is produced, it paves the way for an aggressive tumor type.

Triple Negative

Tumors that test negative for all three receptors are known as triple negative breast cancer. This type makes up only about 10-15% of breast cancer cases, but it can be particularly aggressive and prone to relapse. It is also much more likely to metastasize, usually to the lungs and/or brain, and especially in younger women.

Because triple negative tumors test negative for hormone-receptors, doctors have always assumed drugs like tamoxifen would offer no benefit to these patients. But, that’s where things start to get interesting.

Birth Control and Brain Metastasis

A recent study from the University of Colorado Cancer Center stepped outside the box (or in this case, outside the cell) to study the condition of the tissues that surround and support the cancer. Diana Cittelly, PhD, an investigator from the study, offered this explanation, “The cancer cells aren’t responsive to estrogen, but estrogen influences the microenvironment. We found that astrocytes – one of the main components of the microenvironment in the brain – are estrogen-responsive. When they are stimulated with estrogen, they produce chemokines, growth factors, and other things that promote brain metastasis.”

Specifically, they found that estrogen induced the astrocytes to produce two growth factors: brain-derived neurotrophic factor (BDNF) and Epidermal Growth Factor (EGF). These two factors ‘turn on genetic migration/invasion switches in cancer cells,’ making the environment more conducive to metastasis.

Cittelly speculated, “This may explain why breast cancers diagnosed in younger women are more likely to metastasize to the brain – pre-menopausal women have more estrogen, and it may be influencing the microenvironment of the brain in ways that aid cancer,”

While the team didn’t specifically study the effects of birth control hormones, it doesn’t require too much of a leap to carry the speculation a bit further and consider that the flood of estrogens from contraceptives could also contribute to the higher likelihood of metastasis to the brain for women in their reproductive years.

It’s also interesting to note that EGF, Epidermal Growth Factor, a protein that is believed to play a role in how cells normally grow is the same protein that binds with HER2 as one of its receptors.

Surprised, Not Surprised

While we can’t fully understand the interaction of hormonal birth control with EGF and HER2, it would be hard to deny something bad is happening. In fact, the more we learn the harder it is to deny that something bad is going on pretty much anytime it comes to birth control and breast cancer.

In 2015, Breast Cancer Research published a large cohort study, which analyzed pooled data from 54 studies in the African American Breast Cancer Epidemiology and Risk Consortium. Not surprisingly, they found that both recent use and a long duration of hormonal contraceptive (OC) use were associated with an increased risk of breast cancer. They observed increased risks for up to 15 years or more after the women stopped taking OCs.

They compared three types of tumors: ER-positive, ER-negative, and triple negative, and all three demonstrated increased risks. Now, here’s the surprising part. The highest odds were associated with triple negative (TN) tumors. They reported, “Women who had used OCs in the past 5 years were estimated to have a 78% increased risk of TN breast cancer and those who had used OCs for at least 15 years had a 62% increase.”

By comparison, the increased risks related to OC use within the previous 5 years were 46% for ER-positive, and 57% for ER-negative versus non-users. Put another way, the one type of breast cancer that has been most closely linked to birth control because of its obvious estrogen dependence could ultimately pale in comparison to the increases caused in cancer types for which birth control had previously been given a pass.

Continuing Side Effects

Studies like these are what make me uncomfortable when a woman tells me how long she took The Pill and never experienced any side effects. It disturbs me because I fear she is almost certainly singing victory too soon.

As Dr. Victor Wynn warned at the Nelson Pill Hearings, all human carcinogens are latent, and it could take 10 to 20 years of patient history to determine the cancer impact.

And now, with this new curveball, we can’t even rule out its effect on tumors that test negative for hormone receptors.

Read more about birth control’s vast problems in my new book, In the Name of The Pill.

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.

This article was published originally on June 10, 2019. 

Share

Can Birth Control Lead to Infertility?

2052 views

I vividly recall the most unexpected reaction I got when I told a friend that we were pregnant with our daughter. He asked me not to mention it in front of his wife. He explained that she was in the midst of an emotional crisis. Their attempts to conceive had been unsuccessful, and the doctors suspected she had fertility issues.

As he shared more about their ordeal, he said that they wondered if her years on birth control could have had anything to do with it. I agreed that that seemed like a logical possibility. (This was a decade ago, long before I cared one way or the other about The Pill). We discussed how odd it would be, if birth control could cause fertility issues, that we had never heard anything about it. And, like so many ‘common sense’ questions about hormonal birth control, we shrugged it off.

Fertility Fatigue

That conversation faded into the recesses of my mind until I produced a medical conference a few years later. The conference focused on several inflammatory diseases. I noticed a trend in how carefully the presenters handled the subject of prescribing prednisone, a synthetic corticosteroid. Anytime it was recommended as a treatment, the presenter always included the typical disclaimers – ‘go with the lowest dose possible,’ ‘minimize the duration,’ and ‘taper the patient off the drug’… I was familiar with adrenal fatigue and understood their motivation.

Even low doses of prednisone can upset the body’s delicate endocrine system. Our body responds to the influx of those synthetic steroids by reducing the production of cortisol and other adrenal hormones. Extended use of the drug or sudden cessation can cause an adrenal crisis, and, in some cases, the damage is permanent.

As I contemplated how this flood of synthetic hormones overrides the production of natural hormones, I recalled the previous conversation with my friend. Over the next few days, I struck up conversations with a number of doctors attending the conference. I told them I was curious about the frequent mention of prednisone and how the presenters were clearly concerned about preventing adrenal fatigue. Then, I drew a parallel and asked a simple question, “Should we have the same concern about how the synthetic hormones in birth control may be affecting the production of those hormones?”

Each doctor had virtually the same response. First, a perplexed look crossed their face. Then, they admitted, “That’s a good question. I never really thought about it.”

Delayed Fertility

That’s a fitting response because doctors generally don’t think about it. As side effects go, delayed fertility and even infertility rank low on the totem pole of consequences tied to hormonal birth control. Certainly, doctors are not going to give it the attention they might give other iatrogenic conditions linked to birth control, like breast cancer or strokes. However, the problem isn’t that infertility has been neglected or underestimated so much as it’s been completely dismissed.

Our cultural paradigm tells women that planning their family is as easy as 1-2-3.

Step 1: Take The Pill until you’re ready for kids.

Step 2: Stop taking The Pill.

Step 3: Start your family.

But, it isn’t always that easy. Since doctors are unaware of the connection, they frequently assure patients that their birth control couldn’t have caused infertility. A persistent patient might turn to Google, but those results are just as confusing. One top hit says, “There’s no evidence that long-term use of the birth control pill interferes with fertility,” while another states, “It can take a few extra months to start menstrual cycles…” but confidently adds that “birth control doesn’t hurt your chances of having a baby in the future.”

As Old as The Pill

When I began researching birth control in earnest, my focus was on autoimmune disease, but it didn’t take long to discover that infertility was actually one of the original concerns about The Pill. In fact, Barbara Seaman devoted an entire chapter to it in her famous book, The Doctors’ Case Against The Pill.

She wrote:

It is no longer just a vague worry but an established fact that a certain number of women simply do not start having their periods again after they stop taking the pill. Others have irregular or scanty periods. In either case, they may find that they cannot conceive. They are sterile.

She introduced readers to Dr. M. James Whitelaw, a fertility expert who fought through bitter attacks from some in the medical community to publish a report on a phenomenon he called “oversuppression syndrome” in The Journal of the American Medical Association (JAMA) in February 1966. After its publication, one well-known doctor responded, “Now, Dr. Whitelaw is regarded as a prophet. We all admire his courage and persistence in smoking this thing out.”

When the Nelson Pill Hearings rolled around in 1970, Congress called on Dr. Whitelaw to testify. He explained “oversuppression syndrome” in layman terms, “Any part of the body which is not used, or little used, over a protracted period of time leads to so-called ‘disuse atrophy.’” In this case, the atrophy occurs in the lining of the uterus, and Dr. Whitelaw estimated that it contributed to a 10-percent increase in the rate of infertility.

Dr. Roy Hertz, an FDA advisor, subsequently testified that the introduction of hormonal birth control also disturbed the balance of microscopic activity in the endometrium. These structural and functional abnormalities sometimes lead to cancer of the endometrium, but they also contribute to an atrophy of the endometrium that sometimes leads to permanent infertility.

Recent history hasn’t given us many studies that examine the link between hormonal contraceptives and infertility. However, a 1997 study came to the rather dubious conclusion that, “The return of fertility for women who discontinue oral contraceptives takes longer as compared with women who discontinue other methods of contraception.”

Modern research may have dropped the ball on “oversuppression syndrome,” but it has uncovered some other serious fertility-related concerns.

The Pill: It’s Not Just for Women Anymore

In 1993, Scottish and Danish researchers published a report in the British Medical Journal, The Lancet, with the headline-grabbing announcement that we now live in a “Sea of Estrogens.” They claimed that synthetic chemicals in the environment were mimicking estrogen, which was having a deleterious affect on male fetuses in the womb. They pointed to environmental pollutants like PCBs, detergents, dioxins, soy, and oral contraceptives. The media mostly reported on the other chemicals while downplaying The Pill, despite its being such a prolific and potent synthetic chemical designed specifically for the purpose of mimicking natural estrogen in the body.

The very next year environmental scientists, led by John Sumpter, announced that male fish in 28 rivers across Britain were being ‘feminized’ by pollutants. The Independent reported:

Professor Sumpter is studying fish because their reproductive systems have much in common with humans. Fish and men, for example, both have two testes – the sperm-producing organs – and anything that can disrupt semen-making in fish is likely to have a similar impact on men.

The article stated that the Department of the Environment, which funded the research, told scientists not to reveal the names of the affected rivers for fear of causing panic. I can only surmise that the desire to prevent panic must also explain how this dubious statement made it into the article, “The contraceptive pill is not thought to be responsible for the oestrogens in sewage effluent because women excrete its hormones in a biologically inactive form that has no effect on fish.”

Environmental Pollutants

However, in 2002, Susan Jobling of Brunel University focused the attention squarely on hormonal birth control. Her team demonstrated that fish populations crashed in relation to sewage plant discharges along tributaries feeding the Thames River. And, Jobling wasn’t shy about connecting the dots to make this a human problem as well. She stressed that human sperm counts had fallen by half, in the time since women had started taking birth control.

Charles Tyler, a member of her team from Exeter University, added:

Synthetic oestrogen, ethanol oestradiol, is exquisitely potent at very, very low concentrations, between 50 and 100 times as potent as natural oestrogen. The level at which we can measure the effects in fish are below the levels which we can detect the chemical in drinking water, so we cannot be sure that some of these compounds, even at very low concentrations, are not getting into our drinking water.

Based on their research, the European Union classified hormonal contraceptives as environmental pollutants, and the European Parliament proposed action that would require municipalities to upgrade existing sewage systems to remove these microbial pollutants. However, when the discussion turned to having pharmaceutical companies foot the bill, the powerful Big Pharma lobbying group went to work to have the proposal dismissed.

Equal Opportunity Infertility

The Brits were the first to discover this troubling phenomenon. However, this clearly isn’t just a European problem.

Consider this. Eighteen million women in the U.S. take some form of hormonal contraceptive each day. Ethinyl estradiol, the synthetic hormone used in these drugs, has a biological activity about 100 times that of our natural hormones. In order to effectively prevent pregnancy, these molecules must resist degradation in stomach acid and pass through the body virtually unchanged. Consequently, eighteen million women flush these powerful chemicals into our sewers every day… now that’s a sea of estrogens!

In 2007, Canadian researchers completed a seven-year study in which they simulated the affects of all this hormonal flushing. They calculated the amount of ethinyl estradiol that women in a small city would pass through the sewage plants, and released that amount into an isolated test lake on a daily basis. It resulted in the “near extinction” of the fathead minnow population due to the feminization and transgendering of male fish. And, the consequences had started their ascent up the food chain in a measurable way, specifically in the feminization of mink frogs and green frogs.

In 2006, the United States Geological Survey conducted tests on smallmouth bass here at home, in the Shenandoah and Monocacy Rivers, and found that more than 80-percent of all the male bass living in these waterways were growing eggs.

The Estrogen Is Potent, But We’re Inactive

Over a decade has passed since the litany of alarming reports, warnings, and predictions began to flow. So, what have we done about it?

Well, in 2012, Tim Worstall, a contributor to Forbes, suggested women taking hormonal birth control should pay a $1,500-per-year tax to support the upgrade and maintenance of sewage plants to remove the harmful pollutants from our waterways.

That’s it… That’s the extent of our progress on this very frightening situation – an occasional opinion on who should pay for sewage plant upgrades.

Meanwhile, the headlines from 2017 give us a sense of how far up the food chain the consequences have climbed. The worrisome news began in June, after the CDC released birth rate statistics. The Washington Post blasted this headline, The U.S. fertility rate just hit a historic low. Why some demographers are freaking out.”

By mid-summer, headlines in The Mirror and the New York Times told us, Sperm Counts in Western Men Have Dropped Over 50 Percent Since 1973.”

And, as I’m writing this (September 12), Newsweek just posted this story, Male Fertility Crisis in U.S. Has Experts Baffled.”

Maybe this is the year we will take notice. More importantly, maybe this is the year we will do something about it!

Oh, and the next time a friend wonders out loud whether birth control could have contributed to their infertility, the short answer is YES.

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. 

 

This article was published originally on September 18, 2017. 

Share

Proof, Pudding, and Depo Birth Control

2468 views

In general, I try to avoid concentrating on a single type of hormonal birth control when discussing layers of rot among contraceptives. I never want to create the impression that another method might be safe by comparison. The degree of safety (or lack thereof) is not universal. A low-dose combination Pill that may be ‘relatively safe’ for most women could cause blood clots and kill another woman because each woman’s body chemistry is as unique as she is. See what I mean – I hate to even use the term ‘relatively safe’ because the risks are still so great I would never want my daughters taking even the low-dose formulations.

Now that you know where I stand, I do want to focus on one product that seems to be particularly egregious. Our recent citizens’ petition to the FDA asked for stronger black box warnings on all hormonal birth control, but also singled out the injectable birth control which I will refer to generically as Depo, with a request that it be removed from the market “based on conclusive evidence that it facilitates the transmission of HIV from men to women”.

When Birth Control Hits the Point of No Return

Facilitating the transmission of HIV sounds like a pretty good reason to remove a drug from the market, but several other problems differentiate Depo from other forms of hormonal birth control. As I began to study these differences a little more closely, it led me to question what it would take for doctors to hit a point of no return in their love affair with birth control. Surely, if they encountered a single type of birth control that posed clear risks over-and-above other available methods, they would be able to admit its flaws, right? Welp, the proof is in the pudding.

Think of it this way, you’re a doctor watching Breaking Bad (Spoiler Alert Warning – if you still haven’t had time to watch it, you should really hire an assistant). Let’s say Walter White is Birth Control. At first, you really like him. You know he’s a good person and he has good intentions. As bad things happen to Walt and he begins to make some dubious decisions, you give him the benefit of the doubt. Even when doctors see a tragic side effect in one of their patients, they’ve been told it’s rare and that’s what they want to believe.

Then, evidence starts to mount. Birth Control (and Walt) slide further down that slippery slope. By the time Walt watches Jesse’s girlfriend choke to death on her own vomit, you finally realize he might be irredeemable.

Unfortunately, there doesn’t seem to be a point where doctors can admit even a single birth control product may be irredeemable.

Irredeemable Qualities of Depo

The top of the Depo information pamphlet contains a warning in big, bold letters surrounded by a box. In other words, they’ve manipulated the text in virtually every possible way to get you to pay attention to these words:

WARNING: LOSS OF BONE MINERAL DENSITY

The warning goes on to explain that your bone loss will be greater the longer you take the product and these changes may not be reversible. It reinforces these concerns by stating that Depo should not be used as a long-term birth control solution. It even goes so far as to say it shouldn’t be used longer than two years.

That seems pretty clear and absolute.

However, Depo support groups and online forums are full of women who have been taking Depo for 10 years or more. One woman in a recent thread said she expressed concern to her doctor because she had heard that she shouldn’t be on it longer than two years. He told her, “That isn’t really true.”

It is either ignorant, negligent, or grossly incompetent for a doctor to give a patient Depo for 10 years, but to shrug off a patient’s concern while denying a side effect so clearly stated in the literature is borderline criminal.

Here’s the kicker – many of the women who still take Depo after several years continue taking it because they’re afraid of the withdrawals. Women who stop taking Depo frequently experience severe withdrawals unlike anything seen with other forms of hormonal contraceptives. Symptoms include nausea, dizziness, headaches, painful breasts, flu-like symptoms, trouble sleeping, and fatigue.

But, let’s not overlook the common side effect that happens when you receive the shot – unexplained weight gain. I suppose if there is a positive to be found in any of these side effects, it’s that many women avoid Depo because they’ve heard about the weight gain. In fact, 1 out of every 4 women who get the shot gain 5 percent or more of their starting weight. A study of more than 700 women found that women getting the Depo shot gained an average of 11 pounds over three years with a 3 percent increase in body fat. Researchers aren’t sure what’s causing this weight gain but believe the high dose of progestogen could be lowering the body’s metabolism and causing more fat to be stored.

Neither Candy Nor Supplement

I used to always say that doctors hand out birth control like candy, but it’s worse than that. They hand it out like it’s a supplement. They tell women that it’s a hormone just like their body is already making. It isn’t. That’s why I love the quote from Dr. Hugh Davis at the Nelson Pill Hearings:

“To think of them as natural is comforting but quite false.”

When you stumble across a product like Depo and see that the doctors’ behavior doesn’t change, it becomes harder to believe they are oblivious to the dangers they are promulgating. Their cavalier attitude toward these potent drugs and the damage they are doing should spark outrage in us all.

I would like to conclude by sharing the story that sparked my outrage and inspired this article. I was contacted by a young woman who asked me not to use her real name. She is a medical professional and doesn’t want to jeopardize her career. I will call her Amber.

A Bad Experience with Depo

Amber gave birth to a daughter in March. After the delivery, she was experiencing high blood pressure that landed her in the ER on three different occasions. The ER doctor on the third visit told her he thought she was dealing with postpartum depression and said he was going to give her progesterone to balance out all the lingering estrogen from her pregnancy. He advised her to go see her regular doctor the next day about her high blood pressure.

She didn’t think too much about the shot he gave her until she looked over her discharge papers and was shocked to see he had given her the Depo shot. The next morning she visited her doctor and he gave her blood pressure medication. By that evening, her symptoms had changed. She experienced heart palpitations and flutters. Her anxiety was out of control, and her heart rate was in the 160s.

Paramedics rushed her to the hospital and she was admitted to the cardiac unit. They performed an ultrasound and she was tentatively diagnosed with Postural Tachycardia Syndrome (POTS) – one day after receiving the shot.

Over the following months, she developed more symptoms. There was pressure on her optic nerve. Her thyroid was out of control. The doctors said they couldn’t even be sure whether she needed medication for a hyper- or hypo- active thyroid. They did an ultrasound and discovered two nodules on her thyroid that weren’t there when the previous ultrasound had been done. In 90 days, she had developed two nodules!

She contacted the drug manufacturer and asked them if they could provide information about side effects that have been reported with this drug (remember, she is a medical professional). She was stunned but not terribly surprised when the report she received back stated that they had received spontaneous reports of several side effects not mentioned in any literature, including atrial tachycardia, postural orthostatic tachycardia syndrome (POTS), autoimmune thyroiditis, hyperparathyroidism, hyperthyroidism, hypothyroidism, thyroid cysts, thyroid disorder, thyroid cancer, among a whole host of other side effects.

The Bad Has Broken

We see the effects of doctors and the drug industry downplaying the deadly risks of birth control all around us. A quick look at the patient information booklet along with some simple math, and these doctors would know that the U.S. loses three women every day to birth control related blood clots – and that’s just one side effect.

Then, along comes Depo. Not only does it have additional dangerous side effects but, since it is an injection, it’s even more permanent. You can’t just stop taking it when you’re overcome by side effects. It can take up to 350 days for the drug to leave your system after it’s administered.

How do doctors react to this deadlier, irreversible version of birth control? They deny the confirmed side effects and give it to unwitting new mothers. The further I get in this storyline the more I’m starting to realize our medical industry may be irredeemable.

But wait, Breaking Bad was notorious for giving us glimpses of hope, little signs that humanity may not be all bad. So…

Fade in to Amber in her hospital bed. Her Ob/Gyn heard she had been admitted and stops by to pay a visit. She tells him about the ER doctor who gave her a Depo shot and he becomes enraged. “Are you serious?!”

He calls the hospital CEO and says he is going to petition to get that doctor fired because it is not in his scope of practice.

Maybe there is hope for the medical community. Stay tuned.

For more information about the history of hormonal birth control:

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. 

This article was published originally on December 19, 2019. 

Share

Birth Control is Bad News for Thyroid and Liver

5395 views

A lot of things baffle me about the medical industry’s approach to birth control, but the one thing I’ve struggled with the most has to do with the thyroid. For the life of me, I couldn’t understand how any doctor could prescribe The Pill to a patient and not be concerned about the affect it was having on the young woman’s thyroid.

The most frequent side effects experienced by women on birth control precisely mirror the symptoms of hypothyroidism: weight gain, water retention, constipation, irregular spotting, decreased libido, high cholesterol…

I believed one would have to be willfully blind not to see the connection. Then, I learned about another type of blindness in Daniel Kahneman’s book, Thinking, Fast and Slow.

Blind to Hypothyroidism

Kahneman won a Nobel Prize for his seminal work in behavioral economics. In the book, he describes numerous ways our minds process information and the, sometimes illogical, ways we respond to particular situations. A couple of the cognitive processes he details could help explain why doctors tend to overlook birth control’s affect on the thyroid.

First, what the author calls “a general ‘law of least effort’ [that] applies to cognitive as well as physical exertion.’ He says we have a laziness built into our nature, and once we learn a skill, we utilize fewer regions of the brain and consume less energy when we perform the task. Consequently, we are less engaged (Page 35).

The second factor has to do with attention. Kahneman explains, “When waiting for a relative at a busy train station, for example, you can set yourself at will to look for a white-haired woman or a bearded man, and thereby increase the likelihood of detecting your relative from a distance.” However, by focusing your attention on spotting this relative, you will miss other details – and not just the mundane.

To demonstrate just how focused we can become on a task, he cites the Invisible Gorilla study, which achieved notoriety beyond the realms of behavioral science because it seems so impossibly absurd:

“[The researchers] constructed a short film of two teams passing basketballs, one team wearing white shirts, the other wearing black. The viewers of the film were instructed to count the number of passes made by the white team, ignoring the black players. This task is difficult and completely absorbing. Halfway through the video, a woman wearing a gorilla suit appears, crosses the court, thumps her chest, and moves on. The gorilla is in view for 9 seconds. Many thousands of people have seen the video, and about half of them do not notice anything unusual. It is the counting task – and especially the instruction to ignore one of the teams – that causes the blindness. No one who watches the video without the task would miss the gorilla.” (Pages 23-24)

Likewise, if a new patient, who hadn’t recently started on The Pill, presented the same symptoms, no doctor would miss the warning signs of a hypoactive thyroid.

Focus on You

Doctors, through their training and experience, are intimately familiar with the side effects of hormonal birth control. So when a patient develops common complications soon after starting The Pill, skilled doctors believe it to be normal. They may suggest the symptoms will go away with time or may choose to prescribe a different formulation. Since they already know the source of the symptoms, the solution seems reasonable. It would be unnatural for them to consider the onset of an iatrogenic illness. After all, who keeps looking for the TV remote once they’ve found it?

This compartmentalization bias is precisely why a woman should trust her body more than the doctor when it comes to birth control. It’s not a coincidence that many women’s side effects resemble hypothyroidism (such as Hashimoto’s Tyroiditis), nor is it a coincidence that so many women develop a hyperactive thyroid (such as Grave’s Disease) soon after they stop The Pill.

Thyroid Under Attack

A normally functioning thyroid’s primary role is to produce two hormones known as T3 and T4. Produced in much smaller quantities, T3 is the active hormone, which regulates our energy, metabolism, and internal ‘thermostat.’ T4 could be thought of as T3 in waiting. It is produced in larger quantities so that can be delivered throughout the body, where it will be converted to T3.

Each cell in the body contains receptors for the thyroid hormones. These receptors remove a single iodine molecule from the T4, transforming the T4 into active T3. Thanks to this little miracle of chemistry repeating itself in every system of our body, the thyroid affects nearly every bodily function. Consequently, so does anything that disturbs that delicate balance.

Hormonal birth control creates myriad problems for the thyroid, beginning with the depletion of vital nutrients such as magnesium, selenium, zinc, and essential B Vitamins, like folate. The thyroid needs these important nutrients, especially zinc and selenium, to convert T4 to T3. Unfortunately, no amount of supplements will help your body overcome this obstacle.

While depleting nutrients, birth control also elevates production of Thyroid Binding Globulin (TBG). This protein binds with thyroid hormones to carry them through the blood stream, but renders them unable to attach to cell receptors. Consequently, the body may try to compensate by overproducing T3 and T4, without actually increasing hormone activity. This could explain why some women develop Grave’s Disease after stopping The Pill. Their TBG levels return to normal, but their body continues overproducing T3 and T4.

The Path to Long-term Fatigue

Women taking hormonal contraceptives have also been shown to have a three-fold increase in C-Reactive Protein (CRP), a widely recognized inflammation marker. The liver kicks into overdrive producing CRP in response to the inflammation associated with the birth control. This inflammation serves as a double-whammy to the already struggling tandem of the thyroid and liver.

First, the inflammation makes your cell walls less responsive to all hormones. Second, it disturbs the process of deiodination, leading to the overproduction of another inactive hormone known as Reverse T3 (RT3). As the name suggests, RT3 is the mirror image of T3, meaning the iodine molecule has been removed from the opposite side of the hormone.

RT3 competes with T3 for the same receptors. Since it is inactive, too much RT3 will leave you feeling lethargic. Your body responds by producing more cortisol in an attempt to boost your energy. If this continues for too long, it could lead to adrenal suppression, and long-term fatigue.

Weighing on the Liver

So, what causes this inflammation in the first place? As the central organ in the metabolic process, the liver produces proteins, breaking down fat and hormones to generate energy. When we overload the body with an unnatural flood of factory-produced, artificial hormones, the liver becomes sluggish and inefficient. This sets off a toxic cascade of side effects that leads to inflammation, and could ultimately contribute to chronic illnesses such as heart disease, cancer, and autoimmune disease.

The National Institutes of Health were concerned about hormonal birth control’s affect of the endocrine system from the very early days. When Dr. Philip Corfman, the Director of the Center for Population Research, testified at the Nelson Pill Hearings in 1970 on behalf of the NIH, he warned that The Pill decreased the liver’s ability to change and dispose of certain chemicals, even decreasing its ability to excrete bile.

Their studies from the 1960’s showed that up to 40% of women on oral contraceptives experienced some changes in thyroid function. They made the connection that this had also contributed to changes in adrenal gland function, citing increased cortisol levels. Reading from the NIH report he helped author, Dr. Corfman said:

“Although it is not yet possible to draw definite conclusions about their effect on the health of women and infants, the use of these agents warrants close observation and surveillance. Effects of special concern include alterations in carbohydrate metabolism, the character and distribution of lipids, liver function, protein metabolism, and the development of hypertension as well as alterations of endocrine function.”

Congress followed up on the hearings with a special report issued in 1978. Beyond concerns addressed in the original hearings, the new Congressional Report discussed more hepatic complications associated with The Pill, including the ‘greatly increased risk’ of developing an otherwise rare form of benign liver tumor known as hepatocellular adenoma (HCA). (Page 36) Studies at that time showed that women who had taken The Pill for eight years or more suffered a 500-fold increased risk of developing HCA, with 4% of those becoming malignant.

Good News First

The good news is that many of the side effects of hormonal birth control are reversible, if you stop taking them soon enough. Not every person who experiences symptoms of a hypoactive thyroid will develop Hashimoto’s Thyroiditis. While environmental factors are pivotal in triggering the development of this chronic disease, you must also be genetically predisposed in order to be susceptible to Hashimoto’s or any other autoimmune disease.

The bad news is that a LOT of people are genetically predisposed to Hashimoto’s Thyroiditis. In fact, it is considered the most common autoimmune disease, at 46 cases per 1,000. An estimated 20 million Americans have some sort of thyroid disease, and Hashimoto’s Thyroiditis makes up about 90% of those with hypoactive thyroids.

Don’t ignore the 800-pound gorilla in the room. Please think twice about the potential complications before starting any form of hormonal contraceptive, especially if Hashimoto’s Thyroiditis, Grave’s Disease, or any other autoimmune disease have made their way into your family’s history.

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.

 

This article was published originally on 

Share

Birth Control’s Misremembered History

1930 views

“Memory itself is an internal rumour; and when to this hearsay within the mind we add the falsified echoes that reach us from others, we have but a shifting and unseizable basis to build upon. The picture we frame of the past changes continually and grows every day less similar to the original experience which it purports to describe.”

– George Santayana

With each trip we make around the sun, the truth rings louder in Santayana’s hauntingly beautiful depiction of the evolution of memory. Like characters from Kurosawa’s masterpiece, Rashomon, we are destined to misremember motives and details surrounding the events of our lives. Selective perception puts us at a disadvantage from the outset. Add to that “the falsified echoes that reach us from others,” and we need to accept the possibility of inaccuracies, even in our most vivid memories.

If our own personal memories reside on shifting sands and are vulnerable to outside influences, imagine how much more vulnerable are collective memories spun to the media by sources that have proven to be unreliable.

Sketchy Details

While writing my book, In the Name of The Pill, I became interested in the Puerto Rican drug trials that Dr. Gregory Pincus and Dr. John Rock presented to the FDA during the approval process for hormonal birth control. These trials were later mentioned in the Nelson Pill Hearings, which is where I first read about them.

The testimony in those Hearings discussed five young women who died during the trials. The doctors apparently never even considered attributing the deaths of these otherwise healthy young women to the drug they were studying, and each woman was buried without an autopsy. As I began digging through the media for more stories on the Puerto Rican drug trial, I noticed that recent accounts often neglected to mention the women who died, and the ones that did usually stated that only three women died… Merely shifting sands?

Digging Up More Trials

It is frustrating to try to piece together the facts from the birth control trials because so much of the information is incomplete or errant. This may have been by design. After reviewing Dr. Pincus’ notes in the Library of Congress, women’s health author, Barbara Seaman, mused that she was surprised he hadn’t burned the evidence.

The powerful forces and mysterious manipulations that ultimately gave us hormonal birth control have fueled my passion for this subject over the past few years. No matter how much research I do, the rabbit hole always seems to go deeper.

Recently, Abby Epstein, the director of the upcoming documentary, The Business of Birth Control, shared with me a bundle of archived documents they had just unearthed. It was like a treasure trove of forgotten birth control history filled with interesting facts and tidbits. Immediately, I stumbled upon a new mystery. In an article titled, “Population Manipulation” from Off Our Backs magazine, a bi-monthly published by “radical feminists” in the early 70s. Here’s what caught my attention:

“Women have been the guinea pigs for contraception and population control. Poor women are especially vulnerable. The first testing of the pill was on women in Puerto Rico, Haiti and the mountains of Kentucky…”

I have previously seen mentions of trials in Haiti but this was the first time I heard of trials associated with my birth state, Kentucky – another piece of the narrative that has disappeared over time. This piqued my curiosity. After more research, here is my attempt to clear up birth control’s misremembered history.

A Brief History of Hormonal Birth Control Trials

In 1951, Margaret Sanger helped Dr. Gregory Pincus obtain funds to begin testing the effects of synthetic hormones on the reproductive systems of rabbits. A year later she brought the wealthy heiress, Katherine McCormick, to visit his lab in Worcester, Massachusetts. The women dreamed of a “magic pill” that would empower women everywhere to control their fertility. Mrs. McCormick was so impressed with the promise of his studies she agreed to fund Dr. Pincus’ continuing work.

Dr. Pincus teamed up with Dr. John Rock from Harvard, which had a longstanding relationship with Worcester State Hospital. By 1954, the doctors were testing hormones on human mental patients. After giving the patients the prototype for the birth control pill, they “sliced into their uteruses in an effort to understand the drug’s effect on ovulation.”

In reality, this test did little more than allow them to monitor dosage for toxicity and tolerability. Since the patients weren’t having sex, it provided no proof of efficacy as a contraceptive. As was the case with many of his experiments, many in the medical community questioned Dr. Pincus’ ethics. Another example of his lack of scruples came a short time later at the same hospital, when he performed testicular biopsies on schizophrenic men without anesthesia to study their “castration anxiety.”

Ethical or not, Mrs. McCormick was frustrated by the pace of science when it came to her contraceptive investment, she famously lamented to Mrs. Sanger in a letter, “[We need] a cage of ovulating females to experiment with.”

Science as a Shell Game

The imagery is shocking – caged women reduced to objects of fertility. Her phrasing reveals a lot about how the researchers and their financiers viewed the women who would eventually be taking these drugs and their attitudes toward them. They never anticipated that The Pill would be taken by the women with whom they played bridge. These drugs were being designed for a certain kind of woman – “the wrong type [who] seemed to be multiplying at an unprecedented rate.”

The doctors found their first ‘cage’ of ovulating females in the slums of Puerto Rico in 1956. With no informed consent and no warning that this was a trial, the doctors began giving the women Enovid, the first-generation Pill, saying that it ‘ would keep them from having children they couldn’t support.’ As I mentioned previously, five women died during the trial. 65 percent of the patients complained of at least one side effect. Believing their complaints were psychological in nature, Dr. Pincus chalked up the complaints to the “emotional super-activity of Puerto Rican women.”

As the two doctors refused to let anything impede their progress, red flags were being raised, even by their partner drug company, G.D. Searle. Their medical director sent Dr. Rock to explain, “We here have long been disturbed by the casualness with which materials pass from Pincus’s animals to your patients.”

Undaunted by the drug company’s concerns but displeased with how the trials were progressing, Dr. Rock recommended conducting further trials in the Appalachian Mountains of Eastern Kentucky utilizing Frontier Nursing Service (FNS). Before we dive into FNS, I must confess this brief history is most certainly incomplete as well. I have seen mentions of smaller trials in the slums of Los Angeles as well as the previously mentioned trials in Haiti, but have failed to find any details about them. If anyone has information on those offshoots, please contact me.

Kentucky Birth Control Trials

Life magazine had focused national attention on the “chronic baby boom” happening in the Appalachian Mountains of Eastern Kentucky, calling it “a biological joy ride to hell.” Coincidentally, Dr. Rock’s dear family friend, Mary Breckinridge ran FNS, an organization providing nurse-midwifery services to the region. She had become friends with Dr. Rock’s wife while volunteering after World War I.

Beyond serving the ideal demographic, Dr. Rock found FNS appealing because medical research had been one of the founding goals of the organization. Consequently, they boasted a 30-year history of meticulous recordkeeping.

FNS famously promoted their participation in many trials. Their fundraising materials at the time described studies related to a hookworm treatment, nutritional deficiencies, and toxemia of pregnancy. However, the organization remained curiously quiet about their work on the birth control trial. Historians have noted “little more than a few references in meeting minutes to ‘Dr. Rock’s pills.'”

Archived files show that 140 women participated in the trial between 1959 and 1966. Fifty-two women dropped out of the trial, and one woman died from a heart attack. Records indicate the 30-year old woman had no previous heart problems or unusual health conditions. Nonetheless, as was the case in Puerto Rico, it was assumed The Pill had nothing to do with her death, and she too was buried without an autopsy.

Browbeating the FDA

With Enovid being approved as a contraceptive by the FDA in May 1960, it’s doubtful that any data from the FNS trials, which only started a few months prior, made it into the submission. Regardless of which data comprised G.D. Searle’s submission to the FDA, the truly amazing story is that these synthetic hormones were approved for human use only nine years after Dr. Pincus first began his animal studies.

How is it possible that such a groundbreaking new drug – the first drug designed to be taken chronically by healthy patients – could be approved so quickly?

While recording an interview for an oral history of FNS, Dr. Rock explained that he had grown tired of waiting for the FDA to approve The Pill. He and two officials from Searle flew to Washington D.C. to see if they could speed up the process. Here’s how he explains the encounter:

“The fellow who had charge of it was a thirty-year old practitioner or something in Washington. And he came in the office, and he had all the material – a great stack of stuff on his desk – and he hadn’t even look at it. So we talked about it and he said he would go through it as soon as he could. And I can remember I took off my jacket, stood up… and I went over to the desk. [I said] ‘You have no time. You’ll do it now.’ And he said, ‘Oh alright.’ And so he signed the whatdoyoucallit, and that was it. That made a great impression of the Searle people, that I browbeat the government into taking the final step. But we knew it was all right. I mean I was convinced. My conscience was clear about that.”

Framing the Past

Hormonal birth control has been with us for so many decades that most people assume the question of safety was answered long ago. We forget that the FDA of that day was much different than the agency we know today. Framed by Dr. Rock’s memory of how The Pill was ultimately ‘approved,’ the case can be made that we need to re-evaluate The Pill with fresh eyes. And, we can start with this most basic question, “Are women being properly informed about the risks of hormonal birth control BEFORE being prescribed?”

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. 

This article was published originally on April 6, 2020. 

Share

Birth Control: The More Things Change

1692 views

The medical and drug industries are notoriously arrogant. While each generation of practitioner may acknowledge the errors of the past, they continue down the path of contemporary errors with an inexplicable faith in their own omniscience. Unfortunately, the magnitude of collateral damage from these mistakes has tended to grow exponentially with each passing generation, but no medical mistake (so far) can match the horrific toll still being wrought by birth control.

Time After Time

We aren’t terribly far removed from doctors promoting the health benefits of smoking cigarettes. Nor, in the grand scheme, has it been that long since leeches and bloodletting passed for cutting edge technology – or perhaps sucking edge.

Reflecting on errors of the past shouldn’t imbue today’s doctors with a sense of supreme knowledge. Instead, it should give them pause to wonder what tomorrow’s doctors may find laughable about their current practices.

The modern doctor may laugh at the doctor who promoted cigarettes, while that doctor laughed at those who promoted lobotomies, as those doctors laughed at snake oil salesmen.

While today’s doctors may have largely discarded lobotomies and leeches, the part that sucks most is that we seem to have lost the art of doing away with antiquated medical dogmas once they’ve been proven unsafe… at least, until lawsuits and settlements tip the balance.

Mea Culpa

The drug companies sit in the shadow of a well-documented history of business practices which promote profits-over-people. Examples like thalidomide, DES, and Vioxx should be enough to call into question this industry’s trustworthiness. Whether it’s greed or hubris, the industry consistently releases new drugs with authoritative assurances regarding their safety, and it’s rare to see them back down from these assertions – even as the courts begin to say otherwise.

So, consider how rare this admission was from Dr. Harry Rudel, one of the developers of The Pill:

The pill is something we entered into with the best of faith, something we truly believed affected only ovulation and fertility. It was a relatively small dose of a drug, and it appeared that it was not affecting anything except fertility. Then as we began to look, we began to see that we are influencing many systems in the body.

Change Is in the Air (Or Is It?)

Hormonal birth control remains the one persistent drug that seems to be made of Teflon – nothing sticks. It has been linked to dramatic rises in diseases affecting everything from the heart to the liver. With each newly identified risk, ‘experts’ assure us the benefits still outweigh the risks, and, somehow, that seems to be enough to just make it go away.

At some point, we (meaning ALL of us around the world) need to stop accepting this myopic minimization of all these disparate negative consequences. Sincerely, we are all stakeholders in this fallout, which has grown to a scale that would now be impossible to measure.

Recently, thoughts about the sheer magnitude of this tragedy hit me like a gut punch. I’ll explain what happened and share three scenarios that should be enough to make us seriously rethink our position on hormonal birth control.

Changes in Lupus

I recently participated in a webinar with Sara Harris and Rebecca Asquith from Follow Your Flow, during which I discussed the dramatic evolution of lupus in a relatively short amount of time. I explained how lupus used to be an old person’s disease. Then, with the rollout of birth control, doctors were alarmed that they began to see young women coming into their clinics with lupus.

Fifty years later, lupus is thought of primarily as a young woman’s disease. The tides have shifted so significantly in such a short amount of time that what used to be the norm is now called ‘late onset lupus.’ Women in their 40s and 50s are surprised to learn they can even develop lupus at ‘such a late stage of life.’

Shortly after the webinar, I encountered one of the attendees, who told me that her husband’s sister had been diagnosed with lupus in 1966 at the age of 17. Her specialist had been “so in awe of her condition that she attended presentations/lectures with him.” She died at the age of 24. While it isn’t certain that she was on The Pill, the timing in relation to the wave of young women who suddenly began developing this old person’s disease makes it very plausible.

Thinking of this 24-year-old woman who died so many decades ago struck me. Her family never even knew that her lupus could have been connected to birth control. How many other young women have been struck down so young because of these potent drugs, and nobody was ever the wiser? Please – pause for a second and ponder that – what is the potential body count of young women who have died in the past 60 years from lupus, a stroke, a pulmonary embolism, a heart attack? How many of them were buried with their family wondering why she had the misfortune of being taken so young – without ever knowing how easily it could have been prevented?

Changes in Breast Cancer

Unfortunately, lupus isn’t the only disease that looks different today than it did when hormonal birth control was introduced. Just as expert testimony at the Nelson Pill Hearings (1970) revealed concerns about changes in lupus, other experts testified about how The Pill would likely contribute to breast cancer numbers. One of those experts was Dr. Max Cutler, who warned that The Pill should never be used chronically. He called it a cancer time bomb whose fuse could be 15 to 20 years.

Dr. Cutler practically guaranteed we would see a dramatic rise in breast cancer. At that time, 1 in every 20 women would be diagnosed with breast cancer at some point in her life, which equated to about 75 to 80,000 diagnoses each year.

This year (2021), we expect to see over 281,000 breast cancer diagnoses, and 1 in every 8 women will be diagnosed at some point in her life. That’s an increase of over 250-percent!

Many doctors now dismiss the breast cancer scare as old news attributed to the first-generation pills. They assume the newer ‘low dose’ formulations resolved that problem (because that’s what they’ve been taught). However, a recent Danish study confirmed that women on these newer formulations still faced a 20-percent greater risk of developing breast cancer than women who didn’t take hormonal birth control.

Changes in Multiple Sclerosis

As I’ve written previously on Hormones Matter, multiple sclerosis is a naturally discriminatory disease in terms of gender because of how particular cytokines within the immune system interact with estrogen. This is true of many autoimmune diseases.

So, if the disease has a natural gender bias, how do we know what role birth control is playing in its incidence?

In 1940, well before the introduction of hormonal birth control, twice as many women as men had multiple sclerosis in the US. However, by the year 2000, as the number of overall cases grew, the gender gap also widened – 4 out of every 5 diagnoses were women. That represents a 50-percent change in the gender bias over each decade.

Epidemiological studies from other developed countries revealed similar shifts in the gender ratio over the same timeframe. For example, a Danish study found that men experienced a 30-percent rise in their cumulative incidence rate (CIR), while the CIR for women more than doubled.

The Epidemiological Significance of Rapid Change

Commenting on some of the multiple sclerosis studies mentioned above, Sreeram Ramagopalan, Ph.D., research fellow at University of Oxford, said this:

A change that occurs within a century is too short a time for a genetic cause. This suggests that environmental factor(s) are at work in a sex-specific manner.

Any of these examples alone should be enough to make us feel as if we’ve been collectively punched in the gut. Hopefully, it will eventually spark an epidemiological curiosity in a researcher somewhere.

If you happen to know of an epidemiologist who’s trying to figure out what the sex-specific environmental factor(s) might be, could you direct them my way? I’ve got a thought or two I’d be willing to share.

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. 

Share

Migraines and Birth Control: A Neglected Stop Sign

2464 views

No sooner had we landed than my phone began to convulse with a cacophony of bells and chimes. Most of the notifications were last minute details about the live broadcast that brought me to town. In one voice message, a coworker informed me that the producer cancelled our pre-production dinner meeting because of her migraines. He added, “When she eats certain breads, it triggers her headaches.”

This happened early in my research on hormonal contraceptives, but I had read enough to know that birth control could cause migraines, and women with migraines were at a higher risk for strokes. I also knew that doctors at the Nelson Pill Hearings testified that birth control pills affect the way a woman’s body metabolizes carbohydrates in myriad ways. I had no idea what the mechanism of action could be, but at that moment I would have bet my children’s milk money that our producer was on hormonal birth control, and I intended to ask her about it.

This was my client’s client. I wondered if it was safe to broach the subject of birth control with her, but I knew the answer before I could even fully form the question in my head. I wouldn’t be able to forgive myself if she ever had a stroke, and I hadn’t warned her.

The next morning she felt better and showed up for the load-in. When no one else was around, I asked some questions about her headaches, ending with, “I’m curious, did you start getting migraines after you began birth control?”

When you ask a question like that, you know there’s a better than zero chance the reaction could be negative. Thankfully, not even a glimmer of disapproval flashed in her eyes as she replied, “Oh no, I took The Pill for a long time before I had my first migraine.”

I said, “That’s still after you started.”

She laughed it off as a silly question. However, after sleeping on it, she approached me the next morning, “You know, you may be onto something. I hadn’t thought about it, but my migraine symptoms did get a lot worse when I switched birth control brands.”

Connect the Dots: Birth Control and Migraines

The correlation between birth control and migraines has been known for decades, as has their connection to an increased risk of stroke. However, two hurdles probably play a key role in preventing patients and their physicians from making the connection in the real world today – those being familiarity and latency.

Many side effects of hormonal birth control occur as extremely common ailments, such as breast cancer, strokes, and migraines. Not coincidentally, they’ve grown even more common in direct correlation to the introduction and prevalence of hormonal contraceptives. Paradoxically, they’ve become so familiar, so unremarkable that doctors rarely look for the primary culprit that causes the migraines. Essentially, they can’t see the tree for the forest.

Some side effects, such as migraines or depression, can happen almost instantaneously. (Even so, doctors frequently miss the connection.) However, it usually takes some time for the symptoms to precipitate. This latency can hinder even the most astute physician from considering hormonal contraceptives as the likely cause of problems. I’m being generous in my phrasing. In reality, I can’t help but wonder what role fear of litigation plays in this ‘blindness.’

Ultimately, why they overlook the correlation to birth control is less important than the consequences it creates, which include dramatic under-reporting of complications. In 1970 while discussing strokes at the Nelson Pill Hearings, Senator Gaylord Nelson expressed this prescient concern:

Every time the issue has been discussed here concerning the increased incidence of this disorder or that disorder, they always end up saying, “but the statistical sample is so small that there is room for error, and we can only make sort of an educated guess.”… I am just concerned with the fact that the reporting of these side effects and their effect on the cause of death may not be related to the pill at all. (Monopoly Subcommittee, page 6419)

Dr. Herbert Ratner added his perspective (Monopoly Subcommittee, page 6743), “For the first time in medicine’s history, the drug industry has placed at our disposal a powerful, disease-producing chemical for use in the healthy rather than the sick.” [my emphasis] Yet, forty-five years later, we still have no national registry, no way of tracking patients on birth control so that scientists can conduct comprehensive etiological studies that would connect the dots and precisely reveal the consequences of hormonal contraceptives. In fact, our healthcare reporting system is so fractured we can’t even put our finger on an accurate estimate of how many women take hormonal birth control. Estimates from trusted sources range from 11 million to 18 million.

The Pill, Migraines, and Strokes

The University of Virginia student health services published a document on their website outlining the definitive link between migraines and strokes. Beyond warning that the “increased risk of stroke is amplified by the use of estrogen-containing birth control methods,” the doctors who prepared the document boldly state,

it is strongly recommended that women with a personal or family history of migraine headaches should select non-estrogen methods of contraception. [Their emphasis]

This information should be part of every ‘informed consent’ conversation before a doctor writes the first birth control script. Not to mention the many other complications that need to be discussed. This kind of warning should be the norm. Unfortunately, it’s the exception.

Strokes Redefined

It took only three generations of users for hormonal contraceptives to redefine our perception of strokes. A young women starting on The Pill today may not even realize that when her great grandmother began birth control, strokes were considered an old person’s disease.

But, strokes aren’t just for grandparents anymore. A recent article in the Washington Post leads off with this troubling statement about strokes in young people:

In a study released Wednesday in the Journal of the American Heart Association, researchers found that between 2000 and 2010, hospitalizations for ischemic stroke, the most common type, dropped nearly 20 percent overall – but among people ages 25 to 44, there was a sharp 44 percent increase in the rate.

There are a couple of other interesting facts later in the article – or rather, one interesting fact, and another made interesting by its glaring omission. The first comes from a description of the study:

The data analyzed includes information on 8 million hospital stays and came from the Nationwide Inpatient Sample, the largest publicly available database in the United States on these patients.

In stressing the importance of a large database, the author underscores the necessity for a national registry to track patients so that important lines can be drawn. Of course, the second part is that the lines actually need to be drawn. Amazingly, here’s what the Post article says about what might have contributed to the increase:

Doctors attribute the apparent rise in strokes among younger adults to the same lifestyle risk factors traditionally found in older patients, such as obesity, diabetes and high blood pressure.

It isn’t until much later in the article that they include:

Each year significantly more women die from stroke than from breast cancer — and yet many women think of stroke as a man’s disease. According to a 2015 national survey, only 11 percent of the 1000 women surveyed could identify female-specific stroke risk factors, like migraine headaches with aura, hormone-replacement therapy, oral contraception and pregnancy, particularly in the final month and postpartum.

Talk about burying the lede. Maybe women would stand a better chance of identifying these factors if journalists dared include them in the “lifestyle risk factors” mentioned previously.

Testimony Without Equivocation

The science linking birth control pills to strokes hasn’t changed. As far as I can tell, no one has disputed the correlation since The Lancet first published Dr. Victor Wynn’s study in 1966.

Pay attention to this excerpt from Dr. Alan Guttmacher’s testimony at the Nelson Pill Hearings. Dr. Guttmacher was the founding president of Planned Parenthood/World Population, and was arguably the staunchest proponent of The Pill ever to live:

We know the facts about thromboembolism. I think this is pretty uncontested. We know the facts about development of high blood pressure in a certain small proportion of patients. We know the fact that certain patients get depressed on the pill. These are the facts we are all privy to. (Monopoly Subcommittee, page 6615)

Earlier in the hearings, Dr. J. Edwin Wood explained the phenomenon that caused healthy young women to develop strokes:

One of the major contributing causes of thrombosis in veins appears to be that of reduced velocity of flow of blood in the veins or relative stagnation or stasis of flow in the veins…

Studies of women taking oral contraceptive agents have led to the clear-cut finding of dilatation of the veins of the extremities – other veins as well perhaps but they have not been studied. These dilated veins carry the same amount of blood as before but since they are wider in diameter the blood flows more slowly.

The net effect of this series of events is a slowing of the blood flow during oral contraceptive therapy. This finding is distinctly abnormal and is not observed in any other circumstance in young women except during pregnancy or in the presence of varicose veins. (Monopoly Subcommittee, page 6157-6158)

The facts about hormonal contraceptives and strokes were well known in 1970, yet they somehow seem to have escaped the curriculum in today’s medical schools. It may be uncomfortable but if you know a woman who suffers migraines, don’t hesitate to ask her if she’s on hormonal contraceptives. Then, please share the facts about migraines and birth control.

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. 

This article was first published on November  21, 2016.

 

Share

Birth Control Through the Lens of COVID-19

1901 views

As part of the ‘new normal’ being ushered in as a result of COVID-19, I hope we will turn a critical eye to health, wellness, and the industries that profit from them. We should take the opportunity to reconsider the pros and cons of Big Pharma’s cash cows – old and the new – from new vaccines being rushed through protocols to old drugs with false reassurances – specifically, hormonal birth control. Perhaps we can make ‘just taking the doctor’s word for it’ part of the old normal.

Indeed, this virus gives us good reason to weigh the effects synthetic hormones have on the body – even when not being subjected to a pandemic. But, when it comes to COVID-19, there are essentially two schools of thought regarding hormonal contraceptives – one suggests a protective effect and the other focuses on the accentuation of a shared complication.

Blood Clots as Common Ground

Let’s begin there. It has been pretty well established that women taking combination birth control face 2 to 6 times the risk of developing venous thromboembolic events (VTEs), and they double their risk of having a stroke.

Earlier this summer, medical professionals also began to notice several unusual hypercoagulation abnormalities among COVID-19 patients. They documented increased platelet production, altered gene expressions that led to increased levels of several clot-related proteins and cytokines, which translated into many macro- and micro-vascular VTEs. One study reported that nearly a third of COVID-related ICU patients had a VTE.

Though it is too early to have any clear answers, researchers in the current edition of the journal, Endocrinology, are calling on their peers to study how the paths of each of these two means of hypercoagulation (COVID-19 and hormonal contraceptives) may intersect and/or compound the effects of the other.

Giving New Meaning to ‘Protection’

On the other hand, a preliminary study in the UK found that young women taking hormonal birth control had fewer cases of and fewer hospitalizations from COVID-19. The results didn’t surprise them. In fact, it’s what they expected because of the role estrogen plays in our immune system.

A nurse practitioner quoted in the linked article proclaims, “Further evaluation of how estrogen may magnify [immune system] effects could be very promising in terms of prevention of COVID-19 and reduction in the severity of symptoms.”

Risk Versus Protection

So, which is it – does birth control pose an increased risk of blood clots in the face of COVID-19 or does it provide an added layer of protection? My guess is that the answer is probably both, because of the idiosyncratic nature of how these drugs interact with each woman’s unique body chemistry.

Women who are already susceptible to blood clots are likely to face a greater risk from the dual threat posed by potent contraceptive drugs combined with the effects of the virus. Other women, who are genetically predisposed, may experience something of a protective effect from their birth control, but for those women, the trade-off may not be worth it in the long run.

Estrogen in Name Only

Always and everywhere, it’s important to remember that the estrogens contained in birth control are NOT the same as the estrogens your body produces. Therefore, it’s misleading to assume any type of protection from infectious disease that seems to come from The Pill is equivalent to safeguards afforded by your body’s natural estrogen. Chances are it actually has more to do with the way the synthetic hormones disrupt your body and modify your natural gene expression.

The most interesting genetic activity, as it relates to pathogens (and birth control), occurs in the Human Leucocyte Antigen (HLA) system. In fact, it is the exposure to pathogens that scientists believe contribute to the diversity of the alleles and proteins produced within this gene system. The more diverse our HLA system is, the more efficient our immune system is.

Going Off the Deep End With Genetics

This is a good place for a time out just to clarify that I am not a genome expert. When it comes to navigating the gene pool, I’m pretty much in over my head the moment we venture away from the splash pad.

But, that’s okay, because the evidence is pretty straightforward and, I think, pretty fascinating. For this article, we are going to focus on one gene, CR1, the receptor to C4. (If you have been diagnosed with certain autoimmune disorders or vascular diseases, you may already be familiar with C4, via the C4 blood test used to diagnose many of these disorders.)

The CR1 gene is located among a region of other ‘complement activation’ genes of chromosome 1. It encodes a glycoprotein that mediates several immune complexes. Decreases or mutations of this protein have been associated with everything from gallbladder carcinomas to systemic lupus erythematosus (SLE), but have also demonstrated a protective effect against malaria.

Sometimes CR1 serves as a protagonist (providing immune protection) and sometimes it’s an antagonist (increasing susceptibility). And, the synthetic hormones in birth control seem to influence CR1’s dynamic relationship with these various diseases.

Again, I’m humbly aware of my place as a layman, and my limited knowledge of the human genome. It could be, as I build my case about these various actors and try to connect their roles to particular disease states, I do nothing more than prove the six degrees of CR1. Much like trying to connect actors who shared screen time with Kevin Bacon, their relationship may go no further, but it certainly feels like they are working from a common script.

I would also like to thank Nina Rose, an Australian reader who has shared a lot of valuable insight with me over the past couple of years. She recently contacted me to suggest there seemed to be a strange relationship between malaria, COVID-19, and certain autoimmune diseases.

Let’s dive in. Shall we?

How Malaria Sparked a Human Evolution

In terms of speed and efficiency, scientists recently discovered one of the most dramatic displays of evolution within the human genome. As malaria swept across sub-Saharan Africa about 42,000 years ago, a handful of the population were blessed with a genetic mutation, which protected them from the parasite frequently spread by mosquitoes. Then, about 8,000 years ago, something happened in the region that caused this mutation to explode to the point that 99% of the population enjoyed its protective effect from malaria.

It is believed that interactions within HLA molecules modulate the functionality of natural killer (NK) cells, a specific type of white blood cell that plays a significant role in battling malaria, and that’s where this protective mutation seemed to initiate.

However, there is a trade-off. As a consequence of having this malaria-resistant, hyper-efficient immune system, this population finds itself highly susceptible to other diseases, such as sickle cell disease and autoimmune illnesses, like SLE.

Malaria and SLE on Opposite Sides of the Coin

Not surprisingly, several ethnic groups whose ancestors faced devastating outbreaks of malaria, now find themselves with an increased prevalence of SLE among their population.

Further evidence of the inverse relationship between malaria and SLE came when a team of researchers in India visited a malaria endemic region and found that lower CR1 expression protected against malaria, but left the participants more susceptible to the development of SLE.

Written in the SARS

Scientists studying severe acute respiratory syndrome (SARS) back in 2005 found that, in the early stages of the disease, CR1 expression in red blood cells dropped dramatically, and then gradually returned to normal in the later stages of the disease.

But, what about SARS-CoV-2, the virus that causes COVID-19?

During the first wave of the pandemic, French researchers reported that a “clear acquired decrease of CR1 density (in red blood cells) from COVID-19 patients was observed, particularly among fatal cases.” They recommended the use of CR1 or CR1-like molecules as a treatment to reduce inflammation.

Birth Control and Ill-Fitting Genes

The difference with SLE (and all autoimmune diseases) is that they have a genetic component. You must be predisposed in order to acquire the disease, but the question is – over the generations, could we be altering our genes and creating new genetic predispositions to these diseases?

I believe it’s possible. As I wrote previously on these pages, the incidence of lupus has more than tripled since 1960. Ninety percent of diagnoses are women. And, women who take hormonal birth control are fifty percent more likely to develop lupus than non-users. Clearly, the introduction of these potent contraceptive drugs has provided a devastating catalyst for an explosion of new cases, and they appear to be creating alterations by acting on the same HLA pathway.

But, knowing that SLE requires a genetic predisposition, is it foolish to suggest birth control could also make you more susceptible to a virus?

The Virus Connection

We’ve seen a bit of the yin-yang relationship between malaria and SLE. To carry it one step further, isn’t it interesting that hydroxychloroquine, an anti-malarial drug, is one of the most common treatments for SLE. Now, consider that many doctors claimed to have success using this same drug to treat COVID-19 patients. Personally, I think the only reason it was shot down is because the drug companies were looking for a bigger payday, but that may just be a reflection of how little faith I have in the drug companies.

Admittedly, the idea of birth control making you more susceptible to the Coronavirus sounds dubious, but the concept isn’t without precedent. In 2015, researchers studying the effects of injectable contraceptives and hormonal IUDs discovered these drugs dampen the body’s “innate antiviral mechanisms.” Their study focused specifically on HIV and concluded that the synthetic hormones influenced the “expression of immune-related genes in the endometrium” and left women more susceptible to the transmission of HIV from their partner.

Breaking News

Just as I was completing the first draft of this article, a new study came across my newsfeed. Researchers are warning that some of the new COVID-19 vaccines could also increase the risk of HIV infection. Interestingly, the biggest risk seems to be among men who take the vaccine.

The Takeaway

Okay, I confess, this is sort of like a used “Connect the Dots” book your mom picked up at a consignment shop. I’m throwing down a lot of dots, but even where they appear to already be connected, that connection may be a little faint.

Maybe some of you can connect the dots better than I have and can ultimately tell me what the big picture is.

For now, I’m content thinking of it this way. When it comes to birth control or any of the new COVID vaccines, the drug companies will tell us it offers a protective effect. That’s the yin. But, we must always question what is the possible yang associated with this protection.

Remember, the changes in CR1 levels can be a protagonist on one hand and an antagonist on the other. Is the protection worth the risk? Is the yin worth the yang? Should we approach any drugs at “warp speed?” And, when you’re weighing the benefits to risks, always take into account how long it’s been since Kevin Bacon actually made a good movie.

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. 

Share
1 2 3 4