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Can the Pro-Choice Community Embrace a Birth Control Dichotomy?

Published on September 23, 2014

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In 2004, when I was executive director of Planned Parenthood Alberta, I gave an introductory presentation on fertility awareness for women looking for alternatives to hormonal birth control. One young woman who’d been on Depo-Provera for five years had been recently diagnosed with severe osteopenia. After quitting the drug, she said she realized in retrospect that for those five years she had felt like she was living “under the surface” of her life.

Another told the story of how she had struggled with serious mood issues while on the birth control pill. She would stop taking it, rely on condoms and emergency contraception for a while, then visit her doctor who would urge her to go back on the pill. After a few of cycles of on-off-on, she quit the pill once and for all. She said she decided to “just stop talking to this doctor about birth control.”

I’ve heard scores of stories like these over the past 30 years, and read hundreds more from women commenting on blog posts and online articles. For decades women have stopped using hormonal contraception to improve their health and well-being. Advocating on their behalf has been a major focus of my work as a pro-choice activist.

The Birth Control Dichotomy

I’ve been a pro-choice sexual and reproductive health advocate since I was 15 years old. Today I turn 60, celebrating a 45-year commitment to pro-choice values. But I mark the occasion with frustration and disappointment because the sexual and reproductive health (SRH) community to which I belong has failed to adequately–unreservedly–serve women who won’t, don’t or can’t use hormonal birth control.

I believe that what is keeping them from doing so is failure to acknowledge and embrace the dichotomy that exists within the pro-choice contraceptive framework.

A dichotomy is division of a whole into two mutually exclusive, opposed, or contradictory groups. If pro-choice contraception is the whole, two mutually exclusive groups are:

women who use and like, or want to use hormonal birth control (HBC)
women who use and like, or want to use non-hormonal birth control (NHBC).

Both groups deserve equal attention, support and services to use the birth control methods they decide are right for them. But this is not happening.

Just as we who hold pro-choice values don’t judge or hassle women for the reasons they choose to have abortions, we should not judge or hassle women for the reasons they choose not to use HBC, nor try to deter them. Yet anecdotal evidence abounds that women who want to quit the birth control pill, have their IUDs removed, or learn fertility awareness based methods (FABM) are often actively dissuaded from acting on their choices. It takes extreme self-assurance to do what one young university student told me she did when her doctor questioned why she didn’t want to use HBC. Her response: “My reasons are none of your business.” She said she knew the doctor would try to overcome her objections to the side effects she refused to incur.

I believe that pro-choice sexual health advocates and care providers can and must find a way to do their work effectively within this birth control dichotomy. We must acknowledge the right of women to choose HBC or NHBC depending on which best serves their health and contraceptive needs. And it’s our obligation to help them use their chosen method effectively and confidently, without persuasion or dissuasion.

This is not being done to the standard I believe it should.

Media, social media, and the blogosphere tell us that young women are ditching HBC, but not finding much information or support from their doctors or sexual health clinics for doing so. So why aren’t SRH organizations researching this identifiable “unmet need” or offering workshops on successfully transitioning from HBC to NHBC?

A one-size fits all diaphragm is in the works, and another silicone version is on the market but incredibly hard to find, as is the spermicidal gel required to use with it. So why don’t SRH clinics have programs in place to make them more accessible to women who want them? After all, the diaphragm was the contraceptive of choice for arguably the most influential sexual role model of the last 15 years – Carrie Bradshaw.

Evidence-based medicine proves that pro-choice FABM are as effective as HBC methods, and can be used with condoms to prevent STIs and emergency contraception if indicated, just as for HBC users. So why doesn’t every SRH clinic or organization provide certified FABM training on site or seek collaborative partnerships with certified, secular-based instructors?

Bottom line? The SRH community is failing to fully meet the needs of women who won’t, don’t or can’t use HBC. The current hoopla over LARCs – long-acting reversible contraception including copper and Mirena IUDs and hormonal implants – as the next best birth control “technology” is mere tangent, not solution. Other than the copper IUD, these are still drug-based methods many women want to avoid.

Women who want to use NHBC effectively and confidently, or seek treatments for menstrual cycle problems that do not require hormonal contraceptives, are turning to care providers and information sources outside the SRH community. Is this what we want?

I don’t get it. If I can embrace the birth control dichotomy and retain my pro-choice commitment why can’t other pro-choice health-care professionals, non-profit organizations, and advocates do the same?

My pro-choice values have co-existed for decades with my advocacy for NHBC and menstrual cycle education. But I admit that because of my chosen focus, it is often wrongly assumed that I seek to deny options rather than to increase them, that somehow I cannot possibly be pro-choice.

Successfully using fertility awareness for birth control from age 27 through menopause (See p.4-5) did not keep me from serving 10 years on the board of Planned Parenthood Federation of Canada, or from bringing me back as a current board member of what is now the Canadian Federation for Sexual Health.

Promoting body literacy – acquired by learning to observe, chart and interpret our menstrual cycle events so that we become fully informed participants in health-care decision making – as a life skill that all girls and women should learn, did not keep me from being executive director of Planned Parenthood Alberta. The organization, which became Sexual Health Access Alberta and closed in 2010, distributed educational resources that included the most comprehensive Birth Control Demonstration & Sexual Health Promotion Kit still available for SRH professionals.

Sharing evidence-based medical information about the value of ovulation to women’s health and how to treat menstrual cycle disorders without the use of hormonal contraceptives, did not keep me from writing commentaries in support of abortion rights.

Within the pro-choice sexual and reproductive health community, I’ve chosen to focus on body literacy, menstrual cycle education, and advocacy for increased access to NHBC. At 60, I’m more committed than ever to promote a broader perspective within my community, one that will fully acknowledge and embrace the birth control dichotomy, one that will serve equally, without reservation, the contraceptive needs of all women.

About the Author: Laura Wershler, B.Sc., is a veteran pro-choice sexual and reproductive health advocate and women’s health critic who has worked for or volunteered with Planned-Parenthood-affiliated organizations in Canada since 1986. Laura graduated with a Certificate in Journalism from Mount Royal University in 2011. She has contributed columns on women’s health to Troymedia.com and blogs regularly for re:Cycling, the blog of the Society for Menstrual Cycle Research. Follow her on Twitter @laurawershler.

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Adventures in Natural Family Planning

by Samantha Wiessing

Published on June 19, 2014

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Ten years ago, I began researching fertility and natural alternatives to achieving and avoiding pregnancy. The more research I did, the more I realized that there was a decided lack of current, accurate information on the internet. After becoming pregnant with my first child, I focused my research to learn how to space my children without using birth control. Though my family has a long history of breastfeeding and childbirth, they did not provide me with any information that I could use. I didn’t want to use hormones while breastfeeding but neither did I want to get pregnant again immediately. While there has been significant research validating ecological breastfeeding, at the time it had not caught on. There was very little information on the internet about practically applying it in everyday life. Needless to say, using the information on the internet, I was soon pregnant with my second child and then my third child. At that point, my forays into natural family planning were not working.

Natural Family Planning and Physicians

I was desperate to find a way to space my children without artificial hormones or invasive devices; I looked to my OB/GYN and the local health department. My OB and the health department could not provide me with any information about natural family planning, and in fact I was openly mocked by the doctors and nurses. The health department tried giving me Cycle Beads with very little instruction. I refused them, knowing that they would be completely ineffective as I was breastfeeding and didn’t yet have a menstrual cycle. It seemed that I knew more about managing my fertility than they did.

Do-it-yourself Natural Family Planning

Discouraged and outraged, I obtained as much information as I could and assembled my own version of natural family planning. It worked for two years until I found myself pregnant with child number four. When my family and I relocated to another state, I was soon able to find a natural family planning instructor. I learned the Billings Ovulation Method. I cannot stress enough how important an instructor is when using natural family planning. This system taught me what I had been doing wrong all these years (I will write more about this and other methods in subsequent posts). I was able to successfully navigate breastfeeding my fourth child without getting pregnant.

However, my hormones started acting up in very obvious ways shortly after giving birth. None of the doctors I spoke to about it could give me an answer. I was experiencing what is known as “tail-end brown bleeding” from the end of my menstrual cycle on up to and including the day of ovulation. I went to two OB/GYNs and a hematology specialist. The answers I received ranged from “it is normal” to “there is nothing wrong.” Not one of them could explain this very obviously abnormal symptom. They all seemed unconcerned even though I knew that something was up.

I continued my research of the female reproductive system, as I realized that neither the Billings Ovulation method nor the Sympto/Thermal Method did anything to help the women who had health problems such as PCOS, endometriosis, infertility, or in my case abnormal bleeding.

Natural Family Planning With Irregular Cycles

My continued search for answers led me to another method of natural family planning called the Creighton Model FertilityCare System. The Creighton Model is considered the gold standard of the natural family planning world. Creighton has been able to research and document in a woman’s chart hormonal irregularities and how they relate to her overall fertility and health. Finally, I had a method of not only diagnosing but also treating the abnormality I experienced. With the use of the Creighton Model and NaPro Technology it is possible to work cooperatively with a woman’s cycle to help seek treatment for health problems like my abnormal bleeding pattern.

I fell in love with this method and went through the extensive training course to become a presenter and promoter for the Creighton Model. I originally set out to become a practitioner for this method so that I could help other women get the education they needed. I soon learned about the politics that surround natural family planning. We’ve all heard the jokes. “You know what you call a woman who uses natural family planning?……….. Pregnant.” Well, that pretty much sums up what most people think of natural family planning. Teachers are abundantly available for those interested in learning any method of natural family planning; but there is much more work to be done to change our culture’s current paradigm surrounding natural family planning

Luckily, we have come pretty far over the last decade. There is ever more press and discussion these days about the side effects of hormonal birth control (I will add a few links here). More and more women are deciding against hormonal birth control. Though, there is still much work to be done,natural family planning is becoming a viable alternative to the pill and other devices.

A New Approach: Fertility Awareness

Fertility Awareness is catching on as the new bias free catch phrase for a concept that has been around since the beginning of the birth control explosion. I have dedicated my life to spreading and sharing the wonder that is natural “organic birth control.” What we women really need is more voices who advocate for, and promote today’s modern Fertility Awareness Methods (FAM).

Over the coming weeks, I will be writing articles about the various methods of Fertility Awareness; the pros, the cons and my personal experiences with each. If you’d like learn how to navigate pregnancy naturally or if you have been diagnosed with a women’s health problem that you are currently treating with birth control, follow me on Hormones Matter. If you’d like to share your own experiences with natural family planning and fertility awareness, click Write for Us and send us a note.

How Hair Loss Changed My Life

by Suki Eleuterio

Published on December 19, 2013

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It’s funny to think I have to be thankful for a pill that made my hair fall out. My doctor had just prescribed the latest and greatest birth control pill, a magical pill that allowed you to have a period only four times a year.

But what my doctor didn’t bother to find out was that having a period four times a year was something I was used to. It was something I often felt strange about as a young girl, when all of my friends had their menstrual cycles working like clockwork.

About two months into the magical birth control pill, my hair began to fall out. Not a little bit, but in chunks. I was horrified and called my doctor straight away. Her advice? To go on taking the pill because it probably had to do with “something else.” She asked, “are you stressed at work?”

Desperate for answers, I took to the Internet to see what other women were saying. I was shocked when I came across a forum of women talking about their hair loss and Seasonique. One woman said she had been off the pill for years and her hair continued to fall out.

I ignored my doctor’s suggestion and threw the pill in the trash. The next day, I made an appointment with my dermatologist to see what I could do about my hair. A chunk of hair had fallen out in the front and it was embarrassing and scary.

The Dermatologist Diagnosed My Hormone Imbalance

My dermatologist did what my gynecologist should have done: she ran a battery of blood tests right away. Within a day, she called with some news. “We believe the hair loss is caused by alopecia areata,” she said. “It can be brought on by stress but is a hereditary disease.” She prescribed me steroid injections to stimulate the hair growth but then she added something else:

“You also have elevated DHEA levels,” she said. “This is not something to be too concerned about, but I suggest you speak to an endocrinologist or reproductive specialist.”

DHEA? What was that? I thought. But before I could ask, she was gone.

So commenced the journey of being my own doctor, my own counselor, my own pharmacist, and my own biochemist.

Unfortunately, in this world of busy doctors and poor bedside manner, you sometimes have to take the research upon yourself. Leave no stone unturned. Ask questions. Be annoying. It’s your health and you must fight for it.

Here is what I found out: DHEA, or dehydroepiandrosterone, is an important steroid hormone produced by the adrenal glands. It works as a precursor to both male and female sex hormones and therefore helps regulate over 55 hormones in the human body. Healthy DHEA levels are important to maintaining hormone balance in the body.

Still confused by the meaning of this, I called a reproductive health specialist at a clinic for fertility. I was lucky at the time to have excellent insurance, something I know a lot of women do not.

As soon as I talked to the doctors, who would later end up performing endometriosis surgery on me, I was instantly impressed by their care, efficiency, and expertise.

PCOS and Endometriosis

They quickly diagnosed me with PCOS, or polycystic ovarian syndrome. This, they said, was the reason for my increased DHEA, hair loss, and weight gain. Next, they took a detailed history from me. Through this they discovered what they expected to be endometriosis. They recommended laparoscopic surgery to clear out the endometriosis.

This was all so much information for me, and I took a few days to try to process it. My new doctor, an expert surgeon, said something that intrigued me:

“We are seeing an increase of women who have dual diagnosis: PCOS and endometriosis.”

More women with conditions just like me? Why would this be?

My research began with trying to make sense of the two diseases. I underwent surgery for endometriosis in 2011 and then focused on working with my doctor to change eating habits that exacerbate symptoms of PCOS.

But that link still bothered me.

Why would there be more women with the two illnesses? And what was this increased DHEA doing to my health? And what could be causing this increase? Unfortunately, these questions still linger, with many doctors avoiding my questions.

When my treatment for endometriosis was over (they found adhesions on my bladder, uterus, and small intestines), I was left to pick up the pieces of my scarred body. I ignored my doctor’s advice and went off the birth control pill, something I has been taking for 10 years, and commenced on a journey of self discovery and holistic health.

I’d like to share them in the hopes of helping other women who might be struggling with the same afflictions:

Get a Second (and Third) Opinion

A huge lesson I have learned is that if you think something is wrong with your body, you are probably right. Get a second opinion, get a third opinion, call people day and night if you have to, but don’t take this lying down. Ask questions and make sure your voice is heard when it comes to your health. At the end of the day, if your primary doctor is not helping, seek help elsewhere.

Enjoy the Fruits of Nature

Things that are made in a factory and placed in a can or a box are not healthy for anyone, but particularly for people struggling with hormone imbalance. Xenoestrogens, or estrogen mimicking hormones, can be found in a number of food additives and preservatives. Animals in the United States are raised with doses of antibiotics, steroids and growth hormones. Whatever the animals are eating, you are eating, and it continues the toxic cycle. My suggestion is to turn to a vegetarian, whole foods, organic diet, and keep away from the frozen, boxed, or canned meals. If you want to keep eating meat, just make sure it is organic.

Treat the Whole Self

Undergoing a major procedure or surgery is not just jarring for the body, it is jarring for the mind. A part of you has died and you have to allow yourself time to mourn it. One of the best things I ever did was to explore reiki and other forms of spiritual healing. Whether you choose to do yoga, journaling, hiking, dancing, reiki, acupuncture, or just take yourself on a vacation, make sure you treat the whole self. The body can repair itself in time, but the mind takes much longer. Allow yourself that time. Love yourself as a way to repair.

Work Up a Sweat

The worst thing you can do for hormone imbalance is sit around all day and feel sorry for yourself (those are my mother’s words). In our daily 9 to 5 lives, stuck behind a computer, sitting in our cars stuck in traffic, it’s hard to find time to exercise. But that’s why you have to make the time. Whether you sign up for a gym, start swimming, do yoga, or just walk around your neighborhood, moving your body will help your hormones wake up. Try to get at least 1.5 to 3 hours of cardio a week and you will begin to notice the difference in your physical and mental state.

Get Off the Pills

I am no advocating you run off and get pregnant, but I will say that getting off birth control was a decision I stand by to this day. You have to allow your body to show you how its working without the hormones and then make a decision about your treatment. Nowadays, birth control is prescribed so quickly to young girls, when there is very little research done about their medical history. Meanwhile, women are on birth control for 10, 15, 20 years without doctor’s mentioning that this might not be in their best interest. If you can, try to get off birth control, at least for a while, to see how your hormones are working on their own.

–

Two years later and my hair has fully grown back. Looking back at that time, I would not have changed a thing. And oddly enough, I am glad that my hair fell out, because it woke me up to something that was going on inside of me that might have lay dormant for years. If I were a doctor, I would research quite ferociously the link between PCOS, endometriosis, and DHEA. I would be curious as to why there is a link between PCOS and endometriosis and particularly, why now? Is it because we could not accurately diagnose the two disorders in the past? Or is it because people are eating differently now? Or perhaps because more women are on birth control pills now than in the 1950’s?

These questions are lingering, but one thing remains: you can overcome your symptoms of hormone imbalance, you can overcome your hair falling out, you can overcome surgeries that cut you deep inside, and you can rise to become better and stronger than you ever were before.

The High Cost of Bad Birth Control: Yasmin and Yaz Lawsuit News

by Chandler Marrs, PhD

Published on December 17, 2012

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As the debate over birth control rages, an often ignored aspect of the debate is safety. Some feminist groups contend that we can’t talk about the dangers of certain oral contraceptives or other hormonal birth control methods lest we give ammunition to the anti-birth control crowd.

“If you’ve seen on TV somebody crying that their daughter died taking birth control pills, and you’re a mom, you may not remember the (particular) birth control pill,” said Diana Zuckerman, president of the National Research Center for Women & Families. “You’ll just say you can’t be on it to your daughter.”

That sentiment couldn’t be more wrongheaded. Of course, we should be talking about the safety of birth control. Indeed, we should shouting at the top of our lungs about the dangers of some oral contraceptives and many medications in general. What good is it to have access to birth control, only to be killed or chronically injured from those pills? Death and grievous injury would seem to defeat the purpose of the entire reproductive rights movement.

We Need Safer Birth Control Options

As we’ve reported previously Yasmin, Yaz and other drospirenone based oral contraceptives (generics Syeda, Ocella, Zarah, Loryna,Gianvi, Safyral and Beyaz) appear decidedly unsafe. No amount of marketing will overcome the safety issues.

As of April, there were over 11,000 lawsuits pending with 14,000 plaintiffs. By October of this year, Bayer, the makers of the Yasmin line of birth control, has agreed to pay $750 million to settle the first 3400 lawsuits. With only 7600 more lawsuits to go, this might be one of the most expensive drugs to date.

The Dangers of Drospirenone

Several large studies (here, here, here) have found that women taking drospirenone based oral contraceptives have a two- to threefold increase in deep vein thrombosis and pulmonary embolism compared to other contraceptives. Bayer contests those results with several company sponsored studies that indicate no such risk. Recent reports of withholding data, question Bayer’s assertions.

AdverseEvents.com, a website that tracks all medication side-effects both from FDA and patient reporting, shows that the Yasmin line of oral contraceptives carry with them a range of very serious side effects, including death.

Yasmin, Yaz and Pulmonary Embolism

Notice the number and percentage of deaths, life threatening conditions and hospitalizations compared to other potent and in some cases, already recalled medications.

Yasmin, Yaz and Deep Vein Thrombosis

Why are These Products Still on the Market?

Money.

The Yasmin line of birth control is one of Bayer’s most lucrative product lines with over 4 million women taking these pills monthly. Even with the negative publicity surrounding for these products, revenue for the Yasmin line of products neared 1.1 billion for the first nine months of 2012. After 11 years on the market, total revenue for these products was likely well over $10 billion. If the company pays out $1-2 billion in claims, but makes $10-15 billion, the cost-benefit ratio is skewed in favor of maintaining their market presence. The fines become just another cost of doing business.

What about the FDA?

The FDA relies heavily on some 50 advisory committees to review drug safety. Many of these experts have strong ties to industry. Reports of conflicts of interest abound. In the case of drospirenone, early reports are claiming the decision making was indeed skewed by industry sponsored experts.

At least four and possibly six experts on the panel convened to review the dangers of drosperinone, had financial ties to Bayer. Subsequently, efforts to remove the Yasmin products from the market failed by four votes: 15-11. Instead the panel voted to increase warnings on the labels of these drugs.

Worse yet, unsealed court documents from lawsuits in Illinois indicate the possibility that Bayer knew of the increased dangers associated with the Yasmin products, as early as 2004 and withheld (and continues to withhold) that data from the FDA. According to reporters at Pharmalot and a report by David Kessler, a former FDA commissioner and current advocate for many of the legal cases:

“For instance, in a draft of the August 2004 white paper, Bayer employees wrote: “Compared to the three other (oral contraceptives), Yasmin has a several fold increase in the reporting rates for (deep vein thrombosis), (pulmonary embolism) and confirmed VTEs…When considering only serious AEs, the reporting rate for Yasmin was 10 fold higher than that with the other products which were very similar in magnitude.” Bayer employees argued in a revised draft that “spontaneous reporting data do signal a difference in the VTE rates for Yasmin and other OC users.”

Who to Trust

It is no longer reasonable for patients to blindly assume an FDA approved medication is safe or right for us (Vioxx, for example). Even research in major medical journals is suspect, with publication bias and outright fraud. Medical decision making is not for the faint of heart.

Luckily data are available online and though still convoluted, there is a degree of information availability never before possible. If you look, you can find the information needed to make a decision on almost any medication. We like and trust the data from Adverse Events. Their sole purpose is to expose and make accessible to the public the risks associated with medication.

Moving Forward

Demand better. We’ve long since moved away from the age of innocence where medications are concerned. Before deciding on the appropriate birth control method for you or your daughter, do the research, ask the questions and make an informed decision.

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