dangers of oral contraceptives

Potential Link between Oral Contraceptives and Autism

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It is estimated that 1 in 68 children are diagnosed with ASD in the United States. Increasing awareness and the rapidly growing number of cases of Autism Spectrum Disorder (ASD) have caused national alarm, compelling scientists to search for clues about the causes and contributing factors of ASDs. Many explanations for the rise in prevalence of ASD have been offered and yet, causal factors for ASD are still inadequately understood. Scientists agree that ASD is a complicated disorder thought to be due to interactions between genes and the environment, but as yet, there is no known cause that explains the increase in prevalence of autism and autism spectrum disorders.

Oral contraception use is one possible risk factor for the increase in prevalence that has been profoundly overlooked in the biomedical and epidemiologic literature. Interestingly, as the prevalence of ASD has risen over the last fifty years, so has the prevalence of the usage of oral contraceptives. Usage of oral contraceptives in the United States has increased from 1 million women in 1962 to almost 11 million women today. Because oral contraceptives were created to mimic natural human hormones and disrupt endogenous endocrine function to inhibit pregnancy, there is good reason for concern that the synthetic hormonal components may be causing the harmful neurodevelopmental effects that lead to the increase in ASDs.

Oral Contraceptives are Endocrine Disruptors

One of the compounds found in oral contraceptives is the synthetic estrogen called Ethinylestradiol (EE2). EE2 is a known endocrine disrupting compound (EDC) capable of causing harm to the endocrine system and to progeny. Studies show that EDCs have the potential to do harm by adversely affecting the sensitive hormonal pathways that regulate reproductive function in a variety of species including humans. The National Institute for Environmental Health Sciences (NIEHS) reports that EDCs may disturb the endocrine system and produce adverse developmental, reproductive, neurological, and immune effects in humans and wildlife. The NIEHS indicates that research also shows that the highest risk of endocrine disruption occurs during prenatal and early postnatal development. Humans might be exposed to EDCs through foods, beverages, pesticides, and cosmetics, but the case with EE2 is particularly striking because EE2 exposure in female humans occurs at a pharmacologically effective dose, administered every day, for extended periods of time.

Hormones and their signaling pathways are essential to normal functioning of all tissues and organs in invertebrate and vertebrate species. Normal communication of the endocrine system can be disrupted by exogenous substances like EDCs, which have the same attributes as endogenous hormones. EDCs possess the ability to be active at low concentrations and like endogenous hormones, they are able to bind to receptors at very low concentrations. Therefore, endocrine disruption can occur from low-dose exogenous hormone exposure or from hormonally active substances that interfere with receptors for other hormonally assisted processes. In addition, some EDCs are able to interact with multiple hormone receptors concurrently. They can work simultaneously to create additive or synergistic effects not observed with the individual compounds. EDCs can act on a number of physiological processes in a tissue specific manner. And, as with endogenous hormones, it is often not feasible to extrapolate low-dose effects from the high-dose effects of EDCs. Thus the mimicry of estradiol (E2) and the information that such compounds can cause harmful effects on reproduction and the endocrine system provide mechanistic evidence that EE2 found in oral contraceptives may adversely affect the oocyte or developing embryo.

Disrupting Hormones Chronically: Is This Safe?

Exposure timing is of interest and importance. When does exposure to the endocrine disruptor EE2 in oral contraceptives disrupt the endocrine system? Oral contraceptives were designed to disrupt the endocrine system throughout the month to keep a woman from becoming pregnant. During this disruption, what happens to follicles or the oocytes? As they are repeatedly exposed to the compound EE2, does this modify or change either or both of them? It is conceivable that with contraceptive EE2 exposure alteration in follicles or oocytes occurs, since data from animal models suggest that hormonal compounds do cause changes in follicular, embryonic, and fetal development. Does repeated exposure to the synthetic hormone EE2 cause harmful changes to human follicles and/or oocytes as well? If so, in this case, the adverse effects of disruption would happen even before fertilization occurs.

Becoming Pregnant while on Oral Contraceptives: Potential Dangers

Oral contraceptives are reported to be 99.9% effective if used properly. Less than 1 out of 100 women will get pregnant each year if they always take the pill each day as directed. Moreover, about 9 out of 100 women will get pregnant each year if they don’t always take the pill each day as directed. That means that out of the 11 million U.S. women using oral contraceptives, up to 100,000 may get pregnant while continuing to take EE2 after oocyte fertilization. Those embryos would then be directly exposed to pharmacologic doses of EE2. It is conceivable that exposure to EE2 could adversely affect the developing embryo. And, the time-frame for oral contraceptive wash-out is not clear even after discontinued use of the pills. Even if there is full drug wash-out, persisting toxicological, genetic, and epigenetic effects are possible. Harmful EE2 exposure could then occur after fertilization and during early development of the embryo.

There is also the potential for some EDCs to produce effects that can cross generations, meaning that exposure may affect not only the development of the first offspring but also their offspring over generations. This means that effects of EDCs could increase over generations due to both transgenerational transmission of the modified epigenetic programming, and the continued exposure across generations possibly imparting disease sensitivity later in time. Thus, the ability of ancestral exposures to promote disease susceptibility greatly complicates the possible threat to the health of subsequent generations, through exposure to EDCs such as EE2.

Autism and Oral Contraceptives: Is there a Connection?

The need for human epidemiological investigation into the link between oral contraceptive use and ASD is motivated by the firmly grounded hypothesis that oral contraceptive use is a risk factor for ASD in offspring. In the realm of environmental risk factors this hypothesis is compelling due to several considerations. First, as a category of agents there are specific documented mechanisms through which oral contraceptives can affect the oocyte and/or developing embryo. Second, exposure concentration is directly administered and by definition pharmacologically effective. And, it may be of greater magnitude than other environmental exposures that largely occur through passive secondary mechanisms. The possibility exists that the effects of EE2 could intensify over generations due to transgenerational transmission of altered epigenetic programming and the continued exposure across generations possibly imparting sensitivity to developing ASDs. Lastly, the specific demographic at risk, women who are likely to have children, is the exact demographic that is taking oral contraceptives, specifically during child-bearing years (“first principles”).

If, as I have hypothesized, epidemiological investigation establishes a link between oral contraceptives and ASD, this information would be invaluable to women of child-bearing age evaluating birth control options. Considering the increased prevalence of ASD, the increasing usage of oral contraceptives and  the striking lack of research in this area, this information has a sense of urgency for those women and their progeny.

To read more about possible connections between autism and oral contraceptives see: The link between oral contraceptive use and the increase in the prevalence of autism spectrum disorder.

About the Author:  Kim Strifert has an MA and is currently a student of Public Health at the Graduate School, School of Public Health, University of Alabama at Birmingham. She was previously employed as a healthcare administrator at the Mayo Clinic and Baylor College of Medicine.

References

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Denslow ND, Bowman CJ, Ferguson RJ, Lee HS, Hemmer MJ, and Folmar LC (2001) Induction of gene expression in sheepshead minnow (Cyprinodon variegates) with 17β-estradiol, diethylstilbestrol, or ethinylestradiol: The use of mRNA fingerprints as an indicator of gene regulation. General Comparative Endocrinology 121:250-260.

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Adventures in Natural Family Planning

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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.