hormonal birth control - Page 4

Birth Control and Blood Clots Study Final Week: Add Your Data Now

1927 views

A few months ago, Lucine Health Sciences and Hormones Matter began a pilot study looking at risk factors and warning signs/symptoms in women who have developed blood clots while using hormonal contraception. This study consists of a survey questionnaire, and a personal story/case report, which is shared on Hormones Matter with the study participant’s permission. We would like to thank all of the women who took the time to complete our survey and who courageously shared their stories to help inform our research.

This phase of the study will close on July 25, and we will then perform a full data analysis on all of the results. In the mean time, we have already written about some of our early results here and here. What we have learned so far from our survey results suggests that some information that is commonly accepted about the risks for blood clots on hormonal birth control may not be true, and that the risk information is not communicated to women in a realistic and truthful way.

What We’ve Learned So Far

Early Survey Results

Many blood clots develop after years of use. Although it is thought that the risk for developing a blood clot is highest in the first year after starting or restarting hormonal contraception, our data to date show that 75% of women developed clots after the first year on the medication, and only 25% developed clots within the first year. Many women developed clots even after significant lengths of time on the medication, in some cases, even after up to 21 to 30 years.

Smoking is a risk but not THE risk. Many women are led to believe, by information provided to them by pharmaceutical companies and their doctors, that they are only at risk of a blood clot if they are over 35 years old, and smoke. However, 94% of women in our study were not smoking at the time of the blood clot, and 78% had never been smokers. Smoking does increase the risk, but the idea that you are only at risk of you are a smoker is false.

Clotting disorders are not identified. We also discovered that women are not being tested for blood clotting disorders that significantly increase their risk of developing a blood clot while on hormonal contraception. Fully 89% of the women in our study did not have such testing prior to starting hormonal contraception, and a further 9% did not know if they had any testing. Only 2% of the women were able to state with certainty that they had been tested.

These results, as well as additional results, will be explored further when the study is complete. We will be looking at women’s ages when they developed blood clots, warning signs and symptoms, other side effects from hormonal birth control, additional risk factors, and more.

Personal Story Findings

At Hormones Matter, we believe strongly in the power of the personal story. Like case reports, they give us a breadth and depth of information that cannot be captured as well in the more quantitative results. As part of this project, we have been collecting and publishing these stories. In addition to the trends emerging from the survey results, we’re seeing several disturbing trends regarding whether and how risks for blood clots are communicated, tested for and/or identified. In most cases, there appears to be a significant disconnect regarding these risks.

Risks for blood clots are not communicated. What do these stories have in common? The women who developed clots were not aware that these serious complications could develop as a result of hormonal contraception. Laura Buccellato, whose daughter Theresa died at age 16 from a pulmonary embolism, said in her story

“Our doctor did not go over any of the side effects with us or what to look for if something were to go wrong. I trusted my OBGYN because I have been with her for most of my life and she had four children so I never felt she would put Theresa in any kind of harm.”

If women are taking a medication with the possibility for serious injury or death, they should certainly be informed of risks. They should also be educated about early warning signs and symptoms of blood clots.

Signs of blood clots are not recognized by physicians. Another common and disturbing trend has emerged from the personal stories: in the early stages, and sometimes even in the later stages of the blood clot event, blood clots are not considered in the differential diagnosis. More often than not, when women approach their physicians with signs pointing to blood clots, they are dismissed.  The possibility of having a blood clot is not investigated or even considered, and most doctors do not even ask the patient about their use of hormonal birth control. For example, Kerry Gretchen was suffering from the symptoms of a blood clot in her brain for a month, and was sent home from the emergency room twice and told that her symptoms were due to a migraine. This resulted in even more severe effects from her stroke. Susan Eklund McKenzie had taken her daughter Marit to the doctor twice for symptoms related to a pulmonary embolism, but unfortunately this was never investigated, and Marit died at age 18.

Blood clots are devastating. Another commonality is just how catastrophic these blood clots can be. The women who have had strokes (stories are here, here and here) all had to relearn how to perform the daily functions of life, such as walking, writing, showering and dressing themselves, and some of the women have lasting disabilities.

It is known that pulmonary embolism has a high mortality rate, and the women whose stories we have shared who suffered from a pulmonary embolism, all died as a result (stories are here, here and here). Brittany Malone had a massive blood clot in her leg, and as a result suffered pulmonary hemorrhage, respiratory failure, heart attack, irreversible brain damage, and death.

We would all like to think that this could never happen to us, but as Detrease Harrison said, in her story of having a stroke after 23 years on the birth control pill:

“I used to tell people I had no risk factors for having a blood clot, but almost everyone has some kind of risk factor.”

Participate In The Birth Control and Blood Clots Study

There are two weeks left in this phase of our study, and then the survey will be taken down and to analyze the results fully.

If you are a woman who has suffered from a blood clot while using hormonal birth control, we urge you to participate in our study to help us learn more about this important women’s health issue.

Because of the severity of some blood clots, including death or serious disability, we allow parents, family members, or partners to take the survey for the affected individual.

If you know someone who might like to participate, please share this article with them.

If you have begun the survey and haven’t yet completed it, please do so in order to enable us to use your data. We cannot use your data, if the survey is not complete.

If you’ve completed your survey but haven’t yet sent us your story, please do so.

We will be continuing to share women’s stories over the next few months, so please continue to follow the study on the Hormones Matter website, on our Facebook page, and on Twitter.

Fatal Pulmonary Embolism Precipitated by Diane 35

3170 views

This story is about our daughter Marit McKenzie, who was taking the birth control pill Diane 35 when she died suddenly from a pulmonary embolism on January 28, 2013.

Marit had been having some issues with mild acne. At age 16 her doctor had put her on minocycline, an antibiotic, to treat her acne, but it did not work. Then she was put on Accutane for six months, which she found very drying to her skin and caused severe burning of her eyes. At this point, her sister had been on Diane 35 for about a year, after having been through the various treatments as well. Marit asked her doctor if she could try Diane 35 too, so that she could have clear skin for her graduation in June 2012.

Marit started taking Diane 35 in February 2012. Her skin cleared up and she celebrated her high school graduation.  She continued on Diane 35 into the fall of 2012. Marit started university and was extremely anxious and nervous about going. I didn’t clue into the little changes as she was always very shy girl and was nervous at the beginning of every school year. But looking back on it, her level of anxiety was unusual.

In October 2012, she fell off her bike and pulled a muscle (we thought) but the symptoms disappeared. She also had some pelvic pain after lifting some heavy tires. She went to the doctor to have these issues looked at and the doctor renewed her prescription for Diane 35. To investigate the pelvic pain, she had an ultrasound on her abdomen, and the results of that were normal.

The pains went away and from November to January, Marit seemed relatively normal. We enjoyed Christmas in the mountains and did some cross-country skiing. Marit was faster and better at it than her older sister and me. Through to mid-January she was healthy, but around the 15th of January she started to feel very tired. I took her to the doctor, who said she seemed fine but would check her blood for mononucleosis. The results came back negative.

The following week on January 23rd I took her back to the doctor because her heart was now racing. The doctor said it was fast, but not too fast, and also said that Marit might have hyperthyroidism. So she was sent for tests again: more blood work and an ECG. The lab said they would call me if results were unusual. They did not call.

Marit stayed home from school on Thursday the 24th, trying to rest. Friday morning she drove over to her boyfriend’s and they visited, just sitting on the couch. Too tired to do anything, she came home. I wanted to take her to the hospital, but she just wanted to wait for the results of her tests. She was very afraid of hospitals. We spent the evening watching TV together. She went to bed around 10:30 pm. My husband and I went to bed at the same time.

At 12:30 am that night Marit used her cell phone to call us. She couldn’t fall asleep as her heart was racing again. We took her to emergency. We no sooner got there when she went into cardiac arrest. EMS revived her four times. They did chest x-rays and found a massive bilateral pulmonary embolism. Over the next two days they did everything they could but there was too much brain damage from the heart attacks. Marit died on Jan 28, 2013.

When the doctors told us what caused this to happen we immediately took our older daughter Britta off Diane 35. Our doctor tested Britta, my husband and I for blood clotting disorders. Marit was never tested, but Britta’s tests showed that she might have protein S deficiency, which is associated with an increased risk of venous thrombosis. However, my husband and I do not have any signs of a blood clotting disorder.

Marit was an absolute joy and so intelligent, kind, compassionate and loving. Her best friend Paige had a liver transplant when she was a few months old and because of that and her love for Paige she did her senior project in high school about raising money for the David Foster Foundation. This foundation is a non-profit charitable organization dedicated to providing financial support for non-medical expenses to Canadian families with children in need of life-saving organ transplants.

Marit was also a fine artist and she did a variety of artwork and photography to sell in order to raise money for the David Foster Foundation and to support organ transplantation. She believed in organ donation because she would not have had her amazing friendship without someone having donated their baby’s liver to Paige. Marit asked me to sign her donor card when she was 17! We could never have predicted that a year later we would be donating her organs.

Our hearts are broken; I don’t want another family to go through this senseless tragedy. Why can we not test our young women for blood clotting disorders before they go on birth control? Our doctor did not know how dangerous this drug is, and that 13 other young women in Canada have died from it, not to mention the many others left with disabilities.

I am hoping get the medication Diane 35 banned in Canada, as it is 4 times more dangerous than regular birth control pills. It is prescribed for acne, but does not cure it. It is only supposed to be used for a few months, and when you come off of it the acne usually comes back. The risks of taking this medication do outweigh the benefits in my opinion, certainly considering acne is not life threatening. Please click here to sign and share my petition if you are in Canada.

Real Risk Study: Birth Control and Blood Clots

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

5 Surprising Reasons Not to Use Hormonal Birth Control

10182 views

The following is a list of some the health factors that increase your risk of side effects from taking hormonal birth control. It is by no means a complete list of contraindications but you may find some of these surprising. I know I did.

Five Reasons You May Want to Reconsider Hormonal Birth Control

Reason 1: Smoking and Age

You are probably familiar with these warnings. You may have heard them on television commercials or seen them on magazine advertisements. Or maybe you read my article about risk communication and saw them there. The problem with these warnings is that the wording makes it seem like you are only at risk if you are over 35 and a smoker. But the truth is that these two risk factors stand independent of each other. You are at increased risk if you are over 35 years of age. You are at increased risk if you are a smoker of any age. And if you are a smoker who is over 35, you have an exponentially higher risk for blood clots when using hormonal birth control.

Reason 2: Migraines

According to a 2010 article in the Reviews in Obstetrics and Gynecology, 43% of women in the United States suffer from migraines. That’s a huge number of women. Also, according to the same article, 43% of women using birth control are using hormonal contraception (the pill, rings, shots, implants, etc.). I’m not a statistician but I’m guessing there is some overlap between the women that suffer migraines and the ones using hormonal birth control. This is problematic for two reasons:

  1. A great deal of evidence suggests that migraine, particularly migraine with aura, is associated with an increased risk of ischemic stroke, and that this risk may be further elevated with the use of hormonal birth control. But if you don’t believe me, both the American College of Obstetricians and Gynecologists and the World Health Organization advise that women who suffer migraines with aura should not use hormonal contraception.
  2. Reevaluation or discontinuation of combination hormonal contraception is advised for women who develop escalating severity/frequency of headaches, new-onset migraine with aura, or nonmigrainous headaches persisting beyond 3 months of use.

A 2016 meta-analysis of seven research studies demonstrated “a two- to fourfold increased risk of stroke among women with migraine who use combined oral contraceptives (COCs) compared with nonusers.” But once again, like so many other things about hormonal birth control, the authors of the study report that research is lacking in this area and more studies need to be done.

Reason 3: Family Clotting Disorders

Many people have a clotting disorder and simply don’t know it. When I had my stroke while on birth control pills, I had no idea that I had the fairly common clotting disorder Factor V Leiden (FVL affects between 3-8% of people). But what I did know was that my grandmother had had two strokes. And my aunts and uncle had all had blood clots.

Unfortunately, women are not systematically tested for clotting disorders before they begin using hormonal birth control. This is very dangerous and why it’s so important to give your doctor a thorough family history; something I know I wouldn’t have considered that vital when I was 18 years old.

A lot of health professionals don’t take the time to review your family history, making it even more important that you mention your family history of blood clots and your concerns about hormonal contraception. You might even insist on being tested for clotting disorders before increasing your risk of a dangerous and sometimes deadly blood clot.

Reason 4: Depression and Mental Health

I explore this further in this article but the basics are:

  • Hormonal contraceptives can cause mental health issues
  • Women who suffer from mental health issues are much more likely to suffer from increased symptoms when on hormonal contraception
  • Often the longer hormonal contraception is used, the greater the symptoms
  • Discontinuation of hormonal contraception can usually alleviate mental health symptoms

Reason 5: Diabetes

Dr. Hugh J. Davis, the first doctor to testify at the Nelson Pill Hearings said the following (page 5930):

“A woman, for example, who has a history of diabetes or even a woman with a strong family history of diabetes is not an ideal candidate for using oral contraceptives… [they] produce changes in carbohydrate metabolism which tends to aggravate existing diabetes and can make it difficult to manage.”

Hormonal birth control elevates blood glucose levels, can increase blood pressure, increases triglycerides and cholesterol, and accelerates the hardening of the arteries, among other things. They knew this in 1970. But what about the research now? Well, if you’ve read any of my other articles it probably won’t surprise you that the current research is… wait for it… you guessed it… INCONCLUSIVE! Here’s a look at what I’ve found:

“Cardiovascular disease is a major concern, and for women with diabetes who have macrovascular or microvascular complications, nonhormonal methods are recommended.

There is little evidence of best practice for the follow-up of women with diabetes prescribed hormonal contraception. It is generally agreed that blood pressure, weight, and body mass index measurements should be ascertained, and blood glucose levels and baseline lipid profiles assessed as relevant. Research on hormonal contraception has been carried out in healthy populations; more studies are needed in women with diabetes and women who have increased risks of cardiovascular disease.”

And:

The four included randomised controlled trials in this systematic review provided insufficient evidence to assess whether progestogen-only and combined contraceptives differ from non-hormonal contraceptives in diabetes control, lipid metabolism and complications. Three of the four studies were of limited methodological quality, sponsored by pharmaceutical companies and described surrogate outcomes. Ideally, an adequately reported, high-quality randomised controlled trial analysing both intermediate outcomes (i.e. glucose and lipid metabolism) and true clinical endpoints (micro- and macrovascular disease) in users of combined, progestogen-only and non-hormonal contraceptives should be conducted.

Not enough evidence is available to prove that hormonal contraceptives do not influence glucose and fat metabolism in women with diabetes mellitus.”

As a side note, a recent study demonstrated a link between hormonal contraceptives and gestational diabetes.

Contraception is a very personal choice. I believe all women should research the risks associated with using hormonal contraception, but especially if you experience any of the health conditions above. Should you weigh the risks and benefits of using hormonal birth control and decide it’s still the right choice for you, please take a moment to review the symptoms of the blood clot and seek help immediately if you notice any of these.

Real Risk Study: Birth Control and Blood Clots

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

Shattering Myths: Birth Control and Blood Clots Study Early Results

2634 views

Lucine Health Sciences and Hormones Matter launched an important new research project one month ago. The Real Risk Study: Birth Control and Blood Clots is a multi-phased project designed to assess the breadth and depth of blood clot risks and other side effects associated with hormonal birth control. The current phase of the research involves collecting survey data and case reports from women who have suffered from blood clots while using hormonal birth control. Although data collection is still in the early stages (we have data from 42-50 participants, depending on the question), some important trends are already beginning to emerge.

Are Newer Users Really More At Risk?

One of the statements often made in medical publications, and even stated in the pharmaceutical companies’ own package inserts, is that the risk of developing a blood clot on hormonal birth control is the highest among new users or those restarting (within the first year of use or re-use). In our study, we are asking the question “How many total or cumulative months or years had hormonal contraceptives been used prior to the clot?” In our preliminary data set of 50 women, only 22 percent developed blood clots within the first year of use. The majority of women, 78 percent, developed blood clots after the first year. From our data, it does not seem true that the risk of blood clots is highest within the first year of use.

Seventy-Eight Percent of Hormonal Birth Control Induced Blood Clots Develop After One Year

Birth Control and Blood Clots: Preliminary Results

We further analyzed the data set to refine our understanding of when blood clots were developing relative to length of time on hormonal contraceptives. The chart below shows the percentage of women in our preliminary data set that developed clots after various lengths of time. The size of each box is proportional to the number of women in that group. Because the data is preliminary, and the number of women in each group is still small, we cannot really compare the sizes of the groups to each other until we have more data. However, we can say that women are developing clots after a wide range of time on hormonal contraceptives, even after up to 21-30 years on the medication.

Hormonal Birth Control Induced Blood Clots Develop More Frequently in Years 1-10

Birth Control and Blood Clots: Preliminary Results

Cigarette Smoking as a Risk Factor for Blood Clots

We are also asking survey questions about known risk factors and possible risk factors, to try to get a clearer picture of all of the factors contributing to a woman’s risk of a blood clot while on hormonal contraception. Cigarette smoking is known to increase the risk of developing a blood clot, and it is referenced in the package inserts that come with birth control pills. In the information for Yaz, the most popular birth control pill in the U.S., the warning states:

WARNING TO WOMEN WHO SMOKE: Do not use YAZ or Beyaz if you smoke and are over age 35. Smoking increases your risk of serious side effects from the Pill, which can be life-threatening, including blood clots, stroke, or heart attack. This risk increases with age and number of cigarettes smoked.

However, it has been pointed out that the risk communication by pharmaceutical companies in these inserts employs language that is misleading about the true level of risk, and the message most women who read the inserts come away with is that if they don’t smoke and are not over age 35, they are not really at risk.

In our survey we are asking the question: “Were you a smoker at the time of the blood clot(s)?” So far we have collected data from 42 participants for this question. In our data set, 79 percent of women who suffered from blood clots while on hormonal contraception had never been smokers. Another 12 percent had smoked previously, but were not smokers at the time of the blood clots. Altogether, 91 percent of women in our study were not smoking at the time when they develop the blood clot(s). This means that women cannot be confident that they are not at risk just because they do not smoke.

While these results are very preliminary and will have to be confirmed with the larger sample pool and the additional validation studies we anticipate, the data collected thus far seem to suggest that risks described by the industry do not correspond to the reality of what women experience. Although some women develop clots soon in the weeks and months after initiating hormonal birth control, the vast majority do not. Similarly, although smoking is certainly a risk, not smoking does not equate with lack of risk. So what causes the blood clots in some women and not in others? That is what we are trying to determine with this study.

Birth Control and Blood Clots Is about the Chemistry

We know from the basic chemistry that hormonal contraceptives skew coagulation factors in favor of blood clotting in all who take them. The research on this is pretty clear. These synthetic hormones increase the coagulation factors by 170%, almost three times their normal levels. Simultaneously, hormonal contraceptives decrease the anti-clotting cascades by 20%. This alone is sufficient to create blood clots and yet, not all women who take hormonal birth control develop clots or develop them very quickly. In some cases, it is years before the clotting becomes problematic.

What causes some women to develop clots soon after starting hormonal contraception, versus those who develop clots after many years? What causes some women without any known risk factors to develop massive DVTs and/or massive bilateral pulmonary embolisms, and die in their twenties? Is it determined by genetics, by medication interactions, by lifestyle variables, or by various combinations of risk factors? We do not know. No study to date has been sufficiently comprehensive to determine those risks. The Real Risk Study is.

Participate in Research

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

Sharing My Story, Feeding the Hope

4139 views

When I took this job—combing through the Nelson Pill Hearings, researching and writing about the risks with hormonal birth control, working on the Real Risk study—my mother said to me, “Are you sure you want to do that? Are you sure you want to dig up all that stroke stuff?”

“Mom,” I said, a little exasperated. “It’s been 10 years. I’m fine with it.” Duh was close to what I was thinking but didn’t say. The weird thing is, my mom may have been right. Okay, that’s not entirely fair. My mom WAS right. (NEWSFLASH: My mom is right sometimes!) This job has been hard, and not just because reading congressional testimony is draining and because I’m so passionate about this work. It has been hard because it has forced me, nearly every day since November, to examine what happened to me.

I had a stroke because of hormonal birth control and for a long time I believed my doctors (and much of the research I found when writing my thesis) when they said that I was special. That this sort of thing didn’t happen much. Because I thought I was an anomaly, I was able to bury my head comfortably in the sand and call that “dealing with it.”

It hit me that I had not been dealing with it when I sat in a room with Karen Langhart and the parents of four other young women who had died while using hormonal birth control. As they shared their stories, tears slid down my face. I knew I was not an anomaly. It could have easily been my mom sitting in that room and not me.

I’ve written about how important it is to share patient stories. And we’ve written about the importance of the Real Risk Study. I’ve participated in the study. I’ve written my story (all three parts of it: Part 1, Part 2, Part 3). But it has not been easy for me. Which means it has taken unfathomable courage and strength for the families who have lost their daughters. I had to face a sadness that was buried deep under a layer of “getting on with life.” But for these families, the sadness isn’t buried because there is no “getting on with life.” It’s right there, out in the open, raw and exposed. Their lives will never look remotely the same.

When we publish an article about a health crisis or a death related to hormonal birth control it is not because we are alarmists. It is not because we are whiny or dwelling in the past. It is because this work is important. This study is important. I was not an anomaly. The young ladies who were killed by hormonal birth control are not anomalies. They are daughters, wives, sisters. They could be you or someone you love. We share because we are not alone. We are a group of survivors and advocates.

One of the most amazing things that has happened to me from taking this job is that, despite the challenges, it has helped give meaning to what happened to me. I’ve met and connected with amazing people. While much of it has been cloaked in sadness, the thing that shines even brighter in these interactions is hope. And hope is healing. By sharing my story and participating in this research, I am feeding that hope.

It is my wish that you will help feed that hope, too. If you are a survivor of a blood clot or a family member of someone killed by a blood clot and you have been hesitant to participate, now is the time. If you aren’t, I guarantee that you know someone (a friend or relative or a friend of a friend) who has been affected by a blood clot while on hormonal birth control. Now is the time to share this link. Because there is hope in sharing. And healing in hope.

Real Risk Study: Birth Control and Blood Clots

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

Patients Are Not Statistics: The Case for Personal Stories in Medical Research

2400 views

Lucine Health Sciences and Hormones Matter have begun an important new research project to investigate the relationship between hormonal birth control and blood clots. They are surveying and interviewing women and the families of women who have suffered blood clots while using hormonal contraceptives. A big part of this study includes publishing the personal health stories of these women. (You can read my story here.) Hormones Matter has always been a place to question the status quo in healthcare and believes that one of the most powerful ways we can do that is by allowing patients to have a voice.

Patient stories, or case studies, are vital to the conversation about the safety of medications and they help drive research about health issues. I believe they are the proverbial canary in the coal mine. How else will doctors and researchers know what’s going on? Should they rely solely on the drug companies to share information that may be detrimental to their bottom line? I don’t think so, but over the years many doctors and scientists have dismissed patient stories as anecdotal and therefore not pertinent to the research conversation. They claim that the only valid forms of medical research are the double-blind placebo controlled trial or the large epidemiological investigations and nowhere is there room for the patient experience of his or her symptoms. But these studies are often cost-prohibitive or take many years (sometimes decades) to complete. What about the patients suffering now?

Case Studies Dismissed in Hormonal Birth Control Research

In my research involving birth control safety and the politics and policies surrounding hormonal birth control, the disregard for patient experience, let me rephrase that, human experience, is striking and entrenched. Even back in 1970 at the Nelson Pill Hearings, Dr. Joseph W. Goldzieher, one of the physicians testifying, was so adamant that case stories had no value that he impugned the entire British Medical Journal, the official publication of the British Medical Society and counterpart to the Journal of the American Medical Association. His claim was based on their willingness to publish an article about cervical cancer and the birth control pill when he felt that other journals “would turn it down as proving nothing.” Perhaps it is no coincidence that the British Medical Journal was the first to call attention to the problem of blood clots and the birth control pill. Dr. Goldzieher’s testimony is as follows (from page 6375 of the Nelson Pill Hearings).

Senator McIntyre: Does this statement, the statement that this journal—I am now referring to the British Medical Journal—this journal is noted for its lack of editorial discrimination, represent simply your own opinion, or is it based on some evidence?

Dr. Goldzieher: No, sir. It is my opinion exclusively, and it is based on the fact that this particular journal publishes large numbers of letters of an anecdotal nature, which are perhaps amusing, but are of dubious scientific merit, but which are then used for purposes which are not admissible. Having crept into the scientific literature as information—any statistician would call it anecdotal information—it then gets quoted and re-quoted. This is of questionable value to the medical community.

Senator McIntyre: Doctor, is it not true that letters to medical journals might very well be a manner and a way of detecting problems that may be occurring?

Dr. Goldzieher: I think there are better ways, Senator… This raw information should not, in my opinion, appear in a journal of this type… It should go to somebody which knows what to do with this information. Printing it in the British Medical Journal is no way to handle this kind of information.

Of course statistics are important. And of course we cannot make claims for all women based on the experience of one, or even a few, but in the case of hormonal birth control and blood clots (or really any of the side effects from hormonal contraception or other drugs), we are not talking about a few exceptional cases. Hundreds of thousands of people are harmed every year from medication adverse events. In fact, prescription pharmaceuticals are the fourth leading cause of death in the United States. How hormonal birth control contributes to that risk is unknown. We see from the testimony of doctors, scientists, and researchers that even in 1970 the drug manufacturers knew there were far more side effects with synthetic hormones than had been studied prior to their approval. Imagine what might have happened if more case studies were published instead of dismissed as anecdotal. Would that have driven more research and more awareness of risks?

Case Studies Drive Research

A doctor that testified after Dr. Goldzieher completely refuted Goldzieher’s stance on case studies and the British Medical Journal.

Dr. Philip A. Corfman said (in Nelson Pill Hearings, page 6400.):

“I believe the thromboembolism story provides a good example of what kinds of studies are needed. The story started with clinical observations, letters to the British Medical Journal, and case reports in Sweden and American literature. These observations brought this problem to the attention of medical science, but it was not for several years, five or six at least, until well-designed, carefully controlled studies were undertaken to show that there is indeed a positive relationship between the use of pills and [blood clots].”

 

“We are still in the early stage with the other problems that have been discussed, such as cancer, hypertension, and diabetes.”

Clearly, it takes patient stories to help detect these problems. We cannot afford to wait for an observable statistical jump in the mortality of young women or any group of people before we start investigating whether these medications are really safe. We really cannot trust the drug manufacturers to make this decision for us.

Pharmaceutical Companies Against Case Studies

Perhaps it is no surprise that when Senator McIntyre asks Dr. Goldzieher if he had ever worked for the drug companies, his response was, “I am a consultant at various times to various drug companies.”

So maybe it boils down to Dr. Clark’s testimony upon being asked if he would give his daughter the pill.

“There are two sensible answers to that. The first is, my daughters are both college age now and they would not do anything I told them to anyway. The second answer, I think, is that in a survey such as this, one is dealing with statistics. These have to be looked at in the light of a group of other statistics. When you come down to a question of the patient, that patient is no longer a statistic.” -Nelson Pill Hearings, page 6152.

Patients are Not Statistics

Patients are NOT simple statistics. This is why sharing personal stories is so vital and why we make that a priority at Hormones Matter. The manufacturers and many astute doctors and researchers knew over 40 years ago that hormonal contraceptives needed much more research. In 2016 we still don’t fully understand the risks for deadly blood clots and other serious side effects. Had women not been silenced then, perhaps we’d know more today; perhaps fewer women and their families would suffer the consequences of hormonal birth control related blood clots.

Real Risk Study: Birth Control and Blood Clots

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

 

5 Things Not to Say to a Stroke Survivor

5930 views

Before I had a stroke at 28 from hormonal birth control (you can read my story here), I didn’t really know what a stroke was. And I certainly didn’t understand the implications or ramifications of what it meant to have an “insult to the brain.”

I knew I had physical and mental limitations, that I needed to learn how to walk again, to put on my socks, to bathe myself. But they also told my family that I may have an entirely different personality. Can you imagine? You wake up one day, have a brain injury, and your personality is completely different? And would you be able to recognize how your own personality had changed or would it be something people would whisper about when they thought you weren’t listening? My sister must have been particularly worried about my personality. I remember one morning she had to butter my biscuit for me after I had tried unsuccessfully several times. “I’ll butter your biscuit for you for the rest of your life,” she said. “I’m just so glad you’re still in there.” At least most of me was. That is to say, I still had my struggles with who I was and who I had been. But really, who doesn’t?

The interesting thing about surviving a stroke is learning what you can and cannot do. To others, even others that are informed about brain injuries, you may look so similar to your pre-stroke self that they take for granted you are the same. But you may not be.

So as a public service announcement for Stroke Awareness Month, here is a list of 5 things not to say to a person who has had a stroke (or any brain injury).

1. “Hold this.”

The disconnect between mind and body when you have a traumatic brain injury is a constant surprise. The first time they handed me the receiver to talk on the telephone, I held it backwards. One time I put a Cheeto in my ear instead of my mouth. When my mother asked me if I wanted to put on some lipstick, I took the tube from her, put it on my lips (or near them), then put the cap back on the raised stick of lipstick, crushing it. In the ICU, when they had me brush my teeth and rinse with a paper cup of water, the nurse instructed me to spit the dirty water back in the cup. I nodded. “Of course,” I thought. Then I promptly swallowed it. One of the most surprising things, and this was long after I’d been discharged from the hospital (and if I’m being completely honest, even now sometimes), is how things get lost in my left hand. I can literally be holding my keys in my left hand and be looking around the house for them.

But it’s not just the things in my left hand. Sometimes I will stand before a trash can with a pen in one hand and a tissue in the other and tell myself, “throw away the tissue, throw away the tissue, throw away the tissue.” Then I always have to bend down and pick the pen out of the trash.

2. “Lift your leg.”

During my rehabilitation, I was a bit of a challenge for my therapists. Most stroke survivors have damage to either the right or the left side of the body. But the damage from my stroke went down both sides of my brain and consequently affected my left arm and my right leg. One of the exercises the physical therapist asked me to do was to raise my left arm while all on all fours. I did. Then he asked me to raise my right leg. I did. “Raise your right leg,” he said again. So I raised it again. “Kerry, raise your right leg,” he said, like I might not have realized he was talking to me. “Right leg. Right leg,” my mom added. “I am raising my right leg,” I said, exasperated. What is wrong with them? I wondered. I looked behind me with complete certainty that I would see my leg raised. Of course I didn’t, but I did catch an expression on my mom’s face. It was the same expression she was wearing when we played Boggle in recreational therapy and I only found a few words. It was the same expression she wore when I smashed her tube of lipstick. It was an expression that seemed to say she wasn’t quite sure who I was.

3. “Write this down.”

A day or two after I got out of ICU, my mom asked me if I thought I could still write. You would think after the sock incident, I might have had my doubts. But I’m clearly a slow learner, because I said, “Sure, I can.” She handed me a notebook and a pen. I recently found that notebook, the picture is above. (My mom would continue to lovingly document these little milestones, just like she had when I was a baby.) When I wrote that, I thought I had done a pretty good job. And considering what my brain had been through, it was amazing I could even hold a pen. But when I look at it now, it breaks my heart a little bit. I’m so lucky that I write flawlessly now. Just kidding! My writing, while mostly legible and mostly on the lines of the paper, is still a mess. Until a few weeks ago, I didn’t even realize that messing up every third word, leaving letters out, adding letters where they don’t belong—that isn’t just how everyone writes. After a highly scientific study of asking a few of my friends, it seems that’s not normal. The first paper I wrote in graduate school, I typed the words male and female as “mail” and “femail.” Every. Single. Time. Even when I would remind myself, it still came out wrong. To this day, I have trouble with homonyms but I usually catch the mistake before I send the email or publish the story. But sometimes I don’t. I hope you’ll bare with me… haha.

4. Glare at them when they park in a handicapped spot.

In fairness, glaring at someone is not saying anything to them, but so much of communication is nonverbal that I had to include it. After my stroke, they gave me a temporary handicapped decal for my car. And while I may have looked relatively normal, I assure you I was not. I couldn’t walk long distances. I found any remotely crowded place to be extremely stressful. I had to sit down halfway through a trip to the grocery store. Day-to-day things that used to be easy were difficult and frustrating. But even more frustrating were the looks that people would give me when we parked in handicapped parking. One woman glared at me in such obvious disgust as we got into our car. She waited to comment until we had closed our doors so I didn’t hear what she said, but I’m pretty sure she heard me when I rolled down my window. As my husband sped quickly out of the parking lot, I hung my head out of the car and yelled, “I had a stroke!” at the top of my lungs. Not one of my finer moments, to be sure. The lesson that remains, and one even I frequently have to remind myself of, is that you really never know what a person is going through just by looking at them.

5. “My (insert friend or relative)’s experience was much worse than yours.”

A few months after I got out of the hospital, I was at dinner with friends when a woman I had just met (a friend of a friend) was surprised to learn that I had recently had a stroke. “My grandfather just had a stroke,” she said excitedly. “But his was way worse than yours. He’s still in the hospital.” Of course, what she meant was that I looked like I was fully recovered while he was still having visible problems. And of course, she probably didn’t mean to be dismissive. But it really bothered me. I had a massive stroke. I didn’t just have blood clots in my brain (an ischemic stroke, which accounts for 87% of all strokes). I also had bleeding in my brain (a hemorrhagic stroke—a much less common and far more deadly stroke). In my mind, I had actually survived two strokes. Yes, I was extremely lucky and I know my recovery was nothing short of miraculous. But that didn’t negate what happened to me nor what I was continuing to deal with. This woman knew nothing of my struggle to get to dinner that night, nor the struggle of the months before (and certainly not of the subsequent years), yet she made a value judgment on what had happened to me based on her grandfather’s experience. As human beings, it’s natural for us to draw comparisons and to find patterns. After all, common experiences and sharing stories are the major ways we connect to one another. And when you are interacting with someone who has had a traumatic brain injury, or any health crisis, it is completely fine to ask questions. But then just try to listen.

If you’ve ever had a health crisis, and many of us have, what have people unwittingly said to you? Or have you ever put your foot in your mouth when dealing with a friend or loved one’s health crisis? I know I have! Leave your answers in the comment section below.

Real Risk Study: Birth Control and Blood Clots

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

Announcing the Birth Control and Blood Clot Study

3736 views

Lucine Health Sciences and Hormones Matter are pleased to announce an important new research project to investigate the relationship between hormonal birth control and blood clots.

Women who use hormonal contraception are at higher risk of developing a blood clot. Although some risk factors are well-documented, such as a family history of blood clots, increasing age, and smoking, many women who have suffered blood clots while on hormonal contraception have none of these risk factors. We believe that a deeper understanding of additional medical and lifestyle influences is crucial to providing women with a complete picture of their personal risk for blood clots while taking hormonal birth control. The Birth Control and Blood Clots Study is multi-phased project designed to assess the breadth and depth of blood clot risks and other side effects associated with these medications.

About the Birth Control and Blood Clots Study

Who Should Participate in the Birth Control and Blood Clots Study? Any woman who has developed a blood clot while on any form of hormonal birth control should participate in the research project. This includes birth control pills, patches, rings, implants, and the Mirena and Skyla IUDs. Because of the severity of some blood clots, including death or serious disability, we allow parents, family members, or partners to take the survey for the affected individual.

How Long Does the Birth Control and Blood Clots Study Take?  This phase of the study involves three parts, an online survey, a participant-submitted health story and an interview with a research associate. The survey portion takes approximately 15-20 minutes to complete. Depending upon one’s comfort with writing, the story portion may take up to few hours. The story portion can be completed at your leisure, however, and may be submitted separately. The interview will take approximately 20 t0 30 minutes.

Is The Study Confidential? Yes, your personal and medical information from the survey will be kept confidential and only study researchers will have access to it. However, unlike our previous studies, this project involves sharing a personal health story in addition to taking a survey. This story will be published on Hormones Matter (the publication can be anonymous if you prefer).  The story of your blood clot experience will serve to inform other women about the risks of blood clots and provide clues for future research.

How Will the Data be Used? The results will be published on Hormones Matter and in open access medical journals in order to inform future research and women’s health decision-making.

Who is Conducting this Research? Researchers from Lucine Health Sciences, the parent company of Hormones Matter. For more information on Lucine, click here.

Take the Birth Control and Blood Clots Study Now

For more details and to take the study click here: Birth Control and Blood Clots Study

Share and Follow

If you know someone who has suffered from a hormonal birth control-induced blood clot, please share this post with them. If you’d like to follow the progress of the study, research about hormonal birth control and/or discuss your experiences with others, follow the study on Facebook and Twitter.

Facebook: Birth Control and Blood Clots

Twitter: @BloodClotStudy

Questions

If you have any questions, please contact us by clicking here.