hormonal contraceptives

Birth Control Deserves Honest Discussions

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All throughout school I was something of a class clown. The only difference between then and now is that now I have no class. So, it’s no surprise that it was a joke that first made me start thinking critically (some would argue cynically) about the medical industry.

Q: Do you know what they call the person who graduates at the bottom of their medical class?

A: Doctor.

Seriously. This was something of an epiphany for me as a young man. Prior to that, I automatically put all doctors and even the pharmaceutical industry on a pedestal.

I think it serves us well to remember that, for better or worse, doctors are only human. We especially have to keep this in mind in any conversation we have with them regarding birth control. Most of them have been trained to believe in a very rigid dogma that regards The Pill as a panacea.

The Systemic Indoctrination Surrounding Birth Control

Since my book, In the Name of The Pill came out a few months ago, I’ve received several notes from women thanking me because the book gave them information they weren’t getting elsewhere and brought them comfort as they fought against a system that encourages birth control use at every corner. Some have even said the book made them cry tears of joy because it affirmed that they weren’t crazy. It would be impossible to express how meaningful these messages are to me.

I knew before the book came out that the indoctrination of women began at an early age and I knew that it was relentless. From the time they are young girls, doctors browbeat them with conversations about acne, glowing skin, cramps, PMS, fuller breasts, regulating hormones… With all these benefits, one would be crazy not to want birth control. But even being deeply involved, I am constantly reminded that, as a man, I still have no idea just how bad it is.

This weekend, I received an amazing note from a young woman who was only halfway through my book, but she wanted to thank me because she stopped taking The Pill on the one-year anniversary of starting them. She wrote:

“I decided to stop because I came to the realization that for one whole year I hadn’t felt like myself at all. I suffered from extreme paranoia and depression, my hair was falling out in clumps and I felt so fatigued all the time that I couldn’t even see my friends or enjoy my life. I went to the doctor at least once a month with worries and fears about clots and I just couldn’t do it anymore. My body has been struggling a lot coming off of it but mentally and emotionally I am in such a better place and your book has provided me so much comfort in knowing that I’m not crazy!”

You might wonder, “If it was that bad, why did she wait a whole year before she stopped taking them?” But if you’re wondering that, you’re probably a man because most women already know the answer. She continued:

“I tried to go off of birth control once this past year and felt so sick and my doctors persuaded me to go back on it because I ‘obviously need to be using it, if I don’t feel well.’”

Unfortunately, that seems to be a pretty common outlook from the medical field. When you complain about side effects like paranoia, depression, hair loss, or fatigue while you’re on The Pill, they downplay them or dismiss them altogether. But, when you mention feeling bad as your body tries to readjust after you stop the flood of synthetic hormones, that’s proof that you need The Pill.

A little bit wiser the second time around, she took a different approach:

“I have also convinced another close friend to come off of it and we have been supporting each other through the transition – it’s been tough but so worth it to feel like myself…I am now working on healing and am using non-hormonal methods as birth control and feel empowered and liberated!”

The Truth Will Set You Free

I love that she discussed this with a friend and they formed their own support team. It’s no wonder Holly Grigg-Spall, the author of Sweetening The Pill, subtitled her popular book, “How We Got Hooked on Hormonal Birth Control.” As she documents her own struggles to ditch The Pill, she concludes:

“The silencing of honest discussion causes many women to suffer unnecessarily. It wasn’t until I stopped taking the pill that I developed the needed energy, motivation and clarity of thought to express why I had to stop and to question why it had taken me so long to make that decision.”

As simple as it sounds, honest discussion may be the biggest weapon in our arsenal to fight the ubiquitous messages of misinformation coming from the medical community. There is no informed consent. That’s a myth. Our recent citizen’s petition to the FDA demonstrated that even the patient information pamphlets are incomplete. If informed consent is the goal, that information has to come from somewhere. Unfortunately, in the current culture, open and honest discussions among friends are about the only chance a woman has to be informed about the real risks of taking hormonal contraceptives.

Turn the Spotlight on Hormonal Birth Control

Without these discussions (which shouldn’t be limited to women), the damage being caused by The Pill goes unrecognized and leads to under-reporting. It’s hard to believe, but despite the vast number of documented cases of women being harmed by birth control, those numbers are most certainly insufficient in reflecting the real damage being done because people never consider the link.

Let me give you an example. Earlier this year I joined a client on a project that was going to last a couple of weeks. Knowing I was in the final stages of working on my book, he said that he wanted to hear all about it while we were together. He added, “I’m not sure I agree with your position, but I’m willing to keep an open mind. My ex-wife took The Pill for 20 years and never had any problems.”

I told him that it wasn’t my contention that every single woman who took birth control suffered devastating consequences, but that I did think that fact put her in the minority. Over the next two weeks, we had several in-depth conversations about The Pill, my research, the political landscape, and the broad range of side effects.

In the end, I’m still not sure he was completely convinced, but he did offer this, “I have to tell you, my ex-wife had breast cancer and had her gallbladder removed but we never even knew it could have been related to The Pill.”

The more we all discuss these things – the more the damage will be brought out into the light. That’s why one of the shortest reviews of my book on Amazon may be my favorite. A reader named Melissa wrote:

“Very educational makes me want to start a study group and have each member do a study on 3 family members that have taken the pill to see results.”

Wow, that sends chills down my spine. Can you imagine a room of three or four women – or 20-25 women – the numbers don’t matter – just picture a small group of women suddenly piecing together a family history that reveals the toll that birth control has taken on their mothers, sisters, nieces, and cousins.

Now THAT would be an honest discussion that could liberate and empower an entire group of women at once.

For more information about the history of hormonal birth control:

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In the Name of The Pill

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In the Name of The Pill*

by Mike Gaskins

The FDA approved The Pill despite it not being proven safe. Today, it has been linked to everything from blood clots and cancer to lupus and Crohn’s disease — and still has not been proven safe.
This book explores the medical and historical disconnects that brought us to this point.




 Price: $ 17.95

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Last updated on October 21, 2023 at 9:38 pm – Image source: Amazon Affiliate Program. All statements without guarantee.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

This article was published originally on October 9, 2019.

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Hormonal Contraceptives: Do We Really Know What We Think We Know?

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If you have read any of my posts, you know that this is one of the questions that pervades my work. Do we really know what we think we know? More often than not, the answer is no. Upon examination, what we hold true falls short. In the field of pharmaceutical medicine, where money plays an enormous role in determining what is known about a particular drug, finding the real and honest truth about a medication is difficult and sometimes impossible. Hormonal contraception, because it has been on the market for decades and because as women we really want it to be safe and absent negative side effects, is one of those drugs where what we think we know and what we actually know are two entirely different things.

Over the last few years, we have been commissioned for a two studies on the safety of hormonal contraceptives. One study, the Real Risk project, ended early due to a loss of funding. As a result, Phase 2 data were never analyzed. (We decided to continue collecting data in the hopes of finding funding to complete the study at some point. We haven’t found the funding yet.) Nevertheless, we learned a lot and what we learned should be public. Slowly, some of that information is making its way into blog posts.

Below is a portion of the final report covering the history of the pill, a sort of ‘what they knew when’ of side effects. Looking back at the history of the development of the pill and other forms of hormonal contraception, it becomes clear that the health and safety of the female population was not a primary objective. Indeed, more often than not, the serious side effects were ignored, particularly in the US, setting the precedent for the almost total acceptance of the drug’s safety that we see today. As a woman who used hormonal birth control and developed many of the side effects noted by early researchers, side effects that were ignored by my physicians, reading this is eye-opening. If I had known then what I know now I would have never used this drug.

The History of Birth Control Induced Side Effects

The first case of birth control induced thrombosis, a pulmonary embolism, was reported in 1961, only one year after the drug’s release. This was soon followed by the first contraceptive induced myocardial infarction in 1963. In the years that followed, research groups, primarily in Great Britain, began delineating the risks and mechanisms by which hormonal contraceptives induced the state of hypercoagulability that led to thrombotic events. Much of this research, along with the publication of Barbara Seaman’s book, The Doctor’s Case Against the Pill, formed the impetus for the Nelson Pill Hearings (NPH) in 1970.

Early on, British researchers noted significant changes in blood clotting mechanisms in the women using oral contraceptives compared to those who did not, but also compared to pregnant women. Hormonal birth control, it appeared, increased several pro-clotting factors while simultaneously decreasing anti-clotting factors; changes in hemodynamics that were in many ways, though not entirely, akin to late pregnancy and early postpartum where blood clots are known risks. This was in addition to systemic vessel wall damage that simultaneously set the stage for both clotting and hemorrhage. They also found that clot risk increased over time and was compounded by other variables such as exercise and smoking. In 1967, based upon the results of three studies, the British Medical Research Council issued a preliminary communication that stated:

“The sum of the evidence, however, is so strong that there can be no reasonable doubt that some forms of thromboembolic disorder are associated with oral contraceptives. The association is particularly strong in the group of women with no known medical condition predisposing to thrombosis.”

Politics and Money Rewrite History

These findings, though clearly implicating hormonal contraceptives in thrombosis, became immediately controversial and were all-but-entirely dismissed by American medical societies who argued an inherent difference between British and American women (NPH pages 6222-6259); one that supposedly predisposed British women more strongly towards blood clots than their American counterparts.

Additionally, according to testimony made in the Nelson Pill Hearings, the American Medical Association allowed industry experts to write and publish the early safety statements while simultaneously refusing to publish research and case reports indicative of risk (NPH page 6113). G.D. Searle, one of the early manufacturers of oral contraceptives, went so far as to ‘vote away’ the risk of thrombosis at a medical conference (NPH pages 6108-6133). Sales and marketing materials were designed to dismiss the risk and obfuscate the research (NPH pages 6218-6296). This led American doctors, researchers, and the population as a whole, to presume falsely that the pill was safe and without risks. It bears noting that by failing to publish the evidence implicating the pill in thrombosis and by allowing industry experts to write and publish the safety reports, the American Medical Association set the precedent for what has now become a complete abrogation of scientific and medical ethics, not only regarding contraceptives, but also, for every other drug on the market.

Beyond Thrombosis: System Wide Side Effects

A persistent notion in contraceptive research is that progesterone and estradiol, the two hormones mimicked in contraceptives, are singularly involved with reproduction. What follows is a presumption that these hormones have no impact on other tissues and altering them affects nothing but the intended target. Contrary to this popular belief, these steroid hormones are not solely involved in reproduction. Hormone receptors are distributed throughout the brain and the body, on every organ, in every tissue, and in every fluid. Hormones, thus, regulate every physiological system. When synthetic hormones bind to endogenous or native hormone receptors, they effectively override the body’s natural regulatory functions in ways we have yet to comprehend fully. It is not unexpected then that the use of hormonal contraceptives would have broad based effects. Thus, in addition to the higher incidence of thrombotic events in otherwise healthy women, physicians and researchers testifying at the hearings noted clear associations between the use of hormonal contraceptives and a broad array of disease processes. Some of those effects are highlighted below.

Metabolic Disturbances

Perhaps some of the least well-recognized effects of these hormones include those to a woman’s general metabolism. Hormonal birth control induces wide ranging metabolic disturbances in insulin and glucose regulation, lipid control, and in heart rate, rhythm and pressure leading to weight gain, diabetes, high blood pressure, and cardiovascular disease. One researcher testified accordingly:

“There are more than 50 ways in which the metabolic functions of the body are modified, and to say therefore that normal physiological function has been demonstrated in the years of oral contraception is to overlook a very large amount of information (Dr. Victor Wynn, NPH page 6311).”

“When I say these changes occur, I mean they occur in everybody, more in some than in others, but no person entirely escapes from the metabolic influence of these compounds. It is merely that some manifest the changes more obviously than others (Dr. Victor Wynn, NPH page 6303).”

And yet another said:

“These alterations, which have been demonstrated, include changes in carbohydrate metabolism, fat metabolism, protein metabolism, and the endocrine, liver, nervous and vascular system, among others. The findings are straightforward and reproducible (Dr. Hilton Salhanick, NPH pages 6382).”

Impaired Reproductive Capacity

Impaired reproductive capacity, likely due to the pill’s effects on the pituitary gland and its ability to prevent ovulation was noted (Dr. James Whitelaw, NPH pages 6009-6019). Case studies presented by the physicians indicated use of hormonal birth control often delayed fertility while the body re-adjusted to its non-pill state. In at least 1-2% of the women who used the pill, however, it caused permanent infertility. Ovulation never resumed. Additionally, women who used the pill were more prone to miscarriage, stillbirth, and chromosomal abnormalities in the offspring; abnormalities that as one researcher indicated were:

“…completely incompatible with live birth…”

Sadly, much of this research was disregarded and there has been very little work since. In fact, the use of oral contraceptives to regulate cycles in advance of fertility treatment is now commonplace. Despite research suggesting it is contraindicated.

Beyond the immediate effects to fertility and reproduction, early researchers postulated potential transgenerational effects. That is, when women use hormonal contraceptives, ovulation is suppressed unnaturally and germ cell damage to the ovarian follicles is possible: damage that may not only express itself in the first generation, but also in subsequent generations, e.g. in her grandchildren and great grandchildren.

“An unequivocal abnormality produced by estrogen-progestogen is the suppression of ovulation itself. It is only reasonable to consider the ultimate fate of the ovum that would have been normally released from the ovary. We do not know whether the ovum dies or survives. If it survives, is it altered in any way?”

Cancer

One of the most damning, but again disregarded and disputed, findings of the early researchers was the association between hormonal birth control and cancer. Researchers testifying at the Nelson Pill Hearings noted that cancer developed in all animal models tested when oral contraceptives were administered. In fact, the use of synthetic estrogens is banned in animal husbandry in Europe because it causes cancer in the animals and also in the workers. In the US, there is no such ban, owing partly to the decades delay in cancer onset but mostly to industry lobbying.

“I think here is the proper place to point out that when we talk about the pill being used by 18 million people in the prime of life throughout the world, we are in fact considering an internal pollution, the extent of which is not yet known, but the nature of which is indeed known. And we are threatening the destruction of a large segment of one of our most precious natural resources, the young women of our society (Dr. J. Harold Williams, NPH pages 6219).”

Liver

Liver function, because of its role in drug metabolism and detoxification, is inevitably altered by the use of any medication. To what extent the liver is impacted, is a key safety issue reviewed during drug approval considerations. As one might expect, hormonal contraceptives degrade liver function. At the hearings, researchers testified to four key changes in liver function.

  • A 40% reduction in the ability to clear sulfobromophatalein (a compound used to test liver function)
  • An increase in liver enzyme activity (a marker of liver damage) in 20% of the women who use hormonal contraceptives
  • Jaundice in 1 in 10,000 women that subsided after discontinuation of OC (Dr. Philip Corfman, NPH Pages 6391-6426)
  • Reduction in total plasma protein level (Dr. William Spellacy, NPH Pages 6426-6445)

Overall, the changes in liver function were summed up as follows:

“The immediate effects include the alteration of several of the laboratory tests used in medical diagnoses. Aggravation of existing liver disease, if present, to the point where jaundice may be seen has also been shown. There is no answer to the query of will permanent liver damage result from the use of the oral contraceptives.”

We have yet to answer the question of permanent damage, although a large study in 1997 suggests that liver damage abates upon cessation.

Disturbed Immune Function

One of the most commonly recognized but simultaneously disregarded effects of hormonal contraception include disturbances in immune function. Autoimmune diseases such as lupus and rheumatoid arthritis are significantly more common in women than men, especially in women who use hormonal contraceptives. Once again, the onset and increased incidence post-pill use was noted as soon as these medications hit the market, but because of the complexity of these diseases, all but disregarded. Early researchers noted that with new onset cases once contraceptive use ceased, symptoms resolved and most patients remained symptom free for at least the 2.5 years of the study period (Dr. Giles Boles, NPH pages 6086-6108). In recent years, awareness of this connection has increased somewhat.

“Over the past three years we have seen 22 young women who… after beginning oral contraceptives developed [arthritic symptoms]. The joint swelling was usually limited to the hands. On cessation of the oral contraceptive, the symptoms disappeared… We specifically inquire as to the use of oral contraceptives in all young women we see with rheumatic complaints…”

In addition to the increased incidence of autoimmune diseases associated with hormonal contraception, other immune system changes were noted, and again, dismissed.

“The Pill, by interfering with the natural secretions of the vagina, leaves women susceptible to a variety of infections, including syphilis and gonorrhea. Those who use the Pill develop VD, other sexually transmitted infections, and vaginitis twice as often as the female population as a whole.”

Namely, the use of hormonal contraception increases the incidence of bacterial and fungal infections and the risk for developing sexually transmitted diseases. More recently, researchers have identified the mechanisms by which contraceptives initiate these disease processes – via changes in cervical immune composition that increase a woman’s vulnerability to infection.  Hormonal contraceptives also predispose women to persistent MRSA infections.

Psychiatric Illness

Perhaps one of the more disturbing findings regarding hormonal contraceptives is their role in new onset psychiatric illness and their capacity to induce suicide. In the original trials, at least one women committed suicide while taking the pill. Her case, along with at least 18 other deaths (Dr. Edmond Kassouf, NPH pages 6108-6133), was omitted in the reports filed to the FDA.

“There is considerable incidence of mild to moderate psychiatric morbidity [disease] associated with the use of combination oral contraceptive agents… In three of the four studies, there seems to be agreement that those who have required psychiatric care in the past will be more at risk for the development of morbidity, including psychosis. One study also suggests that there may be some increase in the depth of illness the longer the medication is taken (Dr. Francis Kane, NPH page 6457).”

“The emotional or psychiatric problems are the complications which seem to me to have the most serious potential danger. Three patients have stated that they were desperately afraid that they were going to kill themselves… After the pills were omitted, the depression and suicidal fears of the three patients disappeared, as did the depression of the other patients (Dr. John McCain, NPH page 6473).”

“It is disturbing to consider the patients on the pills whose depression may have ended in suicide and/or homicide with no recognition of any association with the contraceptive pills… Personality changes could be a factor in other conditions such as automobile accidents and divorces (Dr. John McCain, NPH page 6473).”

Despite the early research, connections between hormonal contraceptives and mental health have been largely ignored. In fact, since the nineties, hormonal contraceptives have been marketed specifically for depression and anxiety in direct opposition to the data suggesting these medications cause and/or exacerbated psychiatric illness. As recently as three years ago, an epidemiological study suggested,

“…a protective association between hormonal contraceptive use and depressive symptoms, as well as suicide attempts, in a population-based sample of young, sexually active US women.”

Fortunately, the tide appears to be changing. Fifty years after the release of these medications and after generations of women have complained of serious mental health issues while using hormonal contraceptives, a large study published definitive data indicating that hormonal contraceptives did indeed induce depression, especially in adolescents. No doubt, industry sponsored studies will surface shortly and contradict these findings.

Hormonal Contraceptives Today

Today, 80% of American women will use hormonal contraception at some point in their lives, mostly oblivious to their risks for thrombosis or any other of the side effects. Indeed, most women and physicians consider the side effects extremely rare, if they consider them at all. This is largely due to the fact that the American College of Obstetrics and Gynecology and other medical associations routinely claim they are safe. At any given time, 62% of women of reproductive age are using at least one contraceptive method. In contrast to the perceived lack of side effects, the numbers tell a different story. Fully 60% of women will cease using hormonal birth control within six months of initiation because of side effects and 30% will try up to five different types of hormonal contraceptives, switching between brands to temper side effects.  Given that most brands may vary in name only, switching between brands is often a fruitless endeavor, something prescribing physicians seem not to appreciate.

That there are over 200 brands currently available on the market worldwide, suggests an abundance of options, but from a pharmacological standpoint, not much has changed in hormonal contraceptive technology over the last half century. The predominant estrogen used in contraceptives remains the same as was developed decades ago, a compound called ethinyl estradiol (EE2). With the exception of the fourth generation progestins, the progestins used in modern contraceptives involve only slight modifications to the original compounds. Even the ‘newer’ delivery methods, like the intrauterine device and the cervical ring, were developed decades ago, in the 1950s and 1960s. For all practical purposes, contraceptive technology remains as it was over half a century ago. Therefore, today’s contraceptives carry as many or more of the side effects and risks as their predecessors did.

Only now, our increased familiarity with these drugs has fostered a deeply ingrained but false sense of safety. Phrases suggesting that after 50 years on the market these are among ‘the most studied medications’ pepper the literature. When in fact, these medications were never studied properly before their release:

“Evidently, for whatever reasons, there is no sound body of scientific studies concerning these possible effects available today, a situation which I regard as scandalous. If we proceed in the future as we have in the past, we will continue to stumble from one tentative and inadequately supported conclusion to another, always relying on data which come to hand, and which were not designed for the purpose (Dr. Paul Meier, NPH pages 6548-6560).”

And they have not been studied conclusively since. For all intents and purposes, safety issues associated with hormonal birth control remain largely under-investigated and unrecognized. What research exists generally favors commercial interests, and if we’re honest, our interests as women. We want easy, safe and effective birth control. We need it and so we ignore the side effects and ignore any research that confirms our suspicions. We allow ourselves to accept the risks. Maybe it’s time we didn’t. Maybe it’s time we dig in and find out what is really going on and then fix the problems.

Share your Story

If you have a birth control story, please consider sharing it on Hormones Matter.

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

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This article was published originally in June 2017. 

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Ding, Dong! Hormones at Your Door!

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The side effects of hormonal birth control are notoriously under-recognized. So much so, that I filmed a documentary about them, entitled, Hormoneously Alone, highlighting the severe lack of research since the 1950s. What I learned was shocking. Because hormonal birth control has been available for over 60 years, everyone, doctors included, presume these drugs are completely safe and have very few, ‘rare’ side effects. I spoke to experts in women’s health who have researched the effects of the pill and other forms of hormonal birth control and, contrary to the general consensus, these drugs do elicit many ill-effects that are detrimental to health. These side effects can develop while on the pill but also upon withdrawal as the body struggles to adapt to the loss of synthetic hormones.

My original post on this website documenting my own experience is what drove me to investigate the side effects of hormonal birth control, and ultimately, make a documentary to inform other women. Over four years, hundreds of women have left comments indicating they had similar experiences with hormonal birth control and even more have reached out to me personally for advice. Research on this website and other case stories concur.

With all of the potentially negative health consequences attributed to hormonal birth control, imagine my surprise when I learned that these drugs can be ordered online, without so much as a physician consultation. Of course, since most physicians do not recognize the side effects, I guess ordering online is no less safe than from a physician who ignores the health or experience of his/her patients.

My goal is that women will research and educate themselves about the risks they are taking when ordering birth control online. I hope my articles and my documentary will encourage them to speak up, and ask questions, but what if that does not happen? At least when these drugs are prescribed by a physician there is a small chance the more serious side effects will be recognized. When ordered online, with no health intake or counseling of any sort, the possibility for potentially dangerous health interactions between the pill and the patient increases. This risk is increased for young girls, who do not have the experience to understand the side effects associated with these drugs.

Ordering Birth Control Pills Online

Anyone can order hormonal birth control online. While doing research for my documentary, I investigated the process.  There are no safety mechanisms in place to determine whether the information one inputs is truthful or not, or whether the individual might have a family medical history that can affect the choice of the type of hormone prescribed. I know this because I tested it. I went online and created a fake profile with fake information and submitted a request for a three month trial. It took me about five minutes from start to finish. I tried multiple vendors, some of the more popular ones, and none of them had any issues with prescribing a pill for me. Surprisingly, none of these vendors asked when my last OBGYN appointment was or if there was a family medical history for any cancers that the birth control pill may help promote or any other health issue that might be exacerbated by the pill. A genetic predisposition may increase one’s risk for certain illnesses and cancers. Breast cancer, for example, may be exacerbated by certain synthetic hormones. Autoimmune disease may also be exacerbated by these hormones.

I wanted to see how far I could push the dial, so I also falsely claimed to smoke cigarettes daily, had high blood pressure and migraines with aura. These are all cases where hormonal birth control is clearly contraindicated because of the elevated risk for blood clots. And yet, even with these risk factors, I was able to order a prescription. There was no dialogue with an online doctor or chat system. It was just me, my mouse, and my keyboard.

I am all for women’s rights and easy access to medications, but as a woman who understands the risks of these drugs, who has experienced some of them, this enraged me. Why are women not told of these risks? Online prescriptions seriously lack the ability to oversee a patient’s full chart and medical history, to understand a patient’s concerns, and to have the foresight to avoid a medication that may catalyze a genetic predisposition. This seems totally careless.

Women’s Rights

In today’s highly politicized landscape, it is difficult to talk about birth control safety and side effects, especially with the current onslaught of attacks against women’s health care options. Recently, over the counter hormonal birth control has been approved by the FDA. This eliminates any and all preliminary precautions and the online ordering has become even easier. Regardless of where we are buying these pills, I think we have to acknowledge that talking about safety and accessibility is not an attack on women’s rights, rather a concern for their well-being. I believe the ability to order medication online is generally a good thing. The accessibility of these online birth control pills not only allows a user to obtain them quickly, but also, discreetly, and inexpensively. It is, for the most part, hassle-free. This works well for the quick-click generation and society that we have evolved into. Women should always be in charge of their bodies, and this new technology affords them that opportunity, which is a really powerful and important idea in and of itself. I do, however, struggle with the idea that we might be missing possible interactions that could result in serious side effects and health issues. These websites do not have a warning anywhere, just, in my opinion, a vague questionnaire. As you will see below, there is little to no health intake when ordering and no counseling regarding side effects.

The Age of Consent

In my research for the documentary, I wondered about the accessibility of online ordering to young girls. As I flipped through the magazines that I once read religiously as a teenager, now, from an adult’s perspective, I see just how targeted the ads can be. In the most common teenage magazines, there are ads almost every 5 pages that push ordering hormonal contraceptives online. These ads are impossible to miss and can be very persuasive to young girls.

Imagine a parent and not knowing what medications your child was on. Imagine a child not understanding the seriousness of the birth control pill and taking too many because they missed a few? Imagine a child taking the pill not knowing why they are feeling poorly, suddenly getting migraines, a possible sign of neurological issues including stroke, or having labored breathing, a sign of pulmonary emboli. These side effects are more common than you would think. Is it smart to have such accessible medications with potentially severe side effects available online without so much as a health warning? Will teenagers read the fine print? Yet, the FDA allows online ordering. It would be easier for a child to click and order rather than having the uncomfortable conversation with their parents or their doctor. A fake profile and credit card is all that is needed.

Since most patients do not ask questions when being prescribed the birth control pill by a physician and, from my experience, most doctors do not offer this information up, what would prompt the conversation online? Is a child who is taking the pill going to read the pamphlet, and if so, will they understand it?

Candy From Strangers

When the package of hormonal birth control came to my door about a week after placing the order, it had some candies and chocolates with it. This felt ironic. “Don’t take candy from strangers,” feels oddly similar to “Don’t take pills from the internet,” or the idea of candy not being healthy for you accompanying the controversial birth control pill. It all felt wrong. Because of the emphasis that providers put on the safety of birth control pills, it seems to negate the impact these pills have on the female body. The pill may be generally safe to take every day, but what are the effects that we are missing under the surface? Are they actually safe even if we do not see the effects immediately? Is the pill for everybody?

It is extremely important that women be in charge of their bodies, but having autonomy means having an understanding of the full picture. Women should absolutely be able to order pills online, but they should also be given adequate information to make that decision and protect themselves against possible harm. Omitting critical health information in favor of accessibility does nothing to serve women’s health interests. Women need to understand the side effects associated with these drugs in order to make an informed decision.

I believe we, as a society, are sacrificing leniency on a topic we truly do not know much about for quick and cheap pill availability. I think we need to revisit the accessibility of these pills and take a step back to understand the potential harm we are causing.

Hormoneously Alone

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter. 

Photo by the blowup on Unsplash.

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Blood Clots, Birth Control and Female Athletes: Are We Missing Important Risk Factors?

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Over the last several years, stories of young women, many of them athletes (here, here), suffering from dangerous and sometimes deadly blood clots have filled the press and academic literature (herehere, here). Often mentioned in passing is the fact that these women were taking hormonal contraceptives at the time of the event. As a mom of a female athlete, a lifelong jock myself, and a researcher, I cannot help but wonder if we aren’t missing critical connections between some very common real life variables that predispose young women to serious health risks. Are athletic women more at risk for hormonal birth control-induced blood clots than other women? I think they might be.

We all know, or at least should know, that hormonal contraceptives increase the risk of blood clots for any woman who uses them. We often don’t pay attention to those warnings, especially when we are young, consider ourselves healthy, and when we are athletes. We ignore the warnings because taking birth control is, in many cases, a practical decision. Hormonal contraceptives, whether in the pill, patch, implant, vaginal ring, shot, or IUD, regulate if and when we bleed. That is, we bleed on a schedule, controlled entirely by synthetic hormones.

Scheduling is wonderful for female athletes. With no control over the scheduling of competitions, the ability to schedule one’s period is a great advantage. Let’s face it, competing while bleeding and cramping is never fun and near impossible for women with painful periods. Who wants to spend years training for that one event, only to have her period start? No one.

Optimal athletic performance requires that we control extraneous variables to the extent possible. Controlling one’s period takes care of a major variable in the life of the female athlete. And since it prevents pregnancy, hormonal birth control is a win-win.

Or is it?

Aside from the fact that hormonal contraceptives impact athletic performance (a topic of great debate and conflicting research), induce a variety of unwanted side effects, and that pill bleeds are not periods, hormonal contraceptives increase the risk of blood clots, quite significantly. Conservatively, birthcontrolsafety.org, estimates that out of the nearly 11 million women who use hormonal contraceptives (pill, patch, or ring), approximately 20,000 will develop blood clots and about 600 women will die, every year. There are no data on how many of these women were athletes or exercised intensely; however, it is likely that the numbers are pretty high given the high rate of hormonal contraceptive use in the general population.

Intense exercise, which is the foundation of athletic training, increases the risk of blood clots independently of gender or birth control usage. Indeed, some research suggests that the risk for deep vein thrombosis, blood clots in the legs, may be significantly higher for athletes than the general population. An interaction between hormonal contraception and exercise is likely to increase the odds of blood clots rather significantly. As women, the combination of those two variables alone should give us pause, but when we consider all of the other real world variables that also increase blood clotting and that just so happen to be prevalent in the life of the female athlete, the risk becomes quite concerning.

When Clots are Formed: Virchow’s Triad for the Athlete

When we look at the mechanisms involved in clotting and bleeding, we should remember that blood clotting itself is a necessary and protective mechanism against injury. Without the ability to clot, all sorts of complications can arise from everyday activities. Equally important are the body’s compensatory mechanisms that are designed to prevent too much clotting and to clear out clots once the immediate danger has ceased. The balance of power between the factors that promote clotting and those promote bleeding must be maintained within a fairly narrow window. Disruption to either side creates problems. Hormonal contraceptives shift that balance towards clotting and the normal components of athletic training and competition, shift the balance even further. When we add a few more variables, in any combination, synergies develop and the cumulative effects make female athletes using hormonal contraceptive at risk for serious, and sometimes deadly, blood clots.

Blood Clots and Athletes: The Basics

Blood clot formation is more likely when there are disruptions in blood flow. This can happen with:

  1. Injury to the blood vessel wall (even microinjury induced by a medication or chemical exposure)
  2. Depression of blood flow dynamics
  3. Changes to blood constituents (clotting factors)

These factors constitute what is called Virchow’s Triad, after the German pathologist Rudolph Virchow who developed a framework in 1884.

Off the bat, by using Virchow’s triad, we can identify several potential risks for clotting that are likely more prevalent for athletes, male and female. For example, periods of intense exertion increase blood pressure, heart rate and the shear stress on the vascular walls (inducing damage and inflammation), which increases clotting propensity for athletes; while conversely, the athlete’s slower resting heart rate and lower blood pressure when not in competition, makes clearing those clots efficiently much more difficult. Similarly, periods of dehydration increase blood viscosity, slowing blood flow, as does inflammation and muscular hypertrophy via venous or arterial compression. Injuries and surgeries damage the vascular and arterial plumbing and slow blood flow. Extended travel compresses leg vasculature (and sometimes arm vasculature depending one’s sleeping position) and slows blood flow. Heck, even repeated movements can compress veins or arteries in different regions of the body and slow blood flow. What is athletic training if not repetition, hours upon hours of repetition?

Now consider these variables occurring against the backdrop of hormonal birth control, which changes the very balance of power between clotting and bleeding, effectively overriding many of the systems in place to ensure that clots don’t persist and causes problems. Throw in a few other decidedly female variables that also increase clotting, like monthly NSAID use to stave off menstrual pain, a propensity towards headaches and migraines, a latent genetic disorder or two, maybe even a less than optimal diet, and we have a recipe for disaster.

A Deeper Dive: Common Clotting Triggers for Athletes

Injury to the blood vessel wall

Injury to the blood vessel wall can develop by a number of mechanisms. The most obvious are those that result from direct injuries that occur over the course of training or competition. Surgery falls into this category. The rate of blood clots that evolve into pulmonary emboli after shoulder surgery ranges from 0.17% – 5.1% depending upon the type of surgery. Deep vein thrombosis after knee surgery, however, complicates some 2-13% of cases and upwards of 60% with some procedures. We cannot forget, also, that women are apt to have surgeries related to reproductive health issues, e.g. those related to endometriosis or ovarian cysts.

Less obvious are the micro-injuries or insults to vascular endothelial cells. Micro-injuries are surprisingly easy to induce over the course of athletic training and even in everyday living. They are not commonly recognized as risk factors for blood clots and there are few data that address these types of injuries; perhaps because their effects are likely part of a more complicated set of variables that combine to initiate and/or prolong the clotting, and are not immediately identifiable. I would argue that we ought to consider these risk factors especially in female athletes who use hormonal contraceptives because they are likely quite common. Here are just a few.

Contrast Dyes used for Imaging

Before any injury is surgically managed, imaging studies are common. The contrast dyes used for these studies induces micro-injuries to vasculature where the dye is circulated and are known to induce clots.

Vaccines and Medications

A number of medications and vaccines induce varying degrees of vasculitis or vascular microinjury. The most recent evidence of this is the HPV vaccine. For female athletes, something as simple as this or other vaccines, could initiate a clotting cascade that becomes difficult to end when hormonal contraceptives are involved. Similarly, the most commonly prescribed class of antibiotics, the fluoroquinolones (Cipro, Levaquin, Avelox and others), induce vascular microinjury among other side effects (tendon rupture, rhabdomyolosis, and neuropathy to name but a few).

Nutrient Deficiencies

Nutrient deficiency can induce vascular injuries via mitochondrial cascades. This one is a little bit more complicated and often a longer term process but one that adds to the overall propensity to clot. Briefly, mitochondria are responsible for and/or involved with a long list of functions ranging from bioenergetics (ATP production), to inflammation, steroid synthesis and cellular apoptosis, even platelet aggregation (an important variable in clot formation and dissipation). Mitochondria need several core nutrients to power enzymatic reactions. Most folks, even athletes, are deficient in several of these nutrients, especially if on hormonal contraceptives. Hormonal contraceptives deplete vitamins B1 [thiamine], B2 [riboflavin], B6, B9, B12 (worse if one is a vegetarian/vegan), C, E, magnesium (many athletes are magnesium deficient regardless of contraceptive usage), zinc, and CoEnzyme Q10. Simultaneously hormonal birth control may elevate vitamin K concentrations (which increases clotting), and also, increase copper and iron (too much iron favors hypercoagulation). Nutrient deficiencies and abnormalities cause mitochondrial dysfunction (and a whole host of other problems). Mitochondrial dysfunction leads to cell dysfunction, leading to molecular changes in the vasculature (and elsewhere), injuries, and a propensity for clotting ensues. Mitochondrial damage would also lead to changes in blood flow dynamics and blood constituents. So mitochondrial damage, though more subtle, can affect the entire triad of variables.

Blood Flow Dynamics – The Plumbing

Compression

Like the pipes in our houses, anything that blocks or compresses or otherwise slows the fluid through the pipes can induce a clog or, in this case, a clot. The most obvious of these factors is compression, as occurs on long plane/train/bus trips to and from competitions. According to AirHealth.org:

About 85% of air travel thrombosis victims are athletic, usually endurance-type athletes like marathoners. People with slower resting blood flow are at greater risk of stasis, stagnant blood subject to clotting. Also, they are more likely to have bruises and sore muscles that can trigger clotting. No other risk factor comes close to this. Age over 60 is supposed to be a risk factor, but these victims are younger, 82% of them under 60 [47% of air travel thrombosis cases are between the ages of 20-44].

According to some reports, the increased risk for clotting continues for up to 24 hours post competition, making the long trip home after an event particularly risky.

These are staggering numbers which are likely under-reported and under-studied. Imagine the risk for compression induced clotting to the female athlete who uses hormonal contraceptives. If she’s had an injury that required imaging with a contrast dye, or experienced any of the aforementioned other vascular insults, the risk increases.

May-Thurner Syndrome. Twenty percent of the population is believed to have a narrower than normal left iliac vein leading to blood clots in the pelvic region and left leg. May Thurner Syndrome, Pelvic ClotsMost do not know this until they end up in the hospital with a blood clot. For these women, the risk for deep vein thrombosis, particularly in the left leg is even higher, especially on birth control (most especially, I believe, though this is pure speculation, when using a cervical ring like the NuvaRing). Again, add long sit times, an injury perhaps, and we can begin to see how the risk for blood clots in the female athlete using hormonal contraception can be much higher than for her teammates who do not use hormonal contraceptives.

Paget-Schroetter Syndrome, an anatomical narrowing of the subclavian vein (just under the clavicle or collarbone) and repetitive use trauma either alone or together can initiate clotting from this region. Sports with high upper-body repetition such as swimming, gymnastics, rowing, tennis, baseball/softball, and others, are at most risk.

subclavian vein effort thrombosisIt is believed that the repetitive trauma that these sports require imposes strain on the subclavian vein leading to microtrauma of the endothelium and activation of the coagulation cascade. This alone is a risk factor for developing a blood clot, but when we add a few more variables, an intense competition, dehydration, a long flight home with upper body immobility and perhaps compression (sleeping on one’s arm), and enter these variables into an system primed for coagulation by hormonal birth control, the risk for dangerous blood clots increases significantly.

Viscosity

Sludgy matter doesn’t move through pipes too well. All manner of variables can affect the viscosity of blood. The most common in athletes is dehydration.

Dehydration

Dehydration is common in athletes, especially after a long competition. Dehydration increases the viscosity of the blood, slows the movement through the pipes. Put a dehydrated female athlete, who uses hormonal birth control on a long bus trip home, and clot risk increases. Add some past vascular damage, even minute and unrecognized, plus an injury or two, and the risk increases even more.

Blood Constituents – Changes at the Molecular Level

We can change the intrinsic clotting factors by a number of mechanisms: genetic, epigenetic and via medications (like birth control, NSAIDs and others) or environmental chemicals. There are over 20 proteins involved in maintaining the balance between clotting and bleeding and each of them can be altered towards a pro-clotting state by a myriad of variables (for a full list see here).

Genetics

Beginning with the genetic variables, 3-10 % of the population have heritable genetic mutations that increase their risk of developing blood clots quite significantly, absent other variables. Upwards of 50% of patients who have develop a clot carry one or more of these mutations. Unless there is a known family history of clotting disorders, most women who carry these mutations are unaware of their genetic risks. When these women utilize hormonal contraceptives, their risk of blood clots increases significantly by as much as 35x according to some data. I think all women should be tested for these genetic variables before being given hormonal birth control. Unfortunately, none are, until they end up in the hospital fighting for their lives. Now consider a female athlete who carries one of the mutations and is on hormonal birth control, travels, uses NSAIDs, has had an injury or two, and the likelihood of her developing deadly blood clots is very much increased.

With both genetic and acquired components, antiphospholipid syndrome (APS or APLS), also increases blood clot propensity. In fact, it is the most common cause of excessive clotting, and affects women more than men. APS is autoimmune condition that causes hypercoagulability of blood through unknown mechanisms. APS can occur on its own, or in conjunction with lupus and other rheumatic disease processes like Sjogren’s. Neither of these diseases is uncommon in female athletes, though hard data are difficult to come by. Anecdotally, Venus Williams has struggled with Sjogren’s and case reports abound of female athletes with Lupus (here, here).

Epigenetics

Epigenetics is a fancy term for events that happen above the genetic level. It is an emerging science where investigators look at variables that don’t directly alter the DNA, but rather, aberrantly turn on or off a particular gene. Environmental factors play a large role in epigenetics, medications, vaccines, other chemicals, diet and nutrition. So, just as a woman can carry heritable genetic mutations, she can also carry heritable epigenetic changes that turn on the genes controlling the clotting proteins or turn off those that prevent clotting. We can inherit these epigenetic changes from parents and even grandparents, but also, induce them via every day exposures and activities. I suspect that there are epigenetic components of one’s risk for blood clots.

Medication Induced Clotting

Here’s the big one that we don’t pay nearly enough attention to – medications and vaccines can induce clotting via multiple mechanisms, including changing the balance of power between clotting and bleeding. Briefly, and most importantly to female athletes are hormonal birth control and NSAIDs (ibuprofen and the like). The chemistry is a bit complex, but let us take a stab at it, because when these variables are combined with the normal activity of a female athlete, I believe her risk for blood clots shifts from the ‘if’ category to the ‘when’ category. For more information on the clotting cascade, here is a simple Khan Academy video.

Hormonal birth control increases all of our coagulation factors, but most especially, clotting factors VII and X, where plasma concentrations have been measured at 170% of normal. Fibrinogen (responsible for initiating the fibers that form the clot) is increased by 20%. Hormonal contraceptives also stimulate platelet aggregation (the initial plug that covers the injury), while simultaneously decreasing an anti-clotting factor called antithrombin III. Sit with that for a moment. This is the biochemical foundation that the female athlete is working with. Without doing anything else, her body is primed to clot.

Pro-clotting factors are increased to almost 3X their normal levels, while anti-clotting factors are diminished.

With this biochemistry, a body can only forestall excess clotting for so long. In fact, early reports suggest that clotting risk increases with time used. That is, clotting factors increase over the months and years one uses these medications. This may be why some of the most deadly clots, the pulmonary emboli and cerebral venous thrombi develop in women who have used contraceptives for years.

I have to add one more poorly understood hit to the coagulation system. NSAIDs alter platelet aggregation in some pretty complex ways and the mechanisms by which NSAIDs induce bleeding or clotting are just beginning to be understood. It is well known that NSAIDs like aspirin and ibuprofen can induce excessive bleeding. Gastric bleeds are one of the most common side effects of ibuprofen use. NSAIDs also carry with them increased risk of venous thromboembolism. Excessive bleeding but also excessive clotting–how is that possible? Certainly, it depends upon the formulation and which pathways the drug targets (Cox 2 inhibitors), but the emerging theory is that platelet aggregation may increase over time and become difficult to dissipate, because these medications block the enzyme responsible for keeping injured vessels free of clots while the damage is being repaired.

Another mechanism by which NSAIDs influence coagulation is via heart rhythm irregularities, like atrial fibrillation (at least for older populations, no data are available for younger athletes). With atrial fibrillation, we have a good chance of blood pooling which can result in clot formation. Finally, there is some evidence that NSAIDs increase vasoconstriction, which would impact blood flow. NSAID use is very common in the life of the female athlete and non-athlete alike with regular use both monthly, to stave off menstrual pain, and over the course of training to manage pain and injuries. It is possible that NSAID use may not only impact the post-injury healing process, but also, increase an athlete’s chances of developing a blood clot.

Now What?

Birth control is a personal choice. If pregnancy prevention is the only reason for using these hormonal contraceptives, there are non-hormonal options, including the old stand-bye, the condom, and newer devices for tracking. If scheduling is the primary consideration, I would consider whether or not the opportunity to schedule overrides the risks associated with using these products. Blood clots are a very real danger for athletic women without the additional risks that come with hormonal birth control. Are those risks worth taking?

Share Your Story

If you are a female athlete and have developed blood clots while using hormonal contraceptives, consider sharing your story. Contact us via this link: Write for Us.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was published originally February 23, 2016.

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Why Aren’t Women Tested for Factor V Leiden and Other Clotting Disorders?

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When I had a stroke at age 28, my doctors did some tests and found that I have a fairly common clotting disorder called Factor V Leiden. They told me that this, combined with birth control pills, are what caused me to have the cerebral venous thrombosis (stroke). It didn’t occur to me then to ask what Factor V Leiden actually was. Or to ask why I hadn’t been testing for inherited clotting disorders before I was put on medication that increased my risk for blood clots. These things didn’t occur to me until much later, after I learned to walk again.

I spent most of the first two years after my stroke getting on with my life. It wasn’t until I was searching for a topic for my thesis that I revisited what happened to me. I had no idea that birth control pills could be so dangerous and I certainly didn’t know that I could have an inherited genetic condition which would make them exponentially more dangerous for me. “How many women have the same condition?” I wondered. “Why don’t we test them before they are put on hormones?” These are some of the questions I sought to answer with my research.

What is Factor V Leiden?

Factor V Leiden (FVL) is a 20,000-year-old mutation common in the general population and a major genetic risk factor for thrombosis. It’s the most common genetic clotting disorder, accounting for around half of all cases. It’s most commonly found in Caucasians (3-8%).

Patients with Factor V Leiden can be either:

  • Heterozygous: inherited one mutated gene from a parent

or

  • Homozygous: inherited two mutated genes, one from each parent

What Does It Do?

As my hematologist described, FVL doesn’t cause blood clots but once activated, it dangerously accelerates clotting. Researchers aren’t clear on why some people with FVL activate and others don’t but there is almost always a precipitating factor—surgery, trauma, immobility, use of hormones, etc.

According to a review in Blood, the journal for the American Society of Hematology, women with heterozygous FVL who also use oral contraceptives have an estimated 30 to 50-fold increased risk of blood clots, while women with homozygous FVL have a several hundred-fold increased risk.

It is the most common genetic cause of primary and recurrent venous thromboembolism in women.

We know that taking estrogen can increase the risk of blood clots, stroke, and heart attack in women. And estrogen, when taken by someone with FVL, can significantly increase the risk of blood clots. Whether women are taking synthetic estrogen in the form of oral contraceptives, or hormone replacement therapy or have increased concentrations of the endogenous estrogens due to pregnancy, they are at much greater risk of clotting.

FVL accounts for 20-50% of the venous thromboembolisms (VTE) that are pregnancy related. In the United States, VTE is the leading cause of maternal death. In addition to causing VTE in pregnant women, FVL has been linked to miscarriage and preeclampsia.

Perhaps the women most at risk for blood clots are those that have been placed on hormone replacement therapy (HRT). A recent review of data from several studies found that women taking hormone replacement therapy were at an increased risk of blood clot and stroke. Worse yet, women with FVL who are also on HRT were 14-16 times more likely to have a VTE.

Despite these risks, women are not systematically tested for FVL before they are prescribed oral contraceptives, before or during pregnancy, or before commencing HRT.

What Women Know about Birth Control and Blood Clots

Part of my thesis research included a survey to assess what women understand about the risks of birth control pills and clotting disorders. Over 300 women who had taken birth control pills participated. What I found was that most women do not understand the side effects of hormonal birth control, nor are they familiar with the symptoms of a blood clot.

As for clotting disorders, nearly 60% of the women surveyed had no knowledge of these conditions. When asked whether they knew about clotting disorders BEFORE they took birth control pills that number increases considerably.

Over 80% of women were taking a medication without the knowledge that they could have an undiagnosed genetic condition that would make that medication exponentially more dangerous.

This shouldn’t come as much of a surprise give that this information is not found in advertisements for birth control pills, on non- profit websites about birth control pills and their risks, or on literature provided with the prescriptions.

Why Aren’t Women Tested for Clotting Disorders?

The most common reason I found in my research for not testing women were cost-benefit analyses measured in cost per prevention of one death.

Setting aside the moral argument that you cannot put a price on a human life, because clearly the government and corporations do just that. (It’s $8 million in case you were wondering.) The cost of taking care of taking care of victims of blood clots is not insignificant.

Each year thousands of women using hormonal contraceptives will develop blood clots. The average cost of a patient with pulmonary embolism (PE) is nearly $9,000 (for a three-day stay not including follow-up medication and subsequent testing).

A hospital stay as a stroke patient is over twice that at nearly $22,000 (not including continuing out-patient rehabilitation, medications, testing, etc.). As a stroke survivor, I can tell you that the bills don’t stop after you leave the hospital. I was incredibly lucky that I only needed a month of out-patient therapy. Most patients need considerably more and will require life-long medication and testing. It’s important to note that due to the increasing cost of healthcare, the figures in these studies (PEs from 2003-2010; strokes from 2006-2008) would be exponentially higher now.

I’m not a statistician but I can do some basic math and while I wasn’t able to find data for the United States (surprise, surprise), the health ministry in France recently conducted a study that showed that the birth control pill causes 2,500 blood clots a year and 20 deaths.  The United States has 9.72 million women using the pill compared to France’s 4.27 million. This doesn’t include the patch, ring, injectable, or hormonal IUD, but for the sake of keeping things simple, let’s just use the pill. So we have over twice the pill-users as France, which means twice the blood clots (5,000) and twice the deaths (40). If we assume that half of the blood clots are PE and half are stroke, we come up with a whopping $77.5 million in hospital bills for these blood clots (not counting life-long treatment). Now adding the cost-of-life determined by the government (40 women times $8 million= $320 million) and we end up with nearly $400 million a year in damages caused by the pill. For the cost of only one year of damages, all 10 million women could have a one-time $40 blood test which would result in considerably fewer blood clots.

Furthermore, the research in my thesis shows that women would be willing to not only take these tests, but also to pay for them!

Of the 311 who answered the question, 82.3% (or 256) said they would be willing to take the test. Only 7.2% said no, with the other 10.6% “not sure.” More than 60% of respondents would be willing to pay for the test (up to $50).

In addition, the cost of a blood test is directly proportional to how frequently it is performed. An increase in testing will result in a decrease in the cost of testing.

Women Deserve Better

Putting aside the monetary costs for a moment, what about the emotional and physical toll for women who suffer these dangerous and debilitating blood clots? There is no excuse for women to suffer strokes, pulmonary embolisms, DVTs, multiple miscarriages, and still births because they have an undiagnosed clotting disorder.

That said, requiring a test before prescribing hormones to women would raise awareness of the dangers of these drugs and may reduce the overall number of women using them. Which leads one to wonder if the absence of testing for women is really just a public relations strategy.

Perhaps one of the most devastating cautionary tales of not testing for clotting disorders comes from Laura Femia Buccellato. Her daughter Theresa was 16 years old when she was killed from a blood clot caused by (undiagnosed) Factor V Leiden and birth control pills. Would Theresa be with us today if she had had a simple blood test? Would I have had a stroke? When we will demand better?

We Need Your Help

More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

Yes, I would like to support Hormones Matter.

This article was first published in September 2016.

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What Is A Woman’s Life Worth? Birth Control and Blood Clots

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I recently began a new project tackling the economics of testing women for clotting disorders prior to receiving prescriptions for hormonal contraception. Hormonal contraception induces chemical blood clotting cascades in all women, and thus, developing blood clots while on hormonal birth control is a very real risk. In women who have genetic clotting disorders, those already pre-disposed to hypercoagulability, the likelihood of developing a clot while on birth control is exponentially higher. In these cases, hormonal birth control and all synthetic hormones should be avoided, but they are not. Most women have no idea that they carry a genetic predisposition towards clotting; that is, not until they develop a clot and find themselves in the ER fighting for their lives. If they are lucky enough to survive, and many are not, the consequences of not knowing include a lifetime of potentially avoidable health issues. For the loved ones left behind, all that remains is the devastation.

It should be a no-brainer that we test for these clotting disorders before prescribing a drug that induces clotting and poses a very real risk for death, but it is not. Indeed, every report I have found thus far suggests that the economics do not add up, that it is just not worth the economic outlay to test. Testing costs too much and prevents too few deaths, they say (see also, herehere, here, and here). Identifying clotting disorders would cause the loss of hundreds of millions in pharmaceutical revenue annually, a strong disincentive for economic value. And perhaps the most absurd, the old trope and common justification for inaction in women’s healthcare, some researchers indicated that knowing one carried a risk for blood clots, risks that could be minimized if one knew, would cause undue anxiety; anxiety, apparently the fragile female mind is incapable of handling. Therefore, they reasoned, we should not test.

Flawed Assumptions Mean Flawed Calculations

When we look at the economic assessments that dismiss the value in preventing, what are entirely preventable injuries and deaths, they are rife with flawed assumptions, some obvious and others not. Inevitably, the questions asked involve some variation of this: if it costs X dollars to test all women before receiving hormonal contraceptives and testing may prevent, (because we don’t really know), Y blood clot events in this population, and if those events cost hospitals Z dollars in care, is it economically viable to do the testing? Aside from the general callousness of an economic argument for what is ultimately a medical and ethical question, the underlying assumptions about who is tested and what is included or excluded from the ‘cost’ side of the equation suffer from some serious flaws that inevitably skew the results.

One Year of Risk?

Almost all of the studies look at risk for developing clots only over a year of use. Most women use hormonal birth control for years. Limiting the duration of the study period though procedurally expedient is not realistic. Some women develop clots early on, within weeks or months of beginning the prescription, others withstand the hypercoagulability for years, even decades before clotting becomes symptomatic. Our research showed that most clots develop after a year or more of use. It is true, however, that many women with genetic clotting disorders will develop blood clots early on; many, but not all. Some women escape symptomatic clotting while using hormonal birth but go to develop symptomatic clots during pregnancy, postpartum or even during menopause when synthetic hormones come into play. By limiting the duration of the study period, of when women might develop symptomatic clots, we likely fail to capture the totality of events, and thus, surely underestimate the costs of care associated with a clotting event. Strangely, however, if the study encompasses a longer duration of usage, the math seems to reduce the risk of clotting over time, to extent that if we carried the reduction out, it would eventually become zero or perhaps even a negative number. Again, this is not only nonsensical, but underestimates the cost of clotting events.

Limited Type of Clotting Events Studied

In addition to limiting the duration of the study period, most of these studies constrict what is considered a clotting event to the most obvious culprits – the venous thromboemboli (VTE) of either the deep vein thrombosis (DVT) or pulmonary embolus (PE) variety. While it is true that those are the most obvious and most common, contraceptive induced hyper-coagulation affects the body systemically and produces events indiscriminately. From 85% to as high as 96% of all cerebral venous thrombosis (a type of stroke) in young women are a result of hypercoagulability induced by hormonal birth control, often in conjunction with a hereditary prothrombotic condition. In our study, 40% of the clotting events resulted in stroke.

From the Cleveland Clinic, we know hypercoagulability encompasses far more than DVTs or PEs.

“Hypercoagulable states can be defined as a group of inherited or acquired conditions associated with a predisposition to venous thrombosis (including upper and lower extremity deep venous thrombosis with or without pulmonary embolism, cerebral venous thrombosis, and intra-abdominal venous thrombosis), arterial thrombosis (including myocardial infarction, stroke, acute limb ischemia, and splanchnic ischemia), or both. Venous thromboembolic disease is the most common clinical manifestation resulting from hypercoagulable states. Although most inherited conditions appear to increase only the risk of venous thromboembolic events (VTEs), some of the acquired conditions have been associated with both VTEs and arterial thrombosis.

And yet, none of the economic models consider these data relevant. Not assessing the full complement of contraceptive induced clotting events significantly underestimates the incidence of such events, and thus, the cost of care associated with them.

Limited Genetic Factors

The economic models tend only to assess the cost/benefit ratios for the most common clotting disorders, Factor V Leiden (FVL), activated protein C resistance (APC) and sometimes the prothrombin mutation (G20210A). On the surface, this makes sense, a higher population prevalence should equate to greater number of clotting events. We know from non-economic based research, however, that this assumption is not accurate. Testing done post clotting event, shows that most folks who develop clots have more than one genetic susceptibility (and multiple acquired factors where clotting in increased) and that it is the cumulative effects of these variables that correspond to the risk, not necessarily a single mutation or risk factor itself. This suggests that when we limit the genetic testing to the FVL/APC dyad and then try to construct our cost/benefit ratio, we’re missing a whole bunch clotting events that could be prevented if identified before the contraceptives are prescribed. And to be fair, it also means we have to increase the cost of testing to include a more comprehensive panel.

False Independence

One of the more egregious errors that these studies make involves an assumption of independence among the test groups. What I mean by that is the research design assumes that women who use contraceptives, who are pregnant/postpartum, or using HRT are independent groups with different risk profiles. In reality, however, a woman contemplating hormonal contraception, will likely consider pregnancy at some point in her life and she may also consider HRT later in life. If she has a clotting disorder, it will impact her health across her lifespan. Testing and identifying those clotting disorders when a woman contemplates hormonal contraceptives not only reduces the risk of clots induced by the contraceptives, but allows her and her physician the means to prevent or at least manage clotting during pregnancy and postpartum and should inform her decision regarding HRT and other medications/procedures/surgeries where clotting is a factor. From a cost/benefit rationale, the number of clotting events potentially prevented would be much higher if we recognized that a woman with a clotting disorder is in fact, a woman with clotting disorder across her entire lifespan. Test once. Prevent events across the lifespan.

And the List Goes On

Some of the other errors in the research include:

  1. Only ever evaluating clots induced by oral contraceptives and ignoring those induced by the NuvaRing, which seems to have a higher incidence of induced clots. Also ignored, hormonal IUDs, the injectable depo-provera or the implant. Admittedly, the incidence of clotting is lower with these forms, but not absent entirely.
  2. Using hypothetical populations and risk assessments versus actual incidents and actual costs. (A study from Italy did look at actual hospital costs but suffered from other issues). An interesting tidbit, one study looking a clots identified by autopsy versus those identified clinically, argued those identified by autopsy over-estimated the incidence of blood clots while those identified clinically underestimated. My question, how is that the actual, verifiable incidence of clots is an over-estimation?
  3. Addressing hospital and immediate care costs only. Not only are there typical 2-3 primary care and/or hospital visits prior to the diagnosis of blood clots, there are post-hospital care costs medical and rehabilitation costs, as well as, long-term health issues and additional risks associated with surviving a DVT, PE, and especially a stroke. Without fully addressing cost of care across time, the cost and benefits of preventing clotting events cannot be calculated accurately.
  4. Squishy math. To this point, I can find none of the hard costs used in these models, particularly in the US. It is not clear what it cost to test one woman for clotting disorders or treat one woman for either a DVT or PE. The models reviewed offer what I can only describe as a type of ‘unit calculation’ based on a variety of factors that I have yet to fully understand.

How Expensive is Thrombophilia Testing Versus the Cost of Thrombosis Care?

The only study I could find with sufficient information to calculate the cost of saving a woman’s life by testing prior to prescribing hormonal contraceptives suffered from all of the methodological flaws outlined above. In addition, it was conducted from the perspective of the UK National Health Service in 2002, and thus, estimates were made in British pounds and converted to US dollars. As part of this project, we will be looking closely at testing costs in the US. For now though, let’s use the UK figures converted to US dollars.

Based upon a hypothetical population of 10,000 women, testing for thrombophilia before prescribing oral contraceptives would cost approximately $9,150,809.09 or about $915 per test per person. The researchers estimated this would save 7 lives at a cost of $1.3 million per life saved. The study looked at only DVTs and PEs and only oral contraceptives. It did not include other types of clotting events, the cost of care for these women leading to fatalities, the cost of care in women who developed clots and survived, the cost of complications or medical management, short-term or long term, and of course, it considered the cost of saving a woman before prescribing contraceptives, independent of and different from the cost of preventing clotting events across other life phases like pregnancy/postpartum. Nevertheless, based upon these numbers the value of a woman’s life can be viewed either the $915 that it costs to administer the tests per person or the aggregated cost of $1.3 million to save each of the 7 women whose deaths would be prevented. Does it really cost $915 for one test panel? Who knows. That number was derived simply by dividing the total cost offered above by the hypothetical study population. No actual testing costs were provided.

Even more difficult to ascertain are the hospital costs themselves, as this study and the other studies did not provide an actual or estimated dollar amount for caring for one woman who develops a clot, whether it is a DVT or PE. Instead, each study uses calculated unit value that represents a sort of ‘units saved’ if the clot were prevented. To be honest, I have yet to fully understand how these ‘units’ are derived. Sure, the methods sections indicate they captured certain costs associated with care, but I have not been able to translate those factors into dollars. So while, these studies are quick to point out the expense of testing and dismiss the value of these tests based upon economics, the actual economics are ambiguous at best.

What Is a Woman’s Life Worth?

Not much, it appears. If we take the estimate above, the cost of saving one life by testing women for clotting disorders prior to prescribing hormonal contraceptives, the value accorded to the life of a woman is $1.3 million. It sounds like a lot, but when we consider how other federal agencies value human life, it is quite low. Federal agencies that estimate the value of human life in order to calculate the value of programs that reduce fatalities and illness suggest that an American life is worth between approximately $7-10 million. In contrast, the federal agency tasked with valuing and then paying for lives lost on 9/11 determined that the worth of a human life was far less in some instances, but far more in others. That is because the value was calculated based upon one’s income at the time of death and potential income across the lifespan. This begs the question, by what metrics do we determine the value of a life, particularly in a girl or young woman who has yet to reach her income status?

What is a woman’s life worth? Is the value of her life accounted for only by what it costs an institution, a hospital or insurer, to care for her during a discrete period of time?  Why isn’t there a cost associated with the ramifications of the loss of her health or her life – ramifications which affect her family across a lifespan? Blood clots are not simple one and done health events. Provided she survives, the risk of lifelong disability is very real, particularly with stroke, but even so with DVT and the occurrence of post-thrombotic syndromes. Why are those costs not calculated against the cost/benefit of testing?  Why is her potential loss of income not calculated? And why is it acceptable to justify and ultimately dismiss what are entirely preventable injuries and deaths with squishy economic calculations?  I don’t have answers to these questions. As the project progresses, we’ll explore the economics and ethics more fully. For the time being, however, I cannot help but be disappointed in how little value a woman’s life is accorded.

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This article was first published on June 6, 2017.

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More Side Effects from Birth Control- The Liver and the Gallbladder

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This time of year, the holiday season, can be a time of overindulgence for many of us. And how can we talk about overindulgence without taking a look at the liver? To say the liver is important is an understatement. It is the body’s largest gland and while estimates of the number of functions of the liver vary, many textbooks generally cite around 500. Nearly everything we ingest, from drugs and alcohol to vitamins and nutrients, is metabolized by the liver. The vital role it plays in the functioning of our bodies makes the testimony from the 1970 Nelson Pill Hearings about the effects of oral contraceptives on the liver that much scarier.

Research Presented at the Nelson Pill Hearings

Dr. Victor Wynn was one of the first physicians to testify about the effects of hormonal birth control on the liver.

On page 6341 he states, “if you will take cells out of the liver and examine them under the electromicroscope of women taking oral contraceptive medication, you will find some extraordinary changes.” Of these and other changes caused by the pill, he says: “When I say these changes occur, I mean they occur in everybody, more in some than in others, but no person entirely escapes from the metabolic influence of these compounds. It is merely that some manifest the changes more obviously than others.”

Later to testify was Dr. William Spellacy who was specifically called upon to speak about the metabolic effects on the liver. His testimony about the liver begins, “The biochemical effects of the sex hormones on the liver are legion.” Below is a list of liver functions that, based on the research presented in Dr. Spellacy’s testimony, are altered or impaired (NPH 6427):

  • Lowering of total plasma protein level
  • Decrease in the albumin and gamma globulin and increases in other fractions
  • Tests may be abnormal in women on oral contraceptives without disease being present
  • Estrogen (including that in oral contraceptives) interferes with liver function and varies with dosage
  • Some women taking oral contraceptives have abnormally high blood bilirubin levels
  • 1/3 of women who have jaundice on oral contraceptives will get it when pregnant
  • Discontinuation of oral contraceptives “cures” jaundice

He summed up his thoughts on the liver damage caused by hormonal birth control:

“The immediate effects include the alteration of several of the laboratory tests used in medical diagnoses. Aggravation of existing liver disease, if present, to the point where jaundice may be seen has also been shown. There is no answer to the query of will permanent liver damage result from the use of the oral contraceptives.”

The honorary Chairman of the Population Crisis Committee, a “pro-pill” organization focused on population control added his two cents about the effects of oral contraceptives on the women using them. “While metabolic alterations affecting the liver and other organs do result from use of the pill, there is no evidence at this time that they pose serious hazards to health;” General William Draper, Page 6705.

Of course, we shouldn’t assume that just because a medication causes a “legion” of biochemical effects on the livers of otherwise healthy women that there will be any lasting problems, right?

Research Since the Hearings

“Women more commonly present with acute liver failure, autoimmune hepatitis, benign liver lesions, primary biliary cirrhosis, and toxin-mediated hepatotoxicity,” according to a 2013 article in Gastroenterology and Hepatology.

Like I mentioned in my piece about rheumatoid arthritis, whenever a health issue affects women disproportionately, there is often a connection with hormonal birth control. While this study doesn’t specifically mention that, it does call for further studies assess the role of sex hormones and other behaviors on liver problems in women.

These connections were well-documented at the 1970 Nelson Pill Hearings but the subsequent research gets more confusing.

Timeline of Liver Research

1980: Lancet published an article showing the connection between malignant liver tumors and women using oral contraceptives.

1989: The British Journal of Cancer found “confirmation in this population of the association between oral contraceptives and hepatocellular carcinoma” and “the relative risk was significantly elevated in long-term users [of oral contraceptives].”

1992:This study, the largest to date, adds to the number of investigations demonstrating an increased risk of primary liver cancer with use, particularly long-term use, of oral contraceptives.”

2006:Long-term use of oral contraceptives (OCs) and anabolic androgenic steroids (AASs) can induce both benign (hemangioma, adenoma, and focal nodular hyperplasia [FNH]) and malignant (hepatocellular carcinoma [HCC]) hepatocellular tumors.”

Yet a 2015 meta-analysis concluded that “oral contraceptive use was not positively associated with the risk of liver cancer.” However, the analysis also conceded that “a linear relationship between oral contraceptives use and liver cancer risk was found.” And the authors noted the need for further research into specific formulations of oral contraceptives and the duration of usage.

It makes you wonder how we went from pretty convincing and highly damning connections between oral contraceptives and liver cancer to no positive association at all. Did all the scientists from the 1960s to 2006 get it wrong? Or is something else going on here?

What About the Gallbladder?

Perhaps we can look at the liver’s little buddy, the gallbladder, for some more information. The two are intimately connected in that the liver is constantly making bile and sending it to the gallbladder for storage and dispensation. Like problems with the liver, women are more likely to develop gallstones than men. According to the National Institute of Diabetes and Digestive and Kidney Diseases, “Extra estrogen can increase cholesterol levels in bile and decrease gallbladder contractions, which may cause gallstones to form. Women may have extra estrogen due to pregnancy, hormone replacement therapy, or birth control pills.”

This was proven shortly after the Nelson Pill Hearings. According to the revised edition of The Doctors’ Case Against The Pill by Barbara Seaman:

“The Pill also has serious adverse effects on the gallbladder, and women who take the Pill face an increased risk of someday facing surgery for gallstones. Pill use causes higher levels of cholesterol saturation in the bile, according to a study reported in the New England Journal of Medicine in 1976. This high level of fate in the bile is considered ‘an early chemical stage of gallstone disease,” according to Dr. Donald Small of the Boston University School of Medicine… The risk of gallbladder disease rises with the length of time a woman has been on the Pill… In some studies, Pill users are two and a half times as likely to suffer from gallstones as comparable women.”

A meta-analysis conducted in 1993 found “Oral contraceptive use is associated with a slightly and transiently increased rate of gallbladder disease” and “Considering…the rapidly changing formulas of oral contraceptives, the authors suggest that the safety of new oral contraceptives be evaluated by studying bile saturation and biliary function rather than by waiting for gallbladder disease to develop.”

A much more recent study (2011) found that there was even more risk of gallbladder disease with the newer formulations:

  • Long-term use of an oral contraceptive is associated with an increased risk of gallbladder disease compared with no use
  • There was a small, statistically significant increase in the risk of gallbladder disease associated with the use of desogestrel, drospirenone and norethindrone compared with levonorgestrel
  • Both estrogen and progesterone have been shown to increase the risk of gallstones
  • Estrogen has been shown to increase cholesterol production in the liver, with excess amounts precipitating in bile and leading to the formation of gallstones
  • Progesterone has been shown to decrease gall-bladder motility, which impedes bile flow and leads to gallstone formation

The gallbladder shows us that these hormones are damaging the body.

What Now?

So what do you do when you have a gallbladder that’s not functioning properly? The current practice is to take it out! Of course, removing the gallbladder is not the quick fix many think it is and often leads to other health complications like irritable bowel syndrome, acid reflux, and Sphincter of Oddi Dysfunction.

What about when your liver isn’t functioning properly? That’s not as simple. You can’t just take a liver out. How can the gallbladder, an organ so fundamentally connected to the liver, experience drastic and dangerous changes from hormonal birth control but the liver is supposedly unaffected? Have we researched ourselves out of that problem by declaring that it isn’t a problem? Has there been some spin-doctoring going on when it comes to the liver?

As Dr. Wynn said at the hearings, “There are more than 50 ways in which the metabolic functions of the body are modified, and to say therefore that normal physiological function has been demonstrated in the years of oral contraception is to overlook a very large amount of information.”

I think a very large amount of information has indeed been overlooked.

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More people than ever are reading Hormones Matter, a testament to the need for independent voices in health and medicine. We are not funded and accept limited advertising. Unlike many health sites, we don’t force you to purchase a subscription. We believe health information should be open to all. If you read Hormones Matter, like it, please help support it. Contribute now.

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This article was first published December 15, 2016.

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It’s Not All In Your Head: Mental Health and Hormonal Birth Control

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Once upon a time, a 26-year-old woman went to her doctor and asked to be put on the new birth control pill that allowed women to only have four periods a year. She had seen it advertised on television. Four months later, 15 pounds heavier and suffering from mild depression, she returned to the doctor feeling miserable. The doctor told her the weight gain and depression were not from the pill because those were not side effects of hormonal birth control. Wait, does this sound familiar? It’s the same story I told in my article about hormonal birth control and weight gain. Only this time, I’m talking about mental health.

The truth is that I gave my mood changes and my mild depression very little thought. Once the doctor told me they were not a symptom of my new birth control pills, I figured it was my fault I was sad and not dealing with things very well.

What They Knew in 1970

I remembered the connection between my birth control pills and that bout of depression when I began reading the Nelson Pill Hearings. One of the first doctors to testify pointed out that there had been a suicide during the original pill trials in Puerto Rico. Neither the suicide, nor the other three sudden deaths (of five total deaths during the experiments) were investigated. But what really got my attention was that the page after the mention of the suicide was the only one missing in the nearly 1500 pages of testimony. I have since been able to get a copy of that page and while the testimony doesn’t seem that damning given the laundry lists of risks, concerns, and dangers with hormonal contraceptives that are examined at the hearings, it does bring up an interesting point.

Doctor Edmond Kassouf’s testimony answers questions from Mr. James Duffy, minority counsel at the hearings (page 6112):

Mr. Duffy:  One of the five deaths was suicide.

Dr. Kassouf:  Yes.

Mr. Duffy:  So what I would like to understand is how does one take a suicide and link the case of death to the pill?

Dr. Kassouf:  Very simply. It has been of current concern. Many physicians and psychiatrists are concerned about depression and the pill. If this is true, suicide may well be the end result of that combination and, therefore, a reasonable suspect, a reasonable link.

Suicide Attempts While on the Pill

“I’ve really got to look into this more,” I thought. Well, I had to look no further than page 6447 and the testimony of Dr. Francis Kane, Jr., Associate Professor of Psychiatry at the University of North Carolina. To sum up his testimony about the studies conducted with regard to mental health and oral contraceptives, he says this (page 6457):

“There is considerable incidence of mild to moderate psychiatric morbidity [disease] associated with the use of combination oral contraceptive agents… In three of the four studies, there seems to be agreement that those who have required psychiatric care in the past will be more at risk for the development of morbidity, including psychosis. One study also suggests that there may be some increase in the depth of illness the longer the medication is taken.”

Dr. Kane describes a study conducted in England of 50 women on oral contraceptives who were compared to a control group of 50 women who had not used hormonal contraception. There were no differences in socioeconomic status, age, or history of past depressive episodes. But in the group taking the pill, 14 women “had depression of mild to moderate proportions, while only three of the control group reported this.” The pill users also reported greater depression as well as particularly high scores for “guilt, self-absorption, and loss of energy.”

He goes on to say, “Two suicidal attempts in the pill sample were found, which had not been disclosed to the general practitioner. Since completing the study, another depressed pill-taker had made a serious suicidal attempt.” Three suicide attempts in a study of 50 women? That seems incredibly high to me. Ludicrously high. Especially given that there are other methods of contraception.

But Wait, There’s More!

But that’s just one doctor testifying about a few studies, right? Sure. But the next person to testify was Dr. John McCain (not the senator). One of the first things the doctor points out is (page 6471):

“The contraceptive pills are potent steroid hormones. Alterations of the anterior pituitary function are produced by them… the potential endocrine and systemic disturbances are almost unlimited. The effects produced through the anterior pituitary may be so indirect that years may elapse before a correlation is established between the abnormality and the administration of the contraceptive pills.”

You know what else is a hormonal medicine? Anabolic steroids. “Roid rage” is pretty well documented. Is it really such a leap to think that hormones in birth control can also cause changes in mental health?

Dr. McCain spent years documenting the patients in his practice who suffered serious side effects from hormonal contraception. In that time, he recorded episodes from 52 patients. And per his own testimony, his largest concern was mental health (page 6473).

“The emotional or psychiatric problems are the complications which seem to me to have the most serious potential danger. Three patients have stated that they were desperately afraid that they were going to kill themselves… After the pills were omitted, the depression and suicidal fears of the three patients disappeared, as did the depression of the other patients.”

He also points out (page 6473):

“It is disturbing to consider the patients on the pills whose depression may have ended in suicide and/or homicide with no recognition of any association with the contraceptive pills… Personality changes could be a factor in other conditions such as automobile accidents and divorces.”

Is it really so much of stretch to think that a potent steroid could cause personality changes that could lead to the damaging of personal relationships that are beyond repair? Plenty of other potent substances can and do.

What They Say Now

Dr. Kane and Dr. McCain, as well as every other expert who testified at the Nelson Pill Hearings, agreed on one thing. More research was needed.

So what does the research say now?

Medscape published an article from the American Journal of Epidemiology with the claim that “Hormonal contraception may reduce levels of depressive symptoms among young women.” Yet when you read further into their conclusions, they say that nearly one-third of women discontinue hormonal contraceptives within the first year, many because of mood changes, and those women are unlikely to restart hormones. Therefore, “hormonal contraceptive users at any time point may be overselected for less depression than nonusers.”

The study also points out that:

“Existing literature on hormonal contraception and depression has been primarily confined to small, unrepresentative samples. Among these smaller studies, few cohesive findings have emerged.”

And:

“Little research has examined the role of exogenous hormone use in suicidality, and existing research has focused on mortality from suicide rather than suicide attempts.”

And according to WebMD, there are a laundry list of medications that can cause depression. What is not included on this list? Birth control pills. The only hormonal contraception included is Norplant. Interestingly enough, the active ingredient in Norplant is levonorgestrel, a progestin found in many birth control pills as well as hormonal IUDs. So am I supposed to believe that when injected into my arm, synthetic hormones can cause me depression but when taken daily as a pill or sitting in my uterus for 5 years, they won’t? Does that make any sense at all?

It doesn’t make sense to Dr. Kelly Brogan. That’s why when she has patients that complain of depression, anxiety, low libido, mood changes, weight gain, etc. she recommends they stop using hormonal contraception.

What Have We Learned?

  • 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
  • The research promised from the Nelson Pill Hearings has never materialized

Why, if they knew in 1970 that hormonal contraception was deeply connected not only to depression but also to suicide, has it not been further researched? It’s been nearly 50 years since Dr. Philip Ball (page 6493), a specialist in internal medicine, testified before congress. Which makes what he says all the more chilling.

“It is not considered reasonable that there be any mortality or morbidity in a pill used purely for contraception purposes. Medical research has got to offer something better than this. Physicians will probably look back on the contraceptive pill era of the past 5 years with some embarrassment.”

Exactly.

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This post was published originally on Hormones Matter on June 22, 2016.

 

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