hormones - Page 2

Sexual Function after Hysterectomy

126054 views

Whether a hysterectomy will affect sexual function is a common concern amongst women considering the surgery, as well it should be. Sex is a vital part of life and the loss of sexual function can be devastating. Whether and how hysterectomy affects sexual function is not very clear, however, and depends upon a number of variables, not the least of which is sexual function pre-hysterectomy, and particularly, pre-gynecologic problems. In many cases, women have a hysterectomy to rectify conditions associated with heavy bleeding and/or excessive pain like fibroids, endometriosis, adenomyosis and cysts. Reducing pain and bleeding should positively affect sexual frequency; however, effects on function may vary. Hysterectomy can diminish sexual function either directly because of the disconnection of the nerves and blood vessels that supply sexual energy or indirectly via the loss of critical hormones when or if the ovaries are removed or cease to function. And for many women, those with endometriosis, the hysterectomy itself provides only temporary relief from the disease process.

When evaluating the possibility of having a hysterectomy relative to sexual function outcomes, there are a few things women must consider.

Understanding the “Anatomy” of Sexual Function

According to Masters and Johnson, there are four phases of sexual response – Excitement, Plateau, Orgasm, and Resolution.

Sensation to any body part requires proper nerve conduction and adequate blood flow. Many nerves, blood vessels, and ligaments are severed to remove the uterus. The uterus and its ligaments themselves are rich sources of blood supply. As a result, sensation to the vagina, clitoris, labia, and nipples can be diminished by hysterectomy. This loss of sensation can hamper sexual function.

The Excitement phase is triggered by sexual stimuli, either physical or psychological. The stimuli triggers increased blood flow (vasocongestion) to the genitalia. With a blood vessel and nerve network altered by hysterectomy, this process may be hampered.

Contractions of the uterus are listed as a part of the Orgasm phase. So without a uterus, orgasm is not complete. Hence, it would make sense that orgasm is negatively impacted by hysterectomy, ovary removal or not. I have read, however, that some women do not experience uterine orgasm. So for them, a hysterectomy may not affect their orgasms.

My Personal Experience Post Hysterectomy

I realized very quickly after my hysterectomy that my libido, arousal, and ability to orgasm were broken. A steamy sex scene in a novel or movie or a hot looking guy no longer elicited sexual feelings. And the thought of sex was repulsive. That was a very sad day for me and I still mourn the loss of my intact sexuality. Some may question whether these changes are really due to the loss of my uterus or more so from the loss of my ovaries. When my hormone replacement was inadequate, the thought of sex was repulsive. However, I did have occasional orgasms but they were difficult to achieve and very infrequent as well as disappointing compared to before hysterectomy. Before my surgery, I had a good libido and an intense uterine orgasm every time I had intercourse. I have been on a good hormone regimen for over 6 years now. Sex is no longer repulsive but I do not have a libido or feel sexual in any way. Arousal takes much longer and orgasms are still weaker than before hysterectomy, do not always happen, and rarely occur during intercourse. Testosterone did not improve libido or arousal nor improve orgasm frequency or quality. Nipple sensation has been absent since surgery. These losses to my sexuality have affected my marriage relationship as well as social and professional relationships as I lack what I would call “sexual energy” and confidence.  

Other Possible Sexual Sequelae Post Hysterectomy

Removing the Cervix. The changes to the vagina after hysterectomy can further hamper sexual function. The removal of the cervix (the lower part of the uterus) requires that the vagina be shortened and sutured shut. This is called the vaginal cuff. The shortened vagina can present problems with deep penetration. Also, the vaginal cuff sutures can tear (dehiscence) which is a serious medical problem, although this is rare. Retaining the cervix eliminates these concerns and may preserve some of the nerves and sensation. During sex, the tip of the penis is “grabbed” by the cervix enhancing the man’s pleasure. However, even if the cervix is retained, this “grabbing” sensation may not occur without the uterine contractions.

emale sexual function after hysterectomy

Reduced Lubrication. Many women report diminished vaginal lubrication post-hysterectomy even when ovaries are not removed. Lubrication is critical for sexual activity as well as sensation. When the ovaries are removed or fail from the loss of blood flow, lubrication is lost and the vagina atrophies making sex painful. Over time, the vagina may prolapse as it no longer has the uterine ligaments to anchor it. Changes to bladder, bowel, and vagina position and function post-hysterectomy can likewise affect sexual function and satisfaction. A falling vagina and urgency and incontinence are certainly not sexy!

Body Changes. The hysterectomy induced changes to a woman’s figure which include a thick, shortened midsection and protruding belly are another source of sexual dysfunction and anxiety. Appearance changes from hormonal effects such as hair thinning, graying, and texture changes, skin dryness and aging (including loss of plumpness and pinkness in the genitalia), and loss of muscle mass and tone can also negatively impact sexuality. I have written about the anatomical and skeletal effects of hysterectomy here and here.

Emotional Changes. Many hysterectomized women with whom I have communicated report a loss of feeling connected to others including their loved ones. At first I thought the loss of my romantic and maternal feelings was solely attributed to the loss of my ovaries (despite taking estrogen). But after hearing from other women who still had functioning ovaries and reported the same feelings, I realized that maybe our uterus is what makes us loving and social beings. A renowned gynecologist on a talk show a few years after my hysterectomy referred to the uterus as “a woman’s heart center.” And for women love and sex are very much intertwined.

Hysterectomy and Sexual Function

Why is it that so many dismiss sexual problems post-hysterectomy as psychological? If a man has his prostate and/or testicles removed or penis shortened (heaven forbid!), sexual problems are attributed to the loss or surgical alteration of his SEX organ(s). So why would it be any different for women?

Although there have been some studies on sexual function after hysterectomy, I have not been able to make much sense out of them. It seems that most use a benchmark of (impaired) sexual function shortly before hysterectomy when gynecologic problems impede sexual activity and function versus prior to the gynecologic problems that are the reason for the hysterectomy. This observational study compared sexual pleasure, activity, and problems by type of hysterectomy at 6 months post-operative. It concluded that “sexual pleasure significantly improved in all patients, independent of the type of hysterectomy.” However, it also concluded that “the prevalence of one or more bothersome sexual problems six months after vaginal hysterectomy, subtotal abdominal hysterectomy, and total abdominal hysterectomy was 43% (38/89), 41% (31/76), and 39% (57/145), respectively.” With these high rates of “bothersome sexual problems” I cannot imagine how this could have been an improvement. However, if the benchmark was based on the time frame when pre-operative heavy bleeding, discomfort, or pain impaired sexual activity and function, then it would certainly be possible for sexual function to improve post-operatively. That does not mean it was an improvement over NORMAL sexual function (pre-gynecologic problems).

This Boston University School of Medicine article discusses post-hysterectomy sexual dysfunction. It says,

“Desire, arousal, orgasm and pain disorders may all be seen post-hysterectomy…..Internal orgasms are often changed significantly after hysterectomy. This is observed in part due to the inability to have rhythmic contractions of uterine muscles without the uterus present. Also, internal orgasms are changed after hysterectomy due to injury to the nerves which pass near the cervix. Surgeons should try to spare these nerves, but efforts to spare them are limited at the present. The result is that after hysterectomy, many women lose the ability to have an internal orgasm.”

Changing the Mindset: Removing a Woman’s Sex Organs Impairs Sexual Function

First and foremost, we need to stop referring to women’s sex organs as reproductive organs since they have vital, lifelong functions far beyond reproduction. In addition to the sexual functions, these include endocrine/hormonal, bladder and pelvic floor and anatomical and skeletal as detailed in my articles and the HERS Foundation’s video.

Secondly, women need to be more open about the effects hysterectomy has had on their health and quality of life, sexual and otherwise. It seems that some do not connect their problems with the surgery and many others choose not to talk about it. Before surgery, we are likely to believe that hysterectomy is fairly harmless since it is such a common surgery (second to c-section). No surgery is harmless. One that removes a woman’s sexual organs cannot help but cause problems with sexual function.

Some other factors that may be in play are that women seem to value their sex lives less than men. We tend to shortchange ourselves in other areas as well, putting others’ needs ahead of our own. Women of older generations were taught to trust and obey authority figures. So we typically trust our doctors and follow their recommendations. We are particularly vulnerable with gynecologists as we tend to have a long history with them through annual well woman checkups and pregnancies and deliveries. We are easy prey for hysterectomy marketing.

Clearly, there are far too many women being harmed by unwarranted hysterectomies and castrations. According to this 2000 study, 76% of hysterectomies do not meet ACOG criteria. Yet the rates have not declined and the use of robotics seems to be fueling even more hysterectomies with promises of quicker recoveries. Hysterectomies are big business with revenues rolling in to the tune of over $16 billion annually. With so much money at stake, we cannot count on the medical establishment to restrain themselves. It is up to us to spread the word.

Does Hysterectomy Affect Sexual Function?

Yes, it does. How can it not, given the nature of the surgical procedure? Whether the effects are generally more negative or positive is not clear. It largely depends on the reason for the hysterectomy including the severity and prolonged nature of those gynecologic problems. There is very little research and even less consideration or conversation regarding women’s pre- and post- hysterectomy sexual functioning. That is something we can change together by sharing our stories and communicating our needs.

Additional Resources

I highly recommend the non-profit HERS Foundation’s video “Female Anatomy: the Functions of the Female Organs.” It taught me most of what I know about the consequences of hysterectomy and/or ovary removal (castration). When I first discovered the video, some of it did not make sense. But as more time elapsed, the changes became clearer. My body and life have changed in ways I never could have imagined. I only wish I had found the video prior to my unwarranted hysterectomy.

We Need Your Help

Hormones Matter needs funding now. Our research funding was cut recently and because of our commitment to independent health research and journalism unbiased by commercial interests we allow minimal advertising on the site. That means all funding must come from you, our readers. Don’t let Hormones Matter die.

Yes, I’d like to support Hormones Matter.

This article was published originally on April 10, 2014. 

Share

From DES to the Pill: Are We Doomed to Repeat History?

3216 views

“The doctor wouldn’t have given it to me if he thought it was dangerous, right?”

My wife asked this salient question as we discussed the pros and cons of The Pill. It sent us both into deep reflection. Everything we read said The Pill was dangerous, but the doctor had acted like they should come in a Pez dispenser. To this day, I’m not sure where the cognitive began and the dissonance ended.

The DES Debacle: Origins of Obstinance

Doctors are generally dogmatic, but their nearly universal laissez-faire attitude toward The Pill seems particularly paradoxical when you study the scope and seriousness of its side effects. How can doctors believe that The Pill is safe, when tomes of studies suggest otherwise? Research links The Pill to everything from breast cancer and strokes, to Crohn’s Disease and lupus. To understand where we are and how we got here, it’s important to study the journey that brought us here.

By 1970, the current dogma that ‘The Pill is safe’ was well rooted in the medical community. However, enough doctors expressed concerns that Senator Gaylord Nelson decided to hold Congressional Hearings on the matter. The big three networks covered the hearings extensively, which caused great anxiety among women taking The Pill — and even greater anxiety among pill proponents, who subsequently demanded more ‘pro-pill’ doctors be included.

Senator Nelson took umbrage with their complaints, noting that all but one of the previous doctors had actually been ‘pro-pill’ to some extent, but all had reservations about its complications. Nonetheless, many of the doctors in the second round of hearings seemed more decidedly ‘pro-pill,’ including Dr. Kenneth Ryan, who stated,

I know of no information that indicates that biological properties of the estrogens used in the contraceptive pill are any different than stilbesterol for which we have at least 30 years of clinical experience…(Competitive Problems in the Drug Industry, Ninety-First Congress, Second Session, Page 6541)

Very reassuring… Unless you were actually familiar with the 30-year history of stilbesterol, also known as diethylstilbestrol (DES). Sir Charles Dodds discovered DES in 1938, and rushed it to market in the public domain. The English doctor bypassed the patent process hoping it would discourage the Nazis from further tests on women prisoners in their development of ethinyl estradiol (Barbara Seaman, The Greatest Experiment Ever Performed on Women; page 36).

From DES to the Pill

Despite his noble intentions, Dodds soon regretted the decision. Without a patent, drug companies around the globe were free to produce DES. He never expected that synthetic hormones would be given to healthy women, and was horrified that doctors were prescribing it as hormone therapy for natural menopause.

You Can’t Put the Hormones Back in the Tube

Even worse, Dodds soon learned that an American doctor named Karnaky had begun blazing a new trail – doling out DES to ‘prevent miscarriages’. Alarmed by the news, Dodds sent him a study he had personally performed, which showed that the drug actually caused miscarriages in animal subjects. It didn’t deter Dr. Karnaky or the many doctors who followed his lead. (Robert Meyers, D.E.S. The Bitter Pill; pp. 56-73)

Dodds began to feel like he was fighting a monster that he himself had unleashed. He was most concerned about how his discovery could affect certain cancers. He sent DES samples to the newly formed National Cancer Institute in the United States, and urged them to conduct tests and notify doctors.

Dodds wasn’t alone. The Council on Pharmacy and Chemistry warned,

…because the product is so potent and because the possibility of harm must be recognized, the Council is of the opinion that it should not be recognized for general use at the present time…and that its use by the general medical profession should not be undertaken until further studies have led to a better understanding of the functions of the drug. (Barbara Seaman, The Greatest Experiment Ever Performed on Women; page 44)

The concerns sent murmurs through the medical community, and many doctors began experimenting with lower doses of DES. By 1940, the editors of the Journal of the American Medical Association (JAMA) felt compelled to add theirs to the litany of warnings:

“It would be unwise to consider that there is safety in using small doses of estrogens, since it is quite possible that the same harm may be obtained through the use of small doses of estrogen if they are maintained over a long period.” (JAMA, April 20, 1940)

In 1959, the FDA determined the link to side effects (including male breast growth) was sufficient to ban poultry farmers from using DES as a growth hormone. However, the widespread use of DES in humans continued. In fact, it had become standard medical practice by the time Dr. Ryan assured Congress that The Pill was just as safe as DES – showing how medical dogma often trumps scientific evidence.

The greater irony of Dr. Ryan’s statement materialized one year after his testimony, when researchers first linked a rare vaginal cancer to the daughters of women who received DES during pregnancy. The FDA reacted strongly, listing pregnancy as a contraindication for DES use.

Consumer Groups Take the Lead

You would expect this to be the beginning of the end for DES. Shockingly, the medical community responded with indifference, continuing to prescribe DES for a variety of ‘off label’ uses, including as a morning-after pill, to catalyze the onset of puberty, and the old faithful, hormone replacement therapy. (Robert Meyers, D.E.S. The Bitter Pill; page 185)

It took nearly a decade of passionate effort from consumer movements like DES Action to convince doctors to (mostly) abandon DES. Dozens of lawsuits were filed; some were settled; and some are still pending. There is evidence that the harmful consequences could now be affecting a third generation of DES victims.

The current Director of Epidemiology and Biostatistics at the National Cancer Institute, Robert Hoover, M.D. oversees the DES Follow-Up Study to track the ongoing repercussions. With identifiable problems now affecting the grandchildren of women who took DES, the disaster hasn’t yet moved into the past tense of our nation’s history. Despite that, Dr. Hoover says:

There’s essentially a whole generation of medical students who don’t know the story. The story has such powerful lessons that I think that’s a tragedy…For about 20 years now, when I standardly ask in my general epidemiology lecture… how many of you have heard of DES, nobody raises their hand.

Sidney Wolfe, M.D., who headed up Ralph Nader’s Health Research Group offered this perspective,

DES is an excellent example of how drug companies behave, how they take advantage of the ways doctors act, and how they make millions of dollars by ignoring evidence of a drug’s harmfulness, by failing to get evidence that it is effective, and then by marketing a product that plays on fears and misconception. (Robert Meyers, D.E.S. The Bitter Pill; page 208).

In just 20 years, the American Medical Association moved from “It would be unwise to consider that there is safety in using small doses of estrogens…” to embracing the release of insufficiently tested hormones as birth control for millions of women. I’m leery of trusting a dogma founded on such an erratically moving target. In their defense, the dogma really hasn’t moved much in the decades since.

Today, the medical community assures us The Pill is the most researched drug ever. Sorry doc, that reassurance just doesn’t ring true. At this point, it feels more like a phrase learned by rote than a statement based on any kind of empirical evidence. Unfortunately, it’s not the only hollow mantra that should raise a red flag when it comes to hormonal contraceptives. I will discuss how the medical community responds to scientific studies in my next post, The Spin Doctor’s Prescription for Birth Control.

#1
In the Name of The Pill

37 customer reviews

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

Buy now at Amazon*

Price incl. VAT., Excl. Shipping

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 Hormones Matter on August 31, 2016. 

 

 

Share

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

5521 views

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.

We Need Your Help

Hormones Matter needs funding now. Our research funding was cut recently and because of our commitment to independent health research and journalism unbiased by commercial interests we allow minimal advertising on the site. That means all funding must come from you, our readers. Don’t let Hormones Matter die.

Yes, I’d like to support Hormones Matter.

 

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

 

Share

Vitamin D3 and Thyroid Health

11516 views

The benefits of vitamin D3 garner a plethora of glowing press these days but little information has been reported about how this essential nutrient may be associated with thyroid disorders. An alarming number of Americans—over 25 million—suffer from thyroid disease. Women are four times more likely than men to develop a thyroid disorder. The thyroid, a butterfly-shaped gland located in your neck, regulates your metabolism and affects every cell in your body. When your thyroid is not working properly, your body becomes unbalanced, potentially causing symptoms including weight gain or loss and chronic fatigue as well as autoimmune disease and cancer. Let’s look at how vitamin D3 may affect thyroid health:

Thyroid Hormonal Balance

Vitamin D receptors (VDR) are present in the cells of the pituitary, the pea-sized gland located at the base of the brain that controls your thyroid. The pituitary produces a hormone called thyroid stimulating hormone (TSH) that signals your thyroid gland to make thyroid hormone (T3 and T4). Thyroid hormone constantly circulates throughout your body, regulating metabolism. Either inadequate or excessive thyroid hormone can wreak havoc to your health, culminating in hypo- or hyperthyroidism. Understanding the regulating effects of VDR in our cells, I surmise that the amount of activated vitamin D3 in the pituitary’s VDR may be connected to the balance of thyroid hormone.

Autoimmune Thyroid Diseases

Adequate levels of vitamin D3 may protect the immune system from attacking itself. Low vitamin D3 levels have been linked to autoimmune thyroid diseases including Hashimoto’s and Graves’ thyroiditis.

Discovered one hundred years ago by a Japanese physician, Hashimoto’s disease is caused by abnormal blood cells and white blood cells constantly attacking and damaging the thyroid. About 95 per cent of Hashimoto’s disease patients are women. A study published in a 2011 issue of the journal Thyroid revealed that 92 per cent of Hashimoto’s thyroiditis cases had insufficient circulating vitamin D3 levels.

Ten times more likely to develop in women than men, Graves’ disease is caused by antibodies that overstimulate thyroid hormone production, causing hyperthyroidism. Researchers, who investigated Japanese female and male patients with Graves’ disease over a one-year period, found a high prevalence of woefully low circulating vitamin D3 in the female patients compared to the male subjects.

Thyroid Cancer

Incidences of thyroid cancer have doubled over the past four decades. The likelihood of women developing thyroid cancer is three times greater than for men. Activated vitamin D3 regulates cell differentiation, cell proliferation, and cell death. If these vital functions go awry, cancer may develop. Epidemiological studies indicate a link between vitamin D3 and thyroid cancer. Vitamin D researcher W.B. Grant, Ph.D. published a paper in a 2012 issue of the journal Anticancer Research that indicated an association between solar ultraviolet B, vitamin D3, and cancers including thyroid.

A relatively rare form of thyroid cancer—medullary thyroid cancer—originates in the thyroid C cells where a hormone called calcitonin is secreted. Calcitonin’s functions include stimulation of vitamin D3 production in the kidneys. The measurement of calcitonin is a diagnostic screening tool for medullary thyroid cancer. VDR are present in the thyroid C cells. Understanding the powerful effect of activated VDR on cell regulation, I hypothesize that activated VDR in the C cells may possibly prevent the development of medullary thyroid cancer.

In conclusion, recent medical literature suggests a connection between vitamin D3 and thyroid health. However, additional research is required to determine if thyroid dysfunction may cause vitamin D3 deficiency, or low vitamin D3 status may contribute to thyroid disorders.

Copyright ©2012 by Susan Rex Ryan, all rights reserved.

This post was published previously on Hormones Matter in September 2012.

Share

A Joint Problem: Rheumatoid Arthritis and Hormonal Birth Control

23416 views

Rheumatoid arthritis is an autoimmune disorder which causes the body’s immune system to attack the joints, resulting in pain and swelling. About 1.3 million people in the United States have rheumatoid arthritis, and of these, nearly 75 percent are women. “In fact, 1–3 percent of women may get rheumatoid arthritis in their lifetime. The disease most often begins between the fourth and sixth decades of life, however, RA can start at any age.”

At this point in my research into hormonal contraceptives, any disease that affects women so much more drastically than men I find suspicious. While reading the Nelson Pill Hearings (NPH), the testimony of Dr. Giles Boles, a professor of internal medicine, caught my attention. He was discussing oral contraceptives and rheumatoid arthritis. Like diabetes, this is another connection I had never heard about before.

At the hearings, Boles describes a 24-year-old woman who was experiencing mild rheumatic symptoms. After running some tests, she showed three abnormalities commonly associated with lupus. She had been taking oral contraceptives for 8 months and was on no other medication. “She was advised to discontinue her oral contraceptive therapy and within 6 weeks all of her laboratory abnormalities had disappeared.” Doctors continued to monitor her for over 2 years and she remained disease-free.

He also spoke about a two-year study published in 1969 that showed rheumatoid arthritis in women taking oral contraceptives increased more than 50 percent. Another study from the same year reported that 22 women with rheumatic symptoms had their symptoms diminish or disappear after discontinuing the pill (NPH page 6089).

That study, which was originally published in the British medical journal Lancet, was also discussed in Barbara Seaman’s book The Doctors’ Case Against the Pill (page 122):

“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 researching the connection further, my first stop was the Centers for Disease Control. On their page for rheumatoid arthritis under “Risk Factors” is the following:

Oral Contraceptives (OC): Early studies found that women who had taken OCs had a modest to moderate decrease in risk of RA. However, most recent studies have not found a decreased risk. The estrogen concentration of contemporary OCs is typically 80%-90% lower than the first OCs introduced in the 1960s. This may account for the lack of associations in recent studies.

This seems very odd to me for a few reasons. First of all, if oral contraceptives decrease the risk of rheumatoid arthritis, why put it under “Risk Factors?” Secondly, though the “early studies” being cited are from 1993 and 1989, they point to the higher concentration of estrogen from pills in the 1960s as a reason for the conflicting information. Yet in 1970, Dr. Boles testifies about a very real connection between rheumatoid arthritis and the use of oral contraceptives.

Rheumatoid Arthritis on the Rise

A 2010 study from researchers at the Mayo Clinic showed that after four decades of decline, rheumatoid arthritis was on the rise among women. They cited oral contraceptives as one of the culprits:
“The incidence of rheumatoid arthritis (RA) in women has risen during the period of 1995 to 2007, according to a newly published study by researchers from the Mayo Clinic. This rise in RA follows a 4-decade period of decline and study authors speculate environmental factors such as cigarette smoking, vitamin D deficiency, and lower dose synthetic estrogens in oral contraceptives may be the source of the increase.”

Yet this WebMD article discusses a small German study that showed that oral contraceptive use could ease some symptoms of RA. Incidentally, the article also points out, “certain patients with inflammatory arthritis may increase their risk of blood clots by going on oral contraceptives.” This statement makes it seem that only some women are at an increased risk for blood clots when using oral contraceptives. That’s untrue. ALL women who use hormonal contraceptives are at an increased risk for blood clots.

While the German study was small and focused on symptoms, a meta-analysis of 17 studies showed no “protective effect of oral contraceptives on the risk for RA in women.”

Perhaps even more strange are the findings presented at the American College of Rheumatology Annual Meeting in Boston in 2014. The study presented there showed that choice of contraception may influence rheumatoid arthritis autoimmunity risk, with the biggest risk coming from IUDs (intrauterine device), though the research findings don’t specify whether patients used a copper IUD or a hormonal IUD.

According a meta-analysis by Hazes and van Zeben the overall unsatisfactory state of studies relating RA to the contraceptive pill suggest

“that oral contraceptive use may in fact be a marker for some other causal factor.”

Another article by William H. James from the Annals of Rheumatic Disease describes the problem with determining the connection between oral contraceptive use and rheumatoid arthritis:

“Over the last decade a dozen large scale studies have offered strikingly dissimilar conclusions on this possibility. An international workshop was held in Leiden in 1989 in an attempt to reach a consensus. It is not unfair to comment that consensus proved evasive.”

Is Rheumatoid Arthritis Connected to Hormonal Contraceptives or Not?

In 1970, the research clearly showed a connection between rheumatoid arthritis and hormonal contraceptives. Further research confirmed that. Then other studies attempted to demonstrate that the pill mitigated symptoms, while a meta-analysis showed no protective effect. Yet recent findings show an increased risk for women who use IUDs. In all of the recent research, the only consensus seems to be that there is no consensus.

The bottom line is that evidence about the connection between rheumatoid arthritis and hormonal birth control is inconclusive at best, incoherent at worst, and sometimes downright contradictory. Once again, I have to ask why. Why were there not conclusive studies conducted immediately after the 1970 Congressional hearings? Who gains by there still being confusion about this issue? Who loses? That one I can answer; women lose.

Real Risk Study: Birth Control and Blood Clots

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

Share

Blinded By Side Effects: Vision and Hormonal Birth Control

7763 views

I don’t know about you but my vision is pretty important to me. I’m using it right now to type this article. I use it all the time, every waking hour of the day (except maybe when I’m meditating). So when I read the Nelson Pill Hearings and I came across the testimony of Dr. Guttmacher, I was shocked.

“Now, in addition to the danger from thromboembolism which has been described to this committee on several occasions by several witnesses, I think that there are other dangers for the pill… such as high blood pressure, headache, depression, interference with vision, and so on.” (page 6566)

Wait… the birth control pill affects your vision??? How can that be? And how could he just say that in passing? Why did no one on the Senate committee stop him and make him explain that that statement? It turns out, just like diabetes, yeast infections and UTIs, depression, weight gain, and so many other side effects, no one had told me that my vision could be affected by using hormonal birth control.

How Hormonal Birth Control Affects Vision

Hormones affect every system of the body so perhaps it should come as no surprise that they can greatly impact your vision. In fact, it is the fluctuation in hormones that is the primary reason for worsening eyesight with age. So of course, manipulating the body’s natural chemistry by using hormonal birth control can cause a variety of vision problems.

Dry Eye

According to the National Eye Institute (NEI), “Dry eye occurs when the eye does not produce tears properly, or when the tears are not of the correct consistency and evaporate too quickly.” While usually more uncomfortable than dangerous, if dry eye is left untreated it can cause pain, ulcers, scars on the cornea, and in rare cases, some loss of vision.

The NEI also states that it can be temporary or chronic and that one of the causes of dry eye is medications such as birth control. Unfortunately, that means dry eye is often overlooked in young women and teen girls using the pill. As Dr. Reiser of the Cornea Institute at the Children’s Hospital of Los Angeles points out, doctors “may not even think of it, but these drugs are frequently prescribed to treat skin problems and dysmenorrhea. Some [ocular] symptoms can mimic what you see in menopausal women.”

We also see dry eyes as a side effect of women who’ve had hysterectomies. Robin Karr details her experience with it here. It’s obvious that eye health is linked to hormones but the vision problems associated with hormonal birth control don’t stop there. Dry eyes may be the least of our worries.

Glaucoma

Dry eye may be uncomfortable and inconvenient but glaucoma, another eye condition linked to hormonal birth control, can be much more dangerous. Glaucoma causes damage to the optic nerve and can lead to permanent loss of vision. Perhaps the scariest thing about glaucoma is that most patients have no symptoms and are only diagnosed when having an eye exam. A researcher and ophthalmologist from the University of San Francisco found that use of birth control pills for three years or longer doubles the risk of glaucoma.

The fact that glaucoma is the second leading cause of blindness and that there is no cure  is very disturbing. The American Optometric Association downplays the findings of this study and calls for more research. Yet, that seems to be the response to all of the research about the dangerous side effects of hormonal contraception. How much more research do we need to show that these medications are dangerous and dangerously over-prescribed? A woman could literally go blind from a medication she’s been prescribed to treat acne.

Retinal Occlusion

As someone who had a stroke while using hormonal birth control, this risk probably shouldn’t have come as a surprise to me. Retinal occlusion is a stroke of the eye caused by a blockage in the blood vessels of your retina. These blockages can be caused by blood clots, a well-researched and documented side effect of hormonal contraception. Like with a stroke of the brain, recovery isn’t guaranteed. Some people who suffer these retinal occlusions will never see again.

In fact, the risk with oral contraceptive use is so substantiated that you can find it in the “Practicing Ophthalmologists Curriculum Core Ophthalmic Knowledge” on the American Academy of Ophthalmologists website.

It should also be said that many of our Real Risk: Birth Control and Blood Clots study participants experienced vision changes before and during their blood clots. This was the case not just in the women who had had strokes but surprisingly also in the women who suffered pulmonary embolisms.

Seeing Clearly

I used birth control pills for 10 years and I never once had a healthcare professional- not my gynecologist, not my general practitioner, not my ophthalmologist- tell me that vision problems were a side effect. That Dr. Guttmacher mentioned it in passing at Nelson Pill Hearings seemed to indicate that the risk was well-known, even back in 1970. Current research supports that hormonal contraceptives adversely affect vision. Where does that leave us? What would you be willing to give up for a medication? Your physical health? Your mental health? Your libido? Your vision? Your life?

What else do we need in order to see that hormonal contraception is not worth it?

Real Risk Study: Birth Control and Blood Clots

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

Share

The Real Risk Birth Control Study: Take Charge, Find Answers

2469 views

I recently read an article about how fewer women are taking birth control pills now. The article claimed:

“The reasons behind the shift are hard to pin down. Study after study has shown the pill is generally safe for most women, and is 99 per cent effective with perfect use. The pill’s safety has only improved since it was introduced in 1960. It is perceptions that are changing.”

This is completely untrue. It wasn’t safe in 1960 and it certainly isn’t any safer now. It’s also not true that study after study has shown it to be safe. At the Nelson Pill Hearings, the 1970 congressional hearings on the safety of the birth control pill, every doctor that testified agreed that more research was necessary. Yet, every modern study I have found (from research on depressionweight gaindiabetes and more) has said that even more research is necessary to make any conclusions. So in the 46 years since, we still don’t adequately understand the risks with hormonal contraceptives. Dr. Paul Meier, who testified at the hearings, spoke about the challenges of conducting said research:

“Of far greater concern to me is the failure of our governmental agencies to exercise their responsibilities in seeing to it that appropriate studies were carried out… Frankly, the required research, although important, is not especially appealing to scientists. It is not fundamental and it is not exciting. It is difficult, it is expensive, and it is fraught with the risk of attack from all sides.

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.”

We can see that what Dr. Meier warned against is exactly what has happened. Experts testified in 1970 that the pill was linked to depression and possibly suicide. They warned that the pill should not be given to women with a history of depression. Yet, in 2004 when I was depressed after switching my brand of pill, my doctor told me that wasn’t a side effect. It wasn’t until last month that a European study on hormonal contraception said what no American study has dared. The pill is irrefutably linked to depression.

Unfortunately, depression is only ONE of the side effects of hormonal birth control. Obviously, blood clots are one of the most dangerous and why we are looking at them with this research study. Other side effects that were warned about at the Nelson Pill Hearings but for which the current research claims even more research is necessary include: diabetes, weight gain, cancer, loss of libido, urinary tract and yeast infections, lupus, infertility, hypertension. So no, studies do not actually show that “the pill is generally safe.” What studies show is that there STILL needs to be more research. Well, if they haven’t done it in the past 46 years, when are they going to do it?

As for the pill’s safety improving, just look the increased risk with newer formulations. Third and fourth generation pills have significantly higher risk for deadly blood clots.

“The problems with Yaz and its sister pills stem from drospirenone, a fourth-generation progestin.

After years of blood clot reports, the U.S. Food and Drug Administration (FDA), reviewed studies on oral contraceptives and found that an estimated 10 in 10,000 women on newer pills will experience a blood clot versus 6 in 10,000 with older pills.

Another study conducted by the French National Agency for the Safety of Drugs and Health Products (ANSM) found that birth control pills were linked to more than 2,500 cases of blood clots annually between 2000 and 2011. But third- and fourth-generation pills were responsible for twice as many deaths as earlier pills.

Two studies appeared in the British Medical Journal in 2011 and indicated newer pills were two to three times more likely to cause blood clots.

Why would the pharmaceutical industry make newer birth control pills that are less safe? Maybe because once the patent runs out on medication they don’t make as much profit. So they change the formula and market it as a new and better pill. As history has shown though, there never seems to be enough research done before these products are approved. And women are paying the price. Dr. Ball warned of this at the Nelson Pill Hearings when he said (page 6500):

“Each time we change the dose or the chemical, you have a whole new ball game statistically, and then a long period of time has to go by for evaluation. Again, is it going to be just this unscientific, hand-out-the-pills-and-see-who-gets-sick business, which I say is wrong and which has been done. Each time there is a new pill, there is a new problem.”

Alas, that’s exactly the business that’s been taking place. Throw in the fact that doctors often dismiss the complaints from women as psychosomatic and you have a recipe for a completely misrepresented medication.

I don’t know about you but I’m tired of being a rube for the pharmaceutical industry. If we want to know what’s really going on with hormonal contraception, we’re going to have to start looking at it ourselves. We can’t wait for the government or the pharmaceutical industry to provide us with perfectly funded, unbiased research. They haven’t done that in the near 50 years since the Nelson Pill Hearings and there’s little indication they are going to start now. That’s why we’re conducting this research ourselves. We need information to help women assess what their REAL RISK is for taking a medication. Not what their doctors are telling them based on studies conducted by the pharmaceutical industry. The aim of this study is not to take away contraceptive options but to provide more accurate information about which women may have more risk for serious side effects like blood clots and which forms of hormonal contraception may be more dangerous than others.

It’s time to take charge of our health and find our own answers. That’s exactly what this research hopes to do but we need your help to do it. Please participate. And please share our study with those you know who might be willing to help. Thank you.

Take Charge: Participate in the Birth Control and Blood Clots Study

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

Share

Diabetes: Another Problem with Hormonal Birth Control

2345 views

Diabetes is the 7th leading cause of death in the United States according to the American Diabetes Association. Tens of millions of people have diabetes and are at increased risk for a whole host of other problems because of it. The estimated economic cost of diabetes is nearly $245 billion each year. BILLION! So shouldn’t we take a look at how to decrease these risks, lessen this economic burden, save lives?

I’ve done a lot of research on birth control pills, their side effects, and how those risks are communicated to women. My interest in the topic is both personal (I suffered a stroke from hormonal birth control at age 28) and professional. I’ve been reviewing the Nelson Pill hearings and what I’ve found is shocking. Beyond the obvious correlation between blood clots and hormonal birth control, even back in 1970 doctors and scientists knew that these medications affected, contributed to, and caused a myriad of health problems from weight gain to stroke. One of the most surprising to me, because I hadn’t come across it in any of my previous research, was the link between synthetic hormones and diabetes. Dr. Hugh J. Davis, the first doctor to testify at the Nelson Pill Hearings said the following (page 5930):

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

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

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

 

And:

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

 

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

For women with polycystic ovarian syndrome (PCOS), this is particularly troubling. They are already at an increased risk for diabetes. “Researchers in Australia collected data from 6,000 women and found that those who had PCOS were three to five times more likely to develop type 2 diabetes than women who didn’t.” Yet the first treatment doctors usually prescribe for PCOS is birth control pills. It’s unclear whether the PCOS alone increases a woman’s risk or just that most women with PCOS are treated with hormones that make her more likely to develop diabetes.

It begs the question, why are we treating a woman for a condition that increases her risk for diabetes with a drug that increases her risk for diabetes?

Even if you don’t have PCOS, you are still at risk. A recent study showed that “women who used hormonal methods of birth control had higher odds for gestational diabetes than did women who used no contraception.” So using hormonal birth control may prevent you from getting pregnant but at the cost of making a future pregnancy more dangerous? It’s not just dangerous for pregnant women, however. Hormonal contraceptives seem to predispose women to diabetes across the lifespan. For example, another study found:

“The prevalence of diabetes was significantly higher in post-menopausal participants who had taken OCs (oral contraceptives) for more than 6 months than in those who had never taken OCs. The duration of OC use was also positively associated with the prevalence of diabetes. Furthermore, taking OCs for more than 6 months led to a significant increase in fasting insulin levels and HOMA-IR in nondiabetic participants. Past use of OCs for more than 6 months led to a significant increase in the prevalence of diabetes in post-menopausal women, and increased IR in nondiabetic participants. These results suggested that the prolonged use of OCs at reproductive age may be an important risk factor for developing diabetes in post-menopausal women.”

This is further proof that taking hormonal birth control affects women for much longer than the duration they take it. A correlation between synthetic hormones and diabetes was evident to doctors and researchers back in 1970 and we’re still trying to understand those effects today. Dr. Hugh Davis testified (pg 5928) about hormonal birth control:

“While you are accomplishing your contraceptive objective you are producing very, very widespread and generalized changes.”

I’m starting to feel like a broken record here, but at what point are these risks not acceptable? And why do we still not fully understand these risks? The goal of the Nelson Pill Hearings was to determine if these medications were safe and they are clearly not. Over and over, experts testified and said the pill should not be taken off the market but that it should be studied more and replaced by something better as soon as possible. As we can see, that hasn’t happened. Women are still having to make the choice between convenient contraception and their health and safety. The risks involved with hormonal contraceptives are still being downplayed, skewed, and hidden. If a serious and potentially life-threatening condition like diabetes is not too high a price to pay to avoid pregnancy, what is? How about loss of libido? Mental health? Weight gain? Blood clots? Stroke? Loss of life? Dr. Davis also said (pg 5925):

“In using these agents (hormonal contraceptives), we are in fact embarked on a massive endocrinologic experiment with millions of healthy women.”

I couldn’t agree more. And the experiment continues.

 

Real Risk Study: Birth Control and Blood Clots

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

Share