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Let’s Talk About Sex, Baby: Hormonal Contraception & Libido

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“If sexuality is one dimension of our ability to live passionately in the world then in cutting off our sexual feelings we diminish our overall power to feel, know, and value deeply.” –Judith Plaskow

This quote raises an interesting question. If owning our sexuality gives us power, then who benefits from limiting that power? And why is limiting that power an acceptable side effect of hormonal contraception?

During the Nelson Pill Hearings, Dr. M. James Whitelaw testified (page 6015): “How many adult males would be willing to take an oral contraceptive faithfully if they were told that instead of a possible 50-plus adverse side reactions only one remained, that being the possible loss of sex drive and libido? [Laughter]”

What is the implication here? Women can be denied their full sexual capability but the idea of men suffering the same is laughable? Holly Grigg-Spall speaks to that in her book Sweetening the Pill (page 50):

“The pill’s impact on the libido has been publicized but it is generally dismissed with humor. The libido is seen as distinct from women’s emotional and physical health, whereas with men it is linked. The female sex drive is not celebrated or seen as essential to her femininity or sexuality… Research that indicates that lowered libido is experienced by a large number of women on the pill is undercut by the cultural assumption that most women have little real interest in sex regardless of this drug.”

Sexy But Not Sexual

And she’s right. Women are constantly told to be sexy but not sexual. It would seem that hormonal birth control would provide exactly that type of woman. One who could have sex without the consequence of getting pregnant, therefore highly desirable to men; but one who could not fully embrace the power of her own sexuality due to a medication-induced lack of libido. Is this really what we want? A society of women that are physically available for sex but completely disconnected from the powers of her own sexuality? Again I will ask, who benefits from keeping women in that robot-like state?

“The quality of a woman’s sex life, unlike that of a man’s, does not seem to concern the drug companies or the (male) research establishment… Women who reported changes in their sex drive often heard that old refrain: ‘It’s all in your head.’ But the male sex drive is considered so important by the drug companies that it is always studied in conjunction with new male contraceptives, just as it is almost always mentioned in arguments against the condom.” –Barbara Seamen in The Doctors’ Case Against the Pill

It’s true. We hear the argument that condoms lessen sensation during sex. But for whom? Men. Yet for women who use hormonal birth control, low libido and loss of sensation during sex are some of the least dangerous side effects they can expect. Heather Corinna put it so well in her article “Love the Glove” that even Grigg-Spall quoted her:

“If we’re going to talk about condoms changing how sex feels, we need to remember that something like the pill does too, and, unlike condoms, it changes how a woman feels all the time, both during and outside of sex… Other methods of contraception can cause pain and cramping, unpredictable bleeding, urinary tract infections, depression and a whole host of unpleasant side effects. Condoms are the LEAST intrusive and demanding of all methods of contraception, even though some guys talk about them — without considering this perspective — like they’re the most. If guys could feel what life can be like on the pill, use a cervical barrier or get a Depo shot, they’d easily see condoms for the cakewalk they are.”

It’s not just the pill that is damaging to women. As Grigg-Spall explains, Depo Provera (“the shot”) is specifically used to decrease sex drive in sex offender rehabilitation programs. There is something seriously wrong when a birth control option offered to women is the exact same medication used as pharmaceutical castration for sex offenders.

FSD – Female Sexual Dysfunction or Female Sexuality Discouraged?

According to a study of female German medical students published today in The Journal of Sexual Medicine, women taking non-oral and oral hormonal contraceptives were at highest risk of Female Sexual Dysfunction (FSD). Interestingly, women using non-hormonal contraceptives were at lowest risk for FSD, more than women not using any contraceptive.

“Sexual problems can have a negative impact on both quality of life and emotional well-being, regardless of age,” said researcher Dr. Lisa-Maria Wallwiener of the University of Heidelberg, Germany. “FSD is a very common disorder, with an estimated prevalence of about two in five women having at least one sexual dysfunction, and the most common complaint appearing to be low desire.”

Side Effects – Affecting More Than Just the Patient

Why is this okay? Why do we accept this? If a woman is experiencing sexual dysfunction, it not only affects her but it affects her partner as well.

Dr. Philip Ball testified about this very problem at the Nelson Pill Hearings back in 1970 (page 6493): These unhappily newly married women do not know if it is the wrong man, the wrong town, the wrong job, the wrong year, the wrong apartment, or yet something else, when it is really many times the wrong pill.

And he’s not incorrect. Research now shows that taking birth control pills affects women’s taste in men. According to this article from the Scientific American, women on the pill seem to prefer men who are genetically similar to themselves.

“Women who start or stop taking the pill, then, may be in for some relationship problems. A study published last year in Psychological Science found that women paired with MHC-similar men are less sexually satisfied and more likely to cheat on their partners than women paired with MHC-dissimilar men. So a woman on the pill, for example, might be more likely to start dating a MHC-similar man, but he could ultimately leave her less sexually satisfied. Then if she goes off the pill during the relationship, the accompanying hormonal changes will draw her even more strongly toward more MHC-dissimilar men. These immune genes may have a “powerful effect in terms of how well relationships are cemented,” says University of Liverpool psychologist Craig Roberts, co-author of the August paper.”

How any of this is connected to relationship issues, divorce rate, infertility, one can only speculate. But it’s clear that the sexual side effects caused by hormonal contraception are no laughing matter.

Sex is a big part of life. The ability to connect with each other and derive great pleasure from sex is not just a perk of being a human. It is our birthright. And to deny that birthright is to limit our power as women. That’s not what I consider an “acceptable side effect.”

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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.

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Endometrial Ablation – Hysterectomy Alternative or Trap?

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Endometrial ablation seems to be the latest “bag of tricks” in the treatment of women’s gynecological problems. It is an increasingly common procedure used to treat heavy menstrual bleeding. The procedure is premised on the notion that if the endometrial lining is destroyed – ablated – bleeding can no longer occur. Problem solved. But is it? Does endometrial ablation work? Does it resolve the heavy menstrual bleeding and prevent the “need” for a hysterectomy as it is marketed, or does endometrial ablation cause more problems than it solves? The research is sketchy, but here is what I found.

Short-term Complications Associated with Endometrial Ablation

For any surgical procedure there are risks associated with the procedure itself. Here are the short-term complications for endometrial ablation reported in PubMed: pelvic inflammatory disease, endometritis, first-degree skin burns, hematometra, vaginitis and/or cystitis. A search of the FDA MAUDE database included complications of thermal bowel injury (one resulting in death), uterine perforation, emergent laparotomy, intensive care unit admissions, necrotizing fasciitis that resulted in vulvectomy, ureterocutaneous ostomy, and bilateral below-the-knee amputations. Additional postoperative complications include:

  1. Pregnancy after endometrial ablation
  2. Pain-related obstructed menses (hematometra, postablation tubal sterilization syndrome)
  3. Failure to control menses (repeat ablation, hysterectomy)
  4. Risk from preexisting conditions (endometrial neoplasia, cesarean section)
  5. Infection

Long Term Complications of Endometrial Ablation

Endometrial ablation to block menstruation. In order to understand the long-term risks of endometrial ablation, one must understand the hormonal interaction between the uterus and ovaries. The endometrial (uterine) lining builds and sheds in response to the hormonal actions of the ovaries. Ablation scars the lining impeding its ability to shed. But ovaries continue to send the hormonal signals necessary for menstruation and the uterus attempts to function normally by becoming engorged with blood. The problem is, the blood has nowhere to go. It is trapped behind the scar tissue caused by the ablation. This causes all sorts of problems.

Retention of blood in the uterine cavity is called hematometra. If the blood backs up into the fallopian tubes it’s called hematosalpinx.  Hematometra and hematosalpinx can cause acute and chronic pelvic pain. Some data suggest that about 10% of the women who have had endometrial ablation suffer from hematometra. The pelvic pain in women who’ve undergone both tubal sterilization and ablation has been coined postablation-tubal sterilization syndrome.

“Any bleeding from persistent or regenerating endometrium behind the scar may be obstructed and cause problems such as central hematometra, cornual hematometra, postablation tubal sterilization syndrome, retrograde menstruation, and potential delay in the diagnosis of endometrial cancer. The incidence of these complications is probably understated because most radiologists and pathologists have not been educated about the findings to make the appropriate diagnosis of cornual hematometra and postablation tubal sterilization syndrome.”  Long term complications of endometrial ablation

So although ablation can have the desired effect of reduced or even absent bleeding, it can be a double-edged sword. This relief from heavy bleeding may, in the long-term, be overshadowed by chronic, debilitating pain caused by the ongoing, monthly attempts by the uterus to build and shed the lining.

Ablation leads to hysterectomy in younger women. The younger a woman is at the time of ablation, the greater the risk of long-term problems that can then lead to hysterectomy. A 2008 study in Obstetrics & Gynecology found that 40% of women who underwent endometrial ablation before the age of 40 years, required a hysterectomy within 8 years. Similarly, 31% of ablations resulted in hysterectomy for 40-44.9 year old women, ~20% for 45-49.9 year old women and 12% of women over the age of 50 years required a hysterectomy after the endometrial ablation procedure.

Another study, reported a similar link between endometrial ablation and hystectomy. “On the basis of our findings one third of women undergoing rollerball endometrial ablation for menorrhagia (heavy menstrual bleeding) can expect to have a hysterectomy within 5 years. If the linear relationship noted during the first 5 years is extrapolated, theoretically, all women may need hysterectomy by 13 years.”

Post ablation tubal sterilization syndrome. A 1996 study of 300 women who underwent ablation found an array of pathological changes in the uterus including: hematosalpinx, endometriosis, chronic inflammation of the fallopian tubes, and acute and chronic myometritis. Eight percent of the women developed intense cyclic pain that necessitated a hysterectomy within 5-40 months post endometrial ablation.

Informed Consent That Isn’t

Recently, Hormones Matter has begun to explore the legalities of the medical informed consent, here and here. With all the adverse effects associated with endometrial ablation, especially the need for hysterectomy later, one must question whether women are informed about those risks. As I have found when investigating this topic, there are few long term studies on endometrial ablation. Many of the articles cited for this post come from paywalled journals that are not readily available to either the patients or the physicians – the costs are prohibitive for both. So it is not clear whether the physicians performing these procedures are aware of the long-term risks associated with ablation. And as one physician suggests, neither the pathologists nor radiologists responsible for diagnosing post ablation pathology are trained to recognize these complications. Without data or access to data and without training, one wonders whether it is even possible to have informed consent for a procedure like ablation.

You know the sayings “never mess with mother nature” and “you never know what you’ve got ’til it’s gone?” We need to heed those words at least when it comes to treatments that can’t be reversed or stopped! At the very least, we have to become thoroughly educated about the risks and benefits of any given medical procedure.

This post was published originally on Hormones Matter in May 2013.

 

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Weight Gain and Hormonal Contraceptives

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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. This left the young woman feeling like it was her fault she had gained weight. Needless to say, that didn’t help with the depression. But she switched back to her original birth control pill and lived happily (but heavily) ever after. Well, until it gave her a stroke two years later.

I’ve written a lot about my stroke and about blood clots and birth control pills, but there are many other side effects from hormonal birth control. More often than not, we are told that these side effects do not exist; that they are all in our heads. Are they? Or are we simply being ignored and lied to?

What Does The Research Show?

When researching my thesis, I was interested in finding out what women knew about the risks associated with birth control pills. I created a survey based on a published study by researchers in this field. The original study outlined which side effects were and were not associated with birth control pills. The survey used in my thesis demonstrated the following:

“When the women were asked to select which risk factors were associated with birth control pills, most women, 76.7% of the 313 who answered the question, selected blood clots. Weight gain, which is not considered a health risk or even a side effect of birth control pills, was the selection most chosen (79.9%).”

The number one answer most women chose was weight gain, yet all the research I read said that weight gain was not a side effect of birth control pills. My own doctor had told me it wasn’t a side effect when I stood before her 15 pounds heavier after switching pills. Even as I wrote my thesis, I wondered how we could all be so wrong. Well, it turns out we weren’t. The pill can cause weight gain. And they knew it could, even back in 1970. The following is testimony from the Nelson Pill Hearings.

Dr. Francis Kane (page 6453): [In a Swedish study of 344 women] Of the 138 women who stopped using the medication, weight gain and emotional disturbances were the most frequently reported, 26.1 percent and 23.9 percent.

Dr. Louis Hellman (page 6203): My private patients… come off the pill because of a host of minor reactions. The most prevalent one is weight gain. The modern American girl just does not want to gain 5 or 10 pounds if she can help it.

What About Today’s Birth Control Pills?

I took another look at what I could find out about weight gain and hormonal contraception now. According to WebMD:

“When birth control pills were first sold in the early 1960s, they had very high levels of estrogen and progestin. Estrogen in high doses can cause weight gain due to increased appetite and fluid retention. So, 50 years ago they may indeed have caused weight gain in some women. Current birth control pills have much lower amounts of hormones. So weight gain is not likely to be a problem.”

Maybe larger doses of hormones cause more weight gain. But I don’t think that means that smaller doses cause none. And what about taking that smaller dose for a decade or more?

Most current medical information dismisses weight gain completely. On the Mayo Clinic website’s FAQ page for birth control pills it says:

“Do birth control pills cause weight gain? Many women think so. But studies have shown that the effect of the birth control pill on weight is small — if it exists at all.”

That’s right, ladies. Just like your menstrual cramps, weight gain on the pill probably doesn’t exist. But wait, the Mayo Clinic says there are studies that show hormonal contraceptives don’t cause weight gain. Where are these studies?

Inconclusive? Or Incorrect?

A recent meta-analysis (2014) conducted by Cochrane (an independent group that reviews randomized controlled trials and organizes medical research information) found the following:

Available evidence was insufficient to determine the effect of combination contraceptives on weight, but no large effect was evident. Trials to evaluate the link between combination contraceptives and weight change require a placebo or non-hormonal group to control for other factors, including changes in weight over time.

You mean to tell me in the 40+ years since the Nelson Pill Hearings we haven’t been able to conduct one conclusive study to determine how hormonal contraception affects weight? Perhaps it’s time to start asking why. All those studies that provided insufficient evidence, who funded them and who might stand to lose if they were conclusive? I don’t know for sure but I do know that one of the few things women fear as much as an unintended pregnancy is weight gain. Even the staunchest feminists among us often fret over our figures.

According to Naomi Wolfe’s The Beauty Myth, “thirty-three thousand American women told researchers that they would rather lose ten to fifteen pounds than achieve any other goal.” Setting aside how disturbing that is, we can easily see how the fact that hormonal birth control can cause weight gain might adversely affect the pharmaceutical industry’s bottom line (pardon the pun).

At the Nelson Pill Hearings, there were at least a half dozen experts–doctors specifically chosen to testify before Congress–that mentioned weight gain as a side effect of the birth control pill. Including ones who admittedly worked for the pharmaceutical industry. But now, nearly five decades later, the research is inconclusive. Doctors are telling patients that hormonal contraceptives are not responsible for weight gain, yet 80% of women surveyed thought that weight gain was a side effect. Like so much surrounding the pharmaceutical industry, something doesn’t add up here. And who is paying the difference? Women. Yet again we are being told that it’s all in our heads. Have you had experience gaining weight on hormonal birth control?

Further Testimony on Weight Gain

This testimony from the Nelson Pill Hearings just scratches the surface of the side effects caused by hormonal contraceptives. I’ll be expanding more on a lot of this testimony in future articles. But perhaps Dr. Victor Wynn explained most succinctly how these side effects manifest when he testified (page 6303):

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. Robert Kistner (page 6082): I tell her about the side effects plus a weight gain edema and I may even give her a prescription for this.

Dr. John Laragh (page 6165): We do not have any firm clues. But it does look as though those who accumulate salt and water and gain weight on the oral contraceptives might be especially vulnerable [to increased hypertension].

Dr. Francis Kane (page 6449): Complaints of moodiness, being cross and tired, alterations in sexual drive, weight gain, edema, and insomnia were commonest in the group using the estrogen-progestin group.

At the hearings, Dr. Herbert Ratner (page 6737) was asked by James Duffy, minority council:

Mr. Duffy: You use the word “disease” here. Disease to me seems to be a pretty strong word and I am just curious why you would consider weight change to be a disease?

Dr. Ratner: You realize that obesity is one of our major problems in this country.

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.

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Sharing My Story, Feeding the Hope

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

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

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

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

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

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

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

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

Real Risk Study: Birth Control and Blood Clots

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

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A Stroke from Hormonal Birth Control: Part 1

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I opened my eyes and saw my husband, Josh, holding my hand, looking very serious. He was telling me that we would get through this, that even if I had to learn to walk again, that whatever it took, we would be okay. I remember thinking, “It’s okay, honey. I just have a headache.” We had been married for a year. The next time I opened my eyes Josh was leaning over me. I was on my side in the emergency room and the doctor had just asked him to hold me steady while he gave me a spinal tap to check for meningitis. Josh held me so firmly, terrified by the risks of a misplaced needle, that his arms were shaking from the strain. I tried to tell him, “Don’t worry about holding me. I can’t move anyway.” I had lost the use of my limbs hours before, maybe even days. And now it seemed my power of speech was gone, as well.

The headache had started a month earlier. I remember exactly when because it woke me in the middle of night and I had never had that happen before. We were visiting friends in New York right before Christmas. I got up and took some ibuprofen and didn’t give it much more thought. But it never really went away. I saw a chiropractor. I took more ibuprofen. I checked out a book on meditation. By the time I saw a gynecologist, I also had an unexplainable pain in my left thigh. The gynecologist told me the pain in my leg was probably just a muscle strain and she prescribed Imitrex for the headache, a migraine medication that shrinks the blood vessels in the brain.

The migraine medication made the headache go from dull and persistent to unbearable. I visited a health clinic where the doctor suggested an appointment with a neurologist the following week. That night my left arm started to go numb. I called a local pharmacist who said it might be my birth control pills. That’s crazy, I thought. I’ve been on them for 10 years. I slept on the couch because I couldn’t bear the thought of having to move to the bedroom. The music that had been on the television roared in my head like it had been trapped there on repeat. The next day I called the health center again and they told me to go to the emergency room.

Over the course of the next two days I would take 3 ambulance rides, be sent home from the emergency room twice, begin to lose all control of my body, and be given a very stern lecture by a nurse who thought I needed to learn how to “manage my stress.”

The spinal tap in the emergency room was not the first time Josh had to hold me down. Earlier that day, he tried to restrain me while my body thrashed wildly. During the seizure, I told myself that if I just calmed down, it would stop. It must all be in my head since the doctors said it was just a “tension headache.” We locked eyes, both of us terrified of what was happening to me. When the shaking finally subsided, he asked me if he should call 911. Again. All I could do was nod.

I did not have meningitis. There were blood clots in my brain and because they had not been treated right away, one of the veins in my head had burst and was bleeding. I was having a massive stroke.

Later, Josh would tell me about overhearing the neurologist and the neurosurgeon arguing. The neurologist thought they should operate. The neurosurgeon thought it was too risky. Neither wanted to be there. It was Martin Luther King, Jr. day. (I have since learned never to get sick on a holiday weekend.) In the end, they didn’t operate. I don’t remember exactly when they told me that I had had a stroke. But I know I had no understanding of what that meant. (I find that even now, ten years later, I am still learning.) As far as I knew, that was something that happened to old people. I was 28 years old.

At some point, they told me that I had a clotting disorder and that this genetic anomaly coupled with the hormones in my birth control had caused my stroke. This wouldn’t mean much to me until after I learned how to walk again, do math again, shave my own armpits again.

Not long after I was discharged from the hospital, I had an allergic reaction to the anti-seizure medication. I returned to the emergency room at the request of my neurologist. This time they immediately took me to an examination room. When the doctor walked in, the same doctor who had finally diagnosed my stroke, he said, “I’m so glad to see you. I didn’t think you were going to make it.”

That statement stayed with me throughout my recovery. Because though intellectually I understood that the stroke could have killed me, I never really understood the gravity of the situation until he said that to me. And it made me begin to really consider what happened to me and why.

I was first prescribed birth control pills at the university health clinic my freshman year of college. I wasn’t even sexually active at the time, it just seemed like a rite of passage. Why did no one tell me about the dangers of the pill? I wondered. And why didn’t anyone tell me that I could have a clotting disorder without knowing it? How many other women have this clotting disorder? How many other women have had blood clots? How many have actually died from hormonal birth control? Throughout my recovery, I struggled with these questions. Eventually, I even tried to answer some of these questions with my master’s thesis. For more on my recovery and thesis work, see Part 2 of A Stroke from Hormonal Birth Control.

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.

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Testosterone and Breast Cancer: Quick News

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Estrogen receptor positive (ER+) cancers account for approximately 75% of all breast cancers. In ER+ the cancers respond to the presence or absence of estrogens (estrone, estradiol). Almost 65% of ER+ cancers are also progesterone receptor positive (PR+) meaning the cancer also responds to presence or absence of progesterone. In contrast, the HER2 strain of cancers involves an over production of the protein epidermal growth factor. HER2+ cancers are not amenable to hormone treatments and have not been linked to hormone levels, until recently.

A study published in Cancer Epidemiology Biomarkers and Prevention (Sieri et al. 2009) found that high circulating levels of testosterone were associated with an increased risk of breast cancer in menopausal women. The association was strongest for ER+ cancers, but was also present ER- cancers such as the HER2 strain.  Though the association between testosterone and HER2+ cancers was not as strong as observed in the ER+ cancers, it was significant and merits additional research.

The role of androgens in breast cancer is controversial and there are differences between the hormone levels locally in the breast tissue versus those in circulation. Nevertheless, this study suggests that broader research, diagnostic and potentially treatment approach may be warranted.
To read this study go to: (Cancer Epidemiol Biomarkers Prev 2009;18 (1):169–76).

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Vitamin D3 and Influenza

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It’s that time of year again: Signs advertising flu shots dot the commercial landscape. Retail pharmacy stores conveniently sell flu inoculations while shopping. Flu-shot kiosks at airports are common. Pharmaceutical companies produce flu vaccines in nasal-spray form for younger people and high-dose flu shots for older folks. When I think about this ambitious marketing campaign, my reaction is the same: adequate vitamin D3 levels may protect us from influenza as effectively as flu vaccines.

The “flu” is a highly contagious, respiratory disease caused by a type (or strain) of influenza virus. Influenza A, the most common flu virus, usually prevails during the autumn and winter seasons when the least exposure to ultraviolet B sunlight occurs. Seasonal flu vaccines comprise a mixture of the most predictive influenza viruses. However, the effectiveness of flu immunization can be called into question due to the uncertainty about which flu strain will emerge during the season.

Activated vitamin D3 has a profound impact on the immune system. Vitamin D3’s anti-viral and anti-inflammatory functions may lower of the risk of contracting or dying from influenza. To strengthen the immune system, activated vitamin D3 produces two peptides called cathelicidin and defensin that combat viruses. John J. Cannell, M.D., founder and Executive Director of the Vitamin D Council, and colleagues published a paper in the British journal Epidemiology and Infections that proposed low vitamin D3 levels are why the flu occurs more often during the winter. They also suggested that adequate daily vitamin D3 supplementation may reduce influenza symptoms. Subsequently, Dr. Cannell led a team of researchers who further examined vitamin D3’s mechanisms of action on epidemic influenza. Published in the February 2008 issue of the Virology Journal, the researchers confirmed the association between vitamin D3 deficiency and the seasonality of influenza.

From December 2008 through March 2009, researchers conducted a randomized, double-blind, placebo-controlled trial involving over 300 Japanese schoolchildren. Children who took a daily 1,200 IU supplement of vitamin D3 benefited from up to a 60 percent reduction in the influenza A infection rate during the darkest months of the year. Four times as many children in the placebo group developed the flu compared to the vitamin D3 group. (Note: A daily dose of 1,200 IU is quite low compared to current recommendations of vitamin D experts.)

More than 186,000 persons died from the H1N1 “swine flu” (a strain of Influenza A) pandemic in 2009-10. Months after the initial outbreak of the virus, University of Virginia researchers published an article in the Journal of Environmental Pathology, Toxicology and Oncology strongly recommending that “all healthcare workers and patients be tested and treated for vitamin D deficiency to prevent” the spread of the H1N1 virus.

A 2012 article published in the journal Critical Reviews in Microbiology reviewed data from randomized, controlled clinical trials to examine the impact of vitamin D3 supplementation in infectious diseases including influenza. The Dutch scientists indicated that vitamin D3 supplementation may prevent or possibly treat influenza viruses but noted that the optimal daily dosage regimen of vitamin D3 has yet to be determined.

A study published in the September 27, 2012 issue of the European Journal of Nutrition examined laboratory results of the treatment of bronchial cells infected with influenza A virus, specifically the H1N1 strain, with vitamin D3. The Indian researchers found that vitamin D3 reduced the severity of H1N1influenza.

Sales of vitamin D3 supplements have dramatically increased over the past several years.However, for the first time in a decade, worldwide sales of influenza vaccines decreased over $4 billion in 2011, according to Kalorama Information, a healthcare market research publisher. Could vitamin D3 awareness and consumption have contributed to the decline in the flu vaccine markets? Given the research, some in the medical community believe that vitamin D3’s antiviral and anti-inflammatory effects on the immune system may prevent influenza as well as potentially alleviate flu symptoms.

Copyright ©2012 by Susan Rex Ryan
All rights reserved.

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In the ER … Again! Heavy Menstrual Bleeding

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“You really shouldn’t be doing this,” the ER doctor informs me. As if I have any control over my body and its screwed up menstrual cycles. As if I choose this hormonal fate. I want to punch him, but I can barely keep my eyes open to look at him while he talks. “You really need to figure out why you are bleeding so heavy, this isn’t normal.”

If I had enough energy to lift my limp head up off the hospital bed, I would point out the fallacy in his logic – this is not my responsibility. I have been in and out of ER’s and doctors’ offices since I was 18 years old from menstrual bleeding so heavy that I pass out or nearly pass out. It always seems to be more of an inconvenience than a concern for doctors. Oh they are concerned at first. But as soon as I explain my history of this problem, his concern, like all doctors, turns into annoyance. As soon as I tell them I don’t want to take oral contraceptives or any other type of artificial hormone, the concern quickly evaporates like the sweat dripping down my forehead in spite of my shivering body being wrapped up in blankets. Even after I explain my experiences on oral contraceptives (OC) and how the four times I have tried to take it to regulate my periods, I bleed like this every single month, not just occasionally, and that’s on top of the other side effects: extreme depression, weight gain, and epic mood swings that cause my boyfriend to nearly dump me (and who would blame him – I’d dump me if I had to deal with the monster I become on OC).

“Ok” is all I have the energy to muster as I close my eyes to prepare myself for the next cramp I can feel billowing in my lower abdomen. I let the pain wash over me as he continues oblivious to the pain I’m in.

“You need to follow up with your primary or gynecologist,” he tells me. “I’m going to give you progesterone to stop the bleeding…” he goes on to explain the difference between progesterone and estrogen. I don’t stop him to tell him I write for a women’s health ezine or that I’ve done enough research that I likely know more about women’s health and hormones than most general doctors.

A few minutes later my nurse, I’m tempted to start a new religion just so I can appoint her as a saint, walks in with my discharge papers. “Ok honey, I hope you feel better. I’m so happy it’s not an ectopic pregnancy or anything serious.” Throughout the day she has brought in warm blankets and shown more compassion than any doctor I have ever met. I am a problem they can’t fix. They aren’t Dr. House so they’d rather just pass me off to another doctor and move on to a more exotic problem. I’m just a noncompliant patient with hormone problems. God forbid I ask them to think outside the box and figure out what is causing this excessive bleeding. My nurse takes out the IV as careful as you can take out an IV and in a motherly tone says, “I’m glad everything came back normal, but sometimes not knowing is even worse. You go home and take it easy.” I fight back tears. Exhausted and hormonal, I want to hug this woman for her simple acts of kindness and compassion.

“This isn’t really anything new.” I tell her, even though she already knows my medical history. “It sucks, but I’m used to it now.”

“But it shouldn’t be like that,” she says. Like I said, this woman should be appointed as the saint of Emergency Departments.

On my way out of the ER, I stop by the hospital pharmacy and pick up the prescription for hormones that I won’t take. I head back to my office to explain to my male boss that everything was fine and try to make it sound serious enough not to sound like a hypochondriac. He smiles and Okays me to work from home the next day.

I go home to my very concerned boyfriend. I throw the bag with the “magic” pills on the counter and exasperated say, “they gave me IV fluid and hormones, but I’m not taking them.” Naturally, this causes a fight that I don’t have the energy to deal with…again.

Boyfriend: You need to take the medication they give you.

Me: It won’t help and it just messes my system up even more.

Boyfriend: [throws arms in the air … like he’s more exhausted than me at this point?!] You’re not a doctor.

Me: I’m going to bed.

Like every time before, the bleeding slowly lets up in the following days. I’m not a prophet, but I can tell you how this story will end: For the next few weeks, I will walk around like the living dead. I will force myself to eat in spite of having absolutely no appetite. The doctor will call to follow up. “Do you want to take birth control now?” she will ask and when I tell her no, “there’s really nothing more I can do for you at this point…” I know this is how everything will play out because history is simply repeating itself. Sadly I have learned to accept it. In another month, or six, or maybe even a year, I’ll be back in the ER and the cycle will repeat itself again. As I write this I’m so faint that I’m debating going back to the ER to test my blood levels again, but resignation is the only emotion I can muster. Not concern for my own health, but resignation that this is as good as it gets so why fight the system?

So, why do hormones matter? Why don’t hormones matter is a better question. Why is this story an acceptable fate for me and so many other women?

This article was first published on Hormones Matter in July 2013.

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