Blog of the Society for Menstrual Cycle Research

Does it matter that hormonal contraceptives are endocrine disrupting chemicals?

March 6th, 2013 by Laura Wershler

I’ve been wading through State of the Science of Endocrine Disrupting Chemicals – 2012. The 289-page report was prepared by a group of experts for the United Nations Environmental Programme and World Health Organization.

It is dense and complex, but what I’ve been looking for is any acknowledgement that hormonal contraceptives are endocrine disrupting chemicals (EDCs).

Hormonal contraceptives clearly act as EDCs according to the definition used in this report:

An endocrine disruptor is an exogenous substance or mixture that alters function(s) of the endocrine system and consequently causes adverse health effects in an intact organism, or its progeny, or (sub) populations. A potential endocrine disruptor is an exogenous substance or mixture that possesses properties that might be expressed to lead to endocrine disruption in an intact organism, or its progeny, or (sub) populations.

Adverse health effects would include, in this context, anything that disrupts the reproductive systems of humans (and wildlife) or contributes to other health problems such as hormone-related cancers, thyroid-related disorders, cardiovascular disease, bone disorders, metabolic disorders and immune function impairment. Hormonal contraceptives certainly disrupt the reproductive system and have been associated with increased risk of cardiovascular events, loss of bone density, decreased immune function and, in some studies, increased risk for breast cancer. Metabolic disorders? Recent research suggests that long-acting progestin-based birth control may increase risk in obese women for Type 2 diabetes.

The only mention I could find of specific contraceptive chemicals is in section 3.1: The EDCs of concern. In a table under the sub-heading Pesticides, pharmaceuticals and personal care product ingredients, two key components of hormonal contraceptives are listed: Ethinyl estradiol, the synthetic estrogen used in most oral contraceptive formulations, and Levonorgestrel, a synthetic progesterone used in combined oral contraceptive pills, emergency contraception, the Mirena IUD, and  progestin-only birth control pills. Levonorgestrel is considered of “specific interest.”

The concern with these chemicals is not the effects they may have on women taking them, but on the possible reproductive impact on wildlife from the excretion of these chemicals into the aquatic environment. It seems ethinyl estradiol and levonorgestrel are considered safe contraceptive drugs when taken by choice to disrupt fertility, but EDCs worthy of concern when such disruption is unintended.

How would it change our perception of hormonal contraceptives if we acknowledged them as endocrine disrupting chemicals? Would we wonder why there is no discussion of how these EDCs might contribute to the health issues considered in the report? Would we ask why hormonal contraceptive EDCs are routinely used to “treat” (meaning only to alleviate symptoms of) endometriosis, fibroids and PCOS – conditions potentially caused by other EDCs?

Another relevant concern addressed in the report is the effect of “estrogenic agents, and their role in breast cancer.” The report states there “is good experimental evidence that estrogenic chemicals with diverse features can act together to produce substantial combination effects.” I have to wonder how hormonal contraceptive EDCs fit into this mix.

Here’s something to ponder. Last week news stories reported that the incidence of advanced breast cancer among young American women, ages 25 to 39, has risen steadily since 1976. Lead researcher Rebecca Johnson was quoted as saying, “We think it is a real trend and, in fact, it seems to be accelerating.” The increase is small in relative numbers, only 850 cases in 2009, but the “trend shows no evidence for abatement.”

Researchers can’t explain the increase. Lifestyle changes, obesity, sedentary lifestyle and toxic exposure to environmental chemicals are offered as possible factors. But what about the hormonal contraceptives many women of this generation have been taking since they were 15 or 16 years old? Surely these EDCs must be considered as potentially contributing factors.

  

25 Responses to “Does it matter that hormonal contraceptives are endocrine disrupting chemicals?”

  1. Thank you Laura for bringing our attention to the serious effect contraceptive hormones exact on women’s physiology and the environment. This point is too often dusted under the rug in the interest of other concerns yet I continue to see clinically the damage to women’s health due to contraceptive endocrine disruptor use.

  2. Brava Laura – for raising these issues. They have been top on my mind as well. I also noted, commented and posted on the article about the rise in advanced breast cancer in young American women. In all of the articles I have read about endocrine disruptors synthetic hormone contraceptives are not mentioned.

    Now we are generations into the use of these endocrine disruptors – and the synthetic hormone effects are building up in the body – combined with the ED’s in the environment.

    Sadly, I think we are seeing the fall out from what many menstrual cycle advocates stated years ago – “Birth control is the largest uncontrolled experiment in the history of medicine.”

  3. I’ve written about this in my book and mention that Barbara Seaman was calling hormonal birth control the “elephant in the room” in this conversation back in the 1970s.

    I think because the focus is on the environmental damage hbc can cause when it does come up women get very defensive – they feel they are being attacked for causing environmental damage (when of course tons of other drugs get peed into the water systems too). That reaction prevents them from seeing the reality of the situation. The focus is on “You’re trying to take our pills away! You’re anti-sex and anti-women!” rather than “If this pill is bad for a frog…what’s it doing to me?”

    A few months ago a study was released that said if women start taking the pill early on in life, in their teens, they have double the risk of having breast cancer in later life. So that connection is there for sure. Problem is, of course, there are other factors that have an increasing impact on development of cancer but this one is utterly avoidable immediately for many women.

    I once did an interview with an artist whose work centered around campaigning against excessive use of plastics containing endocrine disrupting chemicals. When I asked her if she took the birth control pill, she didn’t know what to say. I told her that it’s an endocrine disrupter by its very design and she replied “I haven’t gone that far yet” and was rather annoyed.

    At the Selling Sickness conference SMCR attended there was lots of talk about endocrine disruption in terms of SSRIs, but again the pill was the elephant in the room. We were worrying about people being misdiagnosed with mental illness and put on powerful drugs but not those millions of people who have no illness on powerful drugs.

  4. Just to add – when I tweeted about this topic at the conference the only people who really took it up, retweeted and discussed intelligently were Catholics and I got many many more Catholic followers as a result. And by Catholics I mean people who describe themselves as that in their profile. In contrast I was confronted by self-described “radical feminists” for trying to make a debate out of their “personal choice.” Not sure what to make of that situation.

  5. Laura Wershler says:

    I imagine there must have been some heated discussions among the experts who compiled this report about hormonal contraceptives as EDCs. The elephant in the room indeed. One we must eat one bite at a time.

    The report does mention HRT as an estrogenic agent related to breast cancer without noting that combined oral contraceptives contain more estrogen than HRT. COCs are now considered safe for women to take into their 40s and 50s – all the way to menopause. To do so puts them at risk for toxic exposure to estrogen.

  6. cassondrajw says:

    As a Catholic it is incredibly frustrating because I feel this issue is 100% health related. Yes, I get where the Church comes from on this issue, but most importantly it is women’s health – not morality or rules. I am in the works of a post actually about how birth control is the elephant in the room because if we criticize the health issues, it is instantly translated to criticizing the women’s movement in general. (Which for me, is not how I feel at all.) And for the very reason that I am Catholic, I feel I must be careful around this subject because people will instantly write me off as “imposing my religion”.
    That’s where I feel Holly has more “weight” in the discussion. Non-Catholics do NOT want to hear from a Catholic how their birth control could be potentially harmful to their health – or the environment.

    • Laura Wershler says:

      Hey, I’m a pro-choice sexual and reproductive health advocate who supports abortion rights, but even my credibility is suspect if I ask hard questions about the health impact of hormonal contraception. There has to be a safe place to ask these hard questions even if they challenge the “sacred cow” status of these contraceptive drugs.

    • Jim says:

      I do think some of the criticism of Catholic sources is justified. Some Catholic groups have opposed contraception from a very heavy-handed, negative, anti-woman perspective. Some haven’t taken the science seriously and pushed outdated, questionable, and junk science in their materials. People have been hurt by this approach.

      If non-Catholics think that Catholics are “imposing their religion”, other Catholics think you are going to bring back the Latin Mass and large families full of “rhythm babies”.

      But whatever you think of the Catholic Church or these various Catholic NFP organizations, the science is the science, and personal opinions or one group’s poor presentation of the facts aren’t going to change them. This is a major women’s health issue. Why are so many women’s health advocates silent?

      • Laura Wershler says:

        “This is a major women’s health issue. Why are so many women’s health advocates silent?”

        This is a good question, Jim. I think in the U.S. it has a lot to do with the polarization of discourse on contraception. Take the Rhreality Check series called: They’re coming for your birth control. This site says it wants to cover the stories no one else is covering but they do not want to cover this story because it opens the door to hard discussions about how we balance the downsides of hormonal contraception with the need for effective contraception.

        Some possible solutions might include discouraging early onset use of COCs in particular. Part of me thinks that this push towards LARCs like the Mirena and implant (progestin-based methods) and the copper IUD, especially for adolescents – is a strategy geared to avoiding the s*@t storm that could erupt should researchers like the ones I mention in this post start suggesting that early use (14, 15, 16) of estrogenic contraceptives might not be a good idea. The report clearly states that puberty is a time of increased vulnerability to EDCs, and it is a fact that many girls start taking these drugs before their reproductive systems are fully matured. I know that LARCs are also being promoted as more effective methods because they are less prone to user error, the result of them being more controllable by the provider. A user can’t just decide she doesn’t like it and stop using it.

        Hormonal contraception is a sacred cow and we need diverse voices – like the ones discussing the issue here – speaking consistently and sincerely to challenge this status.

  7. Julie Sunday says:

    @cassondrajw, I admit that I too don’t trust Catholic institutions on this issue. Individual Catholics aren’t really what I’m worried about (hey, 98% of them use birth control anyway!). But I have found that the Church has taken up this ‘women’s health’ banner as a tool to persuade (I would say ‘trick’) women into not using birth control. I wrote a piece about a shady Church project last year, called 1Flesh. It is an effort to make not using birth control seem ‘cool’ to young people, and encouraging them instead to wait until marriage and ultimately use the Creighton method, a Church-developed natural family planning method. I’m in favor of natural family planning but not by…requirement. I found the 1Flesh project frustrating because I agree with some of what they’re saying about side effects, environmental damage, etc., of hormonal contraceptives but I so utterly reject the theology that I couldn’t align with it. http://howtohavesexintexas.blogspot.com/2012/07/1flesh-1fail.html

    • Jim says:

      **eyeroll**

      1Flesh.org is NOT a Church project. It is the personal project of (an) individual Catholic(s)

      Which is part of the problem from the Catholic perspective. 1Flesh is an 18 year old kid promoting junk science and dubious theology while claiming to be Catholic.

      iusenfp.com is a much better women’s health oriented site started by a Catholic medical student and her friend.

    • Hi Julie – I’d love to read your piece on 1Flesh. Can you email it to me at hollygriggspall@gmail.com? I wrote about the group too – they do have some good information, but as you say, it’s mixed in with rather a lot of bad. There was a similar video produced by a group of nuns which I have written about – it’s essentially the same thing.

  8. Jim says:

    @Julie Sunday: The eyeroll was for 1Flesh, not you.

    • Julie Sunday says:

      thanks jim :) i think it’s a really sophisticated digital project, honestly, and the reason i categorize it as ‘church’ is because some of the people behind it are paid staffers at an organization that does digital media for church projects. so yes, they’re young, but they have real chops. i wish that those of us who are critical of hormonal contraception for non-religious reasons had a project that looked as slick. and just to be clear, i’m totally OK with people not using contraception for religious reasons–my grandmother had 11 kids and remains staunchly catholic to this day–i just don’t like it being imposed. but i’m a big advocate of cycle beads.

      • cassondrajw says:

        I’m currently doing work for Kindara (http://kindara.com/blog/) an iPhone charting app. And I love the work they do because they have genuine women’s health and their best interest at heart. I like being involved in the secular part of the movement because, well, health is health whether you’re Catholic or Atheist, or Buddhist. I am familiar with 1Flesh (and have actually been posted there before) but do agree that the science is often murky. Out of curiosity, how do you think an individual Catholic (like myself) should approach the subject? I generally say, “Your intimate life is totally private and your choice, but here’s a way to go about it that doesn’t involve hormones. Or even just to monitor health alone, intimacy aside.” Have you ever felt attacked by Catholics approaching this subject? How did they approach you?
        I’m just curious and want to avoid doing so!

        • Julie Sunday says:

          @cassondrajw, the individual catholics i know are all awesome people, particularly with regard to contraception (but i’m a sex educator, so i probably don’t know too many conservative catholics :) ). my dad was raised pre-vatican 2 catholic and became quaker before i was born, so i was raised in a pretty different way and my mom was a self-helper so i have known about/been open to NFP as a non-religious method since childhood. i’m just skeptical of any catholic-institution projects (that’s why i don’t like creighton and prefer cycle beads or other non-church methods) because creighton, even if the science supports it, has tons of theology in its literature. which is fine, for religious people who choose it for religious reasons. i bristle at the ‘requirement’ that catholics learn about NFP even though so few of them actually use it. so i guess i have contradictory views since i wish more people knew about NFP but from an empowerment standpoint, not from a ‘this is required by the church’ standpoint. btw, is kindara hiring? it looks awesome! i have reviewed the cycle beads app but this one looks better from a tech/UX perspective. [i have an MPH and work as a full time health educator and researcher at a major university in TX]

        • cassondrajw says:

          Julie, I don’t know if they are hiring, but it never hurts to ask! : ) I am self-taught for the most part, so don’t have much to say about the institution, but I hear Billings Method is a lot better on the front of “Theology”and they don’t push those views on people. Holly, a counter project would be awesome! Or not even counter, just a spin off with more accuracy and reputation? Kickstarter can work wonders if placed in the right place and time!

        • Jim says:

          @Julie Sunday:

          Having sat through Creighton, Billings, and CCL classes, I though that Billings was by far the best presented.

          Billings is a non-sectarian organization, so there is no theological component of the method itself. Some instructors may independently add theological instruction for some clients, but it is taught separately from the method. If couples aren’t interested, it isn’t pushed. The teaching standards were excellent and it was all very scientific.

          The Billings organization is the only one of the three run by women, which I believe explains much of the difference

          CCL was heavy on the theology and had a lot of dated/incorrect science. It was, at the time, very pre-Vatican II conservative Catholicism. The emphasis in the classes was on being open to life and having more children, not body literacy. The materials were confusing and the teaching standards were considerably lower than Billings or Creighton. In all fairness to CCL, they are “under new management” and have had major updates to their materials since we took the classes.

          Creighton is strange because it sells itself as scientific, but has a major theological component. It also has some weird conventions (e.g. if you aren’t following ALL the rules to avoid, then you are trying to achieve). They also were very secretive. I believe they give/withhold information from clients based on what they believed they “should” or should not be doing, which I consider unethical.

          K’s experience with Creighton was not positive, so that does color my view of it. And others have had good experiences with it.

          As for the “Counter” to 1Flesh, I think that is what http://iusenfp.com was trying to be. There is a lot of good stuff there, but I don’t think the founders have the resources or the background to make it as good as it could be.

      • Laura Wershler says:

        In my 25+ years talking about the need for better access to non-hormonal methods, including FAM, I’ve tried to be specific about the difference between religiously-based methods and secular methods. I’ve also stressed recently the need for sexual and reproductive health care providers to either provide certified training onsite or to develop formal, vetted, and evaluated referral programs for women seeking instruction. My colleagues pay lip service to what I’m now calling the “unmet need” for support to use non-hormonal contraception, but very few have actually stepped up to provide this.

        The most formalized secular method that I’m aware of is the Justisse Method. Justisse offers a comprehensive online training program that turns out certified Holistic Reproductive Health Practitioners. http://www.justisse.ca

  9. Also, in terms of sophisticated digital projects, I’ve been talking with someone about making a PSA (perhaps roping in a few celebrities) about body literacy. However, those affiliated with churches seem to have access to money to a level I doubt those of us without church affiliation can easily match.

    It would be a great idea to make a counter project to 1Flesh that provides the same information without the junk and moralism. Perhaps we should, as the SMCR group, consider doing that and trying to fund through Kickstarter?

    I am currently developing a documentary on this topic – precisely because I think although a book is all well and good, a documentary has so much more potential to reach a lot of people and get the message across. Right now I’m calling it something of a “prequel” to The Business of Being Born – doing, I hope, for birth control what that movie did for birth.

  10. I have to share an excerpt of a comment posted on my blog today regarding anxiety and depression (32 y.o). Look at this woman’s birth control history.

    “I started taking the Micronor at 17 until i was 22 then i had the contraceptive injection (depo) from 22-27 i then had an implant from 27-30 (because i was told that it was bad to stay on the depo for a great deal of time) before going back on micronor at 30 then 6 months ago i had a mirena coil fitted. In the last three months i have experienced night sweats before my peroid, anxiety, heart racing, not being able to sleep, moods like you wouldn’t believe, sometimes i am so horrible to my husband i dont know how he puts up with it then a few hours later i look back and wonder who that person was because it couldnt have been me.”

    This woman also stated that she is too afraid to be alone with herself – let along think about caring for a baby.

    She was put on synthetic hormones before her brain was fully formed – affecting the neuro-endocrine-immune system – and the she was switched back and forth between synthetic estrogen to synthetic progesterone and back again like a ping pong ball. What are they thinking?

    Is it any wonder she is so desperate to find some answers?
    Add all of this to the endocrine disruptors in the environment and we have a real problem. And it is only going to get worse.

    Native American proverb: “A nation is not defeated until the hearts of its women are on the ground.”

    • Laura Wershler says:

      Wow. That is a truly horrific birth control story. The bouncing back and forth between these different methods probably happens more than we might think, and no doubt compounding the ill effects of the EDC exposure.

      This hits at another issue of serious concern, the lack of support from healthcare providers in the recovery process from hormonal contraceptive use. Somehow they don’t see this as their problem, which borders on malpractice. The disconcerting thing is most doctors haven’t got a clue what’s happening to or how to help women experiencing serious distress.

      One point the Status Report makes is that dose does not determine effects. There are low-dose effects and high-dose effects but low-dose effects are not necessarily less problematic than high-dose effects. Also, they believe the effects of EDCs go beyond the endocrine system.

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