Blog of the Society for Menstrual Cycle Research
Pfizer has announced that there was a mistake in packaging some of their generic oral contraceptive pills Lo/Ovral(R)-28 and Norgestrel/Ethinyl Estradiol Tablets.
The mistakes seem to have been in the sequence of placebo (sugar pills) and perhaps in the ingredients.
Please check the FDA web site for details.
Is there a woman over the age of 18 anywhere who doesn’t know that taking the birth control pill can make her periods lighter and less painful? Most women know this, but not many know why. The news stories swirling around a new study about the pill and period pain will not enlighten them.
Photo credit: Ceridwen, Creative Commons 2.0
A 30-year longitudinal Swedish study has finally proved the worth of what is accepted practice in North America and Europe: the prescribing of combined oral contraceptives (COCs), or birth control pills with synthetic estrogen and progestin, to treat painful periods known clinically as dysmenorrhea.
Of course, pharmaceutical companies that manufacture COCs are probably eager for this research, as prescribing the pill for dysmenorrhea is still an off-label use in the U.S. (unlicensed use in the U.K.). Pill manufacturers may be able to use this finding to lobby the FDA (or equivalent agencies in other nations) to approve the pill as treatment for menstrual pain, leading to increased sales and insurance coverage. Perhaps that’s why news media have been treating this discovery as breaking news.
Take this headline: Yes, the Pill CAN ease the agony of period pain: Scientists confirm what millions of women already know, or this one: The pill ‘does ease period pain’, or this one: Combination oral contraception pills cut menstruation pain, or, really, any of these.
You can read the abstract of the study by Swedish researchers Ingela Lindh, Agneta Andersson Ellström and Ian Milsom, published this week in the journal Human Reproduction, here: The effect of combined oral contraceptives and age on dysmenorrhoea: an epidemiological study. The conclusions are simple: “COC use and increasing age, independent of each other, reduced the severity of dysmenorrhoea. COC use reduced the severity of dysmenorrhea more than increasing age and childbirth.”
Forget the age factor for the purposes of this discussion. The fact that COC use reduces the severity of dysmenorrhea is not astounding. This is old news. So says Dr. Steven Goldstein, an obstetrician/gynecologist at NYU Langone Medical Center in New York City, quoted in a USA Today story:
“The study results are not surprising. It’s gratifying to see researchers documenting scientifically what practitioners have been seeing for a very long time. The amount of discomfort from a woman’s period with a combination birth control pill is a fraction of what it is without the Pill. There is a diminution of pain from the Pill.”
What is astounding is what Dr. Goldstein, and other OBGYNs, didn’t say in responding to the study. That the reason the pill reduces menstrual pain is because the synthetic hormones in the pill shut down a woman’s own menstrual cycle. The “period” women experience when on the pill is technically known as a “withdrawal bleed,” brought on by seven days of placebo pills. While it feels like a period to menstruators, it is not the same physiologically as the period they experience when NOT on the pill. That’s why it doesn’t hurt as much.
The point is, the pill is too often credited with regulating the menstrual cycle. It does no such thing. The pill does not regulate any woman’s menstrual cycle; it supercedes it. This research, and the many news stories that reported it, once again ascribe power to the pill – this time the power to cut menstrual pain. This is an incomplete truth.
In a recent issue of the UK’s Stylist magazine — a weekly women’s glossy that is available for free at tube stations and selected clothing stores — there was an article headlined ‘What does 10 Years On The Pill Do To You?‘ As a result of my on-going blog, Sweetening the Pill, which documents my experience of coming off the contraceptive pill, I was contacted by the writer to provide some quotes for this piece. Unfortunately, I was edited out. As a journalist myself, I understood this situation has little to do with the writer’s choice of content and more to do with the magazine editor’s final say on what was most fitting for the feature. Yet the title question is the very crux of my blog: having taken the Pill for 10 years, stopping as a result of discovering the answer to this very question.
Photo Credit: Anthony Easton // CC 2.0
According to the Stylist piece the answer is that the Pill changes your memory skills, lowers your libido, makes you attracted to the wrong kinds of men for you, changes weight distribution, prevents you building muscles, make you retain water, make you depressed and jealous…and how can you tell if this all is just you or the Pill? You can’t and you shouldn’t try to find out, is the message here. We are advised to not take a break from the Pill, not even for a week, and if you are concerned, just ask for a different brand from your doctor. There is no discussion of non-hormonal alternatives. There is also no discussion of the benefits of not taking the Pill, of allowing your body to ovulate once a month.
My answer to this question was: “The Pill has a whole body impact. Taking the Pill shuts down a woman’s hormone cycle — and the ovulation and menstruation that is an essential part of this cycle — and replaces it with a low stream of synthetic hormones. This has an affect on every organ in the body — the impact is wide-reaching and crudely administered. The peaks, troughs, and plateaus of a woman’s ‘natural’ cycle are wiped out. The monthly hormone cycle is integral to many of the body’s central functions, including the metabolic, immune, and endocrine systems. This changes everything — from your sense of smell to your libido to your ability to absorb vitamins from your food.
Many women have said to me that coming off the Pill was ‘life-changing’ and, as someone now two years off the Pill after ten years on, I have to agree with the description. The life-threatening potential effects of the Pill get publicity — the blood clots and strokes — but the quality of life-threatening and the emotional and mental effects are barely discussed. Fatigue, muscle loss, urinary tract infections, bleeding gums, stomach disorders, flu-like symptoms, hair loss — relatively minor physical issues caused by the Pill that together can make life very hard. Depression, anxiety, panic attacks, rage, paranoia — all issues brought on by the Pill, due to a combination of switching off the hormone cycle and vitamin B deficiency. I experienced the whole package and when I wasn’t bordering on nervous breakdown I was flatlining, barely able to feel anything at all.”
The Internet abounds with articles, posts and forum discussions about coming off the birth control pill. Women are looking for information and advice. Many are trying to get pregnant, others are just done with hormonal contraception.
It’s a topic that interests many of us connected to the Society for Menstrual Cycle Research (SMCR) because of
Created at an a menstrual arts and crafts event, Andrea, 25, said this piece depicts the multiple emotions she feels around menstruation. Photo by Laura Wershler
how the pill and other forms of hormonal contraception impact the menstrual cycles of the women who take these medications. Some of us are experts in menstrual cycle function and dysfunction, most are advocates for healthy, positive menstrual cycle experiences from menarche to menopause.
A recent blog post at nomoredirtylooks.com on the topic of quitting the pill caught our members’ attention. Re: Cycling blogger Elizabeth Kissling included the post in Weekend Links on November 19.
A young woman in Paris was looking for advice and comments from other blog readers about how to manage the effects of coming off the pill. Siobhan O’Connor, the blog co-editor, shared Paris girl’s story with a graceful, inclusive invitation to readers:
There’s no judgment—implicit or explicit—on anyone who is on or has been on birth control pills. Some people love them, some people have to take them for medical reasons, some people abhor them. Here, we want to talk candidly about what happens when you go off them. Because, whoa. That can be hectic.
The post drew over 80 comments, with a few coming from SMCR members. What struck me was how many women:
1) had already ditched the pill or were planning to
2) expressed a desire for the return of regular, normal menstrual cycles
3) were concerned about their skin (it often breaks out after quitting the pill).
SMCR member, endocrinologist and guest blogger Dr. Jerilynn Prior answered the concerns about acne and bad cramps in a comment posted on November 22, and included a link to Centre for Menstrual Cycle and Ovulation Research website where readers can find information about all things related to menstrual cycle health.
Holistic Reproductive Health Practitioner Geraldine Matus, another member, commented on November 26 that it was concerns and experiences like those expressed by posters that prompted her and colleague Megan Lalonde to write the guide: Coming Off the Pill, the Patch, the Shot and Other Hormonal Contraception.
I invited No More Dirty Looks readers to visit this blog to learn more about the menstrual cycle and the issues raised by their online discussion.
Regular visitors to re: Cycling know that we cover a broad range of topics, but bloggers frequently address hormonal contraception as it relates to women’s health issues.
Check out this sampling from the re: cycling archive:
Several of the women who responded to the Paris girl post at nomoredirtylooks.com expressed eagerness to reclaim healthy, ovulatory menstruation and a willingness to learn how to manage their fertility without the aid of hormonal contraception.
Blood clots are a serious, if rare, side-effect of hormonal contraceptives. If left untreated, clots can lead to debilitating, or fatal, strokes. The increased risk of blood clots in users of some hormonal birth control brands has been the subject of several recent news stories.
In early December, Health Canada asked Bayer Inc. to change the labels on Yaz and Yasmin, two of the most popular birth control pills, because use of the drugs is linked to higher rates of blood clots.
According to a November 2011 story at cbc.ca/news, health problems associated with these two drugs include stroke, deep vein thrombosis, pulmonary embolism and heart attack.
The concern surrounds the progestin – drospirenone – used in Yaz and Yasmin. Although promoted as being associated with less bloating and clearer skin than other progestins, drospirenone is also associated with a “1.5-to-three fold increased risk of experiencing a clot compared to women using other birth control drugs.”
What this means in real terms varies from study to study, but one study led by Susan Jick of Boston University found the rate of non-fatal blood clots to be 30.8 per 100,000 among women taking Yaz or Yasmin (the only drugs containing drospirenone) compared to 12.5 per 100,00 among those taking pills containing the older, more common progestin levonorgestrel.
In related news this past week, advisers to the FDA recommended that Johnson and Johnson revise the label on its Ortho Evra birth control patch to better explain the risk of blood clots. Use of the patch has been associated with a higher rate of blood clots for several years. Publicity about the clot risk has no doubt contributed to a 50% decline in sales in the last five years. The formulary problem with the patch is its higher dose of estrogen compared to other pills.
The FDA advisers also recommended more detailed description of blood clot risks for Yaz and Yasmin.
What caught my eye in both stories were the take home messages from those requiring these label changes to women using these drugs.
Health Canada said women should talk with their doctors about the risks and benefits of taking drospirenone-containing oral contraceptives but did not urge women to stop using Yaz and Yasmin.
The FDA’s reproductive health advisers “voted 19-5 that the benefits of the weekly Ortho Evra patch outweigh its risks, including a potentially higher risk of dangerous blood clots that can cause heart attack, stroke and other life-threatening problems.”
I want to know why the five FDA panelists opposed to this decision think the benefits of the patch DO NOT outweigh the risks.
These news stories beg the question: Should women be concerned enough about the increased blood clot risk associated with Yaz, Yasmin and the Ortho Evra patch to stop using these brands? If you take these drugs, are you concerned?
If adverse publicity about blood clots resulted in a sharp decline in sales of the Ortho Evra patch, we should expect to see a similar decline in sales of Yaz and Yasmin.
The cbc.ca article reports that the family of a Toronto woman, who died of a large pulmonary embolism after taking Yasmin, has filed the first individual civil suit against Bayer Inc. in Canada. It also states that “more than 10,400 individual lawsuits related to the two pills have been filed in the U.S.” Not to mention the class action suits related to these drugs currently in progress in both countries.
One thing is certain, the litany of stories about the adverse effects of hormonal contraceptives is not about to end anytime soon. Stay tuned.
I’ve spent so many years as a professor of Women’s Studies telling students that feminism is about equality, and that being pro-woman doesn’t mean being anti-men. I thought perhaps we’d moved past that 1990s meme of seeing everything that is for women as male-bashing, but here we go again.
The latest marketing strategy of Essure, a permanent birth control method for women that destroys the Fallopian tubes, is to appeal to men’s fear of vasectomy: “because you can only wait so long for him to man up”.
Le sigh.
Of the growing list of reasons why women might want to reconsider using birth control pills, this could well be the strangest.
Researchers at Princess Margaret Hospital in Toronto published a study on Nov. 15 in the BMJ Open Journal in which they found a “strong correlation” between the use of birth control pills and the incidence of prostate cancer worldwide.
One of the possible explanations of how the two are related is the potential impact of the estrogen compound – ethinyloestradiol – that women using the pill secrete in their urine. It has been speculated elsewhere that these endocrine-disrupting substances could end up in our drinking water or get into the food chain.
The Pill, introduced in the 60’s, has been widely used for decades. The study suggests that exposure to these substances over 20 to 30 years could have a clinically significant effect. Researchers said further study of this link is needed.
In 2010 the media was full of stories marking the 50th anniversary of the birth control pill. The Pill at 50: Sex, Freedom and Paradox, rang the headline of a Time Magazine article by Nancy Gibbs. Could rising rates of prostate cancer be part of this paradox?
“No woman can call herself free who does not own and control her body. No woman can call herself free until she can choose consciously whether she will or will not be a mother.”
Raise a glass – today is Margaret Sanger’s birthday. Learn about her and her work at the Margaret Sanger Papers Project.
The U.S. Food and Drug Administration has issued a warning to consumers not to use the emergency birth control medicine labeled as Evital. The drug is not safe or effective in preventing pregnancy. The packaging label of the potentially ineffective and suspect counterfeit version says, “Evital Anticonceptivo de emergencia, 1.5 mg, 1 tablet”, by “Fluter Domull”. It has not been approved for use in the United States, but may be in distribution in some U.S. Hispanic communities.
The FDA is asking that people who have seen this version of the drug contact them with information. Approved versions of EC are available over-the-counter and by prescription to those 17 and older.
[via Feministing.com]
Here’s an interesting political approach. While there are hairs to split (do all women have vaginas? do all people with vaginas consider themselves women? and what about those of us with no sexual partners, or sexual partners without penises?), there’s something to be said for appealing to the majority. After all, those of us who already get it, get it, no?
I do wish it came with an action plan, though. Links to a site for people to contact their congresscritters would be good.
One of the arguments for using hormonal contraception to suppress the menstrual cycle is that it mitigates the logistical challenges menstruation can present in high-stress occupations in harsh settings — such as military service in a combat theatre. Given how compelling the argument is, it’s surprising that birth control pills/patches aren’t used in these settings more frequently.
A new study in Women’s Health Issues indicates that although service women are eager to learn more about the option of menstrual suppression, education about it is lacking. A survey of U.S. women serving in Iraq, Afghanistan, and other combat operations indicates that the number of lost duty days due to menstrual pain would likely decrease with better education about suppression options and compliance regimens.
The Pill makes the cover of NY Mag
Rare is the feature on women’s health from a magazine hip to New York City’s nightlife, dining, arts and entertainment. Within the past two months alone the magazine featured articles on the Julie Taymor Spiderman play, Jimmy Fallon and John Stewart. Not what one might consider provoking and thoughtful. Yet this week’s issue arrived with a juicy six page article titled Waking Up From the Pill that asks readers to consider the side effects of hormonal birth control.
The author begins her journey at a 50th anniversary celebration for the Pill, hosted by a pharmaceutical company, for “a couple-hundred bejeweled women in gowns” who toast to the Pill’s gift of reproductive freedom for women. But author Vanessa Grigoriadis notes a stunning social side effect of hormonal birth control – that women are waiting to conceive, particularly women in New York who “have shifted their attempts at conception back about ten years. And the experience of trying to get pregnant at that age amounts to a new stage in women’s lives, a kind of second adolescence.” She adds that this period is marked by anxiety and obsessions.
Interestingly, Grigoriadis elides information on the Pill’s physical side effects like increased risk of blood clots, strokes, decreased sexual drive and the like, and focuses only on the social side effects. Perhaps fearing a lawsuit, her language strongly connects infertility solely to durational use of the Pill that lingers beyond a woman’s natural reproductive age. “The Pill didn’t create the field of infertility medicine, but it turned it into an enormous industry. Inadvertently, indirectly, infertility has become the Pill’s primary side effect.” Be sure to read on.
