Blog of the Society for Menstrual Cycle Research

“Lives will be saved” – the FDA decision not to ban Bayer’s birth control pill

April 18th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall

 

Photo by Monik Markus // CC 2.0

How many of us read the inserts included in a packet of pills? How many decide not to take the pills on the basis of the information enclosed?  The rapidly reeled-off list of side effects stated at the end of a televised advert for a new drug has more comedic value than serious consequence to most. If we do have doubts, many of us will rely on the reassurance of a doctor, and then take the pill anyway.

I recently wrote a piece for Ms. Magazine Blog outlining the FDA reappraisal of top-selling oral contraceptives Yaz and Yasmin. It was discovered that drugs such as these containing drospirenone held a significantly higher risk of causing blood clots. Research by the FDA and other bodies suggested this conclusion was definite, while research funded by the pharmaceutical company behind these billion-dollar products, Bayer, suggested the opposite conclusion to be true: that there was no increased risk evident. A team of experts, some of which had financial ties to the company, voted against having the pills taken off the market when presented with the question of whether the risks of taking these pills outweighed the benefits.

Bayer is facing 11,300 lawsuits from women who have been seriously injured and family members of women who have died after taking one of the company’s bestselling hormonal contraceptives. They have settled the first 500 addressed with a total of $110 million in payouts. When discussing this process with a lawyer representing many of the women I was told that Bayer would do anything to avoid a trial wherein the full spectrum of their marketing strategies would be revealed.

The FDA came to the decision to add into the insert included with these drugs a statement of the discovery of “conflicting” research that suggested the pills had a higher risk of causing blood clots  (up to three times higher) – acknowledging the discrepancy of the research funded by Bayer and giving it equal standing as that performed by other bodies including the FDA itself.

Prior to this decision being announced a number of women’s health groups got together to write a letter to the FDA asking that they look again at the question put to the board of experts. They argued that the correct comparison for the board to consider would be between drospirenone-containing contraceptives and other oral contraceptives, and not between Bayer’s drugs and unwanted pregnancy. In the final sentence, they remarked that they believed that “lives will be saved” if the pills were no longer on the market. They met with the FDA and one representative asked that the FDA strongly reassess its acceptance of Bayer-funded research. Another asked that the drugs no longer be prescribed and that the FDA “get back to the arc of history and progress that protects women while supporting their contraceptive needs.”

The new labeling will state the “conflicting” findings and advise that women speak to their doctor if concerned. The official statement on this decision, relayed through the media coverage, reminded women that when compared to pregnancy the risk of development of a blood clot was insignificant. They also asked that women currently taking the drugs not stop doing so. Despite the FDA studies suggesting the blood clot risk is particularly high for women under 30, the statement compounded the understanding that the issue is only relevant to those over 35,  those overweight, those that smoke, and those with relevant medical history.

Coming Off The Pill: A Mind Map Guide

March 7th, 2012 by Laura Wershler

Everybody can use a good map to help them get to where they’re going. Why not women heading to the land of non-hormonal contraception?

In my post on January 11, 2012 I asked if coming off the pill was a growing trend. I proposed to write a series of posts about the issues associated with the decision to stop using hormonal birth control.  For the purposes of this discussion assume that “coming off the pill” refers to quitting any method of hormonal contraception including the pill, patch, ring, shot, implant or Mirena intrauterine system.

As I was preparing a list of possible topics, I realized that one way to represent the complexity of issues involved in this decision is with a mind map: “a diagram used to represent words, ideas, tasks, or other items linked to and arranged around a central key word or idea.” It also occurred to me that readers could then add to this schematic, filling in important points based on personal or professional experience. So I got out my colored markers, did a little brainstorming and came up with Coming Off the Pill: Mind Map 1.0. I invite readers to comment, offering additions under the key headings I’ve noted and suggesting other categories that should be included.  Could this become a talking, planning or process guide for women considering the transition to non-hormonal birth control methods?

If you’ve thought about or been through the experience of quitting hormonal contraception, or if you’ve helped others through the experience, please contribute to the development of Coming Off The Pill: Mind Map 2.0 by posting your comments and suggestions. (I’ve already thought about other headings I could have included.) Besides providing me with a guide for writing future posts, what other ways can you imagine this mind map might be used?

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The pill, reduced period pain and the ongoing delusion

January 20th, 2012 by Laura Wershler

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.

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Off the Pill, Off the Magazines

January 12th, 2012 by Elizabeth Kissling

Guest Post by Holly Grigg-Spall

“Less stressed, thinner and more interested in sex.” – but not buying magazines.

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.”

 

Yaz, Yasmin and Ortho Evra patch increase risk of blood clots

December 14th, 2011 by Laura Wershler

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.

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Some recent news about Hot Flushes and Night Sweats

October 25th, 2011 by Chris Hitchcock

Prevalence of Hot Flushes and Night Sweats in UK women 54-65

In a new, large (over 10 000 women)  survey of UK women aged 54-65, Myra Hunter and colleagues reported on the proportion of women who have hot flushes and night sweats (HF/NS), and on how frequent and bothersome they found them. Surprisingly, they did not find a difference across ages; 54% of women reported that they currently experienced hot flushes and/or night sweats, and this was as true for women in their mid-60′s as in their mid-50′s. Current users of hormone therapy were less likely to have current HF/NS, while those who had discontinued hormone therapy were more likely to have HF/NS compared with never users. It is common to think that HF/NS last for 2-5 years in a woman’s early 50′s. This study suggests that there is a need for therapies that are effective and can be used safely for a much longer duration.

FDA says no to Pristiq for (Post)Menopausal Hot Flushes

In early September, the US FDA (Food and Drug Administration) turned down Pfizer’s request to market it’s antidepressant drug, Pristiq, as a treatment for hot flushes in menopausal women. Pfizer inherited Pristiq when it acquired Wyeth (makers of the hormone therapy medication PremPro).  This is the first anti-depressant to seek official approval for this indication, although there has been research and promotion of antidepressants as alternative, non-hormonal, off-label medications for vasomotor symptoms (hot flushes and night sweats) for some time.

Perhaps not surprisingly, there has been little coverage of this in the media, as contrasted with the coverage of the various steps towards this point.

I have noticed that when a drug therapy is approved or takes a step along the path towards approval, news coverage is general and widespread. When there is a hitch in the approval process, often only the financial markets pick up the story, because it affects share values. However, there is an article in Medscape that provides more background on the history of this application.

 

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New versions of menstrual suppression drugs on the way?

August 4th, 2011 by Elizabeth Kissling

Successful tests on rhesus monkeys are a long way from clinical trials on women, but this is interesting to those of us following the conversations and debates about cycle-stopping contraceptives: new research testing progestin antagonists indicates that the drug can be successful in suppressing menstruation without necessarily suppressing ovulation. Another variant of the drug can suppress both menstruation and ovulation.

Dr. Robert Brenner, who is the lead researcher conducting these studies in the Division of Reproductive Sciences at Oregon Regional Primate Research Center, notes that this has potential beyond just a new lifestyle drug:

I would emphasize that we are not talking here only about lifestyle choices but also about the potential to bring relief to the many women who suffer years of misery from distressing complaints such as endometriosis, and painful and excessive monthly bleeding. In fact, excessive bleeding is one of the major reasons that women undergo hysterectomy, and this treatment may also reduce the need for this surgical procedure, with all its attendant risks and costs.

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Breaking News: Pfizer ordered to pay millions in PremPro cases

February 8th, 2011 by Elizabeth Kissling

Pfizer, which now owns Wyeth’s PremPro synthetic progestin-estrogen combination that was widely taken for relief of discomforts that sometimes accompany menopause, has been ordered to pay damages in two separate cases this week. The company must pay more than $10 million in damages to an Arkansas woman after an appeals court reinstated a jury verdict. And yesterday in Pennsylvania, an appeals court overturned a previous ruling that Pfizer’s Wyeth unit deserved a new trial in the case of a Philadelphia woman who had been awarded $1.5 million in compensatory damages and $8.6 million in punitive damages on her claim.


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Don’t Ask, Don’t Smell

January 27th, 2011 by Elizabeth Kissling

female-minority-happy-military-wide-horizontalGuest Post by Emily Swan, Marymount Manhattan College

With the military’s history of suppressing minority groups, its new effort to conceal and terminate menstruation comes as no surprise. Hopefully, the menses will be able to come out of the closet soon enough.

I recently wrote a paper about menstruation in the military and was excited to see this recent post at re:Cycling. Researchers have suddenly become sensitive to the “devastating” effects of menstruation on women in combat and training, citing a potential link to iron-deficiency, among other things. (Might I add that, while the article identifies menses as the culprit, the actual data suggest no correlation between the loss of menstrual blood and the low iron levels of the participants.) Researchers have also conducted studies and interviews to determine the level of difficulty menstruation adds to a variety of physical activities and expose reported difficulty in obtaining, storing, transporting, changing, and disposing of “sanitary products” (Note the hygiene-promoting terminology). These reports have indicated a significant struggle with menstrual management, giving grounds to the military’s new encouragement for women to use continuous oral contraceptive pills (OCPs) to “temporarily” induce amenorrhea.

What’s happening here is not simply a conquering of the menses but an overpowering of women as a whole. The article about iron deficiency says it best, with its opening paragraph explaining the biological disadvantages of women: women’s lower levels of physical strength, inferior aerobic performance, and a number of other physical and mental “shortcomings” that include the ability to menstruate. It states, “the physical differences between genders in the military setting should be minimized as much as possible” (866). They’re not trying to make women more comfortable by stopping their periods; they’re using men to set the physical and mental performance standard for which women must strive. The failure of women to meet this standard lies in their very biology; the study directly blamed their femaleness as the source of this imbalance. It’s not, “Stop menstruating because it will help you.” It’s, “Stop menstruating because it will get you that much closer to being a man.” Oh joy.

The misogyny embedded within this move toward menstrual suppression does not discount the results of the studies; menstrual management poses a serious issue for most military women! In addition to the difficulty reported in transporting, obtaining, and storing products, another article relayed the troubling results of interviews from women of the Air Force, Army, and Navy regarding personal hygiene and field menstrual management.4 These interviews told of highly unsanitary bathroom facilities in combat environments, lack of privacy for the use and changing of menstrual products, and bathrooms that rarely contained receptacles for disposing of the products. The women reported collecting used products in Ziploc bags to either bury them in the secrecy of night or to keep them in their luggage until they returned to the U.S. Because of the hot, moist climates inhabited during deployment; the heavy, reused, and unwashed clothing; and the frequent lack of water or time to wash up, the interviewees reported constant awareness and humiliation surrounding menstrual odor. Most of the women also admitted hesitancy toward utilizing the clinic for menstrual health issues because they were made to feel that their menstrual symptoms were not worthy of care. They also reported that gynecological exams were excluded from their general deployment health examinations.

How much blood is too much?

January 24th, 2011 by Elizabeth Kissling

The US Food and Drug Administration (FDA) approved tranexamic acid tablets as treatment for heavy menstrual bleeding more than a year ago, but you probably haven’t seen much of this television commercial to promote the drug (brand name Lysteda). Matthew Arnold reports in Medical Marketing and Media that television network executives are put off by the ad’s explicit mention of “periods” and “bleeding” combined with the symbolism of fall red rose petals.

(The article appeared in the December, 2010, print issue of MMM, but online October 20, 2010.)

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Menstrual Suppression for Military Women

January 13th, 2011 by Elizabeth Kissling

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.

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S.A.N.E Vax Objects to FDA Ruling Gardasil Use for Anal Cancer

December 29th, 2010 by Elizabeth Kissling

Guest post by Leslie Botha, S.A.N.E. Vax

Increasing Number of Consumers are Concerned over HPV Vaccine Safety

The FDA’s December 22, 2010 ruling to expand the use of Gardasil for anal cancer prevention is unacceptable, according to Norma Erickson, President of S.A.N.E Vax. Last Wednesday, the U.S. Food and Drug Administration approved Gardasil for the prevention of anal cancer and associated pre-cancer lesions due to human papillomavirus (HPV) types 6, 11, 16, and 18 in people ages 9 through 26 years. Immediately, the news flooded the media – with many postings on HIV/AIDS sites.

However, medical consumers are unaware the 2010 Gardasil® Patient Product Information (PPI) states if a woman has “…immune problems, like HIV infection, cancer, or takes medicines that affect the immune system” they must be reported to the health care provider. This should be of grave concern to HIV/AID patients and their physicians who may consider the vaccine to “prevent” anal cancer.

Gardasil is already approved for the same age population for the prevention of cervical, vulvar, and vaginal cancer and the associated precancerous lesions caused by HPV types 6, 11, 16, and 18 in females, and for the prevention of genital warts caused by types 6 and 11 in both males and females in the same age group. 
This same demographic has reported over 20,915 adverse reactions – mostly from Gardasil to VAERS – the Vaccine Adverse Event Reporting System. In addition, 89 deaths and 382 abnormal pap tests post vaccination have been reported with an estimated 1 to 10% of the population filing, according to the National Vaccine Information Center. The rate of deaths and adverse reactions are reported as a percentage of doses distributed, not doses actually administered, and therefore CDC statistics on reported injuries likely misrepresent their frequency.

Data on adverse reactions from males ages 9 to 26 are just starting to be reported to VAERS. Hundreds of social media sited, journalists, researchers and educators have joined forces to publicly decry the faulty science, data, research and fast-tracking of this vaccine through the FDA.

Of course, Merck & Co. denies a causal relationship between the adverse reactions and deaths to their award-winning vaccine. However, on December 20, the QMI News Agency in Canada reported a Quebec coroner can’t explain why a 14-year-old girl died after receiving a dose of the Gardasil vaccine. Even though coroner Michel Ferland’s report concludes the adolescent girl died from drowning, and while there is no evidence the shot killed the teenager, he is refusing to rule out a link between Gardasil and her death. On December 13, Michael Smith, North American Correspondent, MedPage Today wrote an article titled: Many Fail to Finish HPV Series as Recommended stating that “…Many girls and young women may not be completing all three doses of the quadrivalent human papillomavirus vaccine in a timely fashion…” According to Dr. Lea Widdice, Cincinnati Children’s Hospital Medical Center; in a single-institution retrospective analysis, only 14% of girls and young women completed all three doses within seven months of the first, and only 28% did so within 12 months.

Although statistical data was cited for non-compliance, SANE VAX wants to know if the girls were surveyed for their reasons in not completing the vaccine series. Until the true reasons are known, consumers must remain wary about the potential health dangers from the administration of Gardasil and Cervarix.

According to the FDA there are limitations on the use and effectiveness of Gardasil:

  • GARDASIL does not eliminate the necessity for women to continue to undergo recommended cervical cancer screening.
Readers should note that statements published in re: Cycling are those of individual authors and do not necessarily reflect the positions of the Society as a whole.