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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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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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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New “Protectasil” Vaccine

December 30th, 2010 by Elizabeth Kissling

Brought to you by Smerck.

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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.

Sex, Lies and Pharmaceuticals

December 16th, 2010 by Chris Hitchcock

There’s a new book about the intimate role of the pharmaceutical industry in the construction of diseases, using the example of FSD (female sexual dysfunction). The authors are Ray Moynihan, an Australian investigative journalist with a longstanding interest in this topic, and Barbara Mintzes, Assistant Professor in the Department of Pharmacology & Therapeutics at the University of British Columbia. I haven’t yet seen the book, but listened to the webinar, which is now available on the Canadian Women’s Health Network (CWHN) website.

There were a few things that struck me. One is how blatant the interference of the pharmaceutical industry can be. For example, the webinar includes a reference to an email sent to Lenore Tiefer letting her know that a formative 1997 meeting about female sexual dysfunction was only open to those who were either part of or willing to work with the pharmaceutical industry. Another was the way in which the language about the medical understanding of the cause of FSD tracked the introduction of 3 different potential drugs, each with different targets and different mechanisms. So far, each drug has failed in clinical trials.

The medicalization of human sexuality separates our bodies from our emotional lives, and creates a framework within which emotional or relationship difficulties are seen as being caused by the biological, rather than being interdependent. And little attention is paid to the ways in which pharmaceutical cures may even create relationship problems that were not there before.

There are, of course, parallels with other cases. For example, the idea that menopausal is a hormone deficiency disease makes it much easier to argue that every healthy menopausal woman should take hormone replacement therapy. This replacement language is unfortunately still alive and well in both medical and popular usage.

Another parallel is the construction of “premenstrual syndrome” into a psychiatric diagnosis. This has been provisionally incorporated into the Diagnostics and Statistics Manual (DSM) of the American Psychiatric Association, initially as “Late Luteal Dysphoric Disorder”, now “Premenstrual Dysphoric Disorder”. Among other things, this construction supported the repackaging and marketing of Prozac as Sarafem for this newly created psychiatric disorder, extending the marketability of Prozac beyond its patent expiry date.

The APA is currently working on DSM V, to be published in May, 2013, and there is an opportunity for activism. So far, PMDD is listed in the “needs more research” section. But chances are it will be put forward again for the next edition.

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The Don’t Do Drugs

November 24th, 2010 by Holly Grigg-Spall

15 Dangerous Drugs Big Pharma Shoves Down Our Throats

best-diet-pills1

Alternet recently posted a list of the drugs most likely to make you sick. Writer Martha Rosenberg’s ’15 Dangerous Drugs Big Pharma Shoves Down Our Throats’ contained some startling choices.

Yaz is there, described as a “too good to be true” birth control pill that purported to do away with acne, bloating and PMS but ended up causing the deaths of many young women from blood clots and gall bladder disease. Interestingly, she points out that although the pharmaceutical company Bayer has seen a sales slump of late this has been attributed to the appearance of a generic, cheaper version of the pill, and not women’s suspicion of its side effects. This is a testament to the power of the company’s aggressive marketing campaign, and the pull of Yaz’s promise.  I have written at length on my blog, Sweetening the Pill, about the impact Yaz had on my health – from the UTIs to the paranoia – but still when I saw Bayer would be releasing a rebranded version of the drug – Beyaz, with added vitamin B – I still felt tempted to try it. My life has been entirely transformed since ditching the Pill after ten years and looking back I can see very clearly how Yaz destroyed my body and mind, but I am still a woman living in a Pill-pushing culture just trying to avoid the self-doubt I’m sold on every day.

The birth control pill was the first drug created for and prescribed to healthy people. Its release was a catalyst for the industry, showing that although pills for sick people could make a profit, pills for healthy people could make millions. The Pill had a massive potential market of fertile women, and soon became a cure-all for any ailment seen as specific to them. This paved the way for another medicine on Alternet’s list – Lipitor – the heart-attack preventer drug, on which Martha Rosenberg writes:

“”My older patients literally do without food so that they can buy these medicines that make them sicker, feel bad, and do nothing to improve life,” says an ophthalmologist web poster from Tennessee. “There is no scientific basis for treating older folks with $300+/month meds that have serious side-effects and largely unknown multiple drug interactions.” What kinds of side effects? All statins can cause muscle breakdown but combining them with antibiotics, protease inhibitors drugs and anti-fungals increases your risks. In fact, Crestor is so highly linked to muscle breakdown it is double dissed: Public Citizen calls it a Do Not Use and the FDA’s David Graham named it one of the five most dangerous drugs before Congress.”

Lipitor is the best-selling drug in the world because its market is huge – healthy people holding any risk of heart attack, or just holding the fear of a heart attack are the demographic. Whereas the Pill is confined to female parameters, Lipitor also hooks men. Those behind the Pill had to first convince women that stopping ovulation is okay, then that menstruation is at best bothersome and unattractive, and at worst dangerous. Lipitor had a lost less work to do.

Hormone Therapy and the Brain

November 24th, 2010 by Elizabeth Kissling

Medical-Anatomical-Superior-half-of-diseased-brainSo there’s a surge today in news stories about how hormone treatment for menopause (popularly known as ‘hormone replacement therapy’ or HRT) benefits the brain, apparently based on publicity over this study published in Hormones and Behavior. In media interviews, the researchers suggest that HT enhances the communication between left and right sides of the brain, making the older women’s brains more similar to those of younger women. The researchers had the women perform tasks designed to demonstrate fine motor coordination, such as tapping buttons with different fingers. Of the 62 women in the study, the 36 on hormone treatments showed higher levels of motor coordination, leading the researchers to conclude that hormone treatments, especially estrogen, “exert positive effects on the motor system thereby counteracting an age-related reorganization.”

Admittedly, I have not read the entire study, just the abstract and press summaries, but would you consider me too cynical if I suggested that the publicity this research report is receiving is more about promoting the use the hormones among menopausal women than the significance of the research findings?

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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.