Need proof that women are sometimes desperate for information and support when it comes to quitting hormonal contraception? You need look no further than the 100 plus comments in reply to an old blog posting at Our Bodies Ourselves: Questions About Side Effects of Stopping Contraceptive Injections. The comment stream – a litany of woes concerning women’s discontinuation of Depo-Provera – has been active since Nov. 2, 2009.
On March 29, 2012, Rachel, author of the post, wrote a follow-up piece in which she laments: “Although a quick internet search finds many women complaining of or asking about post-Depo symptoms, there isn’t much published scientific evidence on the topic.” Beyond research about bone density and length of time to return to fertility, little is known about the withdrawal symptoms women have been commenting about.
Depo-Provera is the 4-times-a-year birth control injection that carries an FDA “black box” warning that long-term use is associated with significant bone mineral density loss. Never a fan, I made a case against this contraceptive in a paper for Canadian Woman Studies, published in 2005. The comments on the OBOS post indicate that many women took Depo-Provera without full knowledge of the potential for serious side effects while taking it, or of what to expect while coming off the drug.
Considering that Depo-Provera completely suppresses normal reproductive endocrine function, it is not surprising that many women experience extreme or confusing symptoms once stopping it. Take Lissa’s comment for example, posted on February 21, 2011:
Omg I thought I was tripping. I have been on depo for a year and stopped in jan. My breasts constantly hurt, I put on weight, have hot flashes, and sleeping problems. I pray everyday my cycle returns and stops playing with me. I only spot lightly.
Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives,a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.
Lalonde, a Holistic Reproductive Health Practitioner, and Certified Professional Midwife, helps women establish healthy, ovulatory cycles after using hormonal contraception. She says that women who’ve used Depo-Provera generally experience the most obvious symptoms and have the hardest time returning to fertility. She finds that every client’s experience is different and will be affected by the status of their cycles before taking the drug, and their overall health. “It can take time to regain normal menstrual cycles, from a few months to 18 months, in my experience,” says Lalonde. “Some women have minimal symptoms while their own cycles resume, while others might have significant symptoms, including mood changes, unusual spotting and breast tenderness.”
The comments to the Our Bodies Ourselves blog post demonstrate that many women are not finding the acknowledgement and support they need to understand and manage the post-Depo transition. Some are disheartening to read, like this comment by Judy from April 12, 2011, and this recent one posted by Melani on March 21, 2012.
In my last re: Cycling post, I asked for input on the Coming Off the Pill Mind Map I created. I’ll be making a few revisions thanks to the thoughtful feedback readers have provided. I had assumed that this guide would be applicable to all methods of hormonal birth control but, after reading these women’s comments about their Depo-Provera experiences, it appears this contraceptive may require its own branch on the mind map. Continue reading...
Research by SMCR members Tomi-Ann Roberts and Nicki Dunnavan garnered a lot of attention this week. Stories showed up at Live Science – Why Why Women Should Bring Their Periods ‘Out of the Closet, popular ladyblog Jezebel – Your Period Is a Time for Deep Lady-Bonding, and the Daily Mail - Women, start talking about it. Period! Roberts and Dunnavan surveyed 340 religious and non-religious women about their experiences and attitudes about menstruation. As the Daily Mail reported: ”U.S. researchers say women across the world need to be more positive about menstruation – and that means talking about it in public.”
Credit: MK Carroll
There’s been lots of public discussion about contraception, some might say too much! The birth control/medical insurance coverage brouhaha hit a boiling point last week with Rush Limbaugh’s egregious comments about Sandra Fluke, and the heated debate rages still. Maureen J Andrade at OpenSalon writes that Birth Control Is Not a Women’s Issue: It’s a Human Right, while Asma T. Uddin and Ashley McGuire, blogging at the Washington Post, insist It’s about religious liberty, not birth control. A group of crafters has come up with a unique protest action: sending “interfering” male government members a knitted or crocheted uterus, vagina or cervix, while feministing.com has invited readers to Talk About Birth Control For REAL.
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?
Teen girls are getting pregnant, in part, because they don’t understand their menstrual cycles. It’s time for sexual health educators to step up and teach girls the primary sign of fertility.
A recent report by The Centers for Disease Control and Prevention (CDC) on teen pregnancy in the U.S., based on a survey of close to 5,000 young mothers who got pregnant unintentionally, found that half of them had not used birth control. When questioned further, a third of those said that they didn’t think they could get pregnant. Their reasoning ties in with previous research findings that girls who get pregnant in their teens have misconceptions about their menstrual cycles. They don’t seem to understand how ovulation works and are failing to correctly identify the fertile days in their monthly cycles.
Photo by Acaparadora // CC-BY-SA-2.5
My colleagues in sexual and reproductive health education should take notice. These findings reveal a knowledge gap in sex education: Teens don’t know about the easy-to-spot sign of fertility that precedes ovulation – cervical mucus secretions. Let’s fix it by adding one simple phrase to our sex ed classes: “When you have mucus, you can get pregnant.”
We would also need to explain the ovarian cycle, how estrogen promotes cervical mucus production, the role of mucus in sperm survival and how to check for it. This is arguably among the most useful information young women and men could receive before leaving high school.
If girls had this knowledge then I believe that at least some of them would more accurately identify fertile days in their cycles and at least some unintended pregnancies would be prevented. When a girl knows that mucus on the toilet tissue means she is fertile and able to get pregnant, she may be empowered to avoid intercourse, insist on a condom if she has sex, or know if she needs to seek out emergency contraception. Or she may decide to just hang out with her girl friends. I’m not saying that fertility awareness is a magic wand. Of course, many factors influence our decision-making. But teens are capable of making wise choices when they have accurate information on which to base them.
I’ve talked to many public health nurses throughout my 20-year career as a fertility awareness instructor. They usually quibble about the effectiveness of fertility awareness as a birth control method and seem reluctant to mention the existence of cervical mucus for fear that “a little bit of knowledge is a dangerous thing.” They worry that some students, if taught fertility awareness, might screw it up, thinking they were “safe” when they were not. But the CDC report tells us that garbled understanding about how ovulation works is doing more harm than good.
I hasten to reassure my public health colleagues that I am not proposing we teach teenagers natural birth control. What I’m proposing is the awareness part, that we correct this critical gap in teenagers’ knowledge by explaining that mucus is an obvious sign of fertility.
I won over my local sex educator to this idea by showing her the evidence-based Justisse Method of Fertility Awareness User’s Guide. She now teaches the meaning of mucus in her ovulation lessons.I predict her students will benefit. When they feel that slippery wetness when wiping, they will remember that it has something to do with being fertile. When they see clear, stretchy mucus on the tissue, they will know it’s a fertile day. It seems obvious that reducing confusion about the fertile phase would result in fewer unplanned pregnancies among girls who are currently confused about when they’re safe and when they’re fertile.
Instead of withholding useful information about what cervical mucus means, let’s tell teens that avoiding sex when they observe mucus can prevent pregnancy.
In response to Rick Santorum’s recent assertion that birth control only costs “a few dollars” and therefore there shouldn’t be such a big fuss about denying insurance coverage, Mother Jones published a birth control calculator this week that estimates your lifetime costs for birth control, based on your current age. The calculator asks you to enter your age and then select your preferred method. Options include the pill, IUDs, Implanon, injections, the patch, the vaginal ring, and surgical sterilization. (It doesn’t specify sterilization for women or for men, but given the context of the current debates, I’m assuming the calculator estimates only the cost of female sterilization.) It also fails to take into account that, in reality, most women use more than one method throughout their reproductive years.
Now, I know that aside from the cost of reference books, charting supplies, and perhaps a course or two to get started, using Fertility Awareness Methods is free, but condoms and spermicide aren’t. And as NPR reported on Tuesday, it can be difficult or inconvenient to get those methods covered by health insurance. Diaphragms and cervical caps aren’t cheap either, and they both require physician visits to be properly fitted. Diaphragms last a long time, but they do need to be replaced every few years. It’s been a while since I needed one, but I’m pretty sure that my health insurance covered the cost of my diaphragm, although I had to pay out-of-pocket for the accompanying spermicide gel. In my student days, I got both at my school’s Student Health Center, covered by the student health insurance fees that we were required to pay whether we used the student health center or remained on parental insurance.
I’ve written before about my bewilderment at the diaphragm’s disappearance, but I’m increasingly frustrated that the current political debates about the pill are contributing to the apparent erasure of all non-hormonal methods of birth control. The pill has become synonymous with birth control in some quarters, without consideration of the profound implications of that swap for women’s health.
I am not opposed to the pill, by the way. I want it to be available, I think it should be covered by health insurance, and I want it to be safe. But I also want women to have complete, accurate, accessible information about all of their birth control options. And let’s get all of them covered by health insurance.
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.
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.
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:
While the 50th anniversary of the pill was, mostly, celebrated in the media, re: cycling offered a different perspective.
Guest bloggers offer challenging opinions that get readers thinking.
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. Continue reading...
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.
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”.
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?
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.
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.
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.
Two and a half years after publication, the original article continues to garner monthly comments. I’ve read most of them and have yet to see one that offers concrete advice or a referral to resources that provide information and support to women looking for both. One such resource is Coming Off The Pill, the Patch, the Shot and Other Hormonal Contraceptives, a comprehensive, clinical-based guide to assist women transition back to menstruation and fertility, written by Megan Lalonde and Geraldine Matus.
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