Oral Contraception is among the most widely consumed
medication in the world - more than one
hundred million women currently take it every single day. It is common for
girls to be prescribed oral contraceptives to treat everything from acne to
dysmenorrhea. In fact, taking “the pill” has become the norm. Today, it seems
that most women between the ages of 14 and 40 are taking some form of birth control. I can’t tell you
how many patients I see that are on these medications and know next to nothing
about the small pill they take every day of their lives. I want to share some
very important information regarding oral contraceptives to help you make
informed, educated decisions about your health.
The first oral contraceptive commercially available
was Enovid, which was approved by the FDA in the early 1960’s. The approval for
this drug was based on a small study that involved 132 Puerto Rican women who
took the pill for one year. Of the 132 women in the study, three who were young
and healthy at the inception of the study died after experiencing severe chest
pain, yet no autopsy was ever performed. These women were simply eliminated
from the study without further inquiry. One year after Enovid was made available
to the general public, numerous incidents of thrombosis and embolism (blood
clots) were reported, as well as 11 deaths.
While evidence of the danger of this medication poured in, the American
Association of Medical Colleges held a meeting where a man named Nobel Laureate
Frederick Robbins delivered the keynote speech. In that speech, he said, “The
dangers of overpopulation are so great that we may have to use certain
techniques of conception control that may entail considerable risk to the
individual woman.” This statement is not only absurd but it contradicts the
Hippocratic Oath (“above all else, do no harm”). Needless to say,
Enovid was
discontinued in the United States in the late 1980’s, along with many other “1st
generation” high-estrogen oral contraceptives.
Since the days of Enovid, oral contraceptives have
evolved and two more “generations” of these drugs have emerged. So, what about
these 3rd generation oral contraceptives that are so widely prescribed
today? Many people who take the pill daily were never warned about the possible
side effects, which include but are not limited to: migraines, depression,
nausea, vomiting, heart attack, stroke, pulmonary embolism, decreased sex
drive, urinary and lower genital tract infections, breast pain, hypertension,
gall bladder disease, loss of vision, and uterine leiomyoma, among many others.
These side effects are just some of the KNOWN side effects that were observed
during short-term clinical trials. Interestingly, there has never been a
long-term, clinically controlled trial regarding the safety of these drugs, and
yet there are countless women who have been taking these pills daily – some
even for 10 or more years.
I hear all too often that these drugs have been “extensively
studied” and are “safe,” and that the risk of adverse reactions is “very small.”
According to… who? That is exactly what physicians and scientists said about
Diethylstilbestrol (DES), which was a synthetic estrogen prescribed to pregnant
women in order to prevent miscarriages. DES was prescribed from 1938-1971 (33
years!) until it was discovered that the children whose mothers who took DES while
pregnant were developing rare forms of vaginal cancer. I bring that one example
up to make the point that no one will
ever know the full extent of how pharmaceuticals affect the human body, because
we will never fully understand all of the bodies’ biochemical processes. For
this reason, there is not – and will never be – one single pharmaceutical drug
that has absolutely zero side effects.
Let’s get back to 3rd generation oral
contraceptives. Many of you have heard of the drugs Yasmin or Yaz, which were
birth control pills manufactured by the Bayer Company. These were considered “safe”
birth control pills when they were first marketed, but not so much anymore. As
of August 2012, Bayer had been named in 12,000 lawsuits, and counting. A
startling 1,977 cases have been settled for a total of approximately $402.6
million. These millions were paid out to injured users of these drugs who suffered
blood clots that led to disability. It is important to note that Yaz has only
been on the market since 2006. This alarming number of lawsuits will only continue
to increase, because women who took these drugs may have clot formation(s) they
don’t even know about yet – the clots can be totally asymptomatic until they
break free and travel to the lungs, causing a pulmonary embolism (which is almost
always fatal).
What you should really be aware of is this: The most serious and concerning effect of oral
contraception/birth control on the body is actually what it does to Homocysteine
and C-reactive Protein. Homocysteine is a highly reactive by-product that
basically causes inflammation to the vessels in your body. C-reactive Protein
elevates in response to this inflammation. These two substances are the most
significant risk factors for heart disease; they blow cholesterol out of the
water when it comes to assessing someone’s lifetime risk of developing
cardiovascular disease. A study published in 2011 by Norouzi et al. found that
healthy women who did not smoke but took birth control had 3.4 times higher
homocysteine levels and nearly 3 times higher C-reactive protein levels when compared
to healthy women not taking birth
control. The authors observed this elevation in just three months of study
participants taking “the pill.” I can’t imagine what these values might be for
women who have been taking the pill for several years or decades. This is a
major problem, considering the average person’s lifetime chance of having a
heart attack is 1 in 3 without the
added factor of taking birth control.
The purpose of this post is to provide some factual
information you can use to make educated health decisions, and to hopefully
prompt you to further research drugs like birth control that our society has
come to accept as so normal and so routine that people hardly bother asking
even the most basic questions about safety and side effects anymore. For those
of you who are currently taking birth control, I urge you to dig even deeper. Is
taking birth control in order to prevent pregnancy worth increasing vascular
inflammation and accelerating your risk of heart disease? What about the other
serious known side effects and still unknown risks? That is a decision you
will each have to make for yourself. The resources listed below would be a good
place to start if you are interested in making a better-informed choice.
If you have any questions whatsoever regarding this
issue, or any other, please do not hesitate to contact me!
Dr. Brady
References
Norouzi et al. Effects of oral
contraceptive therapy on Homocysteine and C-Reactive Protein. 2011; 11: 698-702.
Brattstrom L & Wilcken DEL
(2000) Homocysteine and cardiovascular disease: cause or effect? Am J Clin Nutr
72, 315–323.
Chambers JC, Obeid OA & Kooner
JS (1999) Physiological increments
in plasma homocysteine induce vascular
endothelial dysfunction in normal human subjects. Arterioscler Thromb Vasc Biol
19, 2922–2927.
Adachi H, Hirai Y, Fujiura Y,
Matsuoka H, Satoh A & Imaizumi T
(2002) Plasma homocysteine levels
and atherosclerosis in Japan: epidemiological study by use of carotid
ultrasonography. Stroke 33, 2177–2181.
Doring
A, Frohlich M, Lowel H, Koenig W. Third generation oral contraceptive use and
cardiovascular risk factor. Atherosclerosis.2004; 172: 281-6.
Schueller PO, Feuring M, Sharkova Y, Grimm W, Christ M.
Effects of
synthetic progestagens on
autonomic tone, neurohormons and C-reactive protein levels in young healthy
females in reproductive age. Int J Cardiol 2006; 111: 42-8.
Chae CU, Ridker
PM, Manson JE. Postmenopausal hormone replacement
therapy and
cardiovascular disease. Thromb Haemost 1997;78:770-80.
Sidney
S, Petitti DB, Quesenberry CP, Klatsky AL, Ziel HK, Wolf S. Myocardial
infarction in users of low dose oral contraceptives. Obstet Gynecol
1996;88:939-44.
Lidegaard Ø.
Oral contraception and risk of a cerebral thromboembolic
attack:
results of a case-control study. BMJ 1993;306:956-63.
