What Every Woman Should Know about Birth Control

Excerpted from the Hopkins Health Watch columns and interviews originally published in the John R. Lee, M.D. Medical Letter

Even the Low Dose Pill is Dangerous
There have been a series of reports in the media lately to the effect that the newer low-dose birth control pills are “safe.” While it's true that they're safer than the old higher dose pills they are still very dangerous. Most of them are made either with just a testosterone-like progestin called 19-nor-testosterone, or a progestin and a small amount of estrogen. That means just for starters that you're getting dosed with a progestin every month, which blocks real progesterone with all its benefits from its receptors. You're also getting some extra estrogen every month, which is the last thing most women need.

It is also well-known that 19-nor-testosterone progestins bind to estradiol receptors and thus have the potential to stimulate breast and endometrial cancer.

Regardless of dose, birth control pills significantly raise your risk of deep vein thrombosis (blood clots) that can be deadly. According to an August 98 article in JAMA (Journal of the American Medical Association), women with gestational diabetes (diabetes during pregnancy) who used progestin-only contraceptives after birth, tripled their risk of getting Type II diabetes.

In a 1997 study reported in the journal Arthritis & Rheumatism, it was found that women who had previously used oral contraceptives were 40 percent more likely to have the immune disorder lupus erythematosus (SLE) than women who had never used them. In fact, the incidence of all the auto-immune diseases is increased in pill users.

New “Low Dose” Contraceptive Pills Have Higher Risk of Blood Clots
The so-called “third generation” of birth control pills — which are touted to be safer because they contain a lower dose of estrogens and/or progestins–actually carry a higher risk of blood clots for women using them, according to a Danish study recently published in the British Medical Journal. The article reported that when the use of the third generation pills rose sharply, the hospital admission rate for women suffering from thromboembolism rose 16 percent. Thromboembolism is caused by a blood clot, usually in the legs, which can be extremely painful. If a piece of it breaks off and travels to the lungs it can be fatal.

A few years ago, the American College of Obstetricians and Gynecologists reported that for every 100,000 women taking the third generation pills, 20 to 30 will develop nonfatal blood clots.

The family planning experts invited to comment on the research dismissed the effect as too small to be of concern, which is par for the course. They think in terms of risks vs. benefit in large populations, and consider the sacrifice of a certain number of women every year as acceptable given the benefit of lower birth rates. A blood clot may not be of concern when your goal is to reduce birth rates, but if you're one of those 20 to 30 per 100,000 women or their families, it's a very real concern, especially if the blood clot is fatal.

British Medical Journal September 25, 1999;319:795-796, 820-821.


Why Are Migraines in Young Women are on the Increase?
According to an article in the October 22nd issue of the journal Neurology, researchers at the Mayo Clinic in Rochester, MN report that the number of women suffering from migraine headaches rose more than 56 percent between 1979 and 1990, especially among younger women in their twenties.

Migraines are severe, debilitating headaches that usually occur on one side of the head. They are more common in women, and often occur premenstrually. Women who use natural progesterone to relieve PMS symptoms often report that their migraines disappear, which would indicate estrogen dominance as a possible cause. Migraines seem to be related to dilation of blood vessels and water retention, both effects of estrogen when it is not mediated by progesterone.

But why are migraines increasing among younger women? One possible cause is the widespread use of birth control pills, which are predominantly progestins, which block the action of natural progesterone. The increase may also have to do with excessive exposure to xenoestrogens, chemicals such as pesticides which have estrogenic effects on the body.


Contraceptives Increase Risk of Cervical Cancer
It’s not particularly politically correct to speak out against oral contraceptives because they do prevent millions of unwanted pregnancies every year, and they’re irresistibly convenient. However, they’re made from the same synthetic hormones found in conventional hormone replacement therapy (HRT) that increase an older woman’s risk of breast cancer, heart disease, stroke and gallbladder disease, and we already know that in younger women they block essential vitamins, interfere with bone building, and increase the risk of stroke and the risk of breast cancer (particularly when taken by girls under the age of 18). In spite of this, doctors routinely hand them out to girls as young as 10 or 11 to help regulate periods.

Perhaps a new study from France, just published in the Lancet, will make doctors more cautious. It was a thorough review which showed that cervical cancer is closely linked to oral contraceptives. It is already well known that the human papillomavirus (HPV) is among the most important causes of cervical cancer. The researchers set out to investigate recent studies which suggest that long duration use of oral contraceptives increases the risk of cervical cancer in HPV-positive women.

Examining 28 studies that included 12,531 women with cervical cancer, and interpreting the results very conservatively, they found that the risk of cervical cancer increased dramatically with increasing duration of use of oral contraceptives, for all women—not just HPV-positive women.

If you are taking oral contraceptives and have had a positive Pap smear (which tests for cervical cancer), please consider going off the contraceptives immediately.

Smith JS, Green J, “Cervical cancer and use of hormonal contraceptives: a systematic review,” Lancet, 2003 Apr 5;361(9364):1159-67.


Drugs Can Interfere with Birth Control
The following drugs can make birth control pills less effective, increasing the risk of an unwanted pregnancy and the risk of birth defects: antibiotics (including macrolides, penicillins, tetracyclines), rifampin for TB, antifungals such as metronidazole (Flagyl), anti-HIV drugs, and epilepsy drugs.


Drugs that Cause Vitamin Deficiencies

Many prescription drugs cause vitamin and mineral imbalances or deficiencies. Diuretics used to lower blood pressure deplete heart-essential minerals such as magnesium. The cholesterol-lowering drugs known as statins (Mevacor, Zocor) deplete coenzyme Q10 which is essential for healthy heart muscles. Birth control pills deplete vitamin B6 and folic acid. Folic acid protects against birth defects and both vitamins protect against cervical dysplasia, the abnormal cell growth detected by a pap smear. You're much better off if you can avoid birth control pills, but if you must take them, be sure to get 50 mg of vitamin B6 and 200 mcg of folic acid daily. People who have Parkinson's disease take a drug called L-dopa which can help relieve symptoms, but it also depletes vitamin B6 and niacin, both vitamins essential to proper brain and nervous system function. Research is also showing that L-Dopa works better when it is taken with the coenzyme NADH. Be sure to also take a B-complex supplement if you're taking L-dopa. The antiepileptic drugs such as Dilantin, Tegretol, and phenobarbital may cause a deficiency in carnitine, an amino acid that is essential to good brain, nerve, immune and muscle function. Anyone taking these drugs should have their carnitine levels tested. Carnitine also helps protect against the toxic effects of the anticonvulsant and anti-migraine drug valproic acid (Depakote).

Prescription Alternatives, Earl Mindell, Ph.D., R.Ph. and Virginia Hopkins;
J Child Neurol 1998;13:546-549.;
Biochem Med Metab Biol, 1986; 36(2): 244-51;
Neurology, 1989, 39: 549-52;


Drug-Induced Nutrient Depletions: Oral Contraceptives
Excerpted from an Interview with Ross Pelton, R.Ph., Ph.D., CCN in the John R. Lee, M.D. Medical Letter

Back in the mid-1970s, studies reporting that oral contraceptives depleted a variety of nutrients began appearing in the scientific literature. Numerous studies now document the fact that oral contraceptives deplete many of the B vitamins, vitamin C, magnesium, selenium, zinc and the amino acid tyrosine.

Let’s begin by examining the health problems associated with folic acid depletion in women taking oral contraceptives, but please keep in mind that other categories of drugs that also deplete folic acid include antacids, antibiotics, anticonvulsants, biguanide anti-diabetes medications, anti-inflammatory drugs, some of the anti-ulcer medications and aspirin.

Health problems associated with a deficiency of folic acid include anemia, birth defects and cervical dysplasia, which is a pre-cancerous condition characterized by abnormal cells that can be detected in the cervix by pap smear and other methods. Many women with cervical dysplasia end up having a hysterectomy. Sadly, hundreds of thousands of women have hysterectomies every year and many of these surgeries could be prevented if women had adequate folic acid. Other problems associated with folic acid deficiency include depression and increased risk of breast cancer and colorectal cancer.

Three B vitamins, folic acid, vitamin B6, and vitamin B12, are necessary to metabolize the toxic amino acid homocysteine. Elevated levels of homocysteine represent one of the most serious risks to plaque build-up in the arteries and, ultimately, heart attacks. All three of these B vitamins are depleted by oral contraceptives. Thus, women who take oral contraceptives for years may very well be increasing their risk of heart disease.

Vitamin B6 is also necessary for the conversion of tryptophan into serotonin, both important brain chemicals. Thus, oral contraceptive-induced vitamin B6 depletion can inhibit the production of serotonin, which increases a woman’s risks of becoming depressed. In one study, one third of the women taking oral contraceptives for two to five years were found to be suffering from depression. In the brain, serotonin gets converted into melatonin, which is a hormone that helps induce sleep. Therefore, the vitamin B6 depletion caused by oral contraceptives also increases a woman’s risk of developing insomnia and other sleep disorders.

Studies have reported that oral contraceptive use causes a significant decline in vitamin C levels. In one study, women taking both high-dose and low-dose oral contraceptives were evaluated. The results revealed that these women had a decrease in serum levels of vitamin C ranging from 30 percent to 42 percent. Some of the problems associated with vitamin C deficiency include a weakened immune system, poor wound healing and easy bruising.

Studies report that women taking oral contraceptives also have lower serum zinc levels than matched controls. Since zinc is one of the most important nutrients for proper functioning of the immune system, oral contraceptive-induced depletion of zinc may weaken the immune system in susceptible women.

Oral contraceptives also deplete magnesium. Thus, women taking birth control pills will be increasingly susceptible to becoming magnesium deficient. Magnesium deficiency is associated with a greater incidence of osteoporosis, muscle cramps, weakness, insomnia, anxiety and depression, as well as cardiovascular problems, including blood clots, elevated blood pressure, irregular heartbeat, and increased risk of heart attacks.


Spermicides Aren't a Perfect Solution
There are no reliable methods of birth control available to women that are as easy to use as the birth control pill but as safe from side effects as the rhythm method. Birth control pills, shots and implants are implicated in just about every known woman's reproductive disease and disorder, including breast cancer, ovarian cancer, cervical cancer, and infertility. The intrauterine device (IUD) can cause irregular bleeding and infertility. That has left the diaphragm, cervical cap, and condoms as supposedly safe and effective alternatives, but they all depend on spermicides for maximum protection.

Now it turns out that spermicides have their own set of problems. Most of them are made from a detergent called nonoxynol-9 that kills sperm by dissolving their outer cellular membrane. That would be fine if it only disabled sperm cells, but nonoxynol-9 also dissolves the membranes of other cells in the vagina, including those of friendly bacteria that help prevent yeast infections, and those that make up the tissues of the vaginal walls.

The other bad news about nonoxynol-9 is that it is broken down by bacteria into nonylphenol, a xenohormone that has estrogenic effects. Researchers studying the estrogenic effects of nonylphenols on rats found that it stimulated cell growth in the uterus just as estrogen would have.

Theoretically, regular exposure to spermicides and their potentially estrogenic effects could be a problem both for women who are already estrogen dominant (for example it could stimulate cervical dysplasia), and also a problem for men who would rather not have estrogenic substances, with their feminizing effects, absorbed through the thin skin of the penis.


Chemical Birth Control Increases Risks
We know that birth control pills increase your risk of breast cancer when taken prior to a woman’s early twenties; we know they reduce the levels of important vitamins such as folic acid and vitamin B6; and we know that they suppress ovulation, replacing your natural hormones with synthetic hormones. Now it seems that oral contraceptives and Depo-Provera injections also increase your risk of getting a vaginal infection such as chlamydia or candida, and also increase the risk of infection with HIV-1.

This may be due to chemical changes caused by the synthetic progestins, by less use of condoms among women using chemical contraception, or a combination of both. Depo-Provera decreased the risk of getting pelvic inflammatory disease (PID) and vaginal trichinosis, both highly transmissible through sexual contact: this may be due to headaches, backaches, fatigue, irritability and lack of libido, and thus less sexual contact among women using this poison!

And while we’re on the topic of using progestins for birth control, a good study from the journal Medicine & Science in Sports & Exercise showed that young women who got regular aerobic exercise and resistance training (e.g. lifting weights) increased their bone density by one to two percent per two years, and those who didn’t exercise lost one to two percent per two years. However, women in this study who were exercising but also using oral contraceptives did not show the same benefit: their bones remained the same in spite of the exercise regimen.

Am J Obstet Gynecol 2001;185;380-385.

Med Sci Sports Exercise 2001;33:873-880.

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