Long-Term Dangers of Birth Control Pills

Dr. Elizabeth Plourde, Clinical Laboratory Scientist, Author, talks, 2011

Dr. Elizabeth Plourde talks about the dangers of using birth control pills for many years and why they are dangerous.

  • Video published on 26 Sep 2011 by iHealthTube.com.

Sweetening the pill : Could some birth-control drugs kill you?

Could some pharmaceutical birth-control methods be having side-effects that are much more dangerous than women realise ?

Featuring interviews with parents and friends of those who’ve died after complications related to some birth control hormones, Abby Epstein and Holly Grigg-Spall question how much the public really know about their medical effects.

  • Find out more about the Sweetening the Pill documentary on Kickstarter.
  • Video published on 22 Jun 2015 by The Guardian.

The Pill : Association of Hormonal Contraception With Depression

Are some side effects of birth control pills being kept secret ?

November 2016, JAMA Psychiatry published a Danish study that found a correlation between the use of hormonal birth control and being diagnosed with clinical depression. The study tracked hormonal birth control use and prescription of antidepressants over six years for over a million women. They found that women who were on hormonal birth control—be it the pill or a hormonal IUD or vaginal ring—were significantly more likely to be prescribed antidepressants.

These findings are only the latest in a long line of battles between women and their doctors over accurate information, broadly.vice reports in The Racist and Sexist History of Keeping Birth Control Side Effects Secret.

In 2018, the popularity of apps like Natural Cycles highlights the serious issues with contraceptives, the conversation reports.

Illustration by Eleanor Doughty, feature image credit broadly-images.vice.

Key Points

  • Question
    Is use of hormonal contraception associated with treatment of depression?
  • Findings
    In a nationwide prospective cohort study of more than 1 million women living in Denmark, an increased risk for first use of an antidepressant and first diagnosis of depression was found among users of different types of hormonal contraception, with the highest rates among adolescents.
  • Meaning
    Health care professionals should be aware of this relatively hitherto unnoticed adverse effect of hormonal contraception.

Abstract

Importance
Millions of women worldwide use hormonal contraception. Despite the clinical evidence of an influence of hormonal contraception on some women’s mood, associations between the use of hormonal contraception and mood disturbances remain inadequately addressed.

Objective
To investigate whether the use of hormonal contraception is positively associated with subsequent use of antidepressants and a diagnosis of depression at a psychiatric hospital.

Design, Setting, and Participants
This nationwide prospective cohort study combined data from the National Prescription Register and the Psychiatric Central Research Register in Denmark. All women and adolescents aged 15 to 34 years who were living in Denmark were followed up from January 1, 2000, to December 2013, if they had no prior depression diagnosis, redeemed prescription for antidepressants, other major psychiatric diagnosis, cancer, venous thrombosis, or infertility treatment. Data were collected from January 1, 1995, to December 31, 2013, and analyzed from January 1, 2015, through April 1, 2016.

Exposures
Use of different types of hormonal contraception.

Main Outcomes and Measures
With time-varying covariates, adjusted incidence rate ratios (RRs) were calculated for first use of an antidepressant and first diagnosis of depression at a psychiatric hospital.

Results
A total of 1 061 997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31-1.42). For depression diagnoses, similar or slightly lower estimates were found. The relative risks generally decreased with increasing age. Adolescents (age range, 15-19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 (95% CI, 1.75-1.84) and those using progestin-only pills, 2.2 (95% CI, 1.99-2.52). Six months after starting use of hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46). When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71).

Conclusions and Relevance
Use of hormonal contraception, especially among adolescents, was associated with subsequent use of antidepressants and a first diagnosis of depression, suggesting depression as a potential adverse effect of hormonal contraceptive use.

Screening for Cervical Cancer – US Preventive Services Task Force Recommendation Statement

New Cervical Cancer Screening Guidelines: What You Need to Know

Some women have a new option for cervical cancer screening — and it doesn’t necessarily involve a Pap test — according to updated guidelines from a government-appointed panel of experts, livescience reports.

Key Points

  • Women under age 21 should not be screened for cervical cancer.
  • Women ages 21 to 29 should undergo screening every three years using a Pap test, also called “cervical cytology.” (HPV testing isn’t recommended for women ages 21 to 29 because, in this age group, HPV infection is common and is often cleared by the immune system.)
  • Women over age 65 do not need to be screened for cervical cancer if they are up to date on their screening, their tests in the previous 10 years were negative and they don’t have other risk factors for cervical cancer.

Abstract

Importance
The number of deaths from cervical cancer in the United States has decreased substantially since the implementation of widespread cervical cancer screening and has declined from 2.8 to 2.3 deaths per 100 000 women from 2000 to 2015.

Objective
To update the US Preventive Services Task Force (USPSTF) 2012 recommendation on screening for cervical cancer.

Evidence Review
The USPSTF reviewed the evidence on screening for cervical cancer, with a focus on clinical trials and cohort studies that evaluated screening with high-risk human papillomavirus (hrHPV) testing alone or hrHPV and cytology together (cotesting) compared with cervical cytology alone. The USPSTF also commissioned a decision analysis model to evaluate the age at which to begin and end screening, the optimal interval for screening, the effectiveness of different screening strategies, and related benefits and harms of different screening strategies.

Findings
Screening with cervical cytology alone, primary hrHPV testing alone, or cotesting can detect high-grade precancerous cervical lesions and cervical cancer. Screening women aged 21 to 65 years substantially reduces cervical cancer incidence and mortality. The harms of screening for cervical cancer in women aged 30 to 65 years are moderate. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone in women aged 21 to 29 years substantially outweigh the harms. The USPSTF concludes with high certainty that the benefits of screening every 3 years with cytology alone, every 5 years with hrHPV testing alone, or every 5 years with both tests (cotesting) in women aged 30 to 65 years outweigh the harms. Screening women older than 65 years who have had adequate prior screening and women younger than 21 years does not provide significant benefit. Screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer provides no benefit. The USPSTF concludes with moderate to high certainty that screening women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer, screening women younger than 21 years, and screening women who have had a hysterectomy with removal of the cervix for indications other than a high-grade precancerous lesion or cervical cancer does not result in a positive net benefit.

Conclusions and Recommendation
The USPSTF recommends screening for cervical cancer every 3 years with cervical cytology alone in women aged 21 to 29 years. (A recommendation) The USPSTF recommends screening every 3 years with cervical cytology alone, every 5 years with hrHPV testing alone, or every 5 years with hrHPV testing in combination with cytology (cotesting) in women aged 30 to 65 years. (A recommendation) The USPSTF recommends against screening for cervical cancer in women younger than 21 years. (D recommendation) The USPSTF recommends against screening for cervical cancer in women older than 65 years who have had adequate prior screening and are not otherwise at high risk for cervical cancer. (D recommendation) The USPSTF recommends against screening for cervical cancer in women who have had a hysterectomy with removal of the cervix and do not have a history of a high-grade precancerous lesion or cervical cancer.

Recommendations of Others

… “Women at increased risk of cervical cancer (ie, women with a history of cervical cancer, a compromised immune system, or diethylstilbestrol exposure) may need to be screened more often.” …

Reference. US Preventive Services Task Force, August 21, 2018.

En dehors de la science et de la justice, le bon sens peut parfois suffire

Pesticides, antidépresseurs et agnotologie du suicide

Publié par Luc Perino, médecin généraliste, humeur du 21/08/2018

Un retentissant procès vient de condamner Monsanto à verser 250 millions d’euros à un jardinier intoxiqué par le glyphosate. Cette sentence est considérée par la plupart des commentateurs comme une preuve définitive de la toxicité du glyphosate. Depuis des décennies, des milliers d’articles scientifiques ont formellement démontré la toxicité des pesticides en général et du glyphosate en particulier. Rares sont ceux qui ont eu un écho, et les plus commentés l’ont été cent fois moins que ce dernier procès. Certes, la science n’a pas le charme médiatique de la justice, mais ce serait là une trop rapide conclusion.

En réalité, la science n’émeut pas les multinationales, car elles en sont les premières productrices. Rien n’est plus facile que de décortiquer les petits biais consubstantiels à toute science et de produire de nouveaux biais. Cette science du doute s’appelle l’agnotologie et elle suffit à maintenir longtemps les institutions en sommeil. Surtout si ce sommeil est profitable à tous les sens du terme.

On pourrait en conclure que seule la justice peut émouvoir les multinationales. Ce pourrait être vrai si les condamnations visaient les dirigeants, mais les peines se résument toujours à d’anonymes indemnités qui ont été largement budgétées en amont. L’industrie pharmaceutique en est coutumière. Le laboratoire Glaxo a payé une amende de 3 milliards de dollars pour avoir dissimulé pendant des années les risques cardiovasculaires mortels liés à son hypoglycémiant (rosiglitazone). Pfizer a payé 2,3 milliards pour avoir promu hors autorisation de dangereux antiépileptiques pour des douleurs banales. Etc. Le procès du glyphosate semble ridicule aux côtés des milliards que paient avec discrétion les compagnies pharmaceutiques pour éviter les procès.

Pourtant, en dehors de la science et de la justice, le bon sens peut parfois suffire. La simple observation de la dévastation animale et végétale immédiate causée par les pesticides suffisait à en évaluer la toxicité. Les paysans du monde entier ne s’y sont pas trompés en choisissant les pesticides comme premier moyen de suicide. Les pesticides sont même responsables de plus d’un suicide sur sept dans le monde. Les antidépresseurs en provoquent probablement plus, mais la preuve est plus délicate, car l’agnotologie pharmaceutique est infiniment plus subtile que l’agnotologie agro-alimentaire.

Constatant le long et tortueux chemin de la vérité avec la science ou la justice comme seul attelage, nous comprenons aisément pourquoi la très grande majorité des humains se réfugie derrière les dogmes. L’industrie agro-alimentaire est là pour nous nourrir. L’industrie pharmaceutique est là pour nous soigner. Voilà des dogmes qui, en plus d’être immuables, sont vraiment reposants.

En Savoir Plus

Endometriosis and pregnancy outcome : women with previously excised posterior DIE

Obstetric complications after laparoscopic excision of posterior deep infiltrating endometriosis: a case–control study

2018 Study Abstract

In this issue, Nirgianakis et al. present a retrospective analysis of the complications of pregnancy after laparoscopic excision of deep infiltrating endometriosis (DIE). Most important is that excision of DIE does not affect the increased risk of placenta previa, gestational hypertension, and intrauterine growth retardation (IUGR) associated with endometriosis. In addition, the risk of a vaginal delivery was not increased in the entire group or in the 26 women with a vaginal excision of endometriosis.

Read the full text (free access).
Fertility and Sterility, Volume 110, Issue 3, Pages 406–407, August 2018.

DES Exposure and Endometriosis

Can exposure to insecticide during pregnancy link to autism in children ?

Association of Maternal Insecticide Levels With Autism in Offspring From a National Birth Cohort

New research published in the American Journal of Psychiatry says that exposure to the notorious pesticide dichlorodiphenyltrichloroethane (DDT) during pregnancy could raise the risk of a child developing autism, ScienceAlert reports.

2018 Abstract

Objective
Autism is a complex neurodevelopmental disorder with a largely unknown etiology. To date, few studies have investigated prenatal exposure to toxins and risk of autism by using maternal biomarkers of exposure. Persistent organic pollutants are lipophilic halogenated organic compounds and include the insecticide dichlorodiphenyltrichloroethane (DDT), as well as its metabolite p,p′-dichlorodiphenyl dichloroethylene (p,p′-DDE), and polychlorinated biphenyls (PCBs). The objective of this study was to test whether elevated maternal levels of persistent organic pollutants are associated with autism among offspring.

Method
The investigation was derived from the Finnish Prenatal Study of Autism, a national birth cohort study based on a nested case-control design. Cases of autism among children born between 1987 and 2005 were ascertained by national registry linkages. In cases of childhood autism and matched control subjects (778 matched case-control pairs), maternal serum specimens from early pregnancy were assayed for levels of p,p′-DDE and total levels of PCBs.

Results
The odds of autism among offspring were significantly increased with maternal p,p′-DDE levels that were in the highest 75th percentile, with adjustment for maternal age, parity, and history of psychiatric disorders (odds ratio=1.32, 95% CI=1.02, 1.71). The odds of autism with intellectual disability were increased by greater than twofold with maternal p,p′-DDE levels above this threshold (odds ratio=2.21, 95% CI=1.32, 3.69). There was no association between total levels of maternal PCBs and autism.

Conclusions
These findings provide the first biomarker-based evidence that maternal exposure to insecticides is associated with autism among offspring. Although further research is necessary to replicate this finding, this study has implications for the prevention of autism and may provide a better understanding of its pathogenesis.

La confiance des patients en leur médecin

Ne pas vexer son médecin…

Publié par Luc Perino, médecin généraliste, humeur du 09/08/2018

La relation médecin-patient est un thème rebattu. Sa qualité est supposée produire celle du soin. Depuis Balint, les médecins sont encouragés à suivre des formations pour améliorer cette relation. La confiance des patients en leur médecin est le fondement de l’effet placebo, lequel représente la plus importante contribution au succès du soin, quels que soient les progrès de la médecine et la gravité des pathologies.

Cette relation n’a évidemment pas échappé aux évolutions sociales et technologiques.

  • L’échange verbal est de plus en plus haché par diverses mélodies de téléphone.
  • Les regards se croisent moins depuis que l’ordinateur du médecin en capte la majorité.
  • Internet en est devenu une tierce personne.
  • Enfin, cette relation, importante pour l’éducation et le conseil et pour toutes les thérapies non médicamenteuses, a perdu de son poids maintenant que les industriels du médicament sont les seuls à façonner l’art et l’enseignement médical.

D’un côté, les décisions thérapeutiques sont basées sur des statistiques biomédicales le plus souvent biaisées. Néanmoins, ces décisions probabilistes sont labellisées, immuables et définitives. Les traitements sont prescrits à vie quelle que soit l’évolution clinique individuelle.
De l’autre côté, le soin empirique, modulable et réversible, façonné par la parole et la relation, est devenu presque suspect.

La souffrance générée par cette dégradation relationnelle est la même des deux côtés du stéthoscope. Médecins et patients sont également victimes de cette évolution. Le médecin se réfugie derrière une ordonnance anonyme, approuvée par sa faculté et son ministère. Le patient accepte cette ordonnance à défaut de ne pouvoir obtenir toute l’attention qu’il espérait.

La petite philosophie synthétique que je livre ici n’a rien d’original et s’est construite au gré de mes désolations de clinicien, mais l’ampleur du problème m’est apparue suite à la récente réflexion d’un ami qui me relatait les suites d’une consultation :

« mon médecin m’a prescrit ce médicament, mais je n’ose pas lui avouer que je ne le prends pas de peur de le vexer ».

Cet ami avait inversé la charge de la confiance. Il tenait manifestement à garder son médecin, bien que n’ayant plus vraiment confiance en lui. L’essentiel semblait être que ce praticien garde confiance en son patient. Ce paradoxe ébranla ma naïveté médicale et me conduisit à de nouvelles digressions sur notre métier. J’imaginai alors les imbroglios que devront démêler les futurs cliniciens.

  • Prescriptions abusives à vie,
  • effets secondaires des médicaments inutiles,
  • dissimulations de non observance,
  • automédication,
  • médicaments frelatés achetés sur internet,
  • multiples prescriptions de spécialistes ou de médecines alternatives,

bref, tous ces échecs de la relation allaient rendre le défrichage des symptômes et de l’évolution clinique infiniment laborieux. Dans la relation médecin-patient de demain, les docteurs Watson auront vraiment besoin de Sherlock Holmes à leurs côtés.

En Savoir Plus

Le lien entre la prise de distilbène de la (grand-)mère et la stérilité de la descendance

Toute une histoire, vidéo publiée le 5 octobre 2015

Le distilbene est un “modèle” des perturbateurs endocriniens.

Le Distilbène DES, en savoir plus

Une fille Distilbène sans enfants témoigne

Extrait d’un journal de bord d’une femme numérique, juin 2017

“Il faut de tout pour faire un monde”,
… et …
“à toute chose malheur est bon”.

dit on… voici un témoignage, d’une fille distilbène, qui sort de l’ordinaire…

Le Distilbène DES, en savoir plus