Womens Health Associates Blog

Empowering Women Through Health

BIRTH CONTROL PILLS: JUST WHAT DO THEY OFFER US? PART THREE by Kim Morse, M.D. November 4, 2011

Filed under: Birth Control Options — womenshealthassociatesblog @ 1:11 pm
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                I think that the birth control pill generally gets a bad reputation.  We see lots of commercials late at night touting all the bad things that can happen when you are taking them and who is to blame.  When is the last time anyone told you the good things about the pill?  As with any medication, there are risks associated with taking combination oral contraceptives, and there are also benefits that extend beyond the prevention of pregnancy.

                There are many different combination birth control pills.  They all have similar composition with estrogen and a type of progesterone.  The progesterone component and the dose of hormone varies between pills and accounts for why some pills work better for some people than for others.

                The pill is often prescribed for problems with menstruation.  Taking birth control decreases the amount of blood lost each month and decreases cramps better than any other medication.  It makes the menstrual cycle more predictable and more manageable for many women.  Taking the pill continuously or using a 24 day pill is often used to treat PMS symptoms as well.  Another problem for some women is menstrual migraines.  These are often treated using a special formulation that adds back estrogen during a women’s period to decrease the frequency and severity of headaches.

                Hormonal imbalances are also treated using the pill.  The hormones in the pill lead to changes in the production of proteins in the blood that bind testosterone and other compounds.  This change results in lowered effects from testosterone and decreases acne and dark hair growth some women have on their faces and chests.

                Other uses for the pill include the treatment of gynecologic disorders, such as uterine fibroids and pelvic pain.  Many women with endometriosis are treated successfully using the pill, as are women with recurrent ovarian cysts.

                As with any medication you need to consider the benefits taking it compared to the risks.  For many women with menstrual or gynecologic problems the pill remains a great resource.

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BIRTH CONTROL PILLS AND THE RISK OF CANCER–PART TWO by Kim Morse, MD October 13, 2011

Filed under: Birth Control Options — womenshealthassociatesblog @ 8:52 pm
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Birth control pills, or oral contraceptives, are one of the most commonly taken prescription medications in women in our country.  In addition to preventing pregnancy, there are other benefits to taking them.  As with any medication there are side effects and risks as well.  In recent years we have seen a lot of media attention on the risk of breast cancer associated with hormone replacement therapy, but there has not been very much on the risk of cancer with birth control use.

There have been many observational studies over the years trying to determine the effect of using OCs on overall cancer risk.  When all types of cancer are combined there is a decrease in the overall cancer risk in women who have ever used OCs.  This decrease is likely due to a substantial decrease in uterine and ovarian cancer in women who take the pill.  Studies have consistently shown that using OCs decreases the risk of ovarian cancer.  Overall the risk is one-third less for women who currently use or have used OCs in the past.  What is most impressive is that the protection lasts for up to 30 years after stopping the pill and all doses of the pill provide the same protection.  Uterine cancer is also decreased in women on OCs, the risk of uterine cancer while on the pill is almost half of what it would be off.  The relative protection can last up to 15 years in some studies.

The effect of the pill on the risk of breast and cervical cancer is more controversial. 

There may be an increase in cervical cancer in women who have taken OCs. Many studies show an increase in cervical cancer that continues as long as the pill is continued.  When the pill is stopped, the risk returns to baseline levels.  Interestingly, women who are negative for HPV (the virus most often associated with cervical cancer) do not have an increase in the risk when using OCs, leading to the conclusion that the pill may interact with the growth of HPV already present.

There have been several studies on the risk of breast cancer in OC users and the results are conflicting.  Several population studies have been done and show no increase in the risk of breast cancer later in life for women who have taken OCs.  The only study that showed an increase looked at women who took high dose OCs (in the 1970’s) AND had a strong family history of breast cancer.  This may indicate that for women of average risk there is no significant increase, but in women who carry the BRCA1 or BRCA2 gene (or who have a strong family history-a mother or sister affected) the risk increases.

Overall, these risks and benefits likely balance out for women of average risk.  In women with a family history of breast or ovarian cancer the circumstances may need to be discussed in more depth with a provider.  It is important to remember that all these risks estimates are pretty low, not doubling or tripling risk.  Another thing to keep in mind is that we increase and decrease our risks of cancer and other chronic diseases everyday, not just in medication choices, but in lifestyle choices as well. 

 

BIRTH CONTROL PILLS — PART ONE by Kim Morse, M.D. September 27, 2011

Filed under: Birth Control Options — womenshealthassociatesblog @ 2:30 pm

When birth control pills were first developed the goal was to prevent pregnancy.  Since that time the medical community has uncovered many non-contraceptive benefits to the pill including less blood loss, less pain as well as the prevention of certain types of ovarian and uterine cancers.  When they were first developed the pills were meant  to mimic an average woman’s cycle of 28 days.  It was thought that a woman would be more accepting of the pill if she had what appeared to be a ‘normal cycle’.  Over the years the pill has changed, as has the reasons for prescribing them.  Overall, today’s birth control pills are much lower dose and better tolerated than those of the past. 

As the reasons for giving the pill have changed, so has the way they are taken.  For years, gynecologists have been having women ‘skip periods’ for medical reasons by rearranging the way they take their regular birth control.  In the past few years the pharmaceutical companies have jumped onto this wagon and started packaging pills for this specific purpose leading women to wonder, “Is it safe to skip my period?”

When talking about the way birth control pills work most  people are referring to a combination pill, one that contains both an estrogen and progesterone component.  These pills mimic the normal hormones produced by the ovary and suppress ovulation to prevent pregnancy.  They also contain less estrogen then most women normally produce and a low but stable amount of progesterone unlike the variation seen in the natural cycle.  This combination of hormones makes it possible to suppress ovarian function while keeping the lining of the uterus thin and healthy. 

Women who are not on a birth control pill do need to have a menstrual cycle at least four times each year to prevent abnormal growth of the lining of the uterus.  Women who are on birth control are keeping the lining thin and healthy by taking the medication and have no medical need to have a period. 

There are now several pills out that lengthen the time between periods (such as Seasonale), or try to eliminate periods altogether (Lybrel).  Newer formulations are meant to shorten the period to 1-2 days but frequently result in no noticeable bleeding at all.  The biggest side effect seen in women taking extended cycle pills is spotting that typically resolves with time.  The good news is that a woman can use any low-dose pill to skip periods after consulting with her physician.

When birth control pills were first introduced it took several years for women to accept them as safe and effective.  Now the next step is for women to accept the manipulation and even elimination of the menstrual cycle is a safe alternative and even added benefit of the pill.

This is the first in a two part series.  Check back for “Part Two: Birth Control Pills and the Risk of Cancer.”