Can Your Birth Control Kill You?

by Emma Orbach on March 23, 2014

Can Your Birth Control Kill You?webmd

 

The development of hormonal contraception in the 1960s revolutionized family planning and reproductive science. The creation of a simple pill that women could take daily to control conception was, and continues to be, an empowering way for women to take charge of their health, sexuality, and life goals. For decades we have assumed that hormonal contraception is relatively harmless for young, healthy women – and in most cases, it is. However, as medicine advances and new generations of synthetic hormones are produced, along with new methods of administration of these hormones, some have begun to question the safety of certain birth control methods.

The variety of hormonal contraception includes two kinds of oral contraception (a pill with synthetic estrogen and progesterones, and one with only progesterones); two options for injectable synthetic hormones (DMPA or combined); intrauterine devices, or IUDs; vaginal rings; a transdermal patch; and the subdermal implant. Hormonal contraception is comprised of synthetic versions of two major classes of reproductive hormones, estrogens and progesterones. All hormonal contraceptive methods fall into two categories: either they are a combination of estrogen and progesterone, or just progesterone. Synthetic forms of these inhibit ovulation, thicken cervical mucus, and thin the uterine lining. Synthetic estrogen is almost always in the form of ethinyl estradiol in the combination birth control, and almost always in the same amount. As medicine has advanced, new types, or “generations” of these synthetic progesterones (called progestins), have become available. In recent years, drug companies have gravitated towards these newer generation hormones, which were formulated to decrease side effects of an androgen like progestin (such as acne, weight gain, and excessive hair growth).

There has been much speculation and concern among the medical community regarding the safety of newer synthetic progestins (third or fourth generation). While newer progestins have a lower risk of breakthrough bleeding and spotting for the woman taking them (and therefore, a higher likelihood of preventing pregnancy), they present a higher risk of thromboembolisms, which are often fatal. The risk is even higher in women with a history of migraines, which are quite common.

With an oral contraceptive, no matter what the dose or generation of progestin, only a small amount can possibly be released at one time, and the amount is always under the control of the patient. While she can’t decide how many micrograms are in each pill, she can decide to take the prescribed dose of one pill per day. Other hormonal contraceptive methods, like the NuvaRing, don’t require as much responsibility from the woman – NuvaRings, IUDs, and subdermal implants are inserted regularly (monthly, in the case of the NuvaRing; and every one to five years for the subdermal implant and IUD) by a doctor, nurse practitioner, or the patient herself and the daily upkeep is nonexistent. However, with the lack of daily upkeep also comes a lack of control for the patient, and the amount of hormones released into the body is subject to the technical error of the device.

NuvaRings in particular have been the subject of increased speculation after they’ve seemingly caused the deaths of several young, healthy women. The American College of Obstetrics and Gynecology, and the British Medical Journal have both published research and peer reviewed studies that demonstrate this. While women on any form of hormonal contraception are more prone to venous thromboembolism, there have been more deaths caused by thromboembolism in patients with NuvaRings than in otherwise healthy patients than with other hormonal contraception. There is an undebatable increase in risk – 2.1 out of 10,000 healthy women of reproductive age who aren’t taking any hormonal contraception will suffer a thromboembolism per year; for women on the NuvaRing, the risk increases 6.5 times. It’s speculated that this is caused by the use of the third generation progestins, usually desogestrel or etonogestrel.

Another issue that is considered to increase the risk of blood clots with use of the NuvaRing is its need to be handled properly before insertion. The NuvaRing is inserted by the patient herself every three to four weeks, and bought using a prescription. The packaging states that it needs to be kept from 68 to 77 degrees Fahrenheit. Research has yet to be collected regarding the changes in effectiveness should the NuvaRing be left in a particularly hot or cold place before insertion. There is also increased speculation by gynecologists that the NuvaRing could become defective and release more hormones than it was meant to.

As research continues to surface and reproductive medicine advances, as will the introduction of medications that could seem “too good to be true”. As a patient, it is always important to not only learn from the appropriate health care professionals, but also to educate yourself on your medical care and what goes in your body. Writing off hormonal contraception entirely is not the answer. Rather, women should take control of their health care and gain a broad perspective of the facts before introducing a synthetic product into their bodies.

 

(1)  http://www.bmj.com/content/344/bmj.e2990.pdf%2Bhtml

(2)  http://www.bmj.com/content/339/bmj.b2921

(3)  http://www.fda.gov/AdvisoryCommittees/Calendar/ucm273236.htm

(4)  http://www.huffingtonpost.com/2013/12/18/nuvaring-blood-clots_n_4461429.html

(5)  http://jfprhc.bmj.com/content/early/2013/04/10/jfprhc-2013-100624.full

(6)  http://journals.lww.com/greenjournal/Abstract/2013/10000/Cardiovascular_Risk_Associated_With_the_Use_of_an.11.aspx

(7)  http://www.vanityfair.com/politics/2014/01/nuvaring-lethal-contraceptive-trial

(8)  http://www.ncbi.nlm.nih.gov/pubmed/23578274

 


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