13/06/2021
Blog Artificial Birth Control: Mechanisms and Side Effects ABC Part 2:
So one of the other things I wanted to go over for folks in this session is understanding of how hormonal birth control works and side effects (not that side effects in themselves are reasons against ABC, really Natural Law is, but I do find it interesting the clamor over J&J vaccine blood clots by CDC yet somehow the greater risk for them from many HBC is ignored...). First off, my Youtube Meeting on this topic is here and part of it goes into the sad research that took advantaged on mentally ill or minority women by the makers of the first birth control pill. This research would not be permitted today and many would be appalled at it, yet on the 50th anniversary, there was hardly a mention of this...
Here is that Youtube Video: https://youtu.be/gImKDb2DohE
First Mechanisms: Although primary mechanisms are not abortifacient, all of them can potentially prevent implantation and although ACOG calls this not abortifacient (because they changed pregnancy definition in the 60s to permit birth control pills), morally speaking human life is human life, not potential human life.
Combined Estrogen/Progesterone (Pills, Nuva Ring, Patches): Main mechanism is to suppress ovulation, but also the progesterone is designed to thicken mucous and keep endometrium thin. Given 8% breakthrough ovulation occurring, effectiveness likely in part could be from preventing implantation (Contraception 1980;22(3):241-7, showed women with breakthrough ovulation endometrium was not receptive to implantation).
Progesterone only pill: Prevent ovulation (though 4/10 still ovulate), thicken cervical muccous, thin endometrium so again can prevent implantation. This is similar with Nexplanon and Depo.
IUD: Primarily acts to make inflammatory response in uterus to cause destruction of s***m, can cause abnormal ova, and progesterone secreting (used to prevent abnormal bleeding seen with Copper IUD), 45-75% still ovulate. Data shows strong likelihood of preventing implantation and those who do become pregnant 50% end with miscarriage even with early removal. It is also used as emergency birth control up to 5 days later so in that setting preventing implantation is likely reason why it is effective 99% of the time. More here on postfertilization data: https://journals.sagepub.com/.../10.1177/0024363919854289.
Side effects:
Combined E/P: 3-6 fold increased risk of venous blood clots as well as heart attacks and strokes, Breast Cancer (label as WHO Class 1 carcinogen): •Taking OCP (for 6 years) prior to first full pregnancy found RR 2.2 (first trimester abortion 2.4 RR) by age 32 (Br J Cancer. 1981 Jan; 43(1): 72–76), ever use 7% increase, current use 24% increase
•Use of OCP prior to age 20 increased risk of BC prior to age 50 (HR = 3.26; 95% CI = 1.06–10.01) Breast Cancer Res Treat. 2015 Jan;149(2):505-15
•Although reductions of Ovarian Cancer and Uterine Cancer are touted, overall risk of cancers increase 22% with 8 years use or more (BMJ. 2008 Jan 12; 336(7635): 59–60), Mental Health: •2018 Swedish Study in 815,662 women 12-30 followed for atleast 4 years without prior psychological disorder found 34% higher risk for new prescription for MH disorder with highest in younger girls (3.5 fold higher than nonusers) while very low in adult women. Su***de: 2018 Study (Skovlund, et al. AJP 2017): Follow-up 8.3 years for young women (mean age 21), compared to nonusers of HBC relative risk among current and recent users was 1.97 (97% increase risk) (95% CI=1.85–2.10) for su***de attempt and 3.08 (3 fold higher) (95% CI=1.34–7.08) for su***de. Also some data in young girls in adolescents on the pill it might actually lower Bone Density increasing osteoporosis risk later on. Other Side Effects: Increase in AI disorders (MS 35%, Crohn’s 3 fold increase,50% Lupus), weight gain, decreased libido, GI side effects, irregular bleeding, may affect fertility when coming off.
Progesterone Only: Depo Provera increases VTE 2.5 fold, oral and IUD secreting less data suggesting link. Breast Cancer risk higher with Levonorgestrel use associated with increased breast cancer (93% oral and 21% IUD device) (N Engl J Med 2017; 377:2228-2239). Mood Disorders: •Current use of Progesterone only BC increased risk of mood disorders (OR 3.0 95%CI: 1.1–7.8, p = 0.03) (J Affect Disord. 2012 Sep;140(1):92-6), •Su***de Attempts on oral progestin-only products, 2.58 (95% CI=2.06–3.22), implanted progestin OR 4.42 (95% CI=3.63–5.39), and Depo 6.52 (95% CI=5.03–8.46) (2018 Skovlund).
Depo provera has been linked to low bone density as well, •Other Side effects: Abnormal uterine bleeding, acne, breast tenderness, headaches, weight gain.
IUD: Copper: • Copper IUD early in first 3 months 38% more painful periods and increased bleeding 68%, with 33% reporting more pain and 49% more bleeding still at 40 weeks use,
Both types of IUD: Abdominal and back pain 60-70% with insertion long term 10-15%. •Pelvic Inflammatory Disease: 0.54% PID within first 90 days, 6 fold higher within first 3 weeks of insertion. • Uterine Perforation: 2 per 1000 insertions, slight increase with breast feeding, within 6 months delivery, fewer pregnancies, more abortions
•Expulsion: 1 out of 20 will be expelled within 3 months
•Other side effects: Increased risk of Yeast Infections (19%), Acne 7-15%, breast tenderness, mood changes, nausea, migraines, weight gain, dyspareunia and lower libido
Progesterone secreting: •Breast cancer 21% increase risk of Breast Cancer with Progesterone IUD (N Engl J Med 2017; 377:2228-2239)
Increased risk of depression, anxiety, panic attacks and su***de; (Skovlund 2018) Risk of su***de attempt increased with LNG-IUD OR 2.86 (95% CI=2.06–3.97).
I think the biggest concern is especially in young women. It is amazing how this can have profound mental health side effects and this traditionally has been overlooked, though they come on rather quickly within a couple months. Now granted for instance the risk of blood clots you need to treat 1428 women with OCP to cause one extra blood clot vs in 55-64 yo women on hormone replacement therapy only 655, so we cannot just say well side effects are the only reason not to, but overall when we think about the overall risks (including that small risk of preventing implantation), the alternative in NFP available and the fact NFP used in the setting of a committed relationship helps to nourish authentic relationships while promoting the natural bodily function and generosity NFP use indeed is transforming families in a beautiful and profound way.
