tag:blogger.com,1999:blog-7100452276682801125.post2433024210916513167..comments2024-02-14T06:42:21.988-06:00Comments on Context and variation: Summer of the Pill: Why do we menstruate?KateClancyhttp://www.blogger.com/profile/10266484364483890008noreply@blogger.comBlogger11125tag:blogger.com,1999:blog-7100452276682801125.post-89412822278025028112011-07-20T14:30:07.112-05:002011-07-20T14:30:07.112-05:00great article! couple questions...
is there eviden...great article! couple questions...<br />is there evidence which is riskier, exposure to synthetic or natural hormones? Is someone on the pill being exposed to natural AND synthetic hormones, or does the body stop producing natural hormone when the synthetic ones are introduced?<br /><br />Where did the data for the preindustrial pattern of menstruation come from? Do we have info on preindustrial women who did not have children, ie. Do they have higher instances of cancer/shorter lifespans?<br /><br />and finally, could you give more links to articles concerning traditional/preindustrialized reproduction in general? <br />Thanks!Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-82812537860768665012011-06-25T00:03:25.012-05:002011-06-25T00:03:25.012-05:00I agree that contraception should be individualize...I agree that contraception should be individualized, and with so many varied options nowadays I think (hope) a more lengthy conversation is occurring. Various algorithms exist regarding how combination pills should be prescribed, with the progestin components accounting for the variation in side effects, ie, some are more androgenic, others more estrogenic, some with diuretic action, etc. I'd like to think that pharmaceutical reps are not overly influential, but that may be too much to ask.<br /><br />Yes, progestins are not without side effects (depression, weight gain, bone loss), but, as you've said, they are considered safer than estrogens. Of course, pregnancy and abstinence are also not without side effects either.Tonyhttps://www.blogger.com/profile/03056377038486402824noreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-31992003831906759702011-06-24T23:55:08.159-05:002011-06-24T23:55:08.159-05:00NEJM has a review of combination pill benefits and...<a href="http://www.scribd.com/doc/37414657/Combination-Estrogem-Progestin" rel="nofollow">NEJM</a> has a review of combination pill benefits and risks, with prodigious references. <br /><br />Regarding anemia: <i>"Oral-contraceptive use decreases menstrual blood flow and is associated with a reduced prevalence of anemia and increased hemoglobin concentrations in anemic women."</i> (12-14)<br /><br />12. MilmanN,ClausenJ,BygKE.Iron status in 268 Danish women aged 18-30 years: influence of menstruation, contraceptive method, and iron supplementation. Ann Hematol 1998;77:13-9. <br /><br />13. Rivera R, Almonte H, Arreola M, et al. The effects of three different regimens of oral contraceptives and three different intrau- terine devices on the levels of hemoglobin, serum iron and iron binding capacity in ane- mic women. Contraception 1983;27:311-27. <br /><br />14. Effects of contraceptives on hemoglobin and ferritin. Contraception 1998;58:262-73<br /><br />Yes, these are old studies with some flaws; rightly or wrongly the idea has become lore in the practice of contraception.Tonyhttps://www.blogger.com/profile/03056377038486402824noreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-61194411738009504482011-06-24T12:24:13.440-05:002011-06-24T12:24:13.440-05:00Hi Tony, thanks for commenting. I'm a bit more...Hi Tony, thanks for commenting. I'm a bit more hesitant than you to fall head over heels in love with synthetic progesterones. I have heard too many women, even in progestin-only preparations, who have had terrible experiences. That said, I do agree the synthetic estradiol is more often the culprit. But it's important that the medical system starts recognizing women as variable, and prescribing hormonal contraception based on the documented baseline hormone levels and activity levels of their patients. The focus groups I have run on the topic suggest most doctors simply recommend their favorite brand as the first brand, then their second favorite, etc, rather than making recommendations on which brand or preparation to use based on any evidence about that patient's physiology.<br /><br />I'd be interested to read the papers that suggest women on hormonal contraception have higher hemoglobin, if you happen to know the citations. Thanks!KateClancyhttps://www.blogger.com/profile/10266484364483890008noreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-18962900259510549872011-06-24T09:17:19.243-05:002011-06-24T09:17:19.243-05:00"I am do not have any financial affiliations&...<i>"I am do not have any financial affiliations"</i><br /><br />Should say: I am <b>not</b>, and I do not have any financial affiliations. (Fat fingers.)Tonyhttps://www.blogger.com/profile/03056377038486402824noreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-39695541689463626382011-06-24T09:14:56.841-05:002011-06-24T09:14:56.841-05:00Excellent post on hormonal contraception, I especi...Excellent post on hormonal contraception, I especially enjoy the perspective of other cultures and species-- something we don't really cover in med school. <br /><br />Oral contraceptives are primarily progestational, with only enough estrogen added to provide endometrium to slough. The amount of estrogen has been decreasing sequentially since the 1960's since it's estrogen that adds the health risks: blood clots, breast cancer, endometrial cancer. You are correct that the associations can be murky, however.<br /><br />Migraine prevention is only one benefit of hormonal contraception. Reduction in lifetime risk of ovarian cancer and endometrial cancer, not to mention risks associated with unplanned pregnancy, are others. Woman on hormonal contraception tend to have higher hemoglobin levels too, perhaps adding to well-being.<br /><br />Nowadays more and more women are using progestin-only contraception-- Mirena IUD, Depoprovera-- because of the lower risks, and also to eliminate their menses altogether. These methods also have better compliance and lower contraceptive failure rates. Progesterone is perhaps the safest exogenous chemical we provide in medicine.<br /><br />Don't mean to hog the comments. Excellent post, I look forward to more. (In re-reading my comment, I sound like a drug salesman! I am do not have any financial affiliations.)Tonyhttps://www.blogger.com/profile/03056377038486402824noreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-60896643560496639302011-06-19T21:19:27.689-05:002011-06-19T21:19:27.689-05:00This is a great post (and series). I second the co...This is a great post (and series). I second the comment about the migraines, although I decided the risk of extra hormones wasn't worth the relief (for me) because I am still functioning with migraines. Interestingly, I take a pill designed to combat hormonal acne (called Diane in Australia - not sure what it is in the US), but I still break out in my week off the pill. To see if I could combat this, I tried taking the pill continually; however, I wasn't able to cheat the system. Instead of breaking out every 4 weeks, I was just breaking out every 6 or 8! Not sure what the scientific basis for this might be (if any), but just an interesting tidbit.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-5092984942401683612011-06-17T17:10:14.206-05:002011-06-17T17:10:14.206-05:00Erica and Karen, thanks for commenting. Yes, conti...Erica and Karen, thanks for commenting. Yes, continuous hormones can do wonders for women who suffer from migraines (though strangely, there are some women who seem to get headaches from the pill). And Karen, my cycle is very different now that I have had a child! And while I didn't used to have changes in mood, I do now. Very interesting stuff.<br /><br />Anon, I'm not 100% certain that the experience of the pill and the patch or ring are the same -- they are sometimes the same hormone, sometimes not. And some studies I've read lump all hormonal contraceptives in their studies, while some focus only on oral contraceptives. I'm sorry that I don't have a better answer.<br /><br />As for your question about hormone exposure -- yes, back when doctors were first figuring out breast cancer they called it the nuns' cancer because nuns got it in far greater quantity. Nowadays not having kids is only one thing to worry about, since, as you said we are so much heavier than we have ever been. That is probably an even greater problem now.<br /><br />As for your last question, the way you can disentangle this is to only study average weight subjects, or you can statistically control for weight. But I agree that these are interrelated issues.KateClancyhttps://www.blogger.com/profile/10266484364483890008noreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-52942897602146743152011-06-17T12:50:53.083-05:002011-06-17T12:50:53.083-05:00Can we assume all of this information relating to ...Can we assume all of this information relating to "the pill" is also relevant for other hormonal contraceptive methods such as the ring?<br /><br />Also- regarding the comment about increased hormone exposure as a possible trigger for breast cancer- can't this also be an issue for women who do not get pregnant at all in their lifetime (or with as much frequency as more traditional societies)through use of non-hormonal barrier methods? I'm thinking they are exposed to a more steady stream of cancer-causing hormones than women who are often pregnant/lactating..<br /><br />Additionally, I understand fat breaks down into estrogen. With many industrial women being quite heavy, can this also be contributing to increased breast cancer risk? How can we disentangle obesity and cancer formation from contraceptive use and cancer formation?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-64858906411037642612011-06-17T10:49:23.637-05:002011-06-17T10:49:23.637-05:00Thank you for this. I took pill packs back-to-back...Thank you for this. I took pill packs back-to-back for over 6 years and it worked wonderfully. And yes, to reference Erica's comment above, my migraines were significantly reduced.<br /><br />BUT...then I had my daughter and it's like my hormones are completely different at baseline. I get breakthrough bleeding now and I'm having mood issues I didn't have before. So now I'm looking at a non-hormonal IUD. <br /><br />Before taking the Pill, I was also on Depo for 5 years, which means I essentially didn't menstruate for over ten years. I don't have a genetic link to breast cancer so it seemed like a reasonable gamble. I guess we'll see if there are any long-term consequences, but if anyone's interested in trying it, I can recommend it.Karen P.http://www.paleoperiodical.comnoreply@blogger.comtag:blogger.com,1999:blog-7100452276682801125.post-34759896231701072011-06-17T09:29:33.429-05:002011-06-17T09:29:33.429-05:00I would like to add that I take my pills straight ...I would like to add that I take my pills straight through to combat another hormonal related problem - I have severe migraines linked to my cycle and they are reduced by being on a steady dose of hormones. If there are other women out there suffering from migraines, it's a good idea to chart your migraines along with your cycle on a calendar so you can see if they are also affected in this way. If so, this may be a therapy option to discuss with your doctor.Ericahttps://www.blogger.com/profile/11554498539390028841noreply@blogger.com