Contraception (=BCP)

Oral contraception (=OC) utilizes the fact that in order for ovulation (=release of a fertile egg) to take place it requires a complex interaction between the gonadotropin hormones LH and FSH from the pituitary gland as well as the right mixture of estrogen and progesterone from the ovaries. Without that proper hormonal interaction ovulation will not take place leading to an infertile cycle. With contraception scientists were able to suppress ovulation for as long as the birth control pill is taken regularly.

By giving a small amount of estrogen and progesterone like substance (called "progestin") in the oral contraceptive form (the birth control pill) ovulation is stopped, the lining of the uterine cavity is stabilizd by estrogen and the mucous plug in the cervical canal is thickened making it much more difficult for sperm to enter (Ref. 15, p. 330).

Birth control pill and breast cancer: One of the side effects of the pill is promotion of the development of breast cancer. It appears that the risks outweigh the benefits beyond 5 years of hormone replacement. There are also higher risk subpopulations of women who should avoid the BCP as can be seen from this table where the approximate risks for breast cancer are depicted (modified from Ref.15, p. 375).

Relative risk for developing breast cancer in relation to various factors
Conditions:	Relative risk:	Comments:
woman with no cancer risk, but on BCP	1.6 to 1.8-fold	risk becomes significant after about 5 years of BCP
had 1st degree relative with breast cancer on one breast	2.5-fold	genetic reasons for breast cancer underlying
had 1st degree relative with breast cancer on both breasts	9.5-fold	genetic risk is more pronounced here
no relative, but patient had history of breast cancer	4-fold	about threefold the risk compared to a woman without risk using BCP
first child born later than 30 years of age	1.9-fold	compared to a woman who has her first child prior to age 20
if woman consumes 3 oz. of alcohol per day	2-fold	versus a woman who does not use alcohol or BCP
prior radiation for Hodgkins disease (age 10 to 19)	10- to 75-fold	radiation exposure during time of breast development leads to enormous risk about 15 years later

Risks multiply when it comes to exposure to several risk factors. A woman who drinks 3 oz. of alcohol per day and takes the birth control pill for 10 years has a risk of 3.2- to 3.8-fold of developing breast cancer as compared to a woman who does not drink alcohol and does not take the BCP.

This is the reason why no woman who belongs into the above classification should take the BCP or should take estrogen for hormone replacement after menopause. These high risk women should, if a BCP is desired, take the POP's (=progestin only pills) as described above. The risk for ovarian cancer and for endometrial (=uterine cancer) cancer is reduced on the BCP. It is important for any woman who wants to take the BCP to be aware that certain medications, particularly antiepileptic drugs and certain antibiotics can cancel or weaken the contraceptive effect of the BCP. There are many more details that you will want to ask your physician about oral contraception, but the above will have given you a good overview.

Ethical concerns from various religious or church groups regarding the BCP are discussed under "injectable contraception", which you will find when you click on the link of "contraception" below.

Birth Control Patch

At a recent conference for family physicians (Ref.27) Dr. Debra Millar, professor of obstetrics and gynecology at the University of BC in Vancouver, outlined the advantages of a patch (ORTHOEVRA Transdermal System) versus the regular birth control pill. Women often forget the pill and when this happens there is a danger of a breakthrough ovulation and unwanted pregnancy. In the past patches were good for only 2 or three days, but the delivery systems and skin adhesiveness of the patch have been significantly improved. Now with ORTHOEVRA (from Ortho) it is possible to apply the patch for one week as the hormone reservoir reliably delivers enough hormones through the skin and achieves the same birth control effects as the pill by mouth. ORTHOEVRA is the "pill in a patch". Here is how it works: there are three consecutive weekly patch applications, always applied on the same weekly day. The 4th week is off and your period will occur then. On day one of the period the patch is applied again and the cycle is repeated. If you use the patch, do not exceed seven consecutive patch-free days. In women who weigh more than 198 lbs. (=90 kg) the patch is not as reliable. Discuss this and other questions about the patch with your doctor. Side-effects are comparable to oral contraception. Barrier methods against sexually transmitted diseases need to also be applied similar to the birth control pill. Trials have shown that women were better able to stick to the patch regimen than to the pill form of contraception. The patch withstood exposure to swimming, sauna, whirlpool and treatmill exercises without peeling off.

Hormone considerations:

The birth control pill may work on the short term. However, on the long term it disrupts the woman's hormone balance as the estrogen-like and progesterone-like synthetic hormones are not bio-equivalent. The Women's Health Initiative (Ref.28) has taught physicians a tough lesson: you cannot mess with nature's hormones or else you create a risk of strokes (41%), heart attacks (29% more), blood clots (twice as many), breast cancer (26% more), colorectal cancer (37% more) and you increase Alzheimer's disease (76% more often). This was a trial involving over 16,000 postmenopausal women. Although the hormones used in these women were slightly different in concentration, structurally they are very similar to the ones used for birth control purposes. What nature seems to tell us is that you cannot mess with hormone receptors or you get one of the diseases just listed. At the core of contraception is that scientists thought they could partially block the hormone receptors and this would lead to a reversible blocking of ovulation. The truth is that these synthetic estrogen-like and progesterone-like substances are not bio-identical hormones and they suppress ovulation, which means they are creating a progesterone deficiency in the woman who takes these synthetic hormones. The artificial hormones are functioning as "xenohormones" and the end result is that physicians create estrogen dominance in these women, which according to Dr. Lee is the reason for the above listed complications (Ref. 29).
The solution to this is not to mess with "new and better hormones", but to leave the women's hormones as they have always been. Instead it makes more sense to use less invasive alternatives for birth control methods. A well fitted IUD (inserted by a gynecologist) is a good alternative. This will not create havoc with the woman's hormones and will not create infertility after contraception is no longer needed (see also Ref. 30). Bio-identical progesterone replacement using creams is being used to rebalance the original hormones.

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Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

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18. Gabbe: Obstetrics - Normal and Problem Pregnancies, 3rd ed., 1996 Churchill Livingstone, Inc.

19. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 251.

20. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 250.

21. Ignaz P Semmelweiss: "Die Aetiologie, der Begriff und die Prophylaxis des Kindbettfiebers" ("Etiology, the Understanding and Prophylaxis of Childbed Fever"). Vienna (Austria), 1861.

22. Rosen: Emergency Medicine: Concepts and Clinical Practice, 4th ed., 1998 Mosby-Year Book, Inc.

23. Mandell: Principles and Practice of Infectious Diseases, 5th ed., 2000 Churchill Livingstone, Inc.

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27. The 50th Annual St. Paul's Hospital Continuing Medical Education Conference for Primary Physicians, Nov. 16 - 19, 2004

28. Writing Group for the Women's Health Initiative Investigators: Risks and benefits of estrogen plus progestin in healthy postmenopausal women. Principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321-333.

29. Dr. John R. Lee, David Zava and Virginia Hopkins: "What your doctor may not tell you about breast cancer - How hormone balance can help save your life", Wellness Central, Hachette Book Group USA, 2005. Page 360 to 374 explains xenohormones.

30. Dr. Volker Rimkus: "Die Rimkus-Methode - Eine natuerliche Hormonersatztherapie fuer die Frau", Verlag Mainz, 2006 (in German).

Last Modified: Jan. 27, 2012