Oral Contraceptive Use Tied To Prostate Cancer

There is a significant link between use of oral contraceptives or birth control pills and the incidence of prostate cancer, said researchers who set out to investigate the suggestion that byproducts of these drugs get into the environment, for instance the water supply, and lead to an increase in low level estrogen exposure in affected populations.
David Margel, and Neil E Fleshner from the Princess Margaret Hospital at the University of Toronto in Canada, write about their findings in the 14 November online issue of BMJ Open. They conclude that their study shows a significant association between oral contraceptives and prostate cancer and that:

"It is hypothesised that the [oral contraceptive] effect may be mediated through environmental oestrogen levels; this novel concept is worth further investigation."
Several studies have already suggested that exposure to estrogen may increase the risk of prostate cancer, so Margel and Fleshner took this a stage further: what if use of oral contraceptives could be placing enough estrogen into the environment that it increases prostate cancer risk in the exposed population?
For their ecological study they analyzed global data from the International Agency for Research on Cancer (IARC) for 2007 and the United Nations World Contraceptive Use 2007 report to correlate statistics on prostate cancer incidence and related deaths to use of contraceptives.
They analyzed the data by country and by continents, and they compared results from oral contraceptive use with all other forms of contraception, such as intra-uterine devices, condoms or vaginal barriers.
The results showed that:

• Oral contraceptive use was significantly tied to prostate cancer incidence and related deaths in individual nations.
• Oral contraceptive use was also linked to prostate cancer incidence in Europe.
• There was no link between use of other forms of contraceptive and prostate cancer incidence or deaths.
• Further analysis showed the links with oral contraceptive use did not depend on a country's wealth.

Although the authors point out the study does not prove a cause and effect link, the findings suggest there is a need for further investigation, both to confirm them and to try and find out the chemical and biological pathways between possibles causes and effects.
In their discussion, they suggest one plausible explanation for the link between oral contraceptive use and prostate cancer is that the oral contraceptives in use today frequently contain high doses of ethinyloestradiol (an orally bio-active estrogen), that is "excreted in urine without degradation. This can then end up either in the drinking water supply or passed up the food chain".

Related articles

• Oral Contraceptive Use Tied To Prostate Cancer (medicalnewstoday.com)

Read more »

Contraceptive Birth Control Pills Double Risk Of Blood Clot

One of the largest studies to look at the link better "the pill" and blood clots, showed the older formulas to have a lower risk, but the newer versions to perform better in regards to venous thromboembolism (VTE). The researchers stressed that women should consult their doctor before changing brands or formulas.

Blood clots can be particularly dangerous because once formed in a peripheral vein, usually in the leg, the clot can break free and travel to more sensitive parts of the body, such as brain or vital organs.

Medical records of close to 1.3 million women were included in the study, with 30% of them never having used hormonal contraception, while nearly 70% had used some form of hormonal birth control.

Of the total, 4,307 cases of blood clots required treatment with (64%) as deep vein thrombosis (DVT), where a blood clot chokes circulation in a limb, causing a leg or arm to become swollen, stiff, or painful. 25% were blood clots in the lungs. Around 2% had blood clots that caused strokes.

The older-generation pill that contains an estrogen and the progestin hormone levonorgestrel roughly doubled the risk compared to women not on any hormonal birth control.

The newer kinds of pills, which contain the progestin hormones drospirenone, desogestrel, or gestodene along with estrogen, doubled the risk again, making it six to seven times as high as women who weren't using hormonal forms of birth control. On average, roughly 10 out of 10,000 women taking newer kinds of birth control pills had venous thromboembolism within a year.

The study which is probably going to trouble doctors, patients and drug companies alike, was published in BMJ, just as the FDA is reviewing the safety of newer birth control pills. The FDA birth control investigation was announced in May 2011 and is scheduled to be finished shortly.
In September, the agency said it had not yet reached a conclusion but :

"remains concerned about the potential increased risk of blood clots with the use of drospirenone-containing birth control pills."

The problem is that the wide use of the birth control pill can create a real public health problem even if its only small number statistically. Researcher Ojvind Lidegaard, MD, professor of obstetrics and gynecology, Rigshospitalet at the University of Copenhagen, in Denmark said : "

"You have to consider that 200 million women, every day, worldwide take such a pill. So even if it's only one in 500 per year who get the thrombosis if they are on a fourth-generation pill and are 30 years old, then you actually get a relatively high number of complications .... and you could actually halve that number just by changing the pill from a fourth- to a second-generation pill."

But experts say changing back to an older version of the pill may not be the smartest choice for all women. Philip C. Hannaford, MD, who is the Grampian Health Board chair of primary care at the University of Aberdeen, in Scotland, says in an email to WebMD.

"It is important to have a range of different oral contraceptives available because some women tolerate one preparation better than another."

Obviously some women prefer one kind of pill over another for practical daily reasons such as less nausea, fluid retention, acne, or weight gain.

"This means that clinicians and women often chose to use combined oral contraceptives which do not contain levonorgestrel, and this seems a pragmatic and sensible thing to do given that the background risk of DVT is very low."

It would also be important for women and their health care professionals to take into account other factors, such as medical history, family history and other risk factors such as smoking, alcohol consumption, weight and general health.
Written by Rupert Shepherd

Related articles

• Contraceptive Birth Control Pills Double Risk Of Blood Clot (medicalnewstoday.com)

Read more »

The Pill Alters How Women Select A Partner

Women who chose their partner while on the contraceptive pill tend to be satisfied with their stable relationship, but less so regarding sexual satisfaction, compared to those who chose their men while not on the pill, researchers reported in Proceedings of the Royal Society B. The researchers added that the ones who were on oral contraceptives (OC) when choosing their mate had relationships that lasted on average two years longer than the other women's.

Dr. Craig Roberts, of Stirling University, Scotland, said:

"Our results show some positive and negative consequences of using the pill when a woman meets her partner. Such women may, on average, be less satisfied with the sexual aspects of their relationship, but more so with non-sexual aspects.

Overall, women who met their partner on the pill had longer relationships - by two years on average - and were less likely to separate. So there is both good news and bad news for women who meet while on the pill. One effect seems to compensate for the other."

At the moment of forming a partnership, 1,514 females were on no type of hormonal contraception, while 1,005 used combined oral contraceptives. Those on other forms of hormonal contraception, such as progestogen-only pill, implants and injection were excluded from the study.

Of the 2,519 remaining volunteers, 1,761 were still together with their first child's biological father. Of the 758 who were no longer with the biological father, 734 had separated or formally divorced (both termed in this study as separated), the remaining 24 whose partners had died were excluded from the study.

The women's average age was 37.7 years. 1,200 of them were from the USA, 999 from the Czech Republic, 159 from the UK, 98 from Canada, and 43 from other countries.

Of the 1,761 women whose relationships were ongoing, the researchers detected some considerable differences between those who had been using OC (oral contraceptives) and those who had not when they met their partner.

Those on OC when choosing their partner had a lower score on sexual arousal compared to the other women. The same was found when asked about their sexual attraction to their partner, and his sexual adventurousness.

The authors also found that those on OC when choosing their partner tended to have improved sexual satisfaction with time.

However, those who had been on the pill when selecting their partner scored better on other (nonsexual) aspects of their relationship, such as financial provision, or the partner being a good father.

The OC women scored better on nonsexual aspects of their relationship, such as the partner being a good father

The authors wrote:

"Although the results of this initial analysis are consistent with predictions generated by a body of laboratory studies (reviewed above) that suggest that OC use might alter mate preferences, it is possible that some or all of these effects could alternatively arise as a result of between-group differences that are unrelated to mate choice and any disruptive effects of OC.

For example, a lower sexual satisfaction score among the OC women might be because of differences in attitudes towards uncommitted, short-term relationships.

In a previous study, Dr. Roberts had found that women's preference for men's body odor changed when they were on the pill. Women on the pill were found to prefer men who were genetically similar, while those not on the pill preferred the smell of genetically different males. At the time the researchers suggested that perhaps when on the pill women would choose different men than they would normally choose.

Dr. Roberts wrote:

"Women tend to find genetically dissimilar men attractive because resulting babies will more likely be healthy. It's part of the subconscious 'chemistry' of attraction between men and women.

Similarly, women's preferences subconsciously change over time so that during non-fertile stages of the menstrual cycle they are more attracted to men who appear more caring and reliable - good dads.

The hormonal levels of women using the pill don't alter much across a month and most closely reflect those typical of the non-fertile phases of the menstrual cycle. It seems that our preferences are shaped by these hormonal levels, so preferences of women on the pill don't change around ovulation in the way seen in normally-cycling women.

(conclusion) Choosing a non-hormonal barrier method of contraception for a few months before getting married might be one way for a woman to check or reassure herself that she's still attracted to her partner. "

Written by Christian Nordqvist

Related articles

• The Pill Alters How Women Select A Partner (medicalnewstoday.com)
• Hormonal Contraceptives Double HIV Risk (beinhealthwomen.blogspot.com)

Read more »

HIV Infection And Transmission Rates Double With Hormonal Contraceptive Usage

Women who use a hormonal contraceptive have double the risk of becoming infected with HIV-1, and are also twice as likely to pass the infection on to their sexual partner, researchers from the University of Washington, Seattle, reported in The Lancet Infectious Diseases. The raised risk is especially notable among those using injectables. The authors informed that over 140 million adult females around the world use hormonal contraception, including long-acting injectables or oral pills.

Co-author, Jared Baeten said:

"These findings have important implications for family planning and HIV-1 prevention programmes, especially in settings with high HIV-1 prevalence."

Lead author, Renee Heffron said:

"Recommendations regarding contraceptive use, particularly emphasising the importance of dual protection with condoms and the use of non-hormonal and low-dose hormonal methods for women with or at risk for HIV-1, are urgently needed."

A significant number of females in sub-Saharan Africa who are HIV positive use hormonal contraception. HIV susceptibility linked to hormonal contraction had been studied before, but with inconsistent and inconclusive results, the authors wrote.
The aim of this study was to determine whether using hormonal contraception raises a woman's risk of HIV infection and transmitting it to male sexual partners. It involved 3,790 couples, with one partner infected with HIV-1 and the other not (serodiscordant couples); they were all heterosexual. The individuals came from Zimbabwe, Uganda, Tanzania, South Africa, Rwanda, Kenya and Botswana.
The study found that:

• A woman's risk of becoming infected with HIV-1 doubled if she was on hormonal contraception
• There was a more significant risk for those taking an injectable hormone contraceptive (DMPA)
• Those on injectable contraceptives were twice as likely to transmit their HIV-1 infection to their male sexual partners, compared to women not on hormonal contraception

The authors wrote:

"To our knowledge, ours is the first prospective study to show increased HIV-1 risk in male partners of HIV-1 infected women using hormonal contraception.
(conclusion)Data on HIV-1 risk associated with...other hormonal contraceptives, such as implants, patches, or combined injectables . . . and non-hormonal contraceptive methods such as intrauterine devices, are urgently needed, and strategies to improve accessibility and uptake of these lower-dose and non-hormonal methods should be prioritised. Contraceptive counseling should be combined with HIV-1 counseling and testing."

Charles S Morrison from Clinical Sciences, Durham, USA, wrote in an Accompanying Comment in the same journal:

"Active promotion of DMPA in areas with high HIV incidence could be contributing to the HIV epidemic in sub-Saharan Africa, which would be tragic. Conversely, limiting one of the most highly used effective methods of contraception in sub-Saharan Africa would probably contribute to increased maternal mortality and morbidity and more low birthweight babies and orphans - an equally tragic result.

The time to provide a more definitive answer to this critical public health question is now; the donor community should support a randomised trial of hormonal contraception and HIV acquisition."

Hormonal contraception

There are two main types of hormonal contraceptives:

• Combined contraceptives - these contain both an estrogen (ethinyl estradiol) and a progestin. The most popular medication is the combined oral contraceptive pill (COCP), also known as the pill. It is typically taken once daily for 21 consecutive days, followed by nothing for seven days - there are alternatives to this cycle. For those not on ongoing hormonal contraception, COCPs can be administered after sexual intercourse as emergency contraception. COCPs are presented in a variety of formulations.
• Progestogen-only contraceptive - these contain progesterone or progestin (a synthetic analogue of progesterone). POP (progestogen only pill) is taken every day, within the same three-hour window each day. There are several different POP formulations. POPs are taken every day with no breaks. For those not on continuous POPs, POPs can be taken after sexual intercourse as emergency medication. POPs come in a variety of formulations.

Ormeloxifene, while not a hormone, acts on the hormonal system to prevent pregnancy.
Written by Christian Nordqvist

Related articles

• Hormonal Contraceptives Double HIV Risk (beinhealthwomen.blogspot.com)

Read more »