Not everything you hear of these days is the
sweetness and light it may
seem. January 1999 brought main news headlines
of a newly published
25 year study reported in the British Medical
Journal(Jan 8th 1999) on
the pill's long term side effects. "Pill Study
shows no long term
side-effects" ran the headline in the Irish
Times.. "Pill gets all clear in 25
year study" reported the Irish Independent.
Ten years after giving up
the pill, its adverse effects by death from
cancer and stroke were no
different than any other causes. Ecstatic
acclamations were reported
from the pill providers in Ireland. "Fantastic
news" was the reaction by
Irish Family Planning Associations (IFPA)
board member Professor
Walter Prenderville reported in the Irish
Times January 8th 1999. There
was now "little cause for concern" for women.
Dr Sheila Jones, also of
the IFPA, commented "it was very reassuring
for women who might
have been worried" One could be forgiven for
thinking that perhaps all
along we had been too hard on the pill and
all the negative press it had
suffered. Too hard, that is, until one actually
reads the British Medical
Journal (BMJ) article itself and analyses
it in the light of current medical
literature.
Only half the story was reported in the press.
The study in question
explicitly admitted "significant excess mortality"
amongst women who
are current users and recent users (up to
ten years since last use) For
this group, the risk of death for cervical
cancer was increased by as
much as 200%, for cerebrovascular disease
(stroke) an increase of 170%
and circulatory diseases 120%. It was only
amongst those who survived
the first ten years that the relative risk
returned to baseline! This is small
comfort for those women who DID die of clotting,
stroke or cancer.
Those women, for obvious reasons, weren't
included in the statistics for
those women surviving beyond ten years.
And there's more. One glaring weakness in citing
this study are the
statistics for breast cancer. This study bears
no relevance to the greatly
increased breast cancer risk (200-480%) reported
in other studies for
early pill users ie 19 years or younger. This
is because the women
involved in the study had a median age of
24 years at the start of the
study and 49yrs at the end. The risks are
2-4 times higher for women up
to 19 years old compared to women 20-24 years
because of the rapid
tissue and hormonal maturation process in
the younger age group.
The figures reported for breast cancer are
surprisingly low in every table
cited even for women using the pill for greater
than ten years duration.
Whilst not questioning the validity of methodology
of the researchers,
the figures reported fly in the face of all
the other studies reporting
substantial correlation between breast cancer
and duration of pill use. In
one study of 918 Dutch women diagnosed with
invasive breast cancer,
85% had used the pill at some time in the
past. Another study reported a
310% increase with greater than 10 years use.
Even 3 months use of the
pill was associated with a 100% increase in
breast cancer. The
researchers in the BMJ study did acknowledge
that "further data are
needed to confirm our findings"
Furthermore, this study is completely irrelevant
to the brands of pills
implicated in the 1995 pill scare and deep
vein thrombosis (blood clots).
This study started in 1968, with formulations
that bear no resemblance to
today's pills. With the modern day brands
of pills involved in 1995, the
risk of blood clots is 600-900% higher than
non users of the pill across
all age groups. In 15-19 year olds, this can
be estimated to rise to twenty
fold.
With the incidence of breast cancer, cervical
cancer, blood clots,
infertility and stroke with the use of the
pill, the bald reality is that we are
dealing with drug induced vandalism of the
female physiology. The spin
put on the results of this study by family
planning advocates who
encourage pill use whilst soothingly minimising
the dangers is a
profound injustice to women.
The study reported above deals purely with
the clinical side-effects of
the pill. The inherent abortifacient nature
of the pill is a subject that
women too are kept in the dark about. Witness
the confusing
pharmaceutical jargon employed in the pill
leaflet information to describe
its mode of action, jargon which admits the
possibility of an abortifacient
action with terminology that non-medically
trained women would
struggle to understand. As a pharmacist, I
can say with certainty that
EVERY type of pill has an intrinsic abortifacient
action as a backup
mechanism should the other modes of action
fail. That a women could
unknown to herself be aborting her child after
conception during pill use
is a shocking reality to many when they realise
it. This is a reality denied
by many doctors, family planning associations,
and other healthcare
professionals.
The ethical and moral implications are profound
- not just for the women
using these drugs but for the healthcare professionals
promoting these
drugs. As with abortion, real and uncomfortable
questions arise
regarding the status of the embryo from conception
- its personhood,
dignity and sacred character. It is ironic
that the very people and
organisations who clamoured do much for contraception
in the 1970's
and 80's, claiming it would prevent abortion
in Ireland are the very same
parties who are calling for abortion now in
the 1990's. Indeed, some are
in the forefront of promoting so-called "emergency
contraception"
whilst denying its explicitly abortifacient
action. It is in the interest of the
same parties to minimise the impact of pill
scares so they can continue
their agenda unhampered, an agenda profoundly
at variance with the
Judeo-Christian life and sexual ethic.
Women who use these products deserve to know
all the realities and to
make a fully informed choice. To deprive them
of this is an attack on
their dignity. Women should not be allowed
to be scapegoats in the
pursuit of vast financial interests. The side-effects
of the pill is only a
side issue. What we are really witnessing
is the clash of two opposing
values systems of morality and sexuality.
The choice made will greatly
impact the welfare or the detriment of us
all.
Patrick McCrystal
Executive Director
Human Life International (Ireland)
Jan 1999
Fact Sheet - Contraceptive Pill Side-Effects
1) Breast Cancer
For those women starting
the pill before 20yrs old, the risk of
dying from breast
cancer was 820% higher than for healthy
nonusers of the same
age.(1) *p61
For women starting
pill between 20-25 years, relative risk was
180% higher than
healthy non-users (1) *p61
Other researchers
cite the risk of breast cancer for young
women(<20 yrs
old) is 200-480% higher than for non-pill
users(2,3,4) *p53,219,223
Therefore the range these studies cite for breast cancer is 200-820%
In one study of 918
Dutch women diagnosed with invasive
breast cancer, 85%
had used the pill at some time (4a)
Even 3 months use
of the pill has been reported to be associated
with 100% increase
in breast cancer (4b) *p49
For more than ten
years use, breast cancer risk increased by
310% (4b) *p49
"women with breast
cancer, who at an early age have used OC,
have larger breast
tumours…and a worst prognosis compared
with later (pill
users) and never users(5) *p60
Death rate from
breast cancer
Australia
20.4/100,000
USA
20.7/100,000
Japan
7.1/100,000
ie a x3 fold reduction
in Japan. Australia/USA have a pill history
of 30 years with
identical breast cancer statistics. Industrialised
Japan, has no pill
use, reports one third the rate (5a)
(Note: With use of Depo-Provera (DMPA) - "Use
for two years or
longer before age 25 was associated with a
significantly increased risk
of breast cancer" (ie 360% increase) (6) *p100
2) Cervical Cancer
Pill use in women
<20years old means 280% higher risk of
cervical cancer
In women 20-24 years,
its 70 % higher
In women 25-29 years
its 40% higher (7) *p26, 219
Another study cites
increased risk of 250% for cervical cancer
amongst pill users
(8) *p21
Longer term users(6-12
years) 100-340% increased risk of
non-users cervical
cancer(9,10) *p24,25
However, one of these
studies showed women who used the pill
for only 1-6 months
had a 190% increase in cervical cancer than
non-users (9) *p24
Clinical evidence
cites the pill's role in activation of and
enhancing HPV (Human
Papilloma Virus) in initiation of cervical
cancer. (11,12) *p36
3) Deep Vein Thrombosis (DVT)
Risk of DVT increased
by 600-900%(ie 5-8 fold) compared to
non-users in users
of 3rd generation progestagen pills (eg
containing gestodene
- eg Femodene, Minulet, Tri-minulet, or
containing desogestrel
- eg Marvelon) (13,14) *p219
Across all age groups,
use of the 3rd generation pill brands had a
770% greater DVT
risk than non-pill users (15) *p80
Second generation
progestagens (levonorgestrel,norethisterone)
have 120-280% increase
risk of DVT (16,17) *p80,82
For teenagers aged
15-19yrs risk of DVT " for the
desogestrel-containing
OC was 7-fold higher than that of the
levo-norgestrel containing
products; among women aged 20-24
the risk was 4-fold
higher" (18) *p81 IMPORTANT! Note that
this x7 increase
was relative to 2nd generation users not
non-users!!
Therefore, by computation,
risk for 15-19yr olds compared to
non-users is
(120%-280%) x 7 =
x 15-26 fold risk!!
A x50 fold increase
risk of DVT for users carrying a blood
clotting factor V
Leiden mutation (19) *p81 This occurs in 3-5%of
Dutch/Swedish women
*p77
Note mechanism -
gestodene causes decreased oestrogen
metabolism in liver
leading to accumulation in body leading to
increased DVT risk
*p74
4) Infertility after pill-use
Women may not conceive
for up to 48 months or longer
depending on age
(19,20) *p93
This is due to atrophy
of the mucus secreting glands thus
preventing sperm
transport *p94-95
5) Teratogenicity
Birth defects/chromosomal
abnormalities in children conceived
right after pill
cessation (21,22) *p92
COMMENT
Fertility drugs cause hyperstimulation of
the ovaries, leading to
increased ovarian cancer of the ovary due
to increased minor trauma of
the covering epilthelium *p141
The pill, and pregnancy, and breast feeding
cause a rest in ovulation,
thus associated with a decreased incidence
of ovarian cancer. Some
family planning advocates defend or advocate
pill use because of the
associated decrease in ovarian cancer rates(0.2%
risk). To do so in light
of the magnitude of the side-effects of the
pill documented is a woeful
ignorance of the facts or a deliberate and
cynical act of injustice to
women.
All references from - A Consumer's Guide to
the Pill by John
Wilks B Pharm
MPS 2nd Ed1997 ALL Publications
Available from HLI (Ireland) £14 which
includes p & p
References
1) Olsson H, Borg A, Ferno M, Moller TR, Ranstam
J. Early oral
contraceptive use and premenopausal breast
cancer - a review of studies
performed in South Sweden Cancer Detection
and Prevention 1991:15
(4): 265-271 Table IV.
2) Olsson H & ML, Moller TR, Ranstam J,
Holm P. Lancet(letter) 1985
March 30, 748-49
3) Olsson H, Moller TR, Ranstam J. Early oral
contraceptive use and
breast cancer among premenopausal women: Final
report from a study in
Southern Sweden. Journal of the National Cancer
Institute.
1989;81(12):1000-4
4) Johnson JH, Weighing the evidence on the
pill and breast cancer
Family Planning Perspectives 1989: 21 (2):
89-92
4a) Rookus & Van Leeuwen. Oral Contraceptives
and risk of Breast
Cancer women aged 20-54 years. Lancet 1994
; 344; p844-51
4b) Millar DR, Rosenberg L, et al Breast Cancer
before age 45 and oral
contraceptive use ; new findings. American
J of Epidemiology 1989;129
(2):269- 80,
5) Olsson H, Borg A, ferno M, Moller T, Ranstam
J. Early oral
contraceptive use and breast cancer in Southern
Sweden. Proc. Annu
Meet Am Soc Clin Oncol. 1989: A367, Ma
5a) WHO Cancer Mortality database 1994 Breast
Cancer Rates by
Country.
6) Paul C, Depo medroxyprogesterone (Depo-Provera)
and risk of breast
cancer Br Med J 1989; 299: p762
7) Thomas DB, Ray RM. Oral contraceptives
and invasive
adenocarcinomas and adenosquamous carcinomas
of the uterine cervix
Am J Epid 1996;144:p284 table 2.,
8) Kohler U, Wuttke P. results of a case control
study of the current
effect of various factors of cervical cancer
risk . 2) Contraceptive
behaviour and the smoking factor. Zentralblatt
fur gynakologie 1994;116
(7): 405- 9 (Ma)
9) Ursin G, Peters RK, Henderson BE, d'Ablaing
G, Monroe KR, Pike MC.
Oral contraceptive use and adenocarcinoma
of cervix. Lancet 1994; 344;
1390-1394
10) Brisson J et al Risk factors for cervical
Intraepithelial Neoplasia:
differences between low and high-grade lesions
American J of
Epidemiology 1994;140:700-710
11) Chen Y-H, Huang L-H, Chen T-M. Differential
effects of progestins
and estrogens on long control regions of human
papilloma virus types
16 and 18. Biochemical and Biophysical Research
Communications
1996;224:p654
12) Kenney JAW. Risk Factors associated with
genital HPV infection.
Cancer Nurse 1996 (Oct);19:5, p353
13) Vandebrouke JP, Rosendaal FR. End of the
line for "third-generation
pill" controversy? Lancet 1997; 349:1113-1114
14) Vandenbrouke JP et al Increased risk of
venous thrombosis in oral
contraceptive users who are carriers of factor
V Leiden mutation. Lancet
1994;344:p 1454
15) Bloemenkamp KW, Rosendal FR, Helmerhorst
FM, Bauller HR,
Vandenbroche JP. Enhancement by factor V Leiden
mutation of deep
vein thrombosis associated with oral contraceptives
containing third
generation progestogen. Lancet 1995;346:8990:1593-6
16) Ref 15 p1594, table 1
17) Spitzer WO, Lewis MA, Heineman LAJ et
al. Third generation oral
contraceptives and risk of venous thromboembolic
disorders: an
international case-control study Br Med J
1996;312:83-8
18) Bloemenkamp et al p1595
19) APPG 24th Ed Microgynon 30 monograph 1995
p1508
20) Micromedex vol 89 Oral contraceptives
monograph
21) Wade ME, McCarthy PM et al. Am J Obstet
Gynaecol 1995; 172:
p698
22) Rahwan R, Prof Pharmacology & Toxicology,
College of Pharmacy
Ohio State University. Chemical Contraceptives,
Interceptives and
Abortifacients 1995
Patrick McCrystal
Human Life International (Ireland)
Jan 1999
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