Women's Health News For women without pre-existing risks for heart disease, the early formulations were generally safe, and the newer ones appear to be even safer, but all the risks and benefits are yet to be established, especially as women's lifestyles change and new forms of contraceptives become available, according to specialists in women's heart disease at Cedars-Sinai Medical Center. "As women use these therapies more frequently and for longer periods of time, there is an urgent need to better understand and minimize associated cardiovascular risks," said C. Noel Bairey Merz, M.D., director of the Women's Heart Center and the Preventive and Rehabilitative Cardiac Center at the Cedars-Sinai Heart Institute. She is senior author of an article in the Jan. 20, 2009, issue of the Journal of the American College of Cardiology that provides an overview of the known cardiovascular risks and benefits of hormonal contraceptives while pointing out areas that require further research. Reproductive hormones affect the tone and function of blood vessels as well as lipid (fat) levels in the blood. Low estrogen levels have been found to increase risk of coronary atherosclerosis (thickening and hardening of artery walls) and "adverse cardiac events," such as heart attacks and strokes. But the use of supplemental estrogen in hormone replacement therapy has been linked to an elevated risk of blood clots that can lead to heart attacks and strokes. "Health care providers must evaluate each woman's risk factors, especially those related to cardiovascular health, prior to starting any contraceptive therapy. Although pre-menopausal women have a much lower risk of cardiovascular disease, routine screening for potential problems and follow-up is important," said Chrisandra L. Shufelt, M.D., assistant director of the Women's Heart Center at the Cedars-Sinai Heart Institute and co-author of the journal article. The earlier contraceptives used higher levels of estrogen than the newer formulations, which are now available not only in pill form but in patches and vaginal rings. The newer formulations use lower doses of estrogen, which is safer in terms of lowering the risk of blood clots, and they tend to use a progestin, a synthetic version of progesterone that is not likely to raise blood pressure and may even slightly reduce it, according to Bairey Merz, who holds the Women's Guild Endowed Chair in Women's Health and is a professor of medicine at Cedars-Sinai. Since 2000, death rates have increased in women between the ages of 35 and 44, while all other age groups have seen a decline. Among factors that may be contributing to the rise are increases in obesity and smoking, a decline in physical activity at this time in life, and a significant increase in the use of oral contraceptives. Women at high risk for cardiovascular problems, especially those who smoke, should consider alternative forms of contraception. Those with other cardiac risk factors, such as hypertension or elevated cholesterol, can consider using hormonal contraceptives if they are carefully monitored by their health care provider, Bairey Merz said. Any woman considering the use of contraceptives should be evaluated for cholesterol levels, blood pressure, smoking, diabetes, kidney problems, obesity and other vascular diseases, including migraines. Healthy, nonsmoking women who are 35 or older can continue taking a low dose oral contraceptive until 50 to 55 years after reviewing the risks and benefits.
Oral contraceptives may be safe, but information gaps remain
Published: Saturday, 17-Jan-2009
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Introduced in the 1960s, oral contraceptives have been used by about 80 percent of women in the United States at some point in their lives.
Monday, January 19, 2009
Oral contraceptives may be safe, but information gaps remain (Women's Health News)
Friday, November 21, 2008
The Pill & Cervical Cancer & Heart Disease
CHICAGO (Reuters) - Women who take oral contraceptives run a higher risk of developing cervical cancer, but this risk is transient and reverts to normal about 10 years after they stop, British researchers said on Thursday. Other studies have found a link between taking the pill and cervical cancer, but this is the first to show how long this risk persists, according to the study in the journal Lancet. Dr. Jane Green, a cancer epidemiologist from Britain's University of Oxford, studied data from 24 studies involving more than 16,000 women with cervical cancer and more than 35,000 without. For women in developed countries who took the pill from age 20 to 30, the number of cases of cervical cancer by age 50 rises to 4.5 per 1,000 women, from 3.8 cases per 1,000 in women who did not take the pill. The incidence rises to 8.3 cases per 1,000 for pill users in less developed countries, compared with 7.3 cases per 1,000 for women who did not take the pill. But this extra risk is outweighed by a reduction in the risk of ovarian and endometrial cancers, the researchers said in a statement. Cancer researcher Ciaran Woodman of the University of Birmingham said the study reinforces the need for routine screening for cervical cancer. "The take-home message should be that all women must come for screening when invited," she said in a statement. Cervical cancer is the second most common type in women and the leading cause of cancer death in some countries. Virtually all cases of cervical cancer are caused by the sexually transmitted human papillomavirus or HPV. The study by scientists in Belgium suggests the pill may increase a woman's risk of heart attack or stroke. The researchers from Ghent University say women who have used oral contraceptives are more likely than those who had not taken the pill to have a buildup of plaque in their arteries. Dr. Ernst Rietzschel who led the study says the main concern is that higher plaque levels increase the risk of a clot developing on one of the plaques resulting in a stroke, heart attack or sudden cardiac death. Dr. Rietzschel and his team studied 1,301 women ages 35 to 55; of that number 81 percent had used the pill, for an average of 13 years. The researchers found a rise of 20 to 30 percent in arterial plaque in the two big arteries, the carotid in the neck and the femoral in the leg, for each decade of use. Plaque levels were measured using a technique called vascular echography. Atherosclerosis results in a hardening and narrowing of the arteries caused by the slow buildup of plaque, made up of fat, cholesterol, calcium and other material, on the inside of artery walls. Rietzschel says the findings should not trigger alarms about the safety of the pill but women should take other steps to reduce their cardiovascular disease risk such as eating a healthier diet, getting more exercise, not smoking and controlling cholesterol. But he also says oral contraception is not the only form of contraception and women could explore other options. Experts have expressed surprise at the results but say the finding needs to be tested in larger and more rigorous studies. Many in the study had taken first-generation birth control pills, which had twice the estrogen levels than most sold today. The birth control pill which uses hormones to suppress ovulation is now taken by 100 million women worldwide. The research was presented at an American Heart Association meeting.
Reuters.com
Cervical cancer risk seen higher when on pill
Questions raised over the safety of the long-term use of the birth control pill
Women's Health News Published: Wednesday, 7-Nov-2007
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New research has again raised concerns about the safety of the long-term use of the birth control pill.
Thursday, November 20, 2008
Birth Control Options
Although perfection remains elusive and choices are equally effective, the review authors were able to pinpoint some preferences. "Basically, all of these methods were similar in preventing pregnancy," said lead investigator Laureen Lopez, Ph.D., research associate at Family Health International in Research Triangle Park, N.C. Last week, the U.S. Food and Drug Administration added warning data to the drug label for the contraceptive skin patch, advising users that the women using the patch have a greater risk of blood clots than pill users. The study prompting the FDA action was not part of the review. For the review, the researchers looked at 11 randomized controlled trials - three comparing the patch to the pill, and eight comparing the ring to the pill - comprising more than 6,000 women. Women using the patch were more likely to use the medication as prescribed than those on the pill were. However, patch users experienced more side effects and were more likely to abandon their method eventually than pill users were. Ring users generally had fewer serious side effects than pill users, but had more vaginal irritation and discharge. Despite this, vaginal ring users tended to stick with their approach longer than the pill group. The patch is a small adhesive square that dispenses hormones and which a woman must replace every week for three weeks, and then leave off for a week. The Ortho Evra contraceptive patch is the only patch approved for use to date. The NuvaRing, which Organon manufactures, releases hormones into the vaginal cavity. A woman inserts the ring, a flexible piece of plastic tubing, where it remains for three weeks; she then removes it for one week. Many consider the ring and patch easier to use than birth control pills because women do not have to attend to them every day. Compared with pill users, patch users had more bleeding breakthroughs, breast discomfort, painful periods, and nausea and vomiting. Rings users, on the other hand, had more vaginal irritation and discharge. Of the two, patch users tended to discontinue the method more readily. The contraceptive review updates one done in the past, for which only two studies of the patch versus the pill were available. The ring data are new. For all methods, several studies had women drop out, which can limit the value of the results according to the researchers. "Women who used the ring had fewer bleeding problems than those on the pill, but they did have irritation," Lopez said. "But discontinuation was similar for the ring and the pill in most of the studies." Clinicians have seen the ring increase in popularity, Lopez added. Mitchell Creinin, M.D., professor and director of gynecological specialties at the University of Pittsburgh, is familiar with all of the review studies. "It all comes back to compliance." Creinin said. "Once a week versus once a day, twice as much hormone entering the body (with the patch), or half as much (with the ring)." Creinin, who was not involved with the review, said it is important to understand the people who would enter these studies: "These studies were done primarily when only the pill was available. Women who were unhappy with their present method of birth control were the ones likely to enter them." He noted that the results differ among studies between European and American women. "North American women tend to have more complaints and are less compliant," he said. Overall, Creinin said, women are happy with their birth control because they are not getting pregnant. Lopez said that women have to consider many issues when choosing a method of birth control. Ease of use, side effects and life situation are each important. For a contraceptive to be effective, the woman must be willing and able to follow the prescribed regimen. "Women are finally beginning to understand that taking a pill every day is difficult." Creinin said. He is working on an upcoming study comparing the ring to the patch.
Birth control options
Women's Health News Published: Monday, 28-Jan-2008
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With many women still searching for the perfect birth control method, a systematic review analyzes a host of studies comparing the contraceptive skin patch or vaginal ring to the pill.
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