Synthetic hormones: Friend or foe?

Recent studies have questioned the impact of hormones used in female contraceptives, with more users reporting breast cancer and other debilitating illnesses than ever before.

Last August, two more studies on hormone replacement therapy (HRT) published bleak results about the treatment’s links to breast cancer.
It seems synthetic hormones are doing more harm than good and maybe we should be asking the same thing about the contraceptive jab.

In the latest UK research, the ‘Million Woman Study’, scientists from the Cancer Research UK’s Epidemiology in Oxford found new evidence that a combined HRT (estrogen and progestin) can double the risk of breast cancer.

It also estimated that HRT could be responsible for an extra 20,000 cases of breast cancer over the past decade.

In the United States, researchers at the Fox Chase Cancer Center found overweight postmenopausal women with higher levels of estrogen in their blood were also at risk of developing breast cancer.

As opposed to past studies that supported the use of synthetic hormones, these studies have done the opposite.

Like the Women’s Health Initiative study called off mid-way through its trial, these studies have raised the stakes of using synthetic hormones.

Last year, British doctors were warned that injectable contraceptives (ICs) like Depo Provera could increase a woman’s chance of developing heart disease.

In another UK study, while a group of Depo Provera users between the ages of 25-33 had no heart disease, after a year of using the jab, tests showed their arteries were not working as well as those who did not use Depo Provera.

The study also highlighted the risk was even greater for women with a history of heart disease.

So what does this mean for users of ICs? Both HRT and ICs use the same progestin – depot medroxyprogestrone acetate (DMPA) (commercially known as Depo Provera).

If long-term users of HRT are at risk of developing life threatening diseases wouldn’t this mean the same for IC users? Shouldn’t IC users be concerned about HRT health risks?

Alison Langley, UK Department of Health spokesperson says the risk of developing breast cancer is age-related and the women who use HRT are much older than those who use contraception.

“It is not, therefore, possible to extend the recent breast cancer findings with the use of combined estrogen plus progestogen HRT to use of injectable progestogen-only contraceptives,” explains Langley.

The risk from oral and injectable contraceptives is already known. But the negative effects of synthetic hormones continue to present a confusing picture.

Perhaps the real picture is only beginning to emerge.

However, it has not dented the jab’s popularity. In fact, ICs are the third most prevalent birth control in use today.

Their popularity translates into an estimated 30 million women using ICs in more than 100 countries and the numbers are rising.

This is partly due to the WHO’s reassuring data about the low risk of cancer and the US Food and Drug Administration’s 1992 approval of Depo Provera, created by Pharmacia-Upjohn.

Added legitimacy means this type of birth control is definitely big business.

How safe is safe?

The DMPA was developed in the 1960s to provide a reliable and reversible method of contraceptives that did not require women to take the pill every day.

Better known as the three-month shot, it is administered through an intra-muscular injection. It is easy to perform and suppresses ovulation.

Depo Provera’s potency means women have to remember it only four times a year and is nearly 100 per cent effective in preventing pregnancy.

So for women who regularly forget to take the pill and find having a period an inconvenience, Depo Provera is a godsend. Or is it?

Just as there are many women opting to take Depo Provera many are voicing their concern over its safety.

On Internet discussion boards, an increasing number of women are speaking out against Depo Provera. They believe the jab is responsible for the many harmful side effects they experienced while on Depo Provera and even after it.

Laura Carrasco, Oklahoma, used Depo Provera for six and a half years and in that time developed chronic migraines, insomnia, a rapid weight gain of 60 pounds, acne, chronic neck tension, back pain, hair loss, constipation, mood swings and anxiety.

Besides, Carrasco was plagued by hot flashes, back pain, painful joints, bloating, irritability, rage and anger, itchy dry skin, allergies, chronic sinus problems, PMS (pre-menstrual syndrome), loss of libido and IBS (irritable bowel syndrome).

Susan Coleman, Fife, WA, was on and off Depo Provera for over two years to control her menstrual cramps. She says her symptoms range from fibromyalgia, headaches, arthritic symptoms, vertigo, to ruptured cysts.

Some women experience side effects with birth control. After all it is a hormonal drug. But how about side effects after quitting the drug?

Furthermore, these women say Depo Provera’s side effects are more like chronic allergic reactions that have had serious consequences on their physical and emotional well-being.

Depo Provera’s twice failed third time lucky approval by the FDA sparked a lot of debate about its health risks.

In its presentation to the FDA, Pharmacia-Upjohn used the WHO study that ruled out any increased risk of breast cancer. It stated that the drug “should not be restricted on the grounds of breast cancer risk.”

However the National Women’s Health Network was not convinced.

They labelled Depo Provera as “a questionable drug with a problematic delivery system” and believed Depo Provera could represent a “risk of irreversible long term effects, specifically cancer and bone cancer.”

Upon Depo Provera’s approval, Pharmacia did admit there was “a need for further study, particularly in potentially high risk groups, including those with (i) extended hormone exposure before the age of 26 and/or first full term pregnancy and, (ii) exposure in the post menopausal period.”

The information black hole

How much are women told about Depo Provera and its systemic impact?

On the surface, it is a synthetic hormone that decreases the frequency of a woman’s ovulation by thinning the uterus lining and thickening the cervical mucus.

Even though it is designed to mimic the natural progesterone, it does not protect against bone loss, help in the breakdown of fat into energy, estrogen dominance and much more.

In the 1995 edition of the Physicians’ Desk Reference, the negative effects of medroxyprogestrone acetate were listed as fluid retention, epilepsy, migraine, asthma, cardiac and renal dysfunction, breakthrough bleeding and menstrual irregularities.

Other effects include sudden or partial loss of vision, breast tenderness, edema, rashes, acne, alopecia, hirutism, weight changes, cervical erosions, cholestatic jaundice, depression, nausea, insomnia, changes in sex drive and urinary tract problems.

Even more serious, medroxyprogestrone acetate can decrease glucose tolerance, a warning sign of diabetics and may contribute to thromboebolic disorders (blood clots in veins, legs, lungs or eyes).

Incidentally, the same side effects are printed in the Pharmacia-Upjohn safety sheet. So many potential side effects do raise the question – why put a drug like this on the market?

How acceptable is acceptable risk?

A 1997-2001 extract from the FDA’s Adverse Effects Report (AER) says more than 4,000 people suffered multiple adverse effects from the hormone.

Over 1,500 cases were attributed to Depo Provera.

FDA Press officer Laura Bradbard says the FDA monitors “all reports of adverse events to ensure an acceptable risk/benefit profile of marketed products.”

The FDA uses a risk management programme to ensure the benefits of medications outweigh the risks in general.

Therefore, what is an acceptable risk or unacceptable one when a patient is admitted to the ER for a life threatening illness instigated by a drug that is deemed reliable?

But the report is just a small portion.

Many women do not report their symptoms because their doctors tell them Depo Provera could not have caused their illnesses even though the negative effects are printed in the physician’s manual.

“When I went in numerous times they weren’t really sure about anything,” says Carrasco. “They said it be could be depression that was making me hurt so much. It was nerves. Well, I know now, it was my body telling me that we have a problem.”

The local Planned Parenthood told Carrasco that it was harmless and totally healthy.

“The only known side effects was very low/mild weight gain and you stop bleeding. It was 99.9 per cent effective. They also knew there was diabetes in my family and I was anaemic. I was told that nothing would be a problem from my family history.”

Before she began using Depo Provera, Carrasco says she was outgoing and had little to speak of problems in her past.

Tina Cross of Montreal, Canada, set up her own website after discovering more women like her suffered the same symptoms.

She registered her complaints with Pharmacia-Upjohn and the nurse’s hotline numerous times but was always told that her body would adjust in time.

After her sixth injection in September 2002, Cross suffered a complete nervous breakdown.

Kristin Presnell, Dallas received her first shot after the birth of her baby. She says the doctor never explained the side effects. After two months, Presnell suffered heavy bleeding, menstrual cramps and sharp stomach pains that landed her in the emergency room.

When she reported her symptoms she was told they were common and would go away with the next shot. “Everything seemed so much better before this shot. I will not be getting this shot again. Sure the shot was convenient but not worth the pain,” says Presnell.

Both HRT and ICs use of medroxyprogestrone acetate raises questions about its safety.

For the price of alleviating menopausal symptoms and preventing pregnancy, women face much graver dilemmas potential health risks.

Are hormonal drugs becoming a game of Russian roulette?

Former users of Depo Provera have labelled it ‘The Poison.’