Teenage girls taking low-dose oral contraceptives showed abnormally low levels of bone growth, and sometimes even lost density, compared with teens who took birth control pills with a higher dose of estrogen, Czech researchers found.

In a randomized, crossover trial, bone mineral density (BMD) failed to increase in girls 15 to 19 years old who took pills with a low dose (15 micrograms) of ethinyl estradiol for nine months, while bone density increased normally in participants taking pills with a high dose (30 micrograms) of ethinyl estradiol, according to Dr. Jan Stepan of Charles University in Prague.

In a presentation here at the American Society for Bone and Mineral Research, Stepan said that based on these findings, girls who need oral contraceptives “could be counseled toward preparations with higher estrogen levels.”

The study involved 82 girls in their middle to late teens — a period during which they should be accumulating bone density.

Twenty-eight girls were given no medications and served as controls. The other 54 were randomly assigned to nine months of treatment with oral contraceptives containing either 15 or 30 micrograms of ethinyl estradiol.

After the initial treatment period, those in the treatment group were switched to the other contraceptive dosage for another nine months.

Lumbar spine BMD and whole body bone mineral content were measured at the outset and after each nine-month period. In the control participants, spinal BMD increased by 1 percent during each treatment period, and whole body bone mineral content rose 2 percent in each period.

Those initially assigned to the 30 micrograms ethinyl estradiol dosage also showed a 1 percent increase in spinal BMD, but it returned to baseline levels when they switched to the 15 micrograms dosage.

Participants first receiving the 15 micrograms dose showed virtually no increase in spinal BMD. After switching to the higher dosage, spinal BMD accumulation paralleled that of control participants.

http://www.medpagetoday.com/MeetingCoverage/ASBMR/15944

http://abcnews.go.com/Health/low-dose-estrogen-birth-control-slow-bone-growth/story?id=8570958

The attorneys at Morgan & Morgan are warning consumers that Yasmin (also known as Yaz) birth control pills have been linked to serious side effects, including heart attack, stroke, and death. Yaz and Yasmin, as well as the generic equivalent Ocella, are daily oral contraceptives designed to prevent pregnancy.

Yasmin is one of the most popular oral contraceptives on the market, and it is the first type of birth control to contain a different kind of hormone, called drsp or drospirenone. Although the manufacturers of this drug claim that it is as safe as other types of accepted birth control pills on the market, drospirenone can increase the potassium levels of users. Increased potassium levels can cause health problems and are particularly dangerous for people with kidney, liver or adrenal disease. Serious side effects that have been linked to the use of Yaz/Yasmin birth control pills include:

1. Heart attack
2. Cardiac arrhythmia
3. Blood clot
4. Deep Vein Thrombosis (DVT)
5. Pulmonary Embolism (PE)
6. Stroke
7. Gallbladder disease
8. Benign liver tumor
9. Sudden death

Risk factors for these side effects include preexisting heart or cardiovascular problems, diabetes, high blood pressure, and obesity. Less serious side effects of Yaz/Yasmin include upper respiratory infection, headache, nausea, diarrhea, vomiting, vaginitis, urinary tract infection, intermenstrual bleeding, dizziness and pain.

The Food and Drug Administration (FDA) has repeatedly reprimanded Bayer Healthcare Pharmaceuticals (the manufacturers of Yaz/Yasmin) for marketing this drug in a way that minimizes these serious side effects and misleads women about the safety of this new type of birth control. However, the drug has not yet been recalled by the FDA or by its manufacturer.

Women who get pregnant within a few weeks of taking birth-control pills seem much more likely than others to have low birth-weight or premature babies, concludes a new Canadian study that deals with one of the most widely prescribed classes of drugs.

The findings suggest couples should consider using condoms and other “barrier” contraception methods in the month before they try to conceive, say the researchers from the University of Ottawa.

The study does not definitively prove a cause-and-effect relationship and needs to be confirmed by more research, said the lead investigator. It is also unclear why oral contraceptives might affect the development of the fetus, added Xi-Kuan Chen, an epidemiologist.

The findings should not be ignored, though, he said.

“Doctors should be bringing this to the attention of patients,” said Mr. Chen, who is also a senior analyst with the Canadian Institute for Health Information. “When they consult with some patients, they should suggest there might be some effect for them.”

Babies born with a low birth weight or prematurely — a growing problem in Canada whose cause is not always clear — are more likely to suffer health problems.

One of Canada’s leading experts on threats to pregnancy, however, said he is skeptical about the team’s results, saying that most previous research has found no link between the pill and such birth problems.

Also, the study could not consider some factors that might have skewed the findings, like whether the women smoked, a leading cause of low-birth weight and prematurity, said Dr. Gideon Koren, head of the Mother-Risk program at Toronto’s Sick Kids Hospital.

It is possible, for instance, that a woman who gets pregnant soon after she was taking the pill had simply forgotten to take the drugs, indicating a careless type who might also smoke, he said.

“This clearly should not be a reason to change practices or change counselling,” said Dr. Koren of the study. “Contraceptives have been in use now for more than four decades and this issue has not come up.”

Tapping into Saskatchewan drug plan and medicare databases — among the most comprehensive in the country — the University of Ottawa researchers looked at three groups of women using oral contraceptives — those who had taken them within 30 days, 31-60 days and 61-90 days of their last period before getting pregnant –1,500 in total.

They were compared to 6,100 women who had not used birth-control pills for at least a year before they gave birth.

Outcomes were similar for most of the contraceptive users and the non-users.

Those who had taken the pill within 30 days of getting pregnant, however, were more than three times more likely to have a very low-weight newborn — under 1,500 grams (3.3 pounds) — and almost two times as likely to have a low-weight baby — under 2,500 grams (5.5 pounds). They were also twice as apt to have a baby born at least six weeks premature. The results means, for instance, that one in 42 of the oral contraceptive users had very low-weight babies, compared to one in 148 of the non-users.

The researchers say their study was unlike previous research in the area in that it isolated out women who had taken the pill very close to the time they got pregnant — where the birth effects were noticed.

But they concede the data had no information on smoking or obesity among the mothers, and that those in the 30-day group may have included a disproportionate number of unplanned pregnancies, a factor that itself might have affected the outcome.

According to researchers at Texas A&M University and University of Pittsburgh women who take oral contraceptives (OC) will find any muscle which might be gained from resistance exercise training is impaired.

The researchers from Texas A&M and the University of Pittsburgh say they have identified a potential new factor that may be independently associated with the characteristics and variability of muscle responses to a controlled resistance exercise training program.
For the study, 73 generally healthy women between the ages of 18-31 were assigned to two groups and completed a 10-week whole-body resistance exercise training (RET).
Group 1 consisted of 34 women who used oral contraceptives (OC). Group 2 consisted of 39 women who did not take birth control pills (non-OC).

The women were encouraged to consume at least 0.5 grams of protein per pound of body weight per day (a third more than is called for by the U.S. government nutritional guidelines) to make sure they consumed enough calories and protein to promote muscle growth.

The participants exercised three times per week for ten weeks under the supervision of exercise physiologists. They performed a variety of exercises to include chest press, lat pull down, leg extension, triceps extension, arm curl and abdominal crunch.

Exercise was done using standard exercise machines and each volunteer performed three sets of 6-10 repetitions per exercise at 75 percent of their maximum strength. Body composition was determined using hydrostatic weighing.

Blood samples were taken before and after the training and assessed to measure anabolic (muscle building) and catabolic (muscle breaking) hormone levels in blood. Resting and fasting blood concentrations were measured for three anabolic hormones: DHEA, DHEAS and IGF1.

Women not taking oral contraceptives gained more than 60 percent more muscle mass than those on the pill.

There were other changes noted in participants on the pill, including reduced concentrations of the hormone DHEA, which Lee explained, is an anabolic hormone and therefore builds muscle.

The team presented their findings at the American Physiological Society meeting, part of the Experimental Biology 2009 scientific conference currently underway in New Orleans.

A 24-year-old Haifa woman who was planning to get married in two months died suddenly this week after a blood clot was discovered in her lungs. Physicians believe that her death was partly due to the hormones in the birth control pills she was taking.

Though death in such instances is rare, another young woman from the Haifa area also died of an embolism several weeks ago.
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Doctors said Tamar Golan’s death Wednesday was caused by a combination of the pills and her tendency to develop blood clots.

“We know that taking birth-control pills makes blood clots four to eight times as likely,” said Dr. Benjamin Brenner, a specialist at the hematology department of Rambam Medical Center, where Golan was treated.

Critical condition

Golan arrived at the hospital in critical condition after losing consciousness in the apartment she shared with her fiance.

She was suffering from excess fluid in her brain and blood clots in her lungs, and died several hours later.

Although Israel has dozens of cases every year of blood clots caused by birth control pills, the clots rarely result in death, said Brenner.

He said it was possible to test for potential blood clot problems, which affect about 20 percent of the population.

Although the link between lupus and oral contraceptives has been debated for some time, this new study adds weight to earlier studies — including the Nurses’ Health Study — that have shown a link between oral contraceptives and lupus, the study authors said.

The findings were published in the April issue of Arthritis Care & Research.

Lupus is characterized by acute and chronic inflammation of various tissues of the body. The immune system mistakenly attacks healthy cells and tissues, potentially damaging joints, skin, blood vessels and organs, according to the U.S. National Library of Medicine.

For the new study, a team led by Dr. Samy Suissa of the Centre for Clinical Epidemiology at Jewish General Hospital of McGill University in Montreal collected data on more than 1.7 million women whose medical records were in the U.K. General Practice Research Database. The women all had prescriptions for oral contraceptives.

During eight years of follow-up, 786 women developed lupus. The researchers matched each of these women with 10 women who did not have the disease.

Suissa’s team found that oral contraceptives were associated with a 1.5-fold increased risk of developing lupus. The risk was greatest during the first three months after starting “the Pill” — when there was a 2.5-fold increased risk.

The researchers speculated that increased estrogen from oral contraceptives could be responsible for the increased risk. Estrogen can affect the body’s immune response, which could trigger a genetic predisposition to the disease, the scientists said.

As reported on

• Forbes
• Modern Medicine
• Science Daily

Most women pop it for birth control
while some take it to beat acne. But the oral contraceptive (OC) pill that is generously doled out at
women’s centres and beauty clinics needs to be downed with a word of caution. Many women have suffered due to ignorance.

Vikhroli resident Tara Chandra might be a rare case, but her stint in the Hinduja Hospital, due to a brain clot explains why women need to be careful before popping the pill. Chandra, 28, went to a dermatologist in King’s Circle for control of acne last November. “He prescribed oral contraceptive pills to be taken 21 days a month. As it would help me for contraception too, I didn’t think twice,” said Chandra.

Chandra, however, belonged to a small group of women (2 per 10,000) who face the risk of developing a blood clot after taking the pill. Within two months, she started complaining of acute headaches. Painkillers did not work and she soon landed up at Joy Hospital in Chembur with numbness in the left side of the body. “An MRI scan showed that she had a brain clot. We shifted her to Hinduja Hospital when her condition worsened,” said her husband Anuj.

She was put on blood-thinning medicines and kept under 24×7 monitoring. In the hospital for a week, the young couple discovered that side-effects related to OC pills are not unheard of. Doctors told them that while it was impossible to correlate the stroke to the pill, the link was a distinct possibility. Chandra was out of work for four months and coughed up Rs 1.5 lakh in hospital bills.

Source: The Times of India

1. Thromboembolic disorders and other vascular problems
• Myocardial infarction
• Thromboembolism
• Cerebrovascular diseases
• Dose-related risk of vascular disease from oral contraceptives
• Persistence of risk of vascular disease



2. Death
3. Carcinoma of the reproductive organs and breasts
4. Hepatic Neoplasia
5. Ocular Lesions
6. Gallbladder disease
7. Elevated blood pressure
8. Headache
9. Bleeding irregularities
10. Ectopic pregnancy

An American woman in her 40s nearly lost a leg to gangrene because of a confluence of health factors exacerbated by a diet that included daily doses of grapefruit, the doctors who treated her reported in a medical journal on Friday.

“The way I think of it actually is like she’s a setup for the perfect storm. And I believe it was the grapefruit that tipped the balance,” Dr. Lucinda Grande, a medical resident at Providence St. Peter Hospital in Olympia, Wa., explained in an interview.

Grande is the first author on the case report, which appears in this week’s issue of The Lancet.

The woman, then 42, arrived at the hospital’s emergency room last November with a badly swollen and discoloured left leg. She was experiencing shortness of breath and light-headedness.

Doctors diagnosed a large deep vein thrombosis – a dangerous blood clot – in her left leg, running all the way from her hip to her calf. Because of the condition of the leg, the doctors treating her were worried she might be developing irreversible gangrene that would force amputation of the limb.

But quick treatment with clot-busting drugs and the insertion of a stent to open a chronic narrowing of a large vein in her hip resolved the problem and saved the leg.

In addition to having this congenitally narrow vein in her left hip, the woman was slightly overweight, took oral contraceptives and had driven for an extended period, about 1.5 hours, the day before the problem occurred.

All of those factors individually increased her risk of developing a blood clot, the authors said. And together they raised the risk even more.

But when Grande was discharging the woman from hospital, the patient mentioned she’d started a diet three days before that involved eating 225 grams of grapefruit every morning. She had rarely eaten grapefruit previous to that and wondered if it might be playing a role.

The doctors consulted the medical literature on the multiple drugs grapefruit interacts with and concluded that it’s likely the grapefruit was the straw that broke the camel’s back in this particular case.

They do not, however, believe others should change their grapefruit consumption patterns based on this case.

“I think … this woman’s story is so unique it should not discourage people in any way from eating grapefruit,” Grande said.

“Grapefruit is not a danger to society. It just happened to be dangerous for this specific person in this specific situation.”

It’s been known for nearly 20 years that grapefruit can trigger serious interactions with drugs. The person who first spotted the problem is Canadian pharmacologist David Bailey, who teaches at the University of Western Ontario.

Bailey was trying to devise a study to see whether alcohol would interact negatively with felodapine, a commonly prescribed drug for high blood pressure. He wanted to make sure the trial was blinded, meaning neither the doctors nor the volunteers would know who was drinking alcohol.

The only way he could find to effectively mask the flavour of the alcohol was to mix it with grapefruit juice. The wonky results he got made him look further, leading to the discovery that grapefruit and grapefruit juice block the ability of the small intestine to break down some drugs.

The result is like an unintentional drug overdose for medications with which grapefruit interacts, Bailey said from London, Ont.

Since Bailey first reported the finding in The Lancet in 1991, more than 55 drugs have been found to interact with grapefruit. Included among them are some statins (cholesterol lowering drugs), some antihistamines, and some drugs used to treat arrhymias or irregular heartbeats.

The authors of this case report said the grapefruit the woman consumed blocked the breakdown of the estrogen in her birth control pills. Estrogen increases the risk of blood clots.

Bailey said the effect of grapefruit on estrogen is not generally large, but in this particular case build up of additional estrogen may have been enough to cause the problem.

“I don’t think on the whole it’s a huge problem….But it may be enough to tip her over the balance,” he said.

Florida’s Department of Citrus disagreed, issuing a statement Thursday disputing the hypothesis.

“We are aware of no validated evidence that grapefruit affects oral contraceptives, and they are generally considered to be safe to consume with grapefruit,” it read.

Bailey said some other citrus fruits also interact with drugs in the same way, including limes, Seville oranges (but not navel oranges) and pomelos.

The Canadian Press

Researcher: Collaborative Group on Hormonal Factors in Breast Cancer
Year: 1996
Number of participants: 150,000
Conclusion: Women who were current or recent users of birth control pills had a slightly elevated risk of developing breast cancer

Researcher: Collaborative Group on Hormonal Factors in Breast Cancer
Year: 2002
Number of participants: 4,575
Conclusion: Factors such as longer periods of use, higher doses of estrogen,
initiation of OC use before age 20, and OC use by women with a family
history of breast cancer were not associated with an increased risk of
the disease

Researcher: National Cancer Institute (NCI)
Year: 2003
Number of participants: 1300
Conclusion: The risk of developing breast cancer is highest for women who used OCs within 5 years prior to diagnosis, particularly in the younger group.