Weighing Risks and Benefits of Oral Contraceptives to regulate periods
Question
Hi. I am happy to have found your site.
I am 39, female, healthy eater and a runner. Very fit and healthy. 5′ 6″ 125 lbs. I have no history of disease, never smoked. I have had two children and breast fed both. I did suffer from depression for six months three years ago, but other than that I have been totally healthy. I have somewhat irregular periods and have since the beginning. I was on birth control pills for about 5 years in the early 80’s.
My mother (75) has never had cancer. Her mother had breast cancer and her sister has had uterine cancer (at age 70).
My gynocologist, whom I adore and have been seeing for twelve years, has prescribed Zovia for me for reduction in the risk of ovarian and uterine cancers and to regulate my periods.
I am extremely hesitant to take any medication. Could you please give me your thoughts on why you would prescribe or not prescribe this drug for me based on this limited information?
Respectfully,
Kerri
Answer
Last Updated: June 14, 2013
Dear Kerri,
For any medicine that is prescribed, there are risks as well as benefits. You are contemplating taking Zovia, an oral contraceptive pill, for the prevention of ovarian and uterine cancer, as well as improving irregular periods. In my opinion, the risks of birth control pills in your situation are greater than the benefits.
Birth control pills may increase your risk of stroke, blood clots in the legs and lung, as well as heart attacks. There are a number of articles linking birth control pills, particularly prolonged use, with breast cancer. Blood sugar abnormalities, gall bladder disease, liver tumors, as well as depression and decreased libido are also some of the major and minor side effects of oral contraceptives. From what you have told me about your health and medical history, you are not at high risk for ovarian cancer. Although your aunt had uterine cancer at an elderly age, I do not think you are at high risk for this cancer either. Uterine cancer is not usually a genetically-linked disease; it is more common in women with no children, diabetes, obesity and high blood pressure, which is not your profile.
A much safer way to deal with irregular periods is cooperative progesterone therapy. You do not describe in which way your periods are irregular (too heavy, too infrequent, too long?) but presumably you are not ovulating monthly. After a workup for conditions such as thyroid disease, polycystic ovarian syndrome and perimenopause, an excellent way of dealing with menstrual irregularities is by charting your cycles. A chart of an ovulation method of natural family planning such as Creighton (FertilityCare) or Billings can tell an experienced observer if one is not ovulating, having an early or delayed ovulation or stress pattern, or normal ovulation in any particular cycle. Often with abnormal cycles there is a deficiency of progesterone. Replacing progesterone with natural progesterone pills or vaginal capsules in the appropriate part of the cycle will help normalize the cycles by making up for the deficient hormone. In addition, the higher levels of progesterone feed back on the pituitary gland and help normalize the following cycle. Cooperative progesterone can also be used for ten to twelve days in the later half of the menstrual cycle without charting (say from day 16-25, day 1 being the first day of the menses), but charting the cycles usually gives more precision and better results to the therapy. This type of therapy is actually treating the hormonal problem, rather than covering up the abnormaility with fake cycles from artificial hormones.
In addition to the above considerations, I calculate your BMI at 20.6 from your height and weight. Although this is very slim and fit from a cardiovascular pouint of view, it is slightly low for optimal reproductive hormone function. Ovulation occurs best at a BMI of 21-25. Below and above that there are some women who will not ovulate regularly, whereas gaining or losing weight will optimize their ovulation.I would not necesarily advise you to gain five or ten pounds to put your BMI over 21 unless you wanted to get pregnant a third time. In that case, gaining a little weight would probably improve your cycles and your fertility.
Dr. Mary Davenport
For any medicine that is prescribed, there are risks as well as benefits. You are contemplating taking Zovia, an oral contraceptive pill, for the prevention of ovarian and uterine cancer, as well as improving irregular periods. In my opinion, the risks of birth control pills in your situation are greater than the benefits.
Birth control pills may increase your risk of stroke, blood clots in the legs and lung, as well as heart attacks. There are a number of articles linking birth control pills, particularly prolonged use, with breast cancer. Blood sugar abnormalities, gall bladder disease, liver tumors, as well as depression and decreased libido are also some of the major and minor side effects of oral contraceptives. From what you have told me about your health and medical history, you are not at high risk for ovarian cancer. Although your aunt had uterine cancer at an elderly age, I do not think you are at high risk for this cancer either. Uterine cancer is not usually a genetically-linked disease; it is more common in women with no children, diabetes, obesity and high blood pressure, which is not your profile.
A much safer way to deal with irregular periods is cooperative progesterone therapy. You do not describe in which way your periods are irregular (too heavy, too infrequent, too long?) but presumably you are not ovulating monthly. After a workup for conditions such as thyroid disease, polycystic ovarian syndrome and perimenopause, an excellent way of dealing with menstrual irregularities is by charting your cycles. A chart of an ovulation method of natural family planning such as Creighton (FertilityCare) or Billings can tell an experienced observer if one is not ovulating, having an early or delayed ovulation or stress pattern, or normal ovulation in any particular cycle. Often with abnormal cycles there is a deficiency of progesterone. Replacing progesterone with natural progesterone pills or vaginal capsules in the appropriate part of the cycle will help normalize the cycles by making up for the deficient hormone. In addition, the higher levels of progesterone feed back on the pituitary gland and help normalize the following cycle. Cooperative progesterone can also be used for ten to twelve days in the later half of the menstrual cycle without charting (say from day 16-25, day 1 being the first day of the menses), but charting the cycles usually gives more precision and better results to the therapy. This type of therapy is actually treating the hormonal problem, rather than covering up the abnormaility with fake cycles from artificial hormones.
In addition to the above considerations, I calculate your BMI at 20.6 from your height and weight. Although this is very slim and fit from a cardiovascular pouint of view, it is slightly low for optimal reproductive hormone function. Ovulation occurs best at a BMI of 21-25. Below and above that there are some women who will not ovulate regularly, whereas gaining or losing weight will optimize their ovulation.I would not necesarily advise you to gain five or ten pounds to put your BMI over 21 unless you wanted to get pregnant a third time. In that case, gaining a little weight would probably improve your cycles and your fertility.
Dr. Mary Davenport
Answered By:
Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.
