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Oral Contraceptives

Oral Contraceptives

Description

Oral contraceptives are, according to the American Medical Association, the most effective method of temporary birth control now available.

Oral contraceptives come in two types. The first is the combination pill which contains synthetic estrogen and progestogen, or can be made of synthetic progesterone. The second type is a progestogen-only pill which alters the mucus secretions from the cervix so the sperm cannot penetrate the barrier and lining of the uterus. In this instance, implantation of the fertilized egg becomes impossible.

The potential dangers involved in the use of estrogens and therefore oral contraceptives have been a concern for years and constitute a serious issue. Much depends upon the amount taken, the duration of use, the potency of the preparation, and any measures taken to counteract detrimental side effects.

Conflicting studies make it difficult to arrive at definite conclusions regarding some of those dangers at the present time. There is fairly good evidence an increased incidence of endometrial cancer follows the prolonged use of estrogens, particularly the synthetic analog diethylstilbestrol (DES).

Comments about the deleterious effects of oral contraceptives must be more guarded than for DES. There is suspicion oral contraceptives containing relatively large amounts of estrogens lead to an increased incidence of venous thrombosis. Such a hypothesis has resulted in several reformulations of the hormonal composition of oral contraceptive, particularly in regard to estrogen content.

Use of oral contraceptives particularly in conjunction with heavy cigarette smoking appears to induce an increased incidence of myocardial infarction. This issue is less clear with regard to breast cancer.

It seems best to suspect use of estrogen may create a predisposition to breast cancer. However, no correlation has been recognized between the use of oral contraceptives and malignant tumors in the breast. The same negative findings apply to endometrial cancer.

While there is clear documentation of an increased incidence of liver adenomas in long-term users of the pill, the magnitude of this risk has not been established.

Causes

Oral contraceptives are used to:

· Reduce the risk of unwanted pregnancy
· Help relieve premenstrual syndrome
· Ease menstrual cramps for those women with severe cramping

The basic medical debate is whether any attendant risks in taking the pill exceed the inherent risks in pregnancy and childbirth.

There may also be protective benefits against cancer of the uterus and ovaries as well as endometriosis and iron-deficiency anemia.

Contraindications include preexisting conditions like: hypertension, or hyperlipidemia or thrombosis (blood clotts). Smoking and obesity are compounding risk factors.

Signs & Symptoms

The results of taking oral contraceptives can vary as to the effects on health in general.

Some women have no side effects. Others will develop side effects varying in type and degree, including one or more of the following:

· Mild cervical inflammation
· Hormonal changes resulting in hyperpigmented areas
· Amenorrhea from discontinuing use after several years on the drug
· Pruritis
· cessation of ovulation with certain kinds of oral contraceptives
· Periodontal disease may be aggravated
· Higher than normal risk of stroke, especially with heavy smoking
· High blood pressure
· Vaginitis

Adverse effects include nausea, vomiting and weight gain.

The mini-pill, especially, may provoke irregular periods, ectopic pregnancy and ovarian cysts.

Nutritional Supplements

Structure & Function:
        Single Nutrients
        Multi Vitamin/Multi Mineral Formulas &
        Energy metabolism


---------------------------------
General Supplements
---------------------------------

Bioflavonoids*
Calcium*
EPO*
Folic acid400 - 800 mcg
Vitamin A25,000 IU
Vitamin B Complex100 mg
Vitamin C3,000 mg
Vitamin E800 IU
Zinc20 - 40 mg
Indole 3 Carbinol*



Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Nutrient Depletion

Long term, continuous use of "the Pill" is also associated with expansive vitamin and mineral depletion, notably:

Biotin, Choline, Folic acid, pyridoxine (vitamin B6), Niacin (vitamin B3), Riboflavin (vitamin B2), Vitamin B12 and Vitamin C; as well as minerals: Calcium, Magnesium, Manganese and Zinc.

Oral contraceptives can rob your body of the following vitamins and minerals:

Vitamin B-6 Studies indicate that B-6 deficiencies can elevate homocysteine levels, greatly increasing the likelihood of heart attacks. Depletion of vitamin B-6 can cause symptoms of depression, anxiety, sleep disturbance and irritability.

Vitamin B-2 People lacking this nutrient often experience eye disorders, skin problems, dizziness, headaches and poor digestion.

Vitamin B-12 Inadequate amounts of B-12 might produce symptoms of anemia, chronic fatigue, constipation, drowsiness and headaches.

Folic Acid Depleted amounts of this nutrient are linked to neural tube defects, anemia, fatigue and elevated homocysteine levels.

(IMPORTANT: the depletion of this nutrient may require 3 months to normalize after oral contraceptives have been discontinued. This should be considered before pregnancy.)

References:

Kuhnz, W. et al., Influence of high doses of vitamin C on the bioavailability and the serum protein binding of levonorgestrel in women using a combination oral contraceptive. Contraception, 1995, 51(2): 111-116.

Mahan, K. & Escott-Stump, S: Krause's Food, Nutrition and Diet Therapy. Saunders, 1996.

Mooij, PN et al., Multivitamin supplementation in oral contraceptive users. Contraception, 1991, 44(3):277-288.

Prasad, AS et al: Effect of oral contraceptive agents on nutrients:II. Vitamins. Am. J. Clin. Nut. 1975,4:385-391.

Drug Interactions

Oral contraceptives increase the level of vitamin K-dependent clotting factors. There is a danger of thrombosis, which increases in relation to the estrogen content of the drug.

Women on oral contraceptives show a subnormal response to coumarin therapy.

Serum iron levels and iron-binding capacity is increased in oral contraceptives users, probably because of decreased menstrual flow; therefore iron loss is lessened with this drug.

Dietary Considerations

No diet is specifically prescribed for users of oral contraceptives by the American Dietetics Association. Barring any underlying health condition, a Dietary Goals Diet should be followed to provide all the nutrients necessary for building a sound and disease-resistant body.

Folic acid deficiency is common in users of oral contraceptives. This is probably due to a history of consuming diets low in folates rather than due to inhibition of their absorption.

Australian research by Dr. Michael Briggs showed that some women suffer depleted vitamin C levels when on the Pill. However, vitamin C supplements would influence the up-take of estrogen. The Pill also influences retention of iron.

Given medical supervision it may be useful to seek vitamin C foods in place of mega-dose vitamin C supplements.

This is a reminder that the arbitrary selection of mega-dose vitamins may be unwise especially in the presence of pharmaceutical hormonal manipulation.

This can result from the stimulation of the liver by the drug to release ceruloplasmin. This copper-containing protein oxidizes vitamin C.

Users of oral contraceptives frequently are deficient in vitamin B-6. The exogenous estrogen from the pill increases the body's need for vitamin B-6, a tryptophan metabolite. Because tryptophan is shunted into making the vitamin, little is left for making serotonin, a neurotransmitter. Low levels of serotonin can cause symptoms of depression. These symptoms disappear with the administration of 10 to 30 milligrams of vitamin B-6 per day.

Deficiencies of vitamin B-12 and/or vitamin B-2 can occur with oral contraceptives.

Oral contraceptives increase the level of vitamin K-dependent clotting factors. There is a danger of thrombosis, which increases in relation to the estrogen content of the drug. Women on oral contraceptives show a subnormal response to coumarin therapy. Serum iron levels and iron-binding capacity is increased in oral contraceptives users, probably because of decreased menstrual flow; therefore iron loss is lessened with this drug.

Serum vitamin A and copper levels are elevated in oral contraceptive users. Calcium absorption from the intestine is increased.

Homeopathic Remedy

DescriptionRemedy
DysmenorrheaViburnum opulus
EndometriosisHelonias Dioica tinct.
HealingArnica montana tinct.
Mucosal painAmmonium bromatum
Ovarian cystsAurum iodatum
OvaritisPalladium
"Dropped uterus"Lilium tigrinum
ThrombophlebitisHamamelis virginica



Treatment Schedule

Over-the-counter homeopathic remedies may be single strength (of fairly weak potency e.g. 6X ) or a blend of several weaker strengths (6X, 8X, 10X).

This may comprise a single remedy, or several remedies.

Doses are administered on a 3 times daily (tid), between meals,schedule and continued for 3 days.

Liquid preparations usually use 8-10 drops per dose.

Solid preparations are usually 2 or 3 pellets per dose.

Children use 1/2 dose i.e. 1 pellet.

If there is aggravation of the symptoms, stop taking the remedy and consult a homeopath.

References

Murphy, R. : Homeopathic Medical Repertory. Hahneman Academy, Pagosa Springs, Colorado. 1993.

Murphy, R. : Lotus Materia Medica. Hahneman Academy, Pagosa Springs, Colorado. 1995.

Pert, J.C.: Homeopathy for the Family. The Homoeopathic Development Foundation, London. 1985 edition.

Herbal Approaches

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Herbs
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Alfalfa
Black Cohosh
Damiana
Dong Quai
Mexican Wild Yam
Vitex

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Contraindications:

Tobacco increases risk of clots with oral contraceptives for women over age 30. Estrogen is metabolized more quickly by tobacco

Newall has compiled a list of hormonally active Herbs:

HerbEffect
Agnus CastusHormonal imbalance disorders
AlfalfaEstrogenic, in vivo
AniseedEstrogenic
BayberryMineralocorticoid
Black CohoshEstrogenic
Fucus / Kelp / BladderwrackHyper-/hypothyroidism reported.
GinsengEstrogenic, human
HorseradishMay depress thyroid activity
LicoriceMineralocorticoid activity, human.
estrogenic in vivo, in vitro
Motherwortoxytocic
Pleurisy RootEstrogenic
Red CloverEstrogenic in vivo
Saw PalmettoEstrogenic and anti-androgenic in vivo,
human use in prostate cancer.
VervainInhibition of gonadotrophic activity
Wild Carrot SeedEstrogenic



It is uncertain how these would interact with oral contraceptives. In case there is an effect, it is good to know a possible cause.

Aromatherapy - Essential Oils

There are a number of different problems which may be associated with oral contraceptive use: infertility, thrombosis or water retention for example.

Ingredients can be customized according to the presenting symptoms. A general overview would be:

Bergamot EssenceClary Sage Essence
Cypress EssenceGeranium Essence
Jasmine EssenceLemon Essence
Rose Essence



Related Health Conditions

Cramp
Hot flash
Hypertension
Menstruation
Nervousness
Pregnancy

Abstracts

References

Back, DJ et al., Gastrointestinal metabolism of contraceptive steroids. Am. J. Ob. Gyn. 1990. 163(6) Pt 2:2,138-2,145.

Bagwell MA et al: Primary infertility and oral contraceptive steroid use. Fertil Steril, 1995 Jun, 63:6, 1161-6.

Berg G et al., Use of oral contraceptives and serum beta-carotene. Eur J Clin Nutr, 1997 Mar, 51:3, 181-7.

Berndt-B et al: Lipoprotein metabolism and coffee intake--who is at risk? Z-Ernahrungswiss. 1993 Sep; 32(3): 163-75.

Bibbo. A 25-Year Follow-Up Study of Women Exposed to Diethylstilbestrol During Pregnancy. New England Journal of Medicine, 298. 1978.

Blackburn, G., et al. Binding of Diethylstilbestrol to Deoxyribonucleic Acid By Rat Liver Microsomal Fractions in Vitro and in Mouse Foetal Cells in Culture. Biochemistry Journal, 158. 1963.

Bland, Jeffrey. Nutraerobics. San Francisco: Harper & Row, 1983.

Bland, Jeffrey. Medical Applications of Clinical Nutrition. New Canaan, Conn.: Keats, 1983.

Briggs, MH: Human metabolism and steroid contraceptives. Part 2. Aust. Fam. Physician, 1977 supp: 23-28.

Brinker, F. Herb Contraindications and Drug Interactions. Eclectic Institute, 1997.

Chasroff, I.J. & J.W. Ellis. 1983. Family Medical Guide. William Morrow and Company Inc., Pub. 594 pp.

Christakis-G & Christakis-P Drug interactions -- nutrients, vitamins, foods. Journal-of-Practical-Nursing. 1986 Mar; 36(1): 51-7

Cole, B.T. Oral Contraceptives and Breast Neoplasia. Cancer, 39. 1977.

Diffey B et al., The effect of oral contraceptive agents on the basal metabolic rate of young women. Br J Nutr, 1997 Jun, 77:6, 853-62.

Emery-MG; De-Lia-JE Nutritional consequences of oral contraceptives. Family-and-Community-Health. 1983 Nov; 6(3): 23-30 (38 ref)

Eschleman, M.M. 1984. Introductory Nutrition and Diet Therapy. J.B. Lipincott Co., Philadelphia. 464 pp.

Goodman MT et al., Association of soy and fiber consumption with the risk of endometrial cancer. Am J Epidemiol, 1997 Aug 15, 146:4, 294-306.

Gray, L.A., Sr., et al. Estrogen and Endometrial Carcinoma. Obstetrics And Gynecology, 49. 1977.

Hill, P. & E.L. Wynder. Diet, Lifestyle and Menstrual Activity. American Journal Of Clinical Nutrition, 33. 1980.

Hoover, R., et al. Menopausal Estrogens and Breast Cancer. New England Journal Of Medicine, 295. 1976.

Hudiburgh, NK & Milner, AN: Influence of oral contraceptives on ascorbic acid and triglyceride status. J. Am. Diet. Assoc. 1979, 75:19-22.

Hui, Y.H. 1983. Human nutrition and diet therapy. Wadsworth, Inc; Belmont, California. 1039 pp.

Klein-CJ et al: A longitudinal study of urinary calcium, magnesium, and zinc excretion in lactating and nonlactating postpartum women. Am-J-Clin-Nutr. 1995 Apr; 61(4): 779-86.

Kuhl-H: [How intestinal diseases, nutrition, smoking and alcohol modify the action of oral contraceptives]. Geburtshilfe-Frauenheilkd. 1994 Jan; 54(1): M1-10

Kuhnz, W. et al., Influence of high doses of vitamin C on the bioavailability and the serum protein binding of levonorgestrel in women using a combination oral contraceptive. Contraception, 1995, 51(2): 111-116.

Kunz, J.R.M. 1982. The American Medical Association Family Medical Guide. Random House Pub, New York. 832 pp.

Lebrun-CM Effect of the different phases of the menstrual cycle and oral contraceptives on athletic performance. Sports-Med. 1993 Dec; 16(6): 400-30.

Lusseveld-EM et al: Multifrequency bioelectrical impedance as a measure of differences in body water distribution. Ann-Nutr-Metab. 1993; 37(1): 44-51.

Madhavapeddi-R & Ramachandran-P Growth and morbidity of breastfed infants whose mothers were using combination pills. Breastfeeding-Review. 1990 Nov; 2(2): 66-8. (13 ref)

Martinez ME et al., A prospective study of reproductive factors, oral contraceptive use, and risk of colorectal cancer. Cancer Epidemiol Biomarkers Prev, 1997 Jan, 6:1, 1-5.

Mahan, K. & Escott-Stump, S: Krause's Food, Nutrition and Diet Therapy. Saunders, 1996.

McClelland-IS & Jackson-AA Urea kinetics in healthy young women: minimal effect of stage of menstrual cycle, contraceptive pill and protein intake. Br-J-Nutr. 1996 Aug; 76(2): 199-209

Moline, M.L. Pharmacologic strategies for managing premenstrual syndrome. Clin. Pharm. 1993, 12:181.

Mooij, PN et al., Multivitamin supplementation in oral contraceptive users. Contraception, 1991, 44(3):277-288.

Mostad SB et al., Hormonal contraception, vitamin A deficiency, and other risk factors for shedding of HIV-1 infected cells from the cervix and vagina. Lancet, 1997 Sep 27, 350:9082, 922-7.

Nash, AL et al., Metabolic effects of oral contraceptives containing 30 mcg and 50 mcg of estrogen. Med. J. Aust. 1979, 2(6): 277-281.

O'Brien T & Nguyen TT: Lipids and lipoproteins in women. Mayo Clin Proc, 1997 Mar, 72:3, 235-44.

Palomo-I et al: [Effect of the prolonged use of intrauterine devices and oral contraceptive on iron nutrition] Rev-Med-Chil. 1993 Jun; 121(6): 639-44.

Pennington, J. 1978. Nutritional Diet Therapy. Bull Publishing Co., Palo Alto, Ca. 106 pp.

Prasad, AS et al: Effect of oral contraceptive agents on nutrients:II. Vitamins. Am. J. Clin. Nut. 1975,4:385-391.

Pratt, R. & H.W. Youngken. 1951. Pharmacognosy: The Study of Natural Drug Substances and Certain Allied Products, J.B. Lippincott Company, Philadelphia.

Rivers, JM: Oral contraceptives and ascorbic acid. Am. J. Clin. Nut. 1975, 5:550-554.

Rivers, JM & Devine, MM: Relationships of ascorbic acid to pregnancy and oral contraceptive steroids. Ann. NY Ac. Sci. 1975, 258:465-482.

Robbins, S.L. & R.S. Cotran. 1979. Pathologic Basis of Disease. 2nd ed. Saunders Pub Co., Philadelphia. 1598 pp.

Roe, D. Drug Induced Nutritional Deficiencies. Westport, Conn.: AVI Publishers, 1979.

Rose, D.P. & P.W. Adams. EGOT Activities and the Effect of Vitamin B-6 Supplementation in Women Using Oral Contraceptives. American Journal Of Clinical Nutrition, 26. 1973.

Ryan, K.J. Diethylstilbestrol: 25 Years Later. New England Journal Of Medicine, 298. 1978.

Subak-Sharpe, G.J. 1984. The Physician's Manual For Patients. Times Books Pub, New York. 607 pp.

Thorp, VJ: Effect of oral contraceptive agents on vitamin and mineral requirements. J. Am. Diet. Assoc. 1980, 76(6): 581-584.

Villegas-Salas E et al., Effect of vitamin B6 on the side effects of a low-dose combined oral contraceptive. Contraception, 1997 Apr, 55:4, 245-8.

Webb, JL: Nutritional effects of oral contraceptive use: a review. J. Reprod. Med. 1980, 25(4):150-156.

Wynn, V: Vitamins and oral contraceptive use. Lancet, 1975,i(7)906:561-564.

Yeung, DL: Relationships between cigarette smoking, oral contraceptives and plasma vitamins A, E, C and plasma triglycerides and cholesterol.

Zamah, NM et al., Absence of an effect of high vitamin C dosage on the systemic availability of ethinyl estradiol in women using a combination oral contraceptive. Contraception, 1993, 48(4): 377-391.

 


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