E-mail describes the death of a woman from blood clots associated with her use of birth control pills.
The above-quoted e-mail attributes the death of a woman named Nicole Dishuk to blood clots resulting from her use of an unnamed birth control product. We can ascertain that the woman identified, 31-year-old Dr. NicoleDishuk McKeon of North Coventry, Pennsylvania, died on 29 August 2006 at Temple University Hospital after suffering a stroke. Without having access to information protected by medical privacy laws, however, we have no way of knowing whether her stroke was related to her use of birth control or whether she had any existing medical condition that might have placed her at a higher risk for a stroke.Although the product referenced in the piece reproduced above is not named, the mention of a 'birth control that allows you to only have your period 3 X's a year' refers to Duramed's Seasonique or Seasonale (levonorgestrel/ethinyl estradiol) oral contraceptives. However, the oral contraceptive Nicole Dishuk was taking was not either of these products, but rather Yasmin (drospirenone/ethinyl estradiol), a low-dose contraceptive. And whatever the facts of this unfortunate death, extrapolating from a single case that a particular product poses a general, serious health risk in ordinary use is an unfounded conclusion.Most oral contraceptives have users undertake a 21-day regimen of active pills followed by seven days of placebos. Seasonique (and Seasonale) users take active tablets for 84 consecutive days followed by seven days of placebos (or seven days of lower-dose synthetic estrogen pills), thereby experiencing only four menstrual cycles per year. However, the pattern of taking a greater proportion of active tablets (with fewer menstrual cycles) is not new - it is something many women were doing well before the FDA's approvals of Seasonique and Seasonale for a variety of health-related reasons:Even before the introduction of Seasonique and Seasonale, women who wanted the convenience of delaying periods would do so by taking all of the active pills in their 28-day prescriptions, said Dr. Christina Chao of PennCare-Pine-lands OB/GYN Associates in Medford and Mount Holly. The active pills prevent a woman's body from building up the lining of the uterus, eliminating the need for the lining to shed, therefore no period results. With the conventional 28-day regimen, periods occur while taking the placebo tablets, and with Seasonique, while taking the final seven pills. 'In regular birth control pills, a lot of people take the whole pack of regular pills and not take the placebo,' said Chao. Although the method works, patients might find Seasonique is a better choice for several reasons. 'If your prescription plan pays for a monthly pill, then you are short,' she said. In addition, she said, 'Having that estrogen all the time will prevent PMS (including mood swings), migraines (and menstrual headaches) and will decrease breakthrough bleeding (bleeding between periods).'The suppression of periods through the use of hormonal contraceptives has not been shown to pose a significant health risk to women, and it is sometimes a recommended option for women who suffer from PMS, heavy flows, cramps, and menstrual migraines:Studies show it's safe to suppress your period using various methods: Seasonale, a pill that limits you to four periods a year; Seasonique, a similar pill that may help fight PMS; or others like Depo-Provera injections that may eliminate your period. 'The hormones keep the lining of your uterus thin, so nothing builds up,' says Rebecca Gould, M.D., an OB-GYN at Delaware County Memorial Hospital in Drexel Hill, Pennsylvania. Side effects that usually go away include breakthrough bleeding. Menstrual suppression is great for women with particularly heavy flows, painful cramps and menstrual migraines.Although some women believe that not having a regular monthly period is dangerous because the cessation of menstrual flow will allow blood and other material to 'build up' in the uterus, this is not the case:As for whether the new [Seasonique/Seasonale] pills are safe, it is useful to look at how they were developed. The pills' creators gave women a 'week off' because the hormone level in the pills was higher at that time and some women had difficulty with it. They also thought women would get psychological benefits from having their periods. These days, some women think that if they don't have their period once a month, the uterine lining and blood will build up since the body isn't getting rid of it. This is absolutely false. When you're on birth control pills of any kind, there is no thickening of the uterine lining and no buildup of blood. There is, in other words, no medical reason to stop taking the pills every 3 weeks.The possibility of side effects and serious health risks (including blood clots, strokes, and heart attacks) accompanies the use of any hormonal contraceptive product, so patients are advised to use them in regular consultation with their health care providers.
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