Ovarian Cancer, Endometrial Cancer, and the Pill

birth-control-pillsThe most popular method of birth control in the United States is the Pill, followed by tubal ligation (permanent sterilization, or getting your tubes tied) and condoms. The Pill is a hormonal method of contraception, while sterilization and condoms are nonhormonal. The distinction between hormonal and nonhormonal methods of birth control are simply that the former contain synthetic versions of human hormones, while the latter do not.


By suppressing ovulation and thinning the uterine lining, the Pill can reduce risk of ovarian and endometrial cancers.


Glands in our bodies, called endocrine glands, produce hormones; additionally, testes and ovaries — which are parts of the human reproductive system — manufacture hormones. Human hormones are powerful chemicals, which do all sorts of jobs, from triggering puberty to helping us extract energy from the foods we eat. So it’s not a huge stretch to wonder if exposure to the hormones present in certain birth control methods — such as the Pill, in addition to the patch, the ring, the shot, the implant, and some types of IUDs — might have unintended effects on the body. Because hormones can play a role in cancer — either in protecting against it or aiding in its development — researchers are very interested to know if the Pill might increase or decrease risk for various types of cancer.

It’s actually a bit tricky to investigate the possible associations between the Pill and various types of cancer. First of all, there are dozens of types of birth control pills, all with different versions of synthetic hormones, at different dosages, and in different proportions to one another. Furthermore, the types of oral contraceptives on the market change over time — today’s birth control pill is not your mother’s birth control pill. Studying “the Pill” as a single entity could obscure differences between brands. Secondly, most cancers tend to develop later in life, many years after someone may have taken oral contraceptives. Researchers need to be careful to control for all the variables that might increase or decrease cancer risk. Continue reading

Telling the Truth About Abortion Politics

Sens. Yee and Barto asked. We answered. It’s Our Turn to share the truth behind abortion politics. We have submitted the following op-ed to the Arizona Republic, but they have not (yet?) published it.

Thank You PP croppedAs a medical professional, I am dismayed at the recent “Our Turn” published in the Arizona Republic titled, “Make doctors tell the truth on abortion drug.” I would like to do just that — tell the truth and correct the record, because the opinion by legislators Barto and Yee was laden with revisionist history, misstatements of legal fact, and most important, non-medical junk science.

Doctors practice up-to-date, evidence-based medicine. I appreciate lawmakers repealing their intrusive foray into the practice of medicine, SB 1324. This law attempted to mandate how doctors dispense abortion medication according to an outdated, 16-year-old protocol contained in the original drug label. SB 1324 was an attempt to re-start a legal case that Arizona was losing. Despite the FDA’s update of the drug label to reflect current medical practice, policymakers and the governor stubbornly insisted on enacting SB 1324. Why, I cannot imagine. The repeal of this legislation was certainly welcome.

Real doctors reject junk science. More disturbing than the FDA label issue is Sens. Yee and Barto’s assertion that “at least 170 healthy babies have been born when medication abortions were reversed.” There is no scientific support for this assertion, just as there is no peer-reviewed medical evidence for the whole notion of “abortion reversal.” A handful of doctors with a moral agenda have attempted to use progesterone to “stop” a medication abortion. However, there is nothing in the literature to justify this practice, save for one report of six informal clinical anecdotes. No significant sample size, no control group, no oversight, no peer review. Regardless, last year these same legislators passed SB 1318, violating physicians’ and patients’ constitutional rights by forcing physicians to inform their patients that it is possible to reverse a medication abortion, which is untrue. Continue reading

The Imaginarium of Doctor Delgado: The Make-Believe Medicine Behind SB 1318

pillDr. George Delgado, a gynecologist based in San Diego, is probably not likely to win the Nobel Prize in Medicine any time soon — or ever. Delgado’s dubious medical claims have been one of the driving forces behind a piece of legislation, Arizona Senate Bill 1318, that pushes what physician and state Rep. Randall Friese calls “fringe medicine.”

Delgado runs a website called Abortion Pill Reversal, offering 24-hour medical advice to women who have taken the abortion drug mifepristone and regret their decision. “There is an effective process for reversing the abortion pill, called ABORTION PILL REVERSAL, so call today!” the website cheers. Most people have probably never heard that a medication abortion — that is, an abortion performed by administering two pills — can be reversed. If this medical breakthrough sounds new, it’s because it doesn’t exist — at least not within any kind of evidence-based, established medical practice.


So-called abortion reversal is untested for safety or effectiveness.


Unsafe abortions have always been the consequence of the anti-abortion movement. Now unsafe abortion reversals can likely be added to that, thanks to the procedure Delgado has performed and promoted — in spite of scant evidence of its safety and effectiveness. In the two-step process of a medication abortion, a provider first administers a dose of mifepristone and then follows it with a dose of misoprostol. Delgado claims he can intervene in a medication abortion so that the patient’s pregnancy can continue. If patients change their minds after the first step, Delgado claims, they can counteract the initial drug with a dose of progesterone.

For published medical literature, Delgado can claim a 2012 article he co-wrote in the Annals of Pharmacotherapy. The article describes six abortion reversal patients, four of whom, he claims, remained pregnant. Though published in a legitimate medical journal, Delgado’s findings were from a small sample of patients, none of whom were compared in a controlled study to patients who did not undergo the progesterone treatment. Moreover, not everything that’s published in medical journals is well received by the medical community. Dr. David A. Grimes, a physician formerly with the Centers for Disease Control and Prevention, calls the article “an incompletely documented collection of anecdotes.” Continue reading

28 Bills Later: Cathi Herrod’s Horror Show Continues with SB 1318

Gynotician Meme

Image adapted from flazingo.com

In February, Sen. Nancy Barto (R-Phoenix), introduced SB 1318 in the Senate. It is a harmful bill barring abortion services from coverage in Arizona’s health care exchange. SB 1318 is the latest in a long series of legislative attacks on reproductive rights in Arizona — the 28th abortion restriction to be introduced since 2009, according to Dr. Eric Reuss of the American Congress of Obstetrics & Gynecology (Arizona Section), who wrote an editorial for The Arizona Republic expressing his and other doctors’ opposition to the bill.


Ask your senator to vote NO on SB 1318!


A wealth of bad ideas was necessary to produce more than two dozen anti-abortion bills, and this newest bill is the product of some of the worst of those ideas so far. For starters, SB 1318 takes on a problem that is all myth and no reality. The idea behind the bill is to keep people who are opposed to abortion from having to fund it — and, in the process, save them money. But the Affordable Care Act included a payment system to ensure that taxpayer funding of abortion wouldn’t happen. When The Arizona Republic checked Sen. Barto’s claim that “Taxpayers are on the hook for elective abortions,” the paper found the statement unsupported. As the Republic summarized, “Federal law already prevents insurance companies from using tax credits and subsidies to cover elective abortions. And federal funds are not allowed to be used to fund abortions with three exceptions — rape, incest or when the life of the mother is threatened.” Continue reading

Let’s Talk Contraception: Contraceptive Implants

implantMany of us want a long-term method of birth control, but know we’re not able to reliably take a daily pill or interrupt a sexual experience to use a barrier contraceptive. There are several other options available that offer protection on a weekly, monthly, or yearly basis. A very effective but often underused method is the contraceptive implant, which provides pregnancy prevention for three years. The Guttmacher Institute reports that only 0.3 to 0.5 percent of women who use birth control choose an implant, but it is one of the most effective contraceptives.


The implant protects you from pregnancy for three years and, with a failure rate of 0.05 percent, is the most effective reversible contraceptive.


There are two hormonal implants available in the United States: Implanon and Nexplanon. Both contain only a progesterone hormone, etonorgesterol. This hormone prevents pregnancy by suppressing ovulation, thickening cervical mucus, and thinning the lining of the uterus. Nexplanon is quickly replacing Implanon because it is designed to be seen on an X-ray. This feature helps medical providers be sure the implant is placed correctly and reduces problems due to incorrect insertion. If the implant is placed incorrectly, you can have numbness and it may be difficult to remove.

Nexplanon is a very small flexible plastic rod, about the size of a matchstick. It is inserted by your provider under the skin in your upper arm, where it slowly releases the progesterone hormone into your bloodstream and prevents pregnancy for three years. After three years, it must be replaced with a new one to provide continuous effective birth control. However, it can be removed at any time before three years if desired. Continue reading

Let’s Talk Contraception: Can I Use Birth Control to Skip a Period?

In 2003, the FDA approved Seasonale, an extended-cycle birth control pill. This pill, a combination of estrogen and progestin, is taken daily for 84 days followed by one week of inactive (placebo) pills, allowing a woman to have her period once every three months — four times per year.

Since that time, several other extended-cycle birth control pills have been marketed, including Lybrel, released in 2007, which offers women continuous contraception coverage with only one period per year.


Using birth control to skip periods doesn’t result in side effects quite this exaggerated.

Prior to Seasonale’s debut, certain types of birth control pills could be taken back to back, allowing users to have period-free weddings and honeymoons, or to treat certain conditions, such as endometriosis. But there was no consensus about how to use birth control pills this way, and no actual product marketed specifically for this type of use. Early studies on extended-cycle pills reported that users were highly satisfied using pills to have fewer periods — and wanted to continue using these pills to reduce periods after the study was completed.

Can skipping periods be beneficial or harmful? Is this a lifestyle choice that’s not “natural”? How many “normal” periods do you need in a lifetime? Continue reading

Let’s Talk Contraception: Emergency Contraception

ECThe Centers for Disease Control and Prevention (CDC) recently reported that 1 in 9 American women — 11 percent — has used the “morning-after pill.” This means that in the United States, 5.8 million sexually active women between the ages of 15 and 44 have used emergency contraception, an increase in use of 4.2 percent from 2002. Most women say their reasons for using emergency contraception are because they engaged in unprotected sex or feared that their method of contraception failed.


The best way to prevent pregnancy is reliable birth control. But sometimes we need a back-up method.


It has also been reported that half of all pregnancies in the United States are unintended. For that reason, the availability of a range of contraceptive options is very important. Emergency contraception is the last choice for a woman to decrease her chance of becoming pregnant after unprotected sex. There are several products available for emergency contraception in the United States. There are many options, and they include:

  • regular birth control pills in specific doses
  • PlanB One-step
  • Next Choice
  • ella
  • copper IUD or intrauterine device (Paragard)

The Yuzpe regimen, which used ordinary birth control pills in specific combinations, was named after a Canadian physician who developed the method in the 1970s. Several brands of birth control pills are approved for this use to prevent pregnancy. This method uses the combined estrogen and progesterone hormones in your regular birth control pills in certain prescribed combinations.

Research showed the progesterone component of contraceptive pills was most effective at preventing pregnancy, so Plan B was developed as a two-pill regimen of levonorgestrel (a type of progesterone). When Plan B was first released, it consisted of one pill taken as soon as possible and another taken 12 hours later. Plan B One-Step, the newest version of Plan B, now has the same dosage of levonorgestrel in just one pill. It should be taken as soon as possible after unprotected sex. This one-dose regimen has been shown to be more effective with fewer side effects. Continue reading