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Rethinking Reproductive Health

By Katie Singer

Recently, in a medical journal, I read that oral contraceptives are useful "in establishing regular menstrual cycles"¹ for women with polycystic ovarian syndrome (PCOS). For years, I’ve observed that western medicine’s primary treatment of common gynecological problems is the birth control pill; still, I was dismayed to read this misinterpretation of what a menstrual cycle is and what oral contraceptives do to it.

A healthy menstrual cycle includes the maturation of about a dozen follicles, unripe eggs that emit estrogen; production of cervical fluid (which can keep sperm alive for up to five days); buildup of a new uterine lining; ovulation (also known as the release of one ripe egg, which will live for 12-24 hours); production of progesterone; and, when pregnancy does not occur, release of the uterine lining.

Oral contraceptives suppress many of these functions. The bleeding that occurs on the Pill results from taking sugar pills and withdrawing artificial hormones. This is not a menstrual period but a "withdrawal bleed" since it does not (with most prescriptions) follow ovulation.

Fertility drugs like Clomid, which are often prescribed "like water"² when pregnancy is desired, hyperstimulate the ovaries to mature many more follicles than they normally do. In turn, the follicles produce three to four times more estrogen than they do in pretreatment cycles.

Are these pharmaceuticals dangerous to the women who take them? To their offspring? Are they changing the way we think about reproductive health? Are safer alternatives available to those who seek to prevent pregnancy or to become pregnant?

What can a woman do if she feels that her health has been compromised by taking the Pill or a fertility drug?

I imagine that people take hormonal drugs for several reasons: it’s become normal to take them; information about their hazards is usually posted in fine print; doctors (including alternative practitioners) are typically not taught natural methods of family planning in medical school--and they cannot give clients what they don’t know; and consumers frequently take prescription drugs and vitamins without researching their effects--because "they worked for my neighbor."

Advertising is another factor. Barr Laboratories is currently engaged in a multi-million dollar campaign to promote Seasonale, their new oral contraceptive, which gives women "the convenience of only four periods [sic] each year" with just "all of the warnings and contraindications. . . identical to any other oral contraceptive." There are currently sixteen million women on oral contraceptives in the US; Barr Labs aims to secure 90 percent of this market.³

Some Problems With
Hormonal Contraceptives

Oral contraceptives are made from artificial steroids that mimic the effects of estrogen and progesterone. The Pill works by:

• Suppressing the release of hormones that trigger ovulation;
• Stimulating production of thick cervical mucus, which prevents sperm survival and ability to travel to a ripe egg in the fallopian tube in the event that ovulation does occur;
• Disrupting the ability of the cilia (whip-like cells that line the fallopian tube) to move a fertilized egg toward the uterus in the event that conception does occur;
• Preventing buildup of the uterine lining, and thereby inhibiting implantation of a fertilized egg in the event that one arrives in the uterus.

It’s worth noting that the mini-Pill, a progestin-only pill, may not suppress ovulation or conception from occurring.^5,6

In The Breast Cancer Prevention Program, Sam Epstein, MD, writes, "more than 20 well-controlled studies have demonstrated the clear risk of premenopausal breast cancer with the use of oral contraceptives. These estimates indicate that a young woman who uses oral contraceptives has up to ten times the risk for developing breast cancer as does a non-user, particularly if she uses the Pill during her teens or early twenties; if she uses the Pill for two years or more; if she uses the Pill before her first full-term pregnancy; if she has a family history of breast cancer." Thus, a woman who takes the Pill for two years before she’s 25 and before she’s had a pregnancy to term increases her risk of breast cancer tenfold.

A study conducted by the World Health Organization found that women who carry the human papilloma virus (HPV) and who have taken the Pill for five to nine years are nearly three times more likely than non-Pill users to develop cervical cancer.⁷ (HPV affects a third of all women in their twenties.) Women with HPV who’ve taken the Pill for more than ten years are four times more likely than non-users to develop the disease.

Women who have a history of migraine headaches and who take combined oral contraceptives are two to four times more likely to have a stroke than women who have migraines and don’t take the Pill.⁸

Women who use low-dose oral contraceptive pills have a two-fold increased risk of a fatal heart attack compared to non-users.⁹ Women who take oral contraceptives and smoke have a 12-fold increase in fatal heart attacks and a 3.1-fold increase in fatal brain hemorrhage.¹⁰ Women who use the Pill after the age of 45 have a 144 percent greater risk of developing breast cancer than women who have never used it.¹¹

Because of blocked hormone production, women who take the Pill have decreased sensitivity to smell. Because sexual interest is communicated through smell, the Pill may decrease women’s sex drives.¹²

In Solved: The Riddle of Illness, Dr. Stephen Langer writes that "the Pill. . . can cause severe bodily damage in hypothyroidism."

Oral contraceptives may aggravate insulin resistance and longterm risk of diabetes and heart disease.¹³

Other hormonal contraceptives may also be problematic. Depo-provera, an injectable contraceptive, requires a shot every three months. Even one shot before a woman is twenty-one can result in bone loss. Adolescent women who use Depo may be more likely to suffer fractures when they reach menopause than those who never took the injections.¹⁴

Women who take Depo-provera shots for two years or more before they’re twenty-five have an almost tripled risk of breast cancer.¹⁵

Dagmar Ehling, a doctor of Oriental medicine, explains that "In its listing of the side effects of oral contraceptives, the Physician’s Desk Reference includes increased blood clotting, uterine bleeding, and carcinoma of the breast and endometrium. In Oriental medicine, these conditions could be categorized as Blood Stasis, a kind of ‘pattern of disharmony.’ Blood Stasis describes sluggish blood circulation, which might manifest as blood clotting, varicose veins, tumors, nodules or cysts. While acupuncture and herbs can address these conditions, from an Oriental perspective, the longer a woman stays on the Pill, the more she increases her risk for these kinds of problems."

Many women taking the Pill have reported weight gain--a sign of estrogen dominance and/or insulin resistance--as well as depression and even psychosis.

If you have taken hormonal contraceptives and feel they have taken your cycles out of sync and negatively affected your health, eating a traditional diet with emphasis on vitamin A-rich foods, and sleeping primarily in the absence of light (a technique that I described briefly in the Spring, 2004 issue of Wise Traditions and more fully in The Garden of Fertility), has helped numerous women to return to health and normal cycles.

Assisted Reproductive Technology

In The Elusive Embryo: How Women and Men Approach New Reproductive Technologies, anthropologist Gay Becker describes couples who pursue their desire for a child "until emotional and financial resources are exhausted." She observes that with the proliferation of assisted reproductive technologies, the emphasis has shifted from diagnosing and correcting abnormal physiology to achieving a pregnancy in the fastest and most direct manner possible, regardless of the cost or invasiveness. This approach aggressively augments the natural reproductive cycle, or bypasses it altogether, and aims for results regardless of the underlying infertility diagnosis.

If you are considering using reproductive technology to help you conceive, please first research its potential hazards--to yourself and to your potential offspring.

Clomiphene citrate, also known as Clomid, a common drug prescribed when a woman has difficulty conceiving, works by binding itself to estrogen receptors in the brain so that naturally occurring estrogen cannot be detected by the body. Clomid tricks the body into producing more and more Follicle Stimulating Hormone, causing more follicles (unripe eggs) to grow than normally would. In turn, more estrogen is produced by the follicles, and more eggs are matured. Typically, a woman taking this drug produces double or triple the amount of estrogen (and releases more eggs at ovulation) per cycle compared to pretreatment cycles. In Our Stolen Future, the pivotal work about how pesticides threaten animal and human ability to reproduce, Theo Colburn and her co-authors report that "numerous studies have linked estrogens, even those occurring in the body, to cancer, suggesting that the greater a woman’s lifetime exposure, the greater the risk."

According to a package insert (available from your pharmacist, by request) about Clomid from Merrell Pharmaceuticals Inc., one of the drug’s manufacturers, "The majority of patients who are going to ovulate will do so after the first course of therapy. If ovulation does not occur after three courses of therapy, further treatment with clomiphene citrate tablets USP is not recommended. . . . If menses does not occur after an ovulatory response, the patient should be re-evaluated. Long-term cyclic therapy is not recommended beyond a total of about six cycles." Merrell Pharmaceuticals also recommends that the first dose of Clomid be 50 mg.

Unfortunately, I know many women who have taken Clomid for as many as twelve cycles; I know others who took the drug at double the dosage recommended by Merrell Pharmaceuticals in their first use of it.

Essentially, Clomid hyperstimulates one aspect of the reproductive system--which then requires the rest of the system (which was perhaps out of sync before the drug was administered) to grasp for health and wholeness in response to being overstimulated.

Educate yourself as much as you can before using reproductive technology. Studies show that treatments like Clomid and in vitro fertilization (wherein conception takes place outside of the woman’s body) increase a woman’s risk of ovarian cancer (especially if she never conceives)^16,17 and her offspring’s risk of birth defects.^18-20 Also, Clomid can dry up cervical fluid, which makes it difficult for sperm to reach the mature egg easily.²¹

Leah Morton, a family physician, observes, "Some women want to be pregnant immediately once they start trying. I see this desire as part of a wider idea in our culture that we can and should be able to control our lives. We should be able to control crime, pollution, educational discrepancies, gender inequalities, our finances, and our fertility. Indeed, technology now may be used to help us control lovemaking, pregnancy prevention, conception, labor and delivery, even raising a child. But really, technological controls have nothing to do with fertility, with being in the unknown, the mystery of life. It’s up to us to respond to the joy, darkness, and awe that we experience."

Dr. Morton also says, "If a couple is having difficulty conceiving or sustaining a pregnancy, my first concern is whether or not they’re eating food that’s not genetically modified, that is organic, whole and low glycemic (this means with little or no refined sugars or starches). Improving one’s diet is one of the hardest things to do in our culture. It also makes for healthier parenting!"

Real Women in the 21st Century

Most women in our culture have taken hormonal drugs at some point in their lives to prevent or achieve pregnancy; and, young women are commonly prescribed the Pill when they have acne, painful menstrual cramps, PCOS, and/or mild depression. Learning the hazards of these drugs can be discomfitting, to say the least.

I know very few people who have not taken some kind of risk-increasing drug. A while ago I read that women who have taken antibiotics every day for a year or more significantly increase their risk of breast cancer. What kind of dumb woman would take antibiotics every day for a year? I wondered--and then realized: a woman like me. As a teenager, I took antibiotics every day for probably two or three years to ward off acne. The drugs didn’t help, but all my girlfriends were treating their acne with antibiotics, and my parents and I didn’t know alternatives.

Indeed, when most of us experience some kind of problem with our menstrual cycles, or we want to prevent pregnancy, or we want to get pregnant, the most readily available option is usually pharmaceutical.

The good news is that there are alternatives. My first recommendation is to learn how the body works. If she learns Fertility Awareness and daily charts her waking temperature and cervical fluid changes, a woman of childbearing age can know whether she’s ovulating and whether she is prone to miscarriage, poly-cystic ovarian syndrome, low thyroid function and other problems.

If you identify a problem or a trend toward a problem, you may wonder what you can do to strengthen your health. Diet can be a great place to start. I know many young women who, in addition to discontinuing hormonal drugs, charted their fertility signals, identified problems with their cycles, gradually switched to a nutrient-dense diet, and found their health steadily improved. Indeed, in many of the groups he studied, Weston Price found that "girls were not allowed to be married until after they had had a period of special feeding. In some tribes, a six-month period of special nutrition was required" to ensure the health of a couple’s offspring.

Night-lighting techniques, herbs, homeopathy, or acupuncture can also strengthen reproductive health. So can meditation and yoga.

Regardless of the options you’re considering (for a health problem, to prevent pregnancy, or to get pregnant), research the risks and benefits involved. Keep researching until you find something that works for you.

The Six Steps of Healing

In the late 1970s, after studying scientific medicine, herbalism, various diets, homeopathy and other alternative healing methods, herbalist and author Susun Weed became increasingly confused--in regard to healing--about what to do first. Once she phrased her question, she realized the reply: First, do no harm.

Weed began to group healing techniques and remedies based on the likelihood of a technique or remedy harming or even killing her. In her books, including Wise Woman Herbal for the Childbearing Years and The New Menopausal Years the Wise Woman Way, she describes The Six Steps of Healing, which outline a way to increase health and decrease harm. The Six Steps encourage us to connect with our body’s wisdom and healing mechanisms and to address problems at their root.

If you suffer from menstrual cramps, mild depression or acne, or are wanting to get pregnant, consider Weed’s six steps as an alternative to taking the Pill. Here they are applied in the context of menstrual cramps:

Step 0: Do nothing. Weed describes this as "a vital, invisible step." She explains, "You must actively do no-thing." Essentially, Step 0 is about taking time for yourself. Unplugging your phone and your TV, meditating and resting are included in Step 0.

Step 1: Collect information. Talk with friends and health care providers, read, search the internet. Learn Fertility Awareness and chart your fertility signals--your waking temperature and cervical fluid. Keep a record of your questions and observations (e.g., Does eating less sugar affect my menstrual cramps?).

Step 2: Engage the energy. Notice what emotions come up around menstruation. Attend to your dreams. Write out a conversation between your period and you. Find out what it wants; find out what you want from your period and see whether there’s a happy medium. Take a bath or try a homeopathic remedy. Give thanks for your interest in your own wellness. Pick one remedy from Step 2, and set a time limit for working with it. Weed says it’s vital to set time limits for every step. If your problem worsens, try another Step 2 remedy, or go on to Step 3.

Step 3: Nourish and tonify. Feed yourself well. Replace processed, sugary fast-foods and drinks with freshly made, nutrient-rich meals. Prepare herbal infusions (which you can learn about from books or an herbalist). Keep your body and mind toned with regular physical activity. Take a yoga class. Grow some of your own food. Take a daily for a walk. If your problem worsens or is not relieved within your time limit, add another Step 3 or go on to Step 4.

Step 4: Sedate and stimulate. Acupuncture, chiropractic, Swedish massage, and most herbal tinctures fall into this category. Susun Weed cautions that "There is always risk of developing dependence on Step 4 remedies. Be aware of the frequency, dosage and duration of your treatments--and your time limits."

Step 5-A: Use supplements. In this step, Weed includes all concentrated, extracted, and synthesized substances--including vitamin and mineral supplements, standardized herbal tinctures and all herbs in capsules. (Supplements can be synthesized or, if made from foods grown with pesticides, include concentrations of pesticides.)

Step 5-B: Use drugs. Over-the-counter and prescription drugs as well as all hormonal medications (including progesterone creams) are included in this step.

Step 6: Break and enter. Besides surgery, Weed includes psychotropic drugs, "fear-inspiring language," shots, diagnostic tests such as laparoscopy and surgery in Step 6. "If all other steps fail and you are a woman with severe menstrual cramps," she says, "a hysterectomy is a reasonable choice."

Susun further explains, "When you do nothing, collect information, engage the energy, and nourish and tonify (Steps 0-3), then functioning and joy increase: you build health. True healing takes place in these early steps. Whether your problem is chronic or acute, Steps 0-3 (along with realistic expectations of the time healing takes) are worthy of your attention.

"Although the impulse in our culture is to jump to Step 4 or 5, each step up increases the possibility of severe side effects. While healing can and does take place with the aid of drugs and surgery, once you get to Step 5, you can damage or destroy health. Drugs might get rid of menstrual cramps, but they don’t address the cause or nourish your body. Drugs mask symptoms. Even common over-the-counter drugs like aspirin can injure health. In the Wise Woman Tradition, symptoms are not enemies to be destroyed but cherished messengers who encourage us to take good care of ourselves."

Life in all its Fullness

All women want to enjoy good health, loving relationships and, if they choose, healthy offspring. The medical model proposes drugs that disrupt natural processes as a way to achieving these goals. Others in the western world understood that fulfillment can only be achieved by working with natural processes, not suppressing them. Francis Bacon (1561-1626) put it this way: Nature is not to be governed except through obeying her. Similarly, Weston A. Price (1870-1948) told those who wish a long and meaningful life: Life in all its fullness is Mother Nature obeyed. These words take on enhanced meaning for women facing decisions about how to have healthy children and achieve long-term reproductive health.

Menstrual cycle by menstrual cycle, Fertility Awareness provides women and men a way to work in concert with nature and their bodies--whether they aim to conceive or to prevent pregnancy. Further, Fertility Awareness does no harm to a woman’s hormonal system or her nutrient stores. The method does take time and effort to learn--just like cooking nutrient-dense meals. And, like knowing how to cook, it is a basic life skill worth passing on to the next generation.

Katie Singer is the author of The Garden of Fertility. She will present a seminar on Fertility Awareness at our 6th Annual Conference, November 11-13.

Resources

Singer, Katie, The Garden of Fertility: A Guide to Charting Your Fertility Signals to Prevent or Achieve Pregnancy--Naturally--and to Gauge Reproductive Health, Avery/Penguin, 2004. Includes chapters on breastfeeding, food and reproductive health, night-lighting, and healing childbearing losses. www.GardenofFertility.com includes fertility charts that can be downloaded for free.

The Fertility Awareness Network. PO Box 1190, New York, NY 10009; 800.597.6267; 212.475.4490. Provides a Fertility Awareness resource packet (for a suggested donation of $5) that includes a list of teachers who offer classes and private consultations with a secular orientation. Offers The Garden of Fertility for people who don’t use credit cards. www.FertAware.com.

The Couple To Couple League. POB 111184, Cincinnati, OH 45211; 800.745.8252. Offers classes and literature about Natural Family Planning with a Catholic orientation. www.ccli.org.

Gladstar, Rosemary, Herbal Healing for Women, Fireside, 1993. Describes how to prepare herbs that address PMS, skin problems, endometriosis, vaginal infections, pregnancy and menopause.

Weed, Susun, Wise Woman Herbal for the Childbearing Year, Ash Tree Publishing, 1985. A classic.

Weed, Susun, The New Menopausal Years the Wise Woman Way: Alternative Approaches for Women 30 - 90, Ash Tree Publishing, 2002. Presents remedies for menstrual cramps, thyroid problems, vaginal dryness, fertility after forty and more.

REFERENCES

1. Marx, Theresa, MD and A Mehta, MD. Polycystic ovary syndrome: Pathogenesis and treatment over the short and long term. Cleveland Clinic Journal of Medicine, January, 2003;70:1, 31-45.

2. Turiel, Judith Steinberg, Beyond Second Opinions: Making Choices About Fertility Treatment, University of California Press, 1998, p.18.

3. Barr Laboratories SEASONALE Conference Call, Sept. 8, 2003, transcript 090803ak.772.

4. Billings, Evelyn, MD, The Billings Method, Penguin Books Australia, 2000, p. 164-165.

5. Hatcher, RA and others. Hormonal Overview. Contraceptive Technology, 14th Ed, Irvington, 191-192.

6. Larimore, MD, Walter, and Joseph Stanford, MD, MSPH. Postfertilization Effects of Oral Contraceptives and Their Relationship to Informed Consent. Arch Fam Med, Feb 2000;9(23).

7. Moreno, Victor and others. Effect of Oral Contraceptives on Risk of Cervical Cancer in Women with Human Papilloma Virus Infection: The IARC Multicentric Case-Control Study. Lancet, 2002;359:1085-92.

8. Lidegaard, O. Oral contraceptives, pregnancy, and the risk of cerebral thromboembolism: the influence of diabetes, hypertension, migraine and previous thrombotic disease. Br J Obstet Gynaecol 1995;102(2): 153-59.

9. Thorogood, M, J Mann and others. Is oral contraceptive use still associated with an increased risk of fatal myocardial infarction? Report of a case-control study. Br J Obstet Gynaecol 1991;98:1245-1253.

10. Thorogood, M. and M Vessey. An epidemiologic survey of cardiovascular disease in women taking oral contraceptives. Am J Obstet Gyn, 1990;163(1) pt. 2:274-281.

11. Researchers, including Dr. Merethe Kumle of Community Medicine in Tromso, Norway, followed 103,027 women between the ages of 30 to 49 from 1991-1999, and reported their findings at the Third European Breast Cancer Conference, 2002.

12. Caruso S, C Grillo and others. A Prospective Study Evidencing Rhinomanumetric and Olfactometric Outcomes in Women Taking Oral Contraceptives. Human Reproduction, 16 Oct. 2001;11:2288-94.

13. Diamanti-Kandarakis, Evanthia and others. A modern medical quandry: Polycyctic ovary syndrome, insulin resistance and oral cnotraceptive pills. Journal of Clinical Endocrinology & Metabolism 2003;88(5):1927-1932.

14. Scholes, D, AZ LaCroix and others. Bone mineral density in women using depot medroxyprogesterone acetate for contraception. Obstet Gynecol 1999;93(2):233-38.; Cromer, BA, JM Blair and others. A prospective comparison of bone density in adolescent girls receiving depot medroxyprogesterone acetate (Depo-Provera), levonorgestrel (Norplant), or oral contraceptives. J Pediatr 1996;129(5):671-76.

15. Skegg, DCG, EA Noonan and others. Depot medroxprogesterone acetate and breast cancer: A pooled analysis of the World Health Organization and New Zealand studies. JAMA, 1995 Mar 8:10:799-804.

16. Whittemore A and others. Characteristics relating to ovarian cancer risk; collaborative analysis of twelve U.S. case-controlled studies. American Journal of Epidemiology 136(10):1175-1220.

17. Rossing, Daling and Weiss. Ovarian tumors in a cohort of infertile women. New England Journal of Medicine, 1994;331:(12)771-6.

18. Anteby IE and others. Ocular manifestations in children born after in vitro fertilization. Arch Opthalmol, Oct. 2001;119(10):1525-9. Ocular anomalies (eye problems) were frequently observed in this cohort of offspring born after in vitro fertilization.

19. Hansen M and others. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med, 2002 Oct 31;347(18):1449-51. Infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have twice as high a risk of a major birth defect as naturally conceived infants.

20. Koivurova S and others. Neonatal outcome and congenital malformations in children born after in vitro fertilization. Hum Reprod, May 2002;17(5):1391-8. Neonatal outcome after IVF is worse than in the general population with similar maternal age, parity and social standing, mainly due to the large proportion of multiple births after IVF. The higher prevalence of heart malformations does not solely arise from multiplicity but from other causes.

21. Weschler, Toni, Taking Charge of Your Fertility, Revised Edition, Quill, 2001.

22. Wynn V. Vitamins and oral contraceptive use. The Lancet, March 8, 1975.

23. Langer, Stephen E, MD and James F Scheer. Solved: The Riddle of Illness. Keats Publishing, 2000.

24. Grant, E, MD. Sexual Chemistry: Understanding Our Hormones, the Pill and HRT. Cedar Press, 1994.

25. Shannon, Marilyn M. Fertility, Cycles & Nutrition, 3rd Edition. Couple to Couple League, 2001.

The Pill and Nutritional Deficiencies

Taking oral contraceptives depletes users of key nutrients including folic acid, vitamins B2, B6, B12 and vitamin C.²² These nutrients are critical for the development of the baby, including the optimization of baby’s intelligence. Thyroid hormones are also depleted by the Pill;23 they are crucial to optimal development of intelligence in the fetus. Drug companies include a warning statement in their handouts about the Pill that women should avoid conceiving within six months of discontinuing it.

To ensure a healthy baby (and a healthy mother), women who have taken the Pill need to favor foods rich in vitamins A and E, B vitamins, essential fatty acids, magnesium and zinc.^23,24 Foods containing iodine and vitamin D are also recommended. We have constantly urged that for six months or longer before trying to conceive, parents-to-be should eat liberally of superfoods like cod liver oil, butter from grass-fed cows, raw milk, liver, eggs from pastured chickens and wild seafood. This advice is especially important for women who have been on the Pill.

How to Research Studies About Drugs and Medical Procedures

To research the hazards of a pharmaceutical drug or medical procedure, go to www.ncbi.nlm.nih.gov.

You might also access The Medline database--the National Library of Medicine’s electronic bibliography, which indexes thousands of articles and abstracts from medical and scientific journals each month. There can be a charge for a Medline search if you’re not affiliated with a doctor, university or hospital that provides access.

Many hospitals have a medical library that is open to the public. Check out The Physician’s Desk Reference (PDR), which pharmacists and libraries keep on hand, for information about prescription drugs.

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