We're told that migraines increase risk - where would that fit in the table (assuming for non-smokers) - or is that yet another thing used to bully us?
Do visual disturbance migraines/ scotomas (pain-free) count as 'migraine with aura'?They are described as "migraine with aura" on the Mayo clinic website, to I'm a bit confused about the definition. Thank you!
Thanks - unfortunately, that message has not been communicated clearly, at least in Australia. Most GPs don't even ask - and the rest don't make it clear that it's migraine with aura; I didn't know that (I'm past needing contraception). Also, there's no viable alternative here - IUDs aren't subsidised by the government, and difficult to get. It leaves many women either not knowing about the risks, or taking risks due to no choice
Migraine *with aura* is independently associated with an increased risk for ischemic stroke; so is COC use. Together, the risk for stroke increases by about two-to-fourfold. This particular risk factor isn’t a “bullying” issue—migraine *with aura* is actually listed as an “unacceptable health risk” for starting estrogen-based birth control, as are things such as complicated valvular heart disease, severe cirrhosis, and venous thromboembolism.
While the media likes to make a big fuss about reports like this, screaming out the headlines, there truly are some health conditions which significantly impact the choice of contraception.
It's a good perspective. But you can further reduce the risk of pregnancy, COVID, getting struck by a car, etc., by doing preventive things. So your risk of getting struck by lightning is zero if you don't go out in thunderstorms, say. But you can't avoid a risk if you need the pill.
And we still need men to step up. Have women invented "the pill for men" yet? Give them pantyhose, too, while we're at it.
As for the infant and mother mortality, it is absolutely unacceptable. Poor white women have a greater chance of a successful pregnancy and delivery than rich Black women! From the NYT: "350 babies born to the poorest white mothers die"; "437 babies born to the richest Black mothers die."
Looking forward to your article about progestin/breast cancer! And at some point would you be willing to tackle breast cancer risk and MHT for those with dense breast tissue?
Since it's like 50% of women, which I'm reminded of after every damn mammogram when I get the letter saying I have "Extremely Dense Breast Tissue," seems like there should be more good (non-scary) info out there, but I can't find it... just info on breast cancer risk in general with various forms of MHT and how lifestyle/diet (like alcohol consumption, etc.) increases risk, which I know you've addressed.
love this! seems like “everyone” is demonizing hormonal contraceptives esp COCs.. are they still seeing long term benefits of long term pill use? decreased risk of endometrial and ovarian cancers?
thank you for this - would you be willing to share link to sources so i can "steal" this to add to my contraception patient education handout folder?- thank you - (FNP - family practice)
My wife and I are having no success finding any research, writing, nor insights on whether or not a person using the pill (Tri-Lo-Sprintec), and nearing typical menopause age (48), could experience symptoms typical to those seen in GUSM. Can you share any insights or research on the topic?
Possibly. I think I can write a post that should help you figure things out if you can give me a little more information. Is your wife taking the pill with a break for a period (so 21 active days and 7 days off) and can you be more specific about the symptoms? Sometimes people think what they are experiencing is a classic symptom of something, but on further questioning it isn't, so I always like to double check. Are they internal in the vagina or external (where the clothes touch the skin) or at the vaginal opening (or a combination thereof?). Thanks. If you can't be more specific, I can work around it.
Amazing, thank you so much! Her pills are 21 days active and 7 days off. Symptoms include dryness, redness, irritation, sandpaper feeling. External seems fine. Symptoms mostly with vestibule and some labia minora. As an aside, confirmed (using your "gold standard") negative for yeast and UTI.
Hi Dr. Gunter, I have a question about a different potential risk of contraceptives that I'm hoping you can shed some light on. I'm 42 year old woman. When I was about 17 yo my GYN put me on Ortho Tri-Cyclen for very heavy and painful periods. While I had no personal or family history of depression (or other situational factors that might explain what happened next), I became severely depressed shortly after starting Ortho Tri-Cyclen. I struggled to pass high school when previously I had been a straight A student. The littlest things took so much effort, my brain was constantly foggy, and I struggled with suicidal thoughts. I went to therapy, I tried antidepressants, all with minimal benefit.
Given the timing of the onset of the depression, my parents asked my GYN if the Ortho Tri-Cyclen could be the cause, and he adamantly denied this as a possibility. It wasn't until 5 years later when my original GYN retired and I starting seeing a new provider that my doc suggested that they may be connected. She suggested I try going off of OT to see if there was an effect on my mood.... the difference was night and day. I'll spare you the details, but essentially the symptoms remitted rather quickly and I felt like a normal human person again. I had my life back. I've had no further episodes of depression since then.
My question is this - how common is my experience? Also, I know that oral contraceptives will soon be available without a prescription over-the-counter. While there are many reasons why this is fantastic, I also find myself concerned for other girls/woman who may start OCs without the knowledge of potential mood effects (if that is indeed a potential side effect of this particular OC). Any thoughts on this?
Very interesting perspective, and hoping your "big project" is the completion of another book.
Watch this space!
We're told that migraines increase risk - where would that fit in the table (assuming for non-smokers) - or is that yet another thing used to bully us?
Migraine with aura is an absolute contraindication to estrogen-containing contraceptives, so this is a very real contraindication.
Do visual disturbance migraines/ scotomas (pain-free) count as 'migraine with aura'?They are described as "migraine with aura" on the Mayo clinic website, to I'm a bit confused about the definition. Thank you!
Thanks - unfortunately, that message has not been communicated clearly, at least in Australia. Most GPs don't even ask - and the rest don't make it clear that it's migraine with aura; I didn't know that (I'm past needing contraception). Also, there's no viable alternative here - IUDs aren't subsidised by the government, and difficult to get. It leaves many women either not knowing about the risks, or taking risks due to no choice
Migraine *with aura* is independently associated with an increased risk for ischemic stroke; so is COC use. Together, the risk for stroke increases by about two-to-fourfold. This particular risk factor isn’t a “bullying” issue—migraine *with aura* is actually listed as an “unacceptable health risk” for starting estrogen-based birth control, as are things such as complicated valvular heart disease, severe cirrhosis, and venous thromboembolism.
While the media likes to make a big fuss about reports like this, screaming out the headlines, there truly are some health conditions which significantly impact the choice of contraception.
It's a good perspective. But you can further reduce the risk of pregnancy, COVID, getting struck by a car, etc., by doing preventive things. So your risk of getting struck by lightning is zero if you don't go out in thunderstorms, say. But you can't avoid a risk if you need the pill.
And we still need men to step up. Have women invented "the pill for men" yet? Give them pantyhose, too, while we're at it.
As for the infant and mother mortality, it is absolutely unacceptable. Poor white women have a greater chance of a successful pregnancy and delivery than rich Black women! From the NYT: "350 babies born to the poorest white mothers die"; "437 babies born to the richest Black mothers die."
We need more charts like this in the world. Thanks
Looking forward to your article about progestin/breast cancer! And at some point would you be willing to tackle breast cancer risk and MHT for those with dense breast tissue?
Since it's like 50% of women, which I'm reminded of after every damn mammogram when I get the letter saying I have "Extremely Dense Breast Tissue," seems like there should be more good (non-scary) info out there, but I can't find it... just info on breast cancer risk in general with various forms of MHT and how lifestyle/diet (like alcohol consumption, etc.) increases risk, which I know you've addressed.
love this! seems like “everyone” is demonizing hormonal contraceptives esp COCs.. are they still seeing long term benefits of long term pill use? decreased risk of endometrial and ovarian cancers?
thank you for this - would you be willing to share link to sources so i can "steal" this to add to my contraception patient education handout folder?- thank you - (FNP - family practice)
My wife and I are having no success finding any research, writing, nor insights on whether or not a person using the pill (Tri-Lo-Sprintec), and nearing typical menopause age (48), could experience symptoms typical to those seen in GUSM. Can you share any insights or research on the topic?
Possibly. I think I can write a post that should help you figure things out if you can give me a little more information. Is your wife taking the pill with a break for a period (so 21 active days and 7 days off) and can you be more specific about the symptoms? Sometimes people think what they are experiencing is a classic symptom of something, but on further questioning it isn't, so I always like to double check. Are they internal in the vagina or external (where the clothes touch the skin) or at the vaginal opening (or a combination thereof?). Thanks. If you can't be more specific, I can work around it.
Amazing, thank you so much! Her pills are 21 days active and 7 days off. Symptoms include dryness, redness, irritation, sandpaper feeling. External seems fine. Symptoms mostly with vestibule and some labia minora. As an aside, confirmed (using your "gold standard") negative for yeast and UTI.
Here you go https://vajenda.substack.com/p/can-you-get-vaginal-symptoms-of-menopause
Phenomenal! Thank you!
Hope it helps!
More information from trusted experts always helps. Thank you for everything you do.
Any further commentary on the recent article would be helpful! Thanks for considering.
Hi Dr. Gunter, I have a question about a different potential risk of contraceptives that I'm hoping you can shed some light on. I'm 42 year old woman. When I was about 17 yo my GYN put me on Ortho Tri-Cyclen for very heavy and painful periods. While I had no personal or family history of depression (or other situational factors that might explain what happened next), I became severely depressed shortly after starting Ortho Tri-Cyclen. I struggled to pass high school when previously I had been a straight A student. The littlest things took so much effort, my brain was constantly foggy, and I struggled with suicidal thoughts. I went to therapy, I tried antidepressants, all with minimal benefit.
Given the timing of the onset of the depression, my parents asked my GYN if the Ortho Tri-Cyclen could be the cause, and he adamantly denied this as a possibility. It wasn't until 5 years later when my original GYN retired and I starting seeing a new provider that my doc suggested that they may be connected. She suggested I try going off of OT to see if there was an effect on my mood.... the difference was night and day. I'll spare you the details, but essentially the symptoms remitted rather quickly and I felt like a normal human person again. I had my life back. I've had no further episodes of depression since then.
My question is this - how common is my experience? Also, I know that oral contraceptives will soon be available without a prescription over-the-counter. While there are many reasons why this is fantastic, I also find myself concerned for other girls/woman who may start OCs without the knowledge of potential mood effects (if that is indeed a potential side effect of this particular OC). Any thoughts on this?