A Foolish Inconsistency on Contraception

By Susan E. Wills, Esq.

October 31, 2012

Here’s a riddle for readers. There are drugs so safe, so effective and so essential to women’s well-being that they are recommended for continual use by all healthy women 15-45 (or thereabouts) for 30 years or more, and that almost every employee health plan will soon have to provide them “for free” under the Preventive Services mandate of the Affordable Care Act.

But these same drugs have twice been determined, by the U.S. Preventive Services Task Force (Task Force), to be too dangerous for doctors to prescribe long-term to healthy women above age 45 or so. In middle-aged and older women, they are to be used only for the shortest possible time, at the lowest possible dose.

What could these Jekyll-and-Hyde drugs be?

Okay, it was a trick question. The synthetic hormones estrogen and progestin—used as combined oral contraceptives (COCs) by most fertile women, and in hormone replacement therapy (HRT) by menopausal/post-menopausal women—are only promoted as being safe and benign. In reality, whether used in COCs or in HRT, they’re more like the sinister Mr. Hyde.

After reviewing the latest research on the risks and benefits of pills containing estrogen and progestin, the Task Force offered a sobering recommendation: “Do not prescribe combined estrogen and progestin for the prevention of chronic conditions” (emphasis in the original Clinical Summary). 

Yet in its 2011 contraceptive mandate, the Institute of Medicine treated fertility like a “chronic condition” that had to be managed with synthetic hormones (to prevent pregnancy) for upwards of thirty years! Now the Task Force concludes that when taken as HRT, these hormones significantly increase the risk of serious adverse events in healthy women, compared to matched controls who received placebos.

The increased risks for women using HRT (compared to matched controls) are 26% for invasive breast cancer, 41% for stroke, 61% for gallbladder disease, 205% for probable dementia, 207% for deep vein thrombosis (DVT) and 213% for pulmonary embolism (PE).

Is there any medical reason for these inconsistent recommendations and warnings? Are younger women immune to the adverse effects simply because of their age? No. Research has shown that, at any age, whether in COCs or HRT, progestin is associated with increased risk of DVT, PE, heart attacks, strokes and problems of the liver and eyes. The main difference is that it’s easier to measure the onset and progression of these diseases and conditions in older women because they are more prevalent with age.

Could the dramatically increased risks be caused by higher doses of hormones in HRT than in COCs? No. Typical COCs contain far more progestin that HRT pills. Loestrin, for example, has three times more norethindrone acetate than Femhrt and Activela (HRT pills). Yasmin (another COC) contains six times more drospirenone than Angeliq (an HRT pill), and Ortho Tricyclen contains 2.8 times more norgestimate than Prefest (an HRT pill).

Estradiol, the estrogen used in most COCs and in HRT, is associated with increased risk of breast cancer, endometrial cancer and gallbladder disease. Although the amount of estradiol in HRT pills is higher than the amount in in COCs, women “rarely have severe side effects from taking estrogens to replace estrogen,” according to the Mayo Clinic website—unlike premenopausal girls and women who are given synthetic estrogen on top of the estrogen they produce naturally.

Is it too much to ask that the U.S. Department of Health and Human Services (HHS) be consistent with respect to the two uses of estrogen/progestin? Could they not put the health of young women ahead of the interests of drug manufacturers, Planned Parenthood and those obsessed with divorcing sex from its natural consequences? Women deserve honest answers to these questions. HHS should be warning them about the risks of combined estrogen/progestin in contraceptives, as in HRT, not forcing almost every woman in America to pay for it in her health coverage.

Susan Wills is Assistant Director for Education & Outreach, Secretariat of Pro-Life Activities U.S. Conference of Catholic Bishops. Go to www.usccb.org/prolife to learn more about the bishops' pro-life activities.