Levonorgestrel - less thrombosis but more headaches, weight gain, and loss of libido?
Philip Hannaford recommends use of levonorgestrel containing hormonal
contraceptives to reduce the risk of venous thrombosis compared with newer
progestogens.1 I note that he also declares departmental payments from
Schering Plough and Wyeth Pharmaceutical who manufacture levonorgestrel
containing contraceptives.
How can Philip Hannaford believe that oral contraceptives are
remarkably safe when he found that young women who ever took the pill were
3 times more likely to die before age 30 than never takers?2
Hannaford still ignores the obvious flaws in the 2008 cancer and 2010
mortality follow up reports.2,3 The RCGP OC study was started in 1968
with young women who took the pill for an average of 44 months. 40 years
after enrollment 3 out of 4 deaths occurred in the last decade during
which no information was available about HRT use. It is unjustified to
claim an overall mortality benefit from long past OC use without knowledge
of current or recent hormone use in takers or controls.
Numerous studies, including RCGP Pill study publications, found that
Pill and HRT use increases cancers, vascular diseases and mental illnesses
which are main causes of death.
It was already clear by 1969 that there were problems with changing
doses and hormone balances of a large range of combined oral
contraceptives.
Levonorgestrel is the active half of norgestrel. Combined with a
constant dose of estrogen, increasing doses of norgestrel changed common
side effects from irregular bleeding to venous dilatation to leg cramps
and thrombosis, then to arteriolar hypertrophy and migraine headaches, and
finally to depression and loss of libido.4 These, and also weight gain,
are still important reasons why one in three women stop taking hormonal
contraceptives in the first year.5
As the world's population reaches 7 billion, the problems caused by
progestogens need to be addressed.
1 Hannaford PC. The progestogen content of combined oral
contraceptives and venous thromboembolic risk BMJ 2011; 343:d6592
2 Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ.
Cancer risk among oral contraceptive users: cohort data from the Royal
College of General Practitioner's oral contraception study.
BMJ2007;335:651-4.
3 Hannaford PC, Iversen L, Macfarlane TV, Elliott AM, Angus V, Lee
AJ. Mortality among contraceptive pill users: cohort evidence from Royal
College of General Practitioners' oral contraception study. BMJ
2010;340:c927.
5 Espey E, Singh RH. Long-acting reversible contraception: implants
and intrauterine devices, Practice Bulletin, American College of
Obstetricians and Gynecologists 2011;121:8-12.
Rapid Response:
Levonorgestrel - less thrombosis but more headaches, weight gain, and loss of libido?
Philip Hannaford recommends use of levonorgestrel containing hormonal
contraceptives to reduce the risk of venous thrombosis compared with newer
progestogens.1 I note that he also declares departmental payments from
Schering Plough and Wyeth Pharmaceutical who manufacture levonorgestrel
containing contraceptives.
How can Philip Hannaford believe that oral contraceptives are
remarkably safe when he found that young women who ever took the pill were
3 times more likely to die before age 30 than never takers?2
Hannaford still ignores the obvious flaws in the 2008 cancer and 2010
mortality follow up reports.2,3 The RCGP OC study was started in 1968
with young women who took the pill for an average of 44 months. 40 years
after enrollment 3 out of 4 deaths occurred in the last decade during
which no information was available about HRT use. It is unjustified to
claim an overall mortality benefit from long past OC use without knowledge
of current or recent hormone use in takers or controls.
Numerous studies, including RCGP Pill study publications, found that
Pill and HRT use increases cancers, vascular diseases and mental illnesses
which are main causes of death.
It was already clear by 1969 that there were problems with changing
doses and hormone balances of a large range of combined oral
contraceptives.
Levonorgestrel is the active half of norgestrel. Combined with a
constant dose of estrogen, increasing doses of norgestrel changed common
side effects from irregular bleeding to venous dilatation to leg cramps
and thrombosis, then to arteriolar hypertrophy and migraine headaches, and
finally to depression and loss of libido.4 These, and also weight gain,
are still important reasons why one in three women stop taking hormonal
contraceptives in the first year.5
As the world's population reaches 7 billion, the problems caused by
progestogens need to be addressed.
1 Hannaford PC. The progestogen content of combined oral
contraceptives and venous thromboembolic risk BMJ 2011; 343:d6592
2 Hannaford PC, Selvaraj S, Elliott AM, Angus V, Iversen L, Lee AJ.
Cancer risk among oral contraceptive users: cohort data from the Royal
College of General Practitioner's oral contraception study.
BMJ2007;335:651-4.
3 Hannaford PC, Iversen L, Macfarlane TV, Elliott AM, Angus V, Lee
AJ. Mortality among contraceptive pill users: cohort evidence from Royal
College of General Practitioners' oral contraception study. BMJ
2010;340:c927.
4 Anon Editorial. Changing oral contraceptives. BMJ 1969;4:789-791.
5 Espey E, Singh RH. Long-acting reversible contraception: implants
and intrauterine devices, Practice Bulletin, American College of
Obstetricians and Gynecologists 2011;121:8-12.
Competing interests: No competing interests