--
Victoria
>
> From: Victoria <nichollsvi@cox.net>
> Date: 2002/05/03 Fri AM 08:50:46 EDT
> To: pcos@obgyn.net
> Subject: Reference BCP post
>
> Hi,
>
> Just repeating a post I made in regards to PCOS and BCP. Just for newbies,
this list is very anti pill. You might want to try PCOSA's PCOS email list, the
PCO list on yahoogroups, or any of the PCOS lists there. I've had women write to
me privately about the reactions of those on this list in regards to BCP as a
choice, so you may not get a balanced opinion. I also keep some comments on BCP
and PCOS on my website: http://nicho_v.tripod.com.
http://forums.obgyn.net/pcos/PCOS.0204/1161.html
Hi all,
These were taken off my website, http://nicho_v.tripod.com, with a couple of
small changes. I'm going to work on putting this as either a webpage or part of
a webpage. In addition, I did speak to Christine DeZarn, the head of PCOSA, as
PCOSA does have literature in regards to the pill and PCOS. I think her comments
were worth passing along.
1) BCP page:
Journal of Clinical Endocrinology and Metabolism's Vol. 80 no. 11 article on
pages 3327-34 about the 'Metabolic effects of oral contraceptives in women with
polycystic ovary syndrome'. This article says that a reduction in insulin
resistance happened.
There is also a good article from S. Nader, M. Riad-Gabriel, and M. Saad on,
'The effect of a desogestrel-containing oral contraceptive on glucose tolerance
and leptin concentrations in hyperandrogenic women' in the Journal of Clinical
Endocrinology and Metabolism, Year 1997, issue 82, pages 3074-307.
There are health benefits of contraception. http://www.arhp.org/betcho.htm
Dr. Leon Speroff's book: A Clinical Guide for Contraception, 2nd edition.
(Medlical library call number: WP 630 5749c 1996 c.1. He states that
levonorgestrel monophasics have a 'negative impact' or don't work well on those
with carbohydrate intolerances. Also that low doses have small but basically
ignorable effects on carbohydrate metabolism and insulin resistance. (Pg 56 -
59.) Dr. Leon Speroff is a well respected author of ob/gyn and reproductive
endocrinology related material.
There are few mental disturbances on the pill, but if the estrogen interferes
with the tryptophan production (to cause things like depression), it can be
reverse with the use of pyridoxine treatment (addition of B6). (Pg 60.)
This article talks about the (http://www.arhp.org/clinical/cpmyths.htm) myths
about oral contaceptives if you are interested.
2) Dr. Speroff webpage:
(Dr. Leon Speroff, "Clinical Gynecologic Endocrinology and Infertility",
published 1999 by Lippincott, Williams & Wilkins). The numbers in parenthesis
are page references.
Losing weight (to the point of going below a BMI of 27) (1106) is going to help.
At this point insulin resistance is not detected (510).
The best OC/BCP contains desogestrel, gestodene, and norgestimate, but this is
not always proven in studies (544). If you are in Europe, Cyproterone Acetate in
Diane/Diane-35/Dianette (OC/BCP) works very well for hirsutism (545). There is
little to no problems with using low dose OC/BCP, because there is little to no
measureable difference in insulin resistance. Spironolactone and flutamide don't
cause any insulin resistance problems either (508-9).
The defect of PCO is not in the P450c17 gene, but in the P450scc gene. (499)
This makes a big difference as to where you are going to look for future
treatments.
(1106) Ratio's of less than 4.5 are considered IR. This is the fasting glucose:
insulin ratio. (798) Two factors of insulin resistance are the amount of carbs
in the diet, and amt. of daily exercise. To measure IR, take the ratio of
fasting glucose to fasting insulin. If its lower than 4.5, its indicative of IR.
<br>
(898) The low dose pills appear to not have the effect of worsening insulin
resistance. He does state that changes in how carbs work are in the non-diabetic
range. Although there are changes, Dr. Speroff states they are minimal. (899)
(544) The best OC/BCP contains desogestrel, gestodene, and norgestimate, but
this is not always proven in studies. (Personal note: PCO women have better luck
with the desogestrel types of OC/BCP, at least from what has been said over a
period of time on several email lists.) These are the same pills that
*supposedly* caused diabetes in 2 out of 16 women in the
http://www.mja.com.au/public/issues/nov16/kidson/kidson.html Kidson study. The
study has noted it was uncontrolled, meaning that other factors that contribute
to getting diabetes were not ruled out and there is no way to prove an absolute
link to BCP and diabetes.
SHBG and IR: (46) "an important mechanism for a reduction in circulating SHBG
levels is insulin resistance and hyperinsulemia (independant of age and weight).
This relationship between the levels of insulin and SHBG is so strong that SHBG
concentrations are a marker for hyperinsulinemic insulin resistance and a low
level of SHBG is a predictor for the development of Type II diabetes. ". (The
pill affects SHBG levels, and I'll be looking up the official citation for
this.)
3) I had a discussion previously with Christine DeZarn, head of PCOSA on the
pill and PCOS. PCOSA does list the pill as a possible treatment of PCOS. When I
talked with her concerning this, the following is an excerpt of what she had to
say.
While I am not aware of an oral contraceptive directly causing diabetes, I don't
want people to ever think that PCOSA only lists treatments that carry no risk
with them. All treatments carry both benefit and risk. Some oral contraceptives
have been shown to slightly increase insulin resistance in some studies. Others
have not. But a pill is not a pill is not a pill. There are actually several
different types of oral contraceptives, some of them with entirely different
ingredients than others, so this accounts for the varying results. But no drug
is without risk, and all of those listed as "treatments" for PCOS carry risk as
well. Women with PCOS need to educate themselves about all of the different
types of oral contraceptives on the market, and the research that goes with
them, then select the best choice for them.
That being said, endometrial cancer is a much greater risk than a slight
increase in insulin resistance. Even if insulin resistance is slightly raised by
an OC, oral contraceptives irrefutably protect against endometrial cancer - the
more immediate life-threatening risk. What women really need to understand is
that they must treat the insulin resistance *in addition* to protecting
themselves against endometrial cancer. Too many doctors just tell a woman to
take the pill and that's it. But that's not enough. The IR absolutely must be
treated. We know that insulin resistance is treatable with diet, exercise and/or
insulin sensitizers. If we are treating the insulin resistance, then a slight
increase in IR from the pill will be addressed anyway. It's always a balance of
benefit and risk, and an educated decision is what is needed.
--
Victoria
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