Re: BCP - repost of article from PCOS forum
From: =?iso-8859-2?q?Zalányi Sámuel ?= (anonymous@obgyn.net)
Wed, 15 May 2002 20:54:12 +0200
Hi Victoria,
You seem to be waging a war in support of BCPs (OCs) in the treatment of PCOS. I do not know your motives for it but your reasoning seem to follow a typical single issue logic.
I do not know what years have you checked, but I am positive that there are several reports on OCs deteriorating glucose tolerance. Some of them was performed by Samsioe in Göteborg/Sweden with whom I had the opportunity to discuss metabolic side-effects of OCs.
As of protection against endometrial cancer, gestagens ore natural progesterone is definitely better than combined OCs.
The same is true for rregulating your bleeding.
For the balanced info of all of you
Sam
> http://forums.obgyn.net/pcos/PCOS.0204/1161.html. I made this post on the
> pcos
> forum, due to claims about how the pill is basically the root of all evil.
> I've
> never seen any American studies (or European) that specifically (controlled
> study) can prove a link between the pill causing diabetes. I'd also ask
> everyone
> to consider: if the pill gave you diabetes, don't you think there would have
> been a lawsuit on it by now? Wouldn't endocrinologists never prescribe the
> pill
> then? I've never seen it come across on the Medscape or Lynx articles that
> endocrinologists should check and make sure all their diabetic patients are
> off
> the pill, because it would make them worse. I'd also ask you to consider, if
> PCOSA, your national organization, believed this to be an absolute truth,
> don't
> you think they would have been warning everyone about this?
>
> 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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