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Re: Depo-provera?From: Victoria (anonymous@obgyn.net)Thu, 26 Sep 2002 9:00:01 -0400
> From: cnmpat@attbi.com (Pat) > To: PCOS-MEDICATION@OBGYN.NET > Subject: Re: Depo-provera?
> I think this could true, but there has not been enough concrete How is this different from evening primrose oil? There was pretty much nothing to go on there. http://forums.obgyn.net/pcos-medication/PCOS-MEDICATION.0208/0088.html me http://forums.obgyn.net/pcos-medication/PCOS-MEDICATION.0208/0103.html me http://forums.obgyn.net/pcos-medication/PCOS-MEDICATION.0208/0106.html me http://forums.obgyn.net/pcos-medication/PCOS-MEDICATION.0208/0075.html Pat http://forums.obgyn.net/pcos-medication/PCOS-MEDICATION.0208/0096.html Pat There has been tested research on whether or not the pill causes diabetes. The consensus is that the first generation pills did, but the newer third generation ones don't.
> Providers have been putting women on BCPs for years, and we Why? Based on what? Dr. Leon Speroff is a pretty well known author: Clinical Gynecologic Endocrinology and Infertility. Page 898: "The glucose intolerance is dose-related and once again effects are less with low-dose formulations." In italics "Insulin and glucose changes with low-dose monophasic and multiphasic oral contraceptives are so minimal, that it is now believe they are of no clinical significance." There are more statements to this effect on this page (along with prescribing to diabetic people) on pages 920, 921, 924, 508, 509. Chapter 12 is devoted to the polycystic ovary. Page 506 talks about patient selection possibly being a factor in whether Metformin works or not. Page 508 talks about progestational agents having no significant effect on the androgen production by the ovaries. Even if contraception is not required and hirsutism isn't a complaint, check the lipids, and should you see androgenic patterns, 'serious consideration should be given to suppression with oral contraceptives'. We have long term data (for what 40 years) on birth control pills. With the estimates of 6 to 15% of the population having PCOS, any study that has 100 people should, by estimates, have at least 6 to 15 ladies with PCOS. That means they would be included in studies. See http://www.medscape.com/viewarticle/434446?srcmp=ms-062102. See 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. In addition, since estrogenic hormones also exert some action on the metabolism of carbohydrates, how much would any extra weight (which has estrogenic properties) have on carbohydrate metabolism? I agree that Metformin should be a choice for women, but why at the exclusion of other options? I recently sent out an article that used Metformin and a birth control pill together, the results were pretty positive.
> They either put everyone on hold (a They have also made things better in some cases. Hirsutism, regular periods, acne (page 918), can be and are improved on the pill. Dr. Speroff wrote on page 918 regarding weight gain, "studies of the low-dose preparations fail to demonstrate a significant weight gain with OC's, and no major differences among the various products. This is obviously a problem of perception." See also http://www.cnn.com/2002/HEALTH/09/24/the.pill.weight.ap/index.html, Study suggests 'the pill' doesn't affect weight Will other forms of birth control protect agaginst benign breast disease or fibrocystic disease, ovarian cancer or endometrial cancer? How about bone density? (pg. 923). What about dysmenorrhea? I have a pretty good discussion listed on my BCP webpage with Christine DeZarn, head of PCOSA. Also see the discussion I had with Dr. William McIntosh in regards to this. See also http://www.medscape.com/viewarticle/441324?mpid=3865 Low-Dose Oral Contraceptive Safe And Effective Treatment For Acne, http://www.medscape.com/viewarticle/440820 Third Generation Oral Contraceptives Do Not Raise Risk of Myocardial Infarction, http://www.cnn.com/2002/HEALTH/06/26/thepill.breast.cancer.ap/index.html The pill and breast cancer Study finds no link - June 26, 2002, http://www.endolinx.com/thearts.cfm?artid=377901&specid=16 New study adds to evidence that taking oral contraception does not increase risk of breast cancer, http://www.obgynlinx.com/thearts.cfm?artid=404919&specid=5 Myocardial infarction and third generation oral contraceptives: aggregation of recent studies, http://www.obgynlinx.com/thearts.cfm?artid=406203&specid=5 Effects of two oral contraceptives on plasma levels of nitric oxide, homocysteine, and lipid metabolism. Kidson's 1998 study in Australia http://www.mja.com.au/public/issues/nov16/kidson/kidson.html said that the study was "uncontrolled" for diabetes. So we can't blame the pill for that. Btw, that formulation is the same one that is mentioned as being one that PCOS women did well one: Desogen. http://www.obgyn.net/displayppt.asp?page=/english/pubs/features/presentations/spitzer/spitzer-ss Doesn't appear that diabetes is a problem Hum Reprod 2002 Jul;17(7):1729-37, Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol-cyproterone acetate in non-obese women with polycystic ovarian syndrome: a randomized controlled study. Hum Reprod 2002 Jan;17(1):76-82, Insulin sensitivity in non-obese women with polycystic ovary syndrome during treatment with oral contraceptives containing low-androgenic progestin. The norgestimate-containing COC significantly decreased androgen production and concentrations of free androgens, without reducing insulin sensitivity in non-obese PCOS subjects. Cas Lek Cesk 2001 Nov 8;140(22):688-94 [Effect of long-term treatment with metformin on steroid levels and parameters of insulin resistance in women with polycystic ovary syndrome] Vrbikova J, Hill M, Starka L, Cibula D, Snajderova M, Sulcova J, Vondra K, Bendlova B. CONCLUSIONS: Long-term therapy with metformin led to the improvement in menstrual cyclicity, without significant change in basal steroid levels or parameters of insulin resistance.
> And, it sounds like Depo Then we would have to pull money from other PCOS research to research this. There are many different types of pills, which ones are we going to research? We'd have to compare against other sources of contraceptives.
> I would suspect eating moderate to low carb, daily exercise and perhaps I can't see where it is proven that the pill causes problems where a PCOS woman would need to avoid it to preserve or improve fertility at all. Can you send us your sources?
-- Victoria
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