Are Oral Contraceptives Really the Answer for PMDD?

Is Levora® making your PMDD worse?  We're going to take a little side trip today, because in the past month alone I've had over 100 requests for information on this subject.  According to information provided by the website Drugs.com, it's possible.

Levora® is a combination drug that contains female hormones that prevent ovulation and also causes changes in your cervical mucus and uterine lining, making it harder for sperm to reach the uterus and harder for a fertilized egg to attach to the uterus. It's primarily used as an oral contraceptive that provides 21 active white tablets and 7 inactive peach tablets.  The tablets contain levonogestrel (a totally synthetic progestogen) and ethinyl estradiol (a synthetic estrogen).  Inactive ingredients in the pills include FD&C Yellow No.6 (which may contain aluminum) and three forms of lactose.

For more specific information on patient-reported Levora side effects, go to: the Rate a Drug site

and/or Treato: The Voice of the Patient.

It should also be noted that continuous combined birth control formulas (such as the one found in Levora®), as opposed to sequentially-based hormone regimens that mimic the natural female cycle, have also been shown to frequently lower a woman's sex drive.

According to Dr. Winnifred B. Cutler, in her book, Hormones and Your Health, a test on monkeys showed that the combination of ethinyl estradiol and levonogestrel (the combination in Levora®) caused large elevations in the stress hormone cortisol, as well as great increases in their heart rates.  Rising rates of cortisol, among other things, messes with your metabolism, causes you to gain weight and suppresses your normal immune functions, leaving you susceptible to every cold and flu that comes your way.  In time your body can get so run down that you develop something serious, even terminal.

For instance, Dr. Cutler also recommends that women avoid ethinyl estradiol after age 45 because it also increases the risk of having a stroke.  In fact, she recommends that (no matter what your age) you have your triglycerides and CRP (C-reactive proteins) checked (via blood tests) if you start ANY oral estrogens at three and/or six months after you start taking them.  You will need to switch hormone regimens if your CRP or triglycerides rise, as rising levels of either of these is predictive of heart disease, even more so than rising levels of LDL (aka the bad) cholesterol. 

No matter what form of oral contraceptive you may be taking, I urge you to find out what exactly is in it, and if it is a continuous formula or a sequential one.  This will go a long way in determining which side effects may or may not apply to you.  Besides, it's just plain smart to know what you're putting into your body.  For instance, if you're having trouble thinking and remembering things, it might be due to the ethinyl estradiol in your hormone pills.  "Estrogen like" as in synthetic estrogens, is not the same as bioidentical estrogen.  Far from it.  Each will have a different impact on your thinking processes.

The rest of the information that follows seems to be the standard patient information for all oral contraceptives, which include Levora®, but may or may not be specific to Levora®.  Still, I looked up the medical terminology you find in your patient information packets, and translated them into everyday words we can understand.

That said, you should not take any combination birth control pills if you have high blood pressure, heart disease, a blood-clotting disorder, circulation problems, diabetes, pre-diabetes, unusual vaginal bleeding, liver disease or liver cancer, jaundice caused by birth control pills, a heart attack, stroke, or blood clot.  Note that there is the possibility of a risk of heart disease even in very young women who take oral contraceptives.  So if you are young, don't go around thinking you're invincible. While a cause and effect relationship has not been scientifically established, some studies have also reported an increased relative risk of developing breast cancer, particularly at a younger age.  This increased risk appears to be related to how long you take the pills.  The risk for benign liver tumors increases after four or more years of use.  (Death can occur if a tumor ruptures.)  Studies have also shown an increased risk of developing liver cancer in long term (greater than 8 years) use of oral contraceptives.

You should discontinue use of your oral contraceptive if you experience unexplained or complete loss of vision, bulging eyes, swelling of the optic nerve, or lesions (scars, bumps, bubbles) in your retinal veins.

Also, be aware that cigarette smoking increases the risk of serious cardiovascular side effects from oral contraceptive use.  This risk increases with age and with heavy smoking (15 or more cigarettes per day). 

Still, if you use oral contraceptives, you should not smoke.  Period.  If you are looking for a way to go off the pill, please check out this website. 

If you do smoke while taking oral contraceptives, some nasty things that can happen include heart attack, blood clots (in the lungs and legs), stroke, liver tumors, and gallbladder disease.  The risk increases significantly if you already have high blood pressure, high cholesterol, diabetes, and/or are obese.  Obesity is defined as having a body mass index of more than 30.  You can figure out your BMI here.  

Oral contraceptives have also been shown to cause glucose intolerance in a significant percentage of users.  Oral contraceptives containing greater than 75 mcg of estrogen (which Levora® does) can cause abnormally high levels of insulin. People with too much insulin have frequent episodes of low blood sugar (hypoglycemia). These episodes can be characterized by a lack of energy (lethargy) and/or irritability. Repeated episodes of low blood sugar increase the risk for serious complications such as seizures, intellectual disability, breathing difficulties, and coma.

Lower doses of estrogen cause less glucose intolerance, but the progestogens in your oral contraceptive can also increase insulin secretion and create insulin resistance.  Therefore pre-diabetic and diabetic women should be especially careful while taking oral contraception.  Talk with your doctor frequently. 

The incidence of high blood pressure also increases with increasing concentrations of progestogens.  Women with a history of high blood pressure or high blood pressure-related diseases, as well as kidney disease, should use another method of contraception.

If you start to get migraines, or your migraines become more severe, stop taking oral contraception until you determine the cause.

When taking any oral contraceptive, you should follow up regularly with your doctor.  You need to pay special attention to your blood pressure, breasts, abdomen and pelvic organs, including pap smears.   Women--especially younger women--with a strong family history of breast cancer should think twice about taking oral contraceptives.

Birth control pills can also be a problem if you have varicose veins, a history of depression, an underactive thyroid, seizures or epilepsy, and/or a history of fibrocystic breast disease, lumps, nodules, or an abnormal mammogram.

As with any drug, you could have an allergic reaction to Levora®.

If any of these adverse effects occurs while you are taking oral contraceptives, call your doctor immediately:

·        Sharp chest pain, coughing of blood or sudden shortness of breath (indicating a possible clot in the lung)

·        Pain in the calf (indicating a possible clot in the leg)

·        Crushing chest pain or heaviness in the chest (indicating a possible heart attack)

·        Sudden severe headache or vomiting, dizziness or fainting, disturbances of vision or speech, weakness or numbness in an arm or leg (indicating a possible stroke)

·        Sudden partial or complete loss of vision (indicating a possible clot in the eye)

·        Breast lumps (indicating possible breast cancer or fibrocystic disease of the breast: ask your doctor or health care provider to show you how to examine your breasts)

·        Severe pain or tenderness in the stomach area (indicating a possible ruptured liver tumor)

·        Difficulty in sleeping, weakness, lack of energy, fatigue or change in mood (possibly indicating severe depression)

       Jaundice or a yellowing of the skin or eyeballs, accompanied frequently by fever, fatigue, loss of appetite, dark-colored urine or light-colored bowel movements (indicating possible liver problems)

It's the references to depression and anxiety that concern and confuse me.  Why would a doctor prescribe something for your PMDD when it could cause more of the very same symptoms you already have?  Plus increase your chances of developing heart disease, among other things.

Side effects they don't consider serious (but you might) include:

Increased blood pressure

Mild nausea

Breast tenderness or swelling, nipple discharge

Freckles or darkening of facial skin, increased bodily hair growth, loss of scalp hair

Rashes

Changes in weight or appetite

Fluid retention, particularly in the fingers and ankles

Problems with contact lenses

Headache

Anxiety

Dizziness

Vaginal itching or discharge

and

Decreased sex drive

And this is not a complete list of side effects.

Special note:  Certain drugs can make birth control pills less effective:  These include Phenobarbital and other barbituates, seizure medications, and St. John's Wort, which many PMDD women use to counter their depression.  So beware if you are self-medicating with St. John's Wort.

In all, there doesn't seem to be a lot of scientific information on the internet specifically about Levora® making your PMDD symptoms worse...which is probably why people are looking for it.  I hope this post has answered some of your questions, or at least pointed you in the right direction for the answers you seek. 

That done, I need to get on my personal bandwagon and ask you to reconsider using birth control to treat your PMDD.  Is the increased risk of heart disease, the number one killer of women, worth the risk of masking your PMDD symptoms for a few years?  Think about this.  Just because fertility and PMDD both involve hormones does not mean the medications for them are interchangeable.  That's like throwing something against a wall to see if it sticks.  A good naturopath or nurse practitioner should be able to help you come up with a hormone regimen individualized for your needs and your body. 

The problem with PMDD begins at ovulation.  Did you know bioidentical estrogen in high enough doses can prevent ovulation?  Without all the unpleasant side effects listed above.

I'm not recommending bioidentical estrogen as birth control, but to help manage your PMDD in a positive and healthy way?  It's certainly worth a shot.  Especially if you're in peri-menopause.

Of course you can't take unopposed estrogen in any form without adding back some progesterone, but again, with the right medical supervision, you can work out a regimen that best suits your body and needs and lifestyle.  That best suits YOU.  Rather than the one-size-fits-all mentality that prevails in the marketplace now.   

Don't you deserve to be treated as the individual that you are?

PMDD Wars: Supportive Partners, Women in Denial

I recently learned of a segment of the PMDD population I've left unaddressed--mainly because I had no idea it existed.  My post, Dealing with PMDD, Advice for Men, was written in response to the many posts I was seeing from women with unsupportive partners.  What, they wanted to know, could they do to help their partners understand their PMDD? 

So I put a post together, which in the end turned out to be three posts.  They're some of my most read posts, and I get the most mail regarding them.  But lately I have been hearing from men who love their wives and girlfriends, and would be more than willing to do whatever it took to help her to deal with her PMDD....

Only she's not interested.

Because she's not the one with the problem, he is, and if he can't deal with that, well, then...

Sound familiar?

It happens in a lot of relationships, and not just those that deal with PMDD.  One partner is trying to work things out, and the other is in denial.  Unfortunately, this is a sure-fire recipe for failure. 

For a relationship to succeed it has to have two consenting adults.  Two people behaving like grownups, each taking responsibility for their part in making the relationship work--or not work.  It's not about power, control, or changing the other person.  It's about doing your part to show your partner that your relationship is a priority in your life, and that you want it to last.

You don't do that by:

Playing the blame game

Expecting your partner to change

Trying to change your partner (for their own good or any other reason)

Ignoring your partner's needs

Being abusive to your partner

Denying there is a problem

Relationships require compromise, day in and day out.  They're not about one partner giving up all sense of self to cater to the wants and whims of the other.  It's a balancing act, and one that needs adjusting and readjusting daily.  It's hard enough to have a successful relationship between two healthy people.  Throw in some PMDD and your difficulties can increase exponentially.

But they don't have to.  Whether you believe it or not, you do have choices when it comes to your PMDD.  You can't control when it hits, but you can manage your reaction to it.  You can either take the path of least resistance and give in to your seemingly uncontrollable urges, or you can take a stand and say, "I am not my PMDD.  I am better than this." 

Your PMDD is not who you are, not the real you.  Root yourself in this knowledge and stand firm.  Refuse to let your PMDD get the better of you.  Refuse to let the negativity win.  Sure, you'll still be weepy and edgy and anxious and irrational at times....accept that that happens, but don't let it have free rein during an episode.  We all slip up now and then, but to totally immerse yourself in the negativity and irrationality...that doesn't do anybody any good--yourself, your partner, or your children.

Think of your children if you can't think of anything else.  Don't they deserve better than to see you not even trying to get along with your chosen mate?

This completely boggles my mind.  I myself entered a PMDD episode starting Friday night.  I knew it was coming, I could feel the storm approaching, and all I wanted to do was to be held.  Unfortunately, the circumstances for that to happen didn't fall in line.  It was payday and my partner was feeling flush.  He called and asked if I wanted to go out to dinner at our favorite restaurant.  I reluctantly said sure.  I was only going to heat up leftovers anyway.  Now I wouldn't have to do even that much.  In short, I adapted.  I decided to let myself be pampered another way since I couldn't have what I really wanted.  

But all night long, he kept asking, "Is something wrong?  You seem distracted."

Something was wrong, and I was distracted, but distraction is also an occupational hazard for me, so he's used to it.

Finally I said, "I can feel the storm coming."

He knew what I meant.

He took me home and I went right to bed. 

We spent the day apart on Saturday, seeing to individual tasks.  I felt all right most of the day, probably because I didn't have to interact with anyone, but around 5:00 p.m. I had an intense craving for carbs.  I ate a bowl of cereal. Shortly thereafter my partner arrived and off we went to church...where I could not stay focused to save myself.  My mind bounced from thought to thought to thought.

Afterward, now out of milk, we went to the grocery store.  I had three things I wanted to get: milk, brazil nuts (for selenium), and cat food.   It took every ounce of my concentration to stay on task, to simply remember those three items, and remember where each was located in the store.  Since by now I was feeling completely miserable--head pounding, joints aching, brain feeling like it was on fire--my mission was to get in, get my stuff, and get out. 

In church, I had let my mind wander, but now, I had to corral all those bouncing thoughts and force my mind to stay on track.  So deliberately focused was I that the minute we arrived in the parking lot, I jumped out of the vehicle and made a beeline for the store, completely ignoring my partner.  As soon as I entered the store, I saw the rack where I had last found the brazil nuts.

In that moment, nothing could have come between me and my goal. 

But they were out of brazil nuts.  They had almonds, walnuts, peanuts, pecans...but no brazil nuts.

My partner caught up with me as I stood in front of the nut rack, feeling completely derailed and wanting to weep.

I turned to him and said, "I want to cry, because there are no brazil nuts here."

I then asked him, "Am I acting strange?"

And he said, "Yes, I noticed something was off in church."

"I thought so," I said.  "It's that time again.  I'm having an episode."

I then turned away and went in search of the milk, once again leaving my partner behind.  As I was walking, I realized I was being rude.  I then recalled other times I had walked off without him and realized that each and every time it was during an episode. 

Suddenly it hit me that I wasn't trying to be rude--it was simply taking every ounce of energy I had to stay on task.  Otherwise I might look left or right, get distracted and we'd be wandering the store looking at nothing in particular until he said come on, let's go, and I would burst into tears for no apparent reason and our evening would be ruined. 

I stopped and explained this to him and we finished our shopping together.

But the whole time, I was feeling very angsty and edgy and primed to have a fight.  As he helped me out of the car when we got home, I said to him, "I could start a fight with you so easily right now."

He looked at me in surprise.  "About what?"

"That's just it," I said.  "About nothing."

I was overtired and achy and weepy and feeling like a toddler on the verge of a tantrum.  No lie.

Instead I went to bed. 

Because I know the difference between me and my PMDD.

And because our relationship matters to me.

It might not have been the most exciting ending to either evening, but at least it wasn't filled with a lot of drama that would leave each of us feeling devastated and alone.  My partner understood my need for rest and solitude because I was able to express it in a quiet and (somewhat) rational matter.  My partner understands my sudden rudeness and self absorption is not a reflection of him, but rather of my PMDD. 

With a different partner, it could have gone completely differently. 

If I had behaved differently, it could have gone completely differently.

Because inside of me was someone dying for a fight.  It didn't matter what the fight was about.  All I wanted to do was goad my partner into sparring with me until I could no longer stand my own irrationality and then burst into the tears I so desperately wanted to weep--and blame him for ruining everything.  Maybe even blame him for abandoning me or not loving me when he walked out the door in sheer frustration, for lack of knowing what else to do.

Not because he doesn't love me.  But because I wouldn't let him love me.  Wouldn't let him see my need, my vulnerability, my (what some would call) weakness, and wouldn't trust him to take care of me.

Think about it:  Which would you rather be...lovingly cared for, or crying and alone?

I'm still having an episode.  My head still pounds, my eyes hurt, my joints hurt, my back hurts, my brain burns, and I want to cry.  There is no doubt I could be drawn into an argument, any argument, with anyone, at the drop of a hat.  It may still happen...because sometimes the strength to hold the negativity at bay just isn't there.  But I do know that if it happens, it will only be for a moment, before I catch myself again, and remind myself that I am not my PMDD, and that my blindsided target doesn't deserve to be abused just because I am having a bad day. 

No one does.

Is PMDD Real? : A Psychotherapist with PMDD Shares Her Story

Today we have a guest post from Dr. Chantal Gagnon, who has been kind enough to fill in for me while I continue my research on progestins and progesterone.  Thank you, Dr. Gagnon, and welcome!

IS PMDD Real?

THE SHORT ANSWER: Yes, it's real.

THE LONG ANSWER

PMDD can be thought of as an extreme form of PMS (Pre-Menstrual Syndrome), but with symptoms that are more severe and debilitating. PMDD symptoms can be physical, such as bloating, headaches, breast tenderness, etc., but typically the symptoms that have the greatest impact for women with PMDD are emotional and behavioral symptoms. For up to two weeks near the time of their period (but less time for some women), PMDD sufferers can experience a range of emotions and behaviors, including depression, suicidal thoughts, anxiety, tension, irritability, anger, even to the point of rage, self-loathing, mood swings and feeling overwhelmed. These symptoms can often feel severe or extreme. It's common during this period of time for women to start fights, give people "a piece of their mind" (i.e. become verbally abusive), and perceive their mates negatively. Sometimes women quit a job or end a relationship or scream like a banshee in the midst of an episode.

What causes PMDD is a sudden drop in the neurotransmitter Serotonin following a shift in hormones as a result of the menstrual cycle. The same biochemistry is implicated in PMS, but women with PMDD either are more biologically sensitive to hormonal shifts in general, or the hormonal shifts they experience are bigger. Depending on which study you look at, this disorder affects between 5% to 10% of women, and may get worse with age (30's and early 40's), possibly because stress can make symptoms worse (women report more stress during the years of raising a family and building a career).

How I Discovered I Had PMDD

My first semester as a counseling student I took a course on psychopathology (mental health disorders). The class was focused on learning and understanding the diagnoses listed in the DSM - the Diagnostic and Statistical Manual of Mental of Mental Disorders published by the American Psychiatric Association (APA). We also learned about disorders that the APA was considering adding to the next version of the DSM. PMDD was one of them. I remember thinking at the time: "This is complete BS! These psychiatrists are taking normal PMS and making it a "disorder" so that pharmaceutical companies can sell more drugs." So, for the first several years of my career, I did not believe PMDD was real. I even did a presentation in another class about how the DSM tries to create "disorders" out of normal behavior, and of course, I included PMDD in that presentation.

I was wrong. I discovered my error in judgment when I developed PMDD in myself in my 30's. I noticed that a day or two before my period, I became suddenly and severely depressed - everything in my life seemed hopeless. It was almost as if I was a different person. But the day my period started, I felt completely better. Weird, I thought. But then, the pattern continued and I became more aware of it. Sometimes my symptoms were depression-related, other times it was irritability and anger. When I got married, it got worse because I couldn't isolate myself from people during those few days of my cycle (which had been a fairly effective coping strategy in the past). My husband was always around now :) So, unfortunately for him, he got caught in the PMDD storm!

Finding Resources and Learning to Cope

So, Ken (my husband) and I began looking for answers. I had a hunch PMDD might be the issue, but I had never really believed it was a real disorder. Plus, I wanted to be mindful to not just be making excuses for my bad behavior. Around that time, we found Liana's website and blog: Living with PMDD (www.LivingWithPMDD.com). Wow, what a great resource! Through her site, a book about PMDD, and discussion board posts from other women relating their experiences with this disorder, I discovered that this was indeed what I was living. I later confirmed the diagnosis with a psychologist, and my husband and I have developed coping strategies that are effective for us, and for my particular symptoms. Needless to say, I now know that PMDD is indeed real. I'm one of the lucky ones though, because I only experience severe symptoms two to four times a year. With proper planning, improved stress management, and coping skills most months have been OK, and for the months that aren't Ken and I now know how to surf that wave, instead of getting caught in the rip current.

Every women is different, and PMDD manifests differently in different women. If you suspect (or if you know) that you have PMDD, it's important to find compassionate support people, educate your family on the disorder, and put into practice coping strategies that will work for you.

Dr. Chantal Gagnon is a licensed psychotherapist, author, and life coach in Plantation (Fort Lauderdale), Florida. To read her blog or learn about her services, visit www.LifeCounselor.net or follow her on twitter @DrChantalGagnon