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?