PMDD and the MTHFR Gene

Today's gift is a post by PMDD Advocate Danielle Lasher Bosley, which helps to explain the mysterious MTHFR gene we have often read about.  

What is MTHFR? It's an enzyme that can be mutated. Women with PMDD don't all have the mutation, but it is assumed the vast majority of us do. If I had to personally estimate based on women I know who have been tested already, I would say above 90%.

MTHFR is highly linked to mood disorders, autoimmune issues, and many, MANY other things. Heart disease, PCOS, cancer, thyroid issues, addiction, miscarriage, fibromyalgia, IBS, bipolar, chronic fatigue syndrome, asthma, MS, cervical dysplasia and much, much more...

People with the MTHFR mutation cannot properly methylate. When methylation is impaired, they can't detox properly, among other things. Birth control, any synthetic hormones, prescription drugs overall are riskier for us. They essentially get us further away from being better while making us feel better temporarily. 

People with MTHFR should NEVER use acetaminophen (stick with bioron or ibuprofen if needed). We also should not be vaccinated. Many of us in the PMDD community who have researched this illness for many years and have also researched vaccines are confident there are potential links and that for some of us, vaccines contributed to or outright caused the start of this illness.

The two most common forms of MTHFR we know of are c677t and a1298c. Heterozygous MTHFR means you have one copy of one of these. That is the least serious form, but it still predisposes the individual to more risks than someone without MTHFR. Compound heterozygous means you have one copy of each form. This is more severe than the first form I mentioned. The most serious form of MTHFR is homozygous. Homozygous c677t is the worst one. This means you have two copies of the 677 form. Methylation is decreased to an estimated rate of just 30% of what the body should be doing in these cases. 

People affected by the MTHFR mutation need methyl folate. They also need to avoid folic acid. Folic acid is the synthetic form of folate (Liana adds: and is promoted heavily by the media to all women of childbearing age.) With MTHFR mutations, only methyl folate can be received and processed by the body. Synthetic folic acid actually builds up on receptors and blocks natural methyl folate from getting through. This makes us sicker.

Keep in mind this goes beyond vitamins. Folic acid is added to a TON of processed foods. Breads, cakes, potato chips, etc... This is part of the reason we improve when we cut out these foods. You might have heard women speak about their PMDD improving when they go Paleo, etc.... It's not merely because they cut out processed food. It's because in that step, they removed the folic acid from their diet and started consuming methyl folate. Their body is finally able to start working properly and detoxing well.

Vitamin B is also important and majorly impacts our moods. We must avoid cyanocobalamin and only use methylcobalamin. (Liana adds: Read the label on your bottle.)

Synthetic hormones and birth control are not only a risk for us because we have higher risks of heart issues, stroke, and pulmonary embolism, but because the synthetic hormones reduce folate! The hormone part makes you feel better today, but the damage its doing underneath the surface will make this illness, as a whole, harder to treat.

We are also at high risk of vaccine injury. Many of us are confident PMDD may be the result of vaccine injury itself. If you've never researched vaccines, they do indeed cause injuries. Many of them are brain injuries and issues that have led to the development of neurological disorders. As of this date, $3 billion has been paid out to victims of vaccine injuries through the federal vaccine court. The numbers continue to grow.

Vaccines are dangerous for us because they contain adjuvants we can't properly detox from when we have either the MTHFR and/or COMT* gene. MTHFR also inhibits our bodies from removing the toxins that vaccines inject. Just some vaccine ingredients include:

Formaldehyde, aluminum, mercury, aborted fetal cells, cow and monkey DNA, glycophosphate, polysorbate 80 (carcinogenic preservative), neurotoxins like ammonium sulfate, antibiotics (more harm to our guts), phenoxyethanol (antifreeze), and more.

Hope you're all hanging in. We ARE going to resolve this illness. ~Danielle

*Catechol-O-methyltransferase (COMT) is one of several enzymes that degrade catecholamines (such as dopamine, epinephrine, and norepinephrine), catecholestrogens, and various drugs and substances having a catechol structure. In humans, catechol-O-methyltransferase protein is encoded by the COMT gene.

Scientific Awareness of PMDD is not the Problem

Almost daily I hear someone mention how we need to raise awareness of PMDD, so that more studies of this debilitating disorder will be done, and someone can finally unlock the secret of what causes PMDD and how to successfully treat it.

So one day last August, a week before my most recent brain surgery, I was apparently looking for some challenging reading material when I got out of the hospital, (thinking positive, I imagine) so I spent an hour and a half clicking on links and printing out various scientific abstracts and studies I could find on PMDD.

In just that small segment of time, I found nearly 50 studies on PMDD, which broke down as follows:

2013 - 19

2009-2012 - 18

2006 - 2008 -  I already have most of these in my files, so did not print them out again

2001-2005 - 10

I am sure there have been countless more studies done in the past 14 years, but this was a random sampling of those I might not already have read, and I also chose not to print out many that were over 7 years old, as so much information about PMDD has changed since 2007. 

Of the 2001-2005 studies, I printed only those that might be of use in my research.  A list of titles appears below.  And yes, I do intend to read each study listed, and share with you in plain language anything that seems relevant.  But first I want to point out that in the scientific community, the problem is not awareness.  Scientists are well aware of PMDD and for what looks like mixed reasons.   An analysis of what those reasons might be will be the subject of a future post. 

For now I just want to repeat that awareness on a scientific level is not the problem.  Awareness in the medical community—short of misleading advertisements by drug companies—and awareness in our friends and families is.  Hopefully blogs like mine will help to rectify that situation for you and your loved ones. 

In the meantime, here is a list of the studies on PMDD I uncovered in less than two hours of searching.  If you think the list is dry reading, imagine reading the studies themselves :).  But like I said, it keeps my brain sharp. Not to mention I'm a total research geek and love it.

If you wish to read any of these studies yourself, you can Google the name provided.  I typed the titles exactly.   Just retype it yourself, or cut and paste the title into your browser.  These can all be found on the PubMed.gov site, which is part of the U.S.  National Library of Medicine, and the National Institutes of Health.  Many of them are abstracts, but you *can* find the full studies if you look hard enough.  Update: the first comment below tells you exactly how you can get copies of the full studies.

Enjoy!

2013

Comorbid bipolar disorder and PMDD: real patients, unanswered questions

Elevated gray matter volume of the emotional cerebellum in women with PMDD

Allopregnanolone serum concentrations and diurnal cortisol secretion in women with PMDD

Examination of premenstrual symptoms as a risk factor for depression in postpartum women

Luteal serum BDNF and HSP70 levels in women with PMDD

PMS and PMDD among Jordanian women

Circulating insulin and leptin in women with and without PMDD in the menstrual cycle

Abnormalities of dorsolateral prefrontal function in women with PMDD; a multimodal neuroimaging study

Lamotrigine augmentation in PMDD : a case report 

Depressive mood and frontal alpha asymmetry during the luteal phase in PMDD

PMDD and severe premenstrual syndrome in adolescents

Selective serotonin reuptake inhibitors for PMS

Premenstrual disorders and rumination

Anger in women with PMDD: Its relations with PMDD and sociodemographic and clinical variables

Non contraceptive benefits of oral hormonal contraceptives

Premenstrual symptoms and posttraumatic stress disorder in Japanese high school students 9 months 

after the great East-Japan earthquake

Personal history of major depression may put women at risk for premenstrual dysphoric symptomatology

A review of treatment and management modalities for PMDD

Biopsychosocial aspects of premenstrual syndrome and premenstrual dysphoric disorder

2012

Pilot investigation of the circadian plasma melatonin rhythm across the menstrual cycle in a small group of women with PMDD

Bipolar disorder and PMS or PMDD comorbidity: a systemic review

Survey of premenstrual symptom severity and impairment in Korean adolescents; PMDD subthreshold PMDD and PMS

Intercountry assessment of the impact of severe PMDD on work and daily activities

2011

Work stress, PMS and PMDD are there any associations?

Lifetime discrimination associated with greater likelihood of PMDD

Posttraumatic stress disorder and trauma characteristics of PMDD

Reduced Phase-Advance of Plasma Melatonin after bright morning lithe in the luteal, but not follicular menstrual cycle phase in PMDD: An extended study

Exposure to American culture is associated with PMDD among ethnic minority women

Health advantage for black women: patterns in PMDD

2010

Histories of major depression and PMDD: evidence for phenotypic differences

Neuroticism related personality traits are related to symptom severity in patients with PMDD and to the serotonin transporter gene-linked polymorphism 5HTTPLPR

Predicting response to leuprolide of women with PMDD by daily mood rating dynamics

Estrogen receptor alpha (ESR-1) association with psychological traits in women with PMDD and controls

Increased sensitivity to light-induced melatonin suppression in PMDD

Prefrontal brain asymmetry and PMDD symptomatology

Explorative evaluation of the impact of severe PMDD on work absenteeism and productivity

2009

Safety, efficacy, actions and patient acceptability of (Yaz) contraceptive pills in the treatment of PMDD

2005

Lack of beneficial effects of clonidine in the treatment of PMDD: results of a double blind, randomized study
Histories of sexual abuse are associated with differential effects of clonidine on autonomic function in women wit PMDD

2004

Historic sexual abuse and current thyroid axis profiles in women with PMDD

2003

The prevalence, impairment, impact and burden of PMDD

Biological correlates of abuse in women with PMDD and healthy controls

2002

Prevalence, incidence and stability of PMDD in the community

Prevalence and predictors of PMDD in older premenopausal women. The Harvard Study of Moods and Cycles

2001

Characteristics of women with PMDD who did or did not report a history of depression: a preliminary report from the Harvard Study of Moods and Cycles

Allopregnanolone levels and reactivity to mental stress in PMDD

Is the Pill Really the Answer for Your PMDD?

Whether you're taking the Pill for contraception, or for your PMDD, you need to read this book.  If you can't afford the book, then read Holly's blog of the same name.  Make sure you are making an informed choice when you pop that pill in the morning for your PMDD.  

To quote author Laura Werschler, who wrote the foreword for Holly Grigg-Spall's book:

"Sweetening the Pill explores and challenges the ways in which the pill and other drug-based contraceptives damage women’s health, threaten our autonomy and thwart body literacy. What we don’t know about our bodies helps pharmaceutical companies “sell” their contraceptive drugs, and keeps us “addicted” to them... Prescribing the pill, or other forms of hormonal contraception, has become, in the minds of most health-care providers, the “standard of care” for being a girl. It is all too common to subjugate a girl’s menstrual cycle to synthetic hormones that superficially “regulate,” but actually suspend the maturation of her reproductive system. And for many girls, the use of hormonal contraception continues well into their 20s, without awareness of what might be or has been sacrificed."

This sacrifice can include, but is not limited to, your mental and emotional stability, both of which are defining symptoms of your PMDD.

For more information, go here, or here.  Or even here.  Learn about what you are putting into your body.  You will be surprised at how many questions these resources will be able to answer.

Birth Control and PMDD

Here's a link to another excellent article by Holly Grigg-Spall, about how your oral contraceptive may be affecting your relationships.  Just remember that in taking birth control for your PMDD, you are messing with your hormones, and your hormones are already messed up, so...

You do the math.

Oral contraceptives only mask the problem.  They do not cure it, or make it go away.  In the end, more often than not, they make the problem worse.  Because eventually you will go off of the Pill, and if it doesn't happen sooner, that's most likely when your hormonal issues will resurface and with a vengeance.

Here's a quote from Holly's article:  Professor Jayashri Kulkarni, the director of Monash Alfred Psychiatry Research Centre in Melbourne, Australia, found women on the pill are twice as likely to be depressed, anxious, have poor self-esteem, feel irritable, hostile, and numb to experiences.

Sound like anyone you know?

“We’ve seen the destruction of relationships, due to women becoming irritable, hostile and prickly when taking the pill. And then they look back and say ‘that wasn’t me’. There can be the breakdown of marriages,” Prof. Kulkarni describes.

You don't deal with a problem by covering it up.  If you are having any of these mood or emotional issues and are on the Pill, don't be so quick to blame yourself alone for feeling any of the above.  Your moods could be getting a boost--and not in the right direction--from your birth control pills.

Taking Yaz or Yasmin for Your PMDD?

How many women know Yaz Flex, Yaz, Yasmin and Beyaz are 99% similar in composition? ~Holly Grigg-Spall, author of the Sweetening the Pill blog and book.

If you are taking Yaz or Yasmin for your PMDD symptoms, you need to read this.  So many of you have written to tell me you are being told the PMDD symptoms you experience are "all in your head."  Well, if you are experiencing any of these reported mental, physical, or emotional side effects for Yaz or Yasmin, don't let anyone tell you they are "all in your head." 

If you choose to take these drugs, then do so knowing the risks.  Don't be taken by surprise.

Another quote from Holly: Monash University in Australia is one of the few facilities to have undertaken research into the correlation between birth control pills and depression. Professor Jayashri Kulkarni found that women on the pill were twice as likely to experience depression, anxiety, and mental numbness.

Sound familiar?  If so, you have a choice to make. 

But at least it's an informed choice. 

Progestins, Bio-Identical Progestins, and Progesterone

Research on the post about progesterone and progestins is nearly complete and the information will be divided into at least four parts: progestins, more about progestins, (including LARCs, or Long Acting Reversible Contraceptives), bio-identical progestins, and progesterone itself. I don't know when they will be done, as some medical issues have cropped up that limit my time at the computer.
When they are complete, however, I will come back and link to them in this post.

In the meantime, I hope you will find other useful information here, and wish you peace, prosperity, and as many PMDD-free days as possible.

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: Progesterone vs. Progestins: Part 1, Progestins

There are many controversies surrounding PMDD, and one of the biggest is the use of progestins and progesterone to help mitigate the symptoms.  I think someone out there must be marketing progesterone for PMDD pretty heavily, because of all of the questions I'm getting on the subject.  So I'm going to back up and start at the very beginning, assuming you know nothing about progesterone and progestins, like I did when I first started researching this topic. 

First of all, we are talking about two different things.  Progesterone and progestins are not the same.  Progesterone is produced naturally in your body; progestins are synthesized to mimic what progesterone does for your body.  It's important that you do not confuse the two, and when reading articles or advertisements or results of clinical studies on hormones, it's important that you know which one they are talking about--natural progesterone, plant-based progesterone, or synthetic progestins, also called progestogens.  

Somehow it all gets lumped into being called "progesterone", and I think this is a big part of where our confusion as consumers comes from.

So:

Progesterone is what your body makes naturally

Bio-identical progesterone - a synthetic progesterone made from plant sources that is biochemically similar to those produced by the body

Progestins  - synthetic progesterone-like chemicals structurally different from what your body makes

Progestogens - synthetic progesterone-like chemicals structurally different from what your body makes

If you read nothing else of this post, please make sure you learn the above distinctions.

Because of the enormous amount of information on progestins alone, I will not get to the information on what is termed bio-identical progesterone today.  If that's all you want to read about, you will have to wait for a different post, but in the meantime I do encourage you to keep reading, as what follows may answer some of your questions, and may help to explain why you feel the way you do.  

Now, back to the basics:

Progesterone is a hormone naturally secreted by the ovary in the second two weeks of a woman's menstrual cycle.  Both bio-identical progesterone (synthesized from plant sources) and progestins (synthesized from chemicals) can also be taken in pill form, the latter by women taking birth control pills and hormone replacement therapy pills.  Progestins can also be used to induce a menstrual period in the case of stopped menstrual periods, or to regulate abnormal bleeding in the case of heavy blood flow problems.  Progesterone is also used in high doses for women with infertility problems and to prevent miscarriages.

There are several different kinds of progesterone being marketed today.  Today's post is about  progestins, the synthetic progesterone-like chemicals (also called progestogens) which bind to the body's progesterone receptors and function, for the most part, just like progesterone.  But because they are chemically different from our own natural progesterone, they have side effects.

Progestins were originally developed because they could be absorbed into the blood when ingested in pill form--this was before the development of micronized progesterone capsules. 

Progestins are only available via a prescription. You find progestins in birth control pills, also called oral contraceptives.  There are two main types of birth control pills: combination pills and progestin-only pills.  Most pills are available in both a 21-day or a 28-day pack, with the 28-day pack containing 7 placebos, or inactive pills, taken on the days you would normally have a menstrual period.  Combination pills are the most popular, due to the well-published side effects of synthesized estrogen-only therapies, and contain both synthesized estrogen and progestin. 

However, all combination pills raise the risk of heart attacks, stroke, and blood clots.  That risk rises if you are either smoker or over the age of 35.  Other factors, such as being obese or having a family history of heart disease make these blood clots more likely, therefore the FDA advises women against taking any combination birth control pills if you have a history of blood clots, heart attack, or stroke. 

One type of birth control pills carries a higher risk of deep vein thrombosis or pulmonary embolism (blood clots that start in a leg vein and travel to the lungs) than others.  Those are the pills that contain the ingredient drospireone and include Beyaz, Gianvi, Lornay Ocella Safyral, Yasmin, Yaz, and Zarah.  According to a post in the blog re: Cycling, as of April, 2012, pharmaceutical giant Bayer (makers of Beyaz, Yasmin, and Yaz) faced 11,300 lawsuits from women who have been seriously injured and family members of women who have died after taking Yaz or Yasmin.  In December of 2012 the company reported they settled the first 3500 cases with a total of $750 million in payouts.  As of this date, the latest case filed, November 28, 2012, is from a woman in Oklahoma who took Yaz for only two months, ten years ago, and developed deep vein thrombosis.

That said, the following side effects, usually severe or sudden, may be caused by blood clots:

Headache or migraine

Loss of or change in speech, coordination, or vision

Numbness or pain in chest, arm, or leg

Unexplained shortness of breath

 More common side effects of progestins include:

Changes in vaginal bleeding

Light bleeding or spotting between withdrawal bleeds

Symptoms of blood sugar problems (Dry mouth, frequent urination, loss of appetite, or unusual thirst)

Mental depression

Nausea

Skin rash

Unexpected or increased flow of breast milk

Abdominal pain or cramping

Breast tenderness

Bloating or swelling of ankles or feet

Blood pressure increase

Dizziness

Headache

Mood changes

Nervousness

Unusual or rapid weight gain

Acne

Brown spots on exposed skin

Hot flashes

Loss or gain of body, facial, or scalp hair

Loss of sexual desire

Trouble sleeping

Certain doses of progestins may also cause a temporary thinning of your bones, which is a factor in developing osteoporosis, but on the other hand, it has been found that progestins *may* offer some protection against osteoporosis in postmenopausal women.  Smoking, drinking alcohol, and taking or drinking caffeine can also thin your bones, so be aware of the added stress you may be placing on your bones by taking progestins.

Progestin-only pills (also called the mini-pill) are most commonly used by nursing mothers, women at risk for blood clots, and other conditions that prevent them from taking estrogen.

Combination birth control pills come in different phases, depending on whether the level of hormones in the pills changes throughout the month.  Monophasic (one phase) pills contain the same amount of estrogen and progestin in all of the active pills.  Two-phase pills change the level of hormones once during the menstrual cycle.  Three-phase pills change the levels of hormones every seven days during the first three weeks of pills.  Then you have the inactive pills for the fourth week, which is when you get what is called a withdrawal bleed.  It's not to be confused with a period.  You bleed, but you don't have a true period.  You can't, because you didn't ovulate.  Four-phase pills change their hormone levels four times per cycle. 

Is it safe or healthy to skip periods?  If you aren't taking oral contraceptives, you need a period after ovulation to shed the lining that's built up in  your uterus in preparation to receive a fertilized egg.  But when you're taking birth control pills, they suppress ovulation, so no eggs are released, and therefore your uterine lining doesn't build up.  The reason you bleed is because of the week of inactive pills in your birth control packet.  And sometimes you might not bleed at all. 

I am of the opinion that it's not a good thing to chemically suppress any natural body functions, but every woman has to decide for herself.  More information on this (so that you can make your own informed decision) can be found at the blog, Sweetening the Pill.

So, in addition to regulating your menstrual cycle by suppressing ovulation, and treating women with no period (amenorrhea) in an effort to bring about a period if possible, progestins are used:

To prevent estrogen from thickening the lining of your uterus

To treat pain related to endometriosis

To help treat cancer of the breast, kidney, or uterus—as progestins can stop the growth of an estrogen-fed tumor

To help prevent anemia (low iron in blood)

and, in high doses:

To stop heavy menstrual bleeding

To help a pregnancy occur during egg donor or infertility procedures

and

To help maintain a pregnancy when not enough progesterone is made by the body to do so.

So both progesterone and progestins are tricky things:  High doses can either start or stop menstrual bleeding, and can be used to help support pregnancy, while low doses can prevent pregnancy from occurring.

However, there have been some reports that high doses of progestins during pregnancy may cause birth defects in the sex organs of a male fetus, and some progestins may cause male-like changes in a female fetus and female-like changes in a male fetus. 

Hormones are powerful things, ladies, so buyer beware.

Before taking progestins, you should also tell your doctor if you have or have had any medical issues with the following, either through your family history, or having experienced these issues yourself, as progestins may make these conditions worse:

Allergies (to medicines, food dyes, preservatives, or animals)

Asthma

Epilepsy

Heart or circulation problems

Kidney disease

Migraines

Bleeding problems

Blood clots

Breast cancer

Deep vein thrombosis

Heart attack

Liver disease

Pulmonary embolism

Stroke

Blood clots in the veins

Breast lumps or cysts

Diabetes

Memory loss

Vision changes

Note:  Just as each woman is individual in her hormonal makeup, each synthetic progestin has a different side effect profile, due to the various formulations, so it is hard to pinpoint which progestins will cause which symptoms in which women.  I'm just trying to cover all the possibilities here so that you can see where, if at all, you fit in. 

Proposed off-label uses for progestins include treating hot flashes (interesting, since they can apparently also cause hot flashes) and polycystic ovary syndrome (PCOS).  An off-label use is one that has not been approved by the FDA, but once a drug has been approved by the FDA (in this case, birth control or hormone replacement therapy) to treat a specific condition or disorder, doctors may then prescribe it as they see fit.  Much marketing is done in the area of off-label use for many drugs touted as PMDD symptom relievers, and several drug companies have been reprimanded and fined by the FDA for promoting non-approved uses of their drugs to treat these symptoms.

We'll talk more about that next time.