Many women have asked me about the meaning of the new report about heart disease and long-term use of birth control pills. I thought I would share my today’s HEALTHY DOSE column with you to address so many of the questions or concerns.
A recent study from Belgium suggested that long-term use of oral contraceptives or birth control pills may increase the chances of having artery plaque or “buildup” that can signal early heart disease. Even though the study is small and the details are not yet known, this is important because it is estimated that about 16 million American women currently take birth control pills and hundreds of millions have used them in the past.
However young women should not rush to stop the pill, since by far and away (for most women at least) the benefits of the pill far outweigh any risk. But heart disease is the leading cause of death and women – and anything that increases that risk – should at least be known and considered by women before they decide to stay on the pill for years and years at the suggestion of their doctors who have assured them that the pill is safe.
Many previous studies have found no major increase in heart attacks among pill users (except in cigarette smokers who should never take the pill - especially if they are 35 or over) however there really have been no large study measuring more subtle heart risk such as early plaque found on ultrasound of the femoral or carotid arteries – a commonly accepted method used to assess heart risk in women (the method used in the Belgium study).
I do have some criticisms of the Belgium study conclusions but must admit this clearly raises a red flag about oral contraceptive (OC) use long term and should be taken seriously given the known possible adverse effects of the pill on heart risk factors such as hypertension or high blood pressure, heart attack and stroke in smokers over age 35, increased thrombosis or clotting (pulmonary embolism and deep vein thrombosis or DVT), increased CRP/c-reactive protein levels meaning increased inflammation.
The Belgium study women likely were on different birth control pills than used in the US, the dose was likely higher, the active ingredient, the progesterone component , was likely different (some newer progestogens are worse for clotting), etc. Many years ago in the US and elsewhere we were using higher OC doses - higher estrogen primarily. However oral estrogen, even in the low dose OC’s used today, can increase BP, increase CRP from the oral estrogen (bioidentical hormones, the patch or skin routes bypass many of these concerns), cause blood clots, etc. and the warnings for OC use remain even with the low dose pills. I think the Belgium study is certainly meaningful HOWEVER much more about the study needs clarification.
I personally believe that OC’s carry some small heart risk in women who take them for many years – and perhaps an even larger risk in older women, smokers, women with high blood pressure, and women with high waist sizes/apple shapes (you can learn more about heart risk with hormones in my book, The Body Shape Solution to Weight Loss and Wellness) and that women should be aware of this small risk so that they can make an informed decision, chose the lowest dose of hormones and always ask about alternative options as well. Even if the Belgium study turns out to be reliable and significant, the heart risk in the form of plaque burden was small and primarily in women with 10 or more years of use although today many women start the pill in their teens and may continue up to menopause. Maybe long-term use is not always such a safe alternative for some women after all.
Bottom Line: whenever I look at a new and surprising study I ask myself an important question – “IS IT BIOLOGICALLY PLAUSIBLE? Does it make sense from what we know about the science?” In this case, the answer is YES. OC’s increase risk of MI and stroke in women, highest risk in women over 35 and who smoke, however the risk in other women is not zero or reduced. Why do they increase risk? OC’s increase blood pressure in some women, increase CRP/inflammation, increase clotting/thrombosis, increase triglycerides, etc. etc. so yes it is plausible. Obviously physiologic or “bioidentical” estrogen (not oral synthetic hormones in much higher doses) is good for women and good for the heart…it is the dose, type, route of administration that matters here. To learn more about what dose, type and route of hormones is best for you and your body shape – read the chapter I have written in my recent book on body shape, The Body Shape Solution to Weight Loss and Wellness. To Read more on hormones click here to read, Dr.Marie’s Healthy Dose “More Good News About Hormones”.
Details of the study: Researchers at the University of Ghent in Belgium decided to look for other signs of heart risks among past and current pill users. They studied about 1,300 healthy women ages 35 to 55 taking part in a long-running observational study in the small town of Erpe-Mere.
About 81 percent had taken oral contraceptives for more than a year at some point in their lives — similar to the prevalence the federal Centers for Disease Control and Prevention reports for American women ages 15 to 44, said the study’s leader, Dr. Ernst Rietzschel. About 27 percent were current users.
Ultrasound exams were done of arteries in their necks and legs to look for buildups called plaque. There was a 20 to 30 percent increased prevalence of plaque for every 10 years of oral contraceptive use.
However, any plaque is thought to raise the risk of heart disease.
Many in the study presumably had taken larger dose birth control pills, which had over 2-4 times the estrogen levels in most pills sold today.
As one of the researchers noted: “It’s incredible that a drug which has been taken by 80 percent of women … is almost bereft of any long-term outcome data, safety data.”
As always, I welcome your questions and comments.