Can Birth Control Pills Cause a Heart Attack?

Are you one of the millions of women worldwide who take progestin-only contraceptives? Most women take combined contraceptives, a blend of progestin and estrogen, although their safety is still debated. But recent studies found that women on the Pill had twice the risk of heart attacks compared to those not taking contraceptives. Women at increased risk of heart disease including smokers and those with high blood pressure - may be counseled to take the progestin-only pills (POC), as past research had found no link between POCs and heart attack. But is that recommendation safe? Heart attacks are uncommon among childbearing-aged women. The annual incidence is two per million among healthy women aged 30-34 years, and increases to 20 per million between 40-44 years. Many studies have debated the relationship between combined oral contraceptives (COC) and cardiovascular disease risk. While some of them failed to show an association between COC use and heart attack risk, others found an increased incidence of coronary events among COC users. A recent Journal of Clinical Endocrinology and Metabolism study examined several previous publications to determine the cardiac risks of progestinonly contraceptives. The studies reviewed included more than 1,800 women between 16-44 years of age on birth control and compared those to women not taking the hormones. The contraceptives studied included so-called mini-pills such as Micronor and Ovrette, plus other progestinonly products such as implants or shots, including depot medroxyprogesterone acetate (DPMA). The study found no link between POCs and heart attacks, and therefore supports the recommendation of POCs in women at increased cardiac risk. In general, the American College of Obstetrics and Gynecology (ACOG) recommends POCs over COCs for patients who are cigarette smokers older than 35, or have coronary artery disease, congestive heart failure, high blood pressure with vascular disease or age greater than 35,or diabetes with vascular disease or age greater than 35 all conditions associated with increased risk of heart attack and stroke. ACOG also recommends POCs for women with a history of migraines, thromboembolism (such as a pulmonary embolism), strokes, lupus with vascular disease, nephritis (an inflammatory condition of the kidneys), and elevated triglycerides. The World Health Organization (WHO) recommends that women younger than 18 and older than 45 years avoid POCs due to concerns about decreased bone mass. According to WHO, women who are immediately postpartum may initiate POCs if theyre not breastfeeding, and if breastfeeding, women should wait until at least six months after giving birth.

Premenstrual Syndrome (PMS)

Many women experience a variety of unpleasant symptoms in the week or two before menstruating. These include irritability, anger, headaches, anxiety, depression, fatigue, fluid retention, and breast tenderness. When emotional symptoms related to depression predominate in PMS, the condition is sometimes called premenstrual dysphoric disorder (PMDD). These symptoms undoubtedly result from hormonal changes of the menstrual cycle, but apart from that general statement, medical researchers do not know the cause of PMS or how to treat it.Conventional treatments for PMS and PMDD include antidepressants, beta-blockers, diuretics, oral contraceptives, and other hormonally active formulations. Of all these, antidepressants in the SSRI family (such as Prozac) are perhaps the most effective. Principal Proposed Natural Treatments There is fairly good evidence that calcium supplements can significantly reduce all the major symptoms of PMS. There is also some evidence for the herbs chasteberry and ginkgo . Vitamin B6 is widely recommended as well, but its scientific record is mixed at best. Calcium A large double-blind, placebo-controlled study found positive results using calcium for the treatment of PMS symptoms. Participants took 300 mg of calcium (as calcium carbonate) four times daily. Compared to placebo, calcium significantly reduced mood swings, pain, bloating, depression, back pain, and food cravings. Similar findings were also seen in earlier preliminary studies of calcium for PMS. For more information, including dosage and safety issues, see the full Calcium article. Chasteberry The herb chasteberry is widely used in Europe as a treatment for PMS symptoms. More than most herbs, chasteberry is frequently called by its Latin names: Vitex or Vitex agnus-castus.A double-blind, placebocontrolled study of 178 women found that treatment with chasteberry over 3 menstrual cycles significantly reduced PMS symptoms. The dose used was one tablet 3 times daily of a chasteberry dry extract. Women in the treatment group experienced significant improvements in symptoms, including irritability, depression, headache, and breast tenderness.Unfortunately, there is little corroborating evidence as yet for this one welldesigned study. A previous double-blind trial compared chasteberry tovitamin B6 (pyridoxine) instead of placebo. The two treatments proved equally effective. However, because vitamin B6 itself has not been shown effective for PMS ( see below ), these results mean little. Even better evidence indicates that chasteberry can help the cyclic breast tenderness often, but not necessarily, connected with PMS. Vitamin B6 Vitamin B6 has been used for PMS for many decades, by both European and US physicians. However, the results of scientific studies are mixed at best. The most recent and best-designed double-blind study, enrolling 120 women, found no benefit. In this trial, three prescription drugs were compared against vitamin B6 (pyridoxine, at 300 mg daily) and placebo. All study participants received 3 months of treatment and 3 months of placebo. Vitamin B6 proved to be no better than placebo. Approximately a dozen other double-blind studies have investigated the effectiveness of vitamin B6 for PMS, but none were well designed, and the results were mixed. Some books on natural medicine report that the

negative results in some of these studies were due to insufficient B6 dosage, but in reality there was no clear link between dosage and effectiveness. Other Proposed Treatments for PMS Ginkgo One double-blind, placebo-controlled study evaluated the benefits of Ginkgo biloba extract for women with PMS symptoms. This trial enrolled 143 women, 18 to 45 years of age, and followed them for two menstrual cycles. Each woman received either the ginkgo extract (80 mg twice daily) or placebo on day 16 of the first cycle. Treatment was continued until day 5 of the next cycle, and resumed again on day 16 of that cycle. As compared to placebo, ginkgo significantly relieved major symptoms of PMS, especially breast pain and emotional disturbance. Additional Treatments Several double-blind, placebo-controlled studies, enrolling a total of about 400 women, found evidence that multivitamin and mineral supplementsmay be helpful for PMS. It is not clear which ingredients in these supplements played a role. Preliminary double-blind trials also suggest that vitamin E may be helpful for PMS. A product containing grass pollen , royal jelly (a product made by bees), and the pistils (seed-bearing parts) of grass has been proposed for use in PMS. In a double-blind, placebo-controlled crossover trial of 32 women, use of the product for two menstrual cycles appeared to significantly improve PMS symptoms as compared to use of placebo. A double-blind, placebo-controlled study of 30 women with complaints of premenstrual fluid retention found that use of oligomeric proanthocyanidins (OPCs) at a dose of 320 mg daily significantly reduced the sensation of fluid retention in the leg; however, actual leg swelling as measured was not significantly improved. One poorly designed human trial hints that krill oil may be helpful for some PMS symptoms. In a 24-week, double-blind study, 49 women with menstrual migrainesreceived either placebo or a combination supplement containing soy isoflavones , dong quai , and black cohosh extracts. The treatment proved at least somewhat more effective than placebo. Soy isoflavones alone have also shown some potential benefit. Evening primrose oil , a source of the omega-6 fatty acids, was once thought to be helpful for cyclic breast pain . However, it probably does not work for this purpose. It has also been proposed as a treatment for general PMS symptoms, but there is only minimal supporting evidence. Highly preliminary evidence suggests that St. John's wort might be helpful for mood changes in PMS. One study often cited as evidence that massage therapy is helpful for PMS was fatally flawed by the absence of a control group. However, a better-designed trial compared reflexology (a special form of massage involving primarily the foot) against fake reflexology in 38 women with PMS symptoms and found evidence that real reflexology was more effective. A small crossover trial of chiropractic manipulation for PMS symptoms found equivocal results at best. Progesterone cream is sometimes recommended for PMS, but there is no meaningful evidence that it is effective. One study failed to find the supplement inositol helpful for PMS. For a discussion of homeopathic approaches to PMS, see the Homeopathy Database .