Sandra Fluke is once again under attack. This time by Representative Joe Walsh. She responded in the Huffington Post to Rep Walsh, writing:

I testified before members of Congress not because “I wanted the American people to pay for my contraception,” but because I wanted the private insurance that women pay for themselves to cover the contraception they need. I was there to tell, not my own, but the story of a close friend who, despite paying her deductible, lost an ovary when she was unable to afford the contraception her insurance failed to cover, but that she needed to treat her polycystic ovarian syndrome.

Unfortunately, her assertion regarding the hormonal contraception as a treatment of ovarian cysts is not accurate.

Let me very clear, what you are about to read is not an attack on Ms. Fluke, but a correction of the medical myth that birth control pills are an effective treatment for ovarian cysts and therefore might have prevented a young woman from losing an ovary. I bring this up because, well, it keeps being brought up.

Hormonal contraception has many health benefits for women, but treatment of ovarian cysts is not one of them. Although birth control pills are commonly prescribed for this reason, they do nothing except make the patient and her doctor feel better because, well, they are doing/prescribing something. According to the American College of Obstetrics and Gynecology (ACOG) Practice Bulletin on the Noncontraceptive Uses of Hormonal Contraceptives, “Combined oral contraceptives should not be used to treat existing functional ovarian cysts.”

The erroneous theory behind hormonal contraception preventing ovarian cysts probably originates from the way the pill works: the hormones in the pill suppress hormones in the brain, which then prevents ovulation. However, the ovaries aren’t always fully suppressed by the pill. Furthermore, studies have not shown any difference in the rate of detection of ovarian cysts in women on birth control pills (level II-2 evidence, Holt et al 1992). Unfortunately, many still believe the pill works for ovarian cysts so I’m not surprised that Ms. Fluke received this misinformation.

Ms. Fluke also writes that her friend who lost her ovary was suffering from polycystic ovarian syndrome (PCOS). PCOS doesn’t typically produce large cysts, meaning the kind of cyst that would result in the loss of an ovary. Birth control pills are also not the “treatment” for PCOS. According to the ACOG Practice Bulletin on PCOS, the combined oral contraceptive is primarily used to treat irregular menstrual bleeding and excess facial hair growth that some women with PCOS experience.

While I have not had the chance to review the medical record of Ms. Fluke’s friend, the assertion that an ovary could be saved by the pill is simply not supported by the current medical evidence. The more likely scenario is some health care provider was wrong in his/her belief that the pill was an effective treatment and the message was passed along.

Combined hormonal contraception has many health benefits that have been missed in this duscussion, such as:

  • Reduction in the incidence of cancer of the lining of the uterus (endometrial cancer) by 50%. Using the pill for more than 5 years may reduce the risk of endometrial cancer by as much as 80%.
  • Reduction in the incidence of cancer of the ovary by 27%. For every 5 years of use there is 20% decreased risk of ovarian cancer.
  • Reduce menstrual flow by 50% and is effective in treating excessively heavy periods and reducing the incidence of anemia (heavy menstrual bleeding is a common cause of iron deficiency and a low blood count)
  • Improve premenstrual dysphoric disorder (a severe form of PMS)
  • Treat acne (while many people think of acne as a cosmetic condition, it isn’t to those who suffer from it and insurance companies certainly don’t consider treatment of acne cosmetic, meaning acne medications are covered by health plans).
  • Treatment of menstrual cramps (15% of teenage girls describe their menstrual cramps as severe and cramps contribute to school absenteeism and activity non-participation).

If the health benefits of hormonal contraception aren’t enough, keep in mind that every $1 spent on the birth control pill saves $4.

If we are going to talk about the health benefits of hormonal contraception it is so important to get the facts
straight. The non-contraceptive benefits of hormonal contraception are clear and they don’t involve treatment of ovarian cysts, although no other reason besides highly reliable contraception should be needed to ensure that contraception is affordable for every woman. As an aside, if any pill reduced the risk of prostate cancer by 80% they’d have it in the drinking water on Capitol Hill.

If I support universal contraception why bring up the ovarian cyst issue at all? Well, it keeps coming up and
frankly medical misinformation gets on my nerves when it’s an Internet meme (no, you are not pregnant in Arizona before you are pregnant), and is harmful when perpetuated enough that it is eventually incorporated into laws (e.g. the requirement that doctors in South Dakota lie to women about abortion). Misinformation needs to be addressed because many politicians have abandoned truth and science. Those of us who support women’s health must continue to be the standard bearers of accuracy.

This is a time when facts matter most of all.

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  1. Hi,

    I have been spending the last days on Google trying to figure out whether combined hormonal contraception does ‘anything’ to existing ovarian cysts. Let me explain and this is rather personal and I am scared to death.

    I am from Eastern Europe where the pill is largely associated with reducing the risk of ovarian cancer and cysts. OK, I have never been on the pill and do not intend to. My doctor identified a right-sided ovarian cyst (39mm/33mm – yesterday’s measurements versus 37mm/30mm measured a month ago) when I showed up in January with some pelvic pain. First, he put me on Duphaston for 7 days which did nothing since yesterday he told me I should either get laparoscopic surgery immediately or take the pill (Midiana) for 1 month and see if the cyst resolves. In any case, his first choice was surgery.

    I have been reading all possible US-published studies on the existing/absent correlation between the pill and cyst resolution. I do suspect there’s no correlation, so what should I do?

    As a doctor, given the aforementioned measurements, what would you recommend? Surgery or waiting another cycle + the pill? I am a young female, 35 years, no children.

    Thanks for reading, much appreciated!

  2. Seems times haven’t changed since you wrote this. My Dr has prescribed me previfem for my cysts and I hate the way I feel on these pills.

  3. Would you still consider tx of PMDD a benefit of the pill now that PMDD is no longer considered a disorder in DSM IV?

  4. Birth control pills can be used to treat women who have recurrent ovarian cysts with their menstrual cycles. Women who use high-dose estrogen and progestin birth control pills have a modestly decreased risk of developing functional ovarian cysts. Low-dose birth control pills seem to have a less preventive effect.

  5. Our breast cancer incidence rate has TRIPLED since the pill arrives, thanks to politically and financially motivated people such as Dr. Gunter who have kept women in the dark about a major cause therof. “Congratulations.”

    “The journal of the Mayo Clinic (Mayo Clinic Proceedings) has published a key article in it’s October 2006 issue entitled “Oral Contraceptive Use as a Risk Factor for Pre-menopausal Breast Cancer: A Meta-analysis”, authored by Chris Kahlenborn, M.D., (Internal Medicine, Altoona Hospital, PA), Francesmary Modugno, Ph.D., (Epidemiology), Douglas M. Potter, Ph.D. (Biostatistics) both from the University of Pittsburgh, and Walter B. Severs, Ph.D., Professor Emeritus of Pharmacology at the Penn State College of Medicine.

    The major findings from this careful analysis of the world literature were that oral contraceptives (OCs) were linked with a measurable and statistically significant association with pre-menopausal breast cancer. The risk association was 44% over baseline in parous women (having been pregnant) who took OCs prior to their first pregnancy. (See graph below to note risk of individual studies). The study re-enforces the recent classification of OCs as Type 1 carcinogens by the International Agency for Cancer Research*.

    According to Dr. Kahlenborn, extraction of reliable data from the world literature is an extremely difficult task because no two studies are exactly alike. However, meta-analysis is a valid statistical tool that has the ability to identify associations and potential risk. He said the present research team was very careful to clearly present how the data were collected and processed, and welcomes opportunities for open and critical debate on this important subject by professionals as well as the lay public.

    Dr. Kahlenborn** stated that he and the entire team believes that in accordance with the standards informed consent, women must be apprised of the potential risk of premenopausal breast cancer prior to commencing drug use.”

  6. Thanks for the post. In terms of oral contraceptive’s affect on cancer risk, I’ve read that the results are a bit more mixed. There seems to be evidence that it may help protect against endometrial and ovarian cancer, but OCs may modestly increase risk of breast and cervical cancer ( I think the potential link to breast cancer is most important to further investigate given it’s high incidence. Anyway, at this point, I don’t think there’s enough evidence to use OCs purely as a cancer preventative tool. There are a lot of other good reasons to use OCs though of course…

  7. I have a similar problem with debate over the so-called “personhood laws,” which have so far not been enacted in any state that I know of. Conservatives like to decry emergency contraceptive as an “abortofacient,” and liberals (full disclosure: I describe myself as one) typically push back against this false claim. However liberals, most notably Rachel Maddow, become the alarmists in proclaiming that personhood laws would ban “hormonal contraceptives.” This is hard for me, because I greatly respect Dr. Maddow.

    Since I am not a doctor, what is the truth of it? Is emergency contraceptive potentially abortion-inducing? Is it possible that hormonal contraceptives can prevent implantation? (My most trusted sources tell me “no” to both of these questions, but a more comprehensive answer would be nice.)

    1. Taking the contraceptive pill is thought to have saved me from ovarian cancer. My mother and many other women in the family had it and we have the Gene. It seems that having taken the pill for so long (I had a handicapped child and wanted to spread my family so I could look after her) may well have saved my life. I had cervical cancer but it was picked up as I was called in for tests for all typical cancers caused by the BRAC gene. I am now 69 and am very grateful for the fact that I missed what so many of my female relatives did not, early death from ovarian cancer.

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