RH Reality Check
Thursday 27 December 2007
Planned Parenthood issued a handy guide to the year in women's health, summing up the major events, trends, and studies of 2007, so RH Reality Check spoke with Dr. Vanessa Cullins, Planned Parenthood's vice president for medical affairs, to get a deeper understanding of the health events that made the news. Emily Douglas picked three of the headlines - long-term use of hormonal birth control resulting in an increase in artery-clogging plaque, the increase in the teen birth rate, and the abnormalities found in the ovaries and reproductive tract tissues of mice that had neonatal exposure to bisphenol A - and asked for Dr. Cullins to provide the story behind the news.
Planned Parenthood writes,
At a recent American Heart Association conference, researchers presented a study that found that women who use the pill for 10 years or more had an unexpected increase in the presence of artery-clogging plaque, a known risk factor for heart disease. The plaque was found in blood vessels in the neck and leg. They also found that women who stopped using the pill were at increased risk for more plaque, which the researchers claimed is a new finding in birth control pill studies.
Emily Douglas: Could you give me context for the recent study that discovered that women using long-term hormonal birth control had an increase in the presence of artery-clogging plaque? What does that actually mean for women's risk of heart disease?
Dr. Vanessa Cullins: No medication or procedure is without risk. There are serious adverse events that are very rare that are associated with combined hormonal contraceptives, like the birth control pill. Serious adverse events include heart attacks, stroke, plus blood clots like in the legs, called deep vein thrombosis, or in the lungs, called pulmonary embolism. These serious adverse events are more common during pregnancy. All of us have to place risk into our own personal circumstances and contexts. Women readily accept those risks when they decide they want to be pregnant. A woman who is on no hormonal contraception and is not pregnant has the lowest risk for these serious adverse events. A person who is on birth control pills or on NuvaRing or Evra has a higher risk than a woman who is not on any hormonal birth control but her risk - the person taking the birth control pills - is less than that which is seen among women who are pregnant and carry the pregnancy to term.
ED: What type of study revealed this finding?
VC: The information I'm giving you on the risk of blood clots, and the risk of heart attack and stroke are from many studies that have been done over many years. The recent study that was presented at the American Heart Association conference was a study where the researchers found that women who used the Pill for 10 years or more had an unexpected increase in the presence of plaque, artery-clogging plaque, and plaque is known to be a risk factor for heart disease. They did not show that the increased plaque that was seen leads to more heart disease among those women. So we actually call this a "surrogate marker study." Because it's not really measuring the clinical outcome of importance. The clinical outcome of importance is heart attack or stroke.
So when in the release it says, researchers have not found an increase in heart disease, that means they've found an increase in plaque, that is an indicator of heart disease. But it's not a guarantee that you're going to have deep-vein thrombosis, or a heart attack, or a stroke.
Planned Parenthood writes,
In August, the Reproductive Toxicology published a study that found abnormalities in the ovaries and reproductive tract tissues of mice that had neonatal exposure to bisphenol A (BPA). Bisphenol A (BPA) is a compound commonly found in plastic water bottles, which many women, men and children use every day. These findings and findings from other animal studies heighten concern that exposure to BPA during fetal development and after birth may cause reproductive tract problems in humans.
ED: At RH Reality Check we've been paying more attention to environmental toxins and their effect on women's health and on women's ability to ensure a safe pregnancy. What do animal studies such as this one suggest about the effect of environmental toxins on reproductive health? What do you make of the increased attention in the medical community to environmental toxins?
VC: I am very happy that the press, hopefully the public, and also medical providers are paying more attention to the issues of reducing environmental toxins and paying more attention to associations between large amounts of certain toxins and reproductive capacity and reproductive health. The entire field is in its infancy as it relates to honing down the connection of causality among humans. There are a lot of animal studies that indicate that it is extremely important for us, as human beings, to minimize our exposure to certain toxins, such as the phalates that can be found in plastic. Based on the animal studies, and in the absence of human studies which will probably never be done because they would be unethical to do, and because environmental toxins are ubiquitous, it is clear that all of us need to be aware of environmental toxins and try to minimize our exposure to them in practical ways.
For example, practical ways include using non-toxic cleaners when cleaning the house, to minimize paint dust and most especially paint dust with lead, to not heat plastic baby bottles in the microwave.
ED: Do you think that small steps like that would actually make a difference for individuals? Or do you think that there's such an overwhelming onslaught of toxins in our daily lives that that doesn't have much of an effect?
VC: We probably will not know for years, if not generations, because you can't do a randomized clinical trial about this. But it's certainly not going to hurt. And it's prevention, and it makes a lot of sense to minimize exposure to poison.
Planned Parenthood writes,
On December 5, the Centers for Disease Control and Prevention (CDC) found that for the first time in 14 years, the teen birth rate has increased. Using data from more than 99 percent of all births in the United States, the CDC found that between 2005 and 2006 there was a three percent increase in the birth rate among teens aged 15-19. Non-Hispanic black teens saw the largest increase in the birth rate, at five percent, closely followed by American Indian teens at four percent. Hispanic teens had a two percent increase.
ED: Finally, I wanted to get your perspective on the increase in the teen birth rate, your thoughts on why that's happening and what you think we need to do to counter that increase.
VC: Most definitely, we need more dialogue between parents and their children about sex, sexuality, and prevention of pregnancy. In addition, we as a culture need to start welcoming honest discussion around sex and sexuality and how pregnancy is both planned and how it is prevented. It's painful to me to see this increase the teen pregnancy rate when at the same time we have evidence that shows that comprehensive, medically accurate sex education leads to teens delaying having sex and also leads to more teens using contraception and condoms when they do decide their ready to have sex. All this to me points to the fact that in addition to improved parental communication about sex and sexuality and contraception, we definitely need to have better sex education through the schools. Because a number of parents are not prepared to have this conversation because they have grown up during a time period where all of us have been conflicted as an American society and we don't provide adequate sex education either through schools or through churches. Our institutions do not provide the proper education around sex, sexuality, and contraception.
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