A Frank Ob/Gyn's Message

An honest assessment of all things medical and ethical.

Archive for the month “February, 2012”

Is contraception preventative health care?

In the much talked about contraception mandate recently promulgated by the Obama administration, I have read and heard some very good discussions on matters of religious freedom and rights of conscience. I agree that the trampling upon religion freedom and rights of conscience are indeed egregious violations against the founding principles of the United States. However, in response to some of the more popular and seemingly convincing arguments in favor of the mandate, I’d like to offer a rebuttal grounded first in scientific evidence and further developed in rational thought. To do so, we need to dig a little deeper into the issue within the issue. Although the groundswell of support for the Catholic Church’s position seems to be in the context of religious freedom from government oppression, I find it quite noteworthy that the proponents are by and large ignoring this point and appealing directly to the supposed good of contraception: as essential health care for women because it has now been exalted to that noble distinction of “preventative medicine”. If this is true, why would anyone’s conscience oppose it? Very well then, let’s talk about contraception and how it relates to a woman’s health.


Let’s first preface all that follows with an important clarification: faithful Catholics have no objection to the use of birth control pills in the situations where they might be a legitimate short-term treatment for an actual medical problem. The Church’s most well-known teaching document on the subject of contraception (Humanae Vitae by Pope Paul VI) makes this point very clear. Sadly, the false charge that we would refuse to allow the use of birth control pills for legitimate medical indications seems to be gaining undeserved credibility.


Contraception itself, however, is neither essential nor is it legitimate health care for women. Preventative, however, it is indeed–although not in the since typically thought. Birth control pills, in particular, are quite effective at preventing women from receiving good health care. Rather than preventing disease or treating any disease, it is frequently used in a manner to merely delay or ignore the actual gynecological problems a woman has. I’ve cared for far too many women whose illness has gone untreated for decades while her doctors simply strung her along on a series of birth control prescriptions without ever bothering to treat her actual pathology. To add insult to injury, peer-reviewed research has repeatedly shown a strong association of hormonal contraception with breast cancer among other cancers and life-threatening illnesses (for example, see Kahlenborn et al. Oral contraceptive use as a risk factor for premenopausal breast cancer: a meta-analysis. Mayo Clin Proc 2006; 81(10):1290-1302). Similarly, mounting medical evidence of hormonal contraception’s association with life-threatening blood clots, strokes, and heart attacks has triggered a new wave of class action lawsuits against various formulations of the “pill.” Although such well-documented health risks should be reason enough for any secularist to give second thought to the ubiquitous distribution of such powerful chemical agents designed to manipulate a woman’s reproductive system, they are not the only reason faithful Catholics (among others) refuse to participate in such assaults against women.


These peculiar people of conscience develop such convictions firstly on that most logical principle (that need not be religiously based at all) wherein a woman’s cyclic fertility is considered a healthy state of being. On the contrary, it is infertility that is considered the diseased state. What fanatical and religious nonsense, right? We so-called “religious nuts” also believe that women’s bodily integrity and personal dignity are best protected by an attitude of respecting a woman’s naturally occurring cycles of fertility, rather than alter such processes with carcinogenic toxins. Even more astounding, we actually consider the conception of new life and the propagation of the human race a good thing. What could be more intolerable? Perhaps an edict should be enforced to prevent such madness.

–Dr. Frank


Should I take the pill to regulate my cycles?

One of the more common complaints I hear are those associated with abnormal menstrual bleeding. Some women suffer from extremely heavy and prolonged bleeding–to the point of becoming anaemic like the woman in Sacred Scripture with haemorrhage who reached out for the cloak of our Lord. Others have an abnormal delay of a menstrual cycle for several months or even years at a time; while still others will have erratic bleeding episodes–as unpredictable as they are disruptive to the woman’s life.

As you should logically and reasonable expect, there are numerous potential causes for each of these general scenarios. Large uterine fibroids, endometrial polyps, a bleeding disorder, or even cancer are only some of the potential causes of prolonged heavy bleeding. Anatomic defects, hormonal disorders, significant stress, and brain tumors are a few of the reasons a woman might stop having periods for months or years at time. Sporadic bleeding between periods might be due to endometriosis, infection, polyps, hormonal abnormalities, or even cancer. The one thing I can think of that is absolutely never the cause of abnormal bleeding in a woman is a deficiency in hormonal birth control pills! If it seems absurd that I would even need to point this out, you may not be aware that the 1st , 2nd, and even 3rd line of treatment for abnormal bleeding problems in women by most physicians (ob/gyn specialists included) is precisely the prescription of none other than, you guessed it–birth control pills.

The correct approach requires taking into consideration the numerous possible causes of the abnormal bleeding, and then determining what type of further evaluation (if any) might be needed to arrive at the appropriate diagnosis. Once a proper diagnosis is determined, a treatment should be offered that involves correcting the underlying problem whenever possible. After a particular treatment is given (be it medical, surgical, or other methods), the patient should be reassessed to determine whether or not the problem was solved (i.e. the disease or pathologic condition cured). If not, the whole process might need to start over with consideration of a different diagnosis altogether. Alas, how much easier my job would be if instead of doing all of this, all I had to do was simply write out a prescription for the ‘magical’ birth control pill. And if my first script didn’t satisfy my patient, I have hundreds of others to choose from until my patient stopped coming back with the same or related complaints. I must admit, such an approach is sometimes quite tempting indeed, especially knowing that most of ob/gyn’s today practice in precisely this very manner. There was, however, a time in the not too distant past when such lack of authentic diagnosis and treatment was justly condemned as quackery (i.e. the stereotypical “snake oil” hawker promising his potion would cure almost all ills.) Regrettably for today’s women, birth control pills are not nearly as harmless as snake oil. In fact, most would suffer less harm from snake oil. For example, I’m not aware of any snake oil that causes blood clots or significantly increases a woman’s risk of breast, cervical, and liver cancer.

Few perceptions instilled in a female patient are quite as misleading as the idea that she needs to take birth control pills in order to “regulate her cycle.” So common is this erroneous idea that many seem to have been led to believe that the such pills are like a sort of super vitamin that is keeping her reproductive system functioning in a healthy, normal, and regular manner. Sadly, such a sentiment could not be further from the truth. There is nothing healthy, normal, or regular about a woman’s reproductive system under the influence of birth control pills. If the pills are functioning as intended, she is not having a physiologic menstrual cycle at all. At best, she’s experiencing a “pseudo-cycle” that merely resembles a menstrual cycle as she experiences some bleeding in response to a temporary withdrawal of the hormonal birth control pills during the seven days of placebo pills at the end of the monthly pack.

The most lamentable consequence of the birth control “pill pushing” approach to women’s bleeding problems is that a true diagnosis is often delayed for years (if made at all) until she’s weary of the pill’s side-effects and finds a physician willing to find and solve any underlying problem. The longer this takes, the longer her original condition may have progressed and the longer her body has been exposed to the carcinogenic effects of the birth control pills. Sadly, it’s not uncommon for me to have new patients who’ve been on “the pill” for 20 or even 30 years, having been started on them after experiencing heavy bleeding or painful cramping in her early teen years, not long after her first period. Awareness is key to protecting women from such inappropriate medial advice. Friends don’t let friends go on the pill.


Dr. Frank


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