Re: science and contraception questions

May 23, 2005

Dear Dr. Bertotti Metoyer, Ph.D.

Good questions!

I can shed some light on question #3 and #4 - or just as plausible contribute to

the confusion.

#3.

The efficacy data on contraceptive methods that are in medical and nursing

textbooks are usually taken from the book " Contraceptive Technology " - edited by

Hatcher, et al., The efficacy data on contraceptives in the book are taken from

those gathered by Trussell, PhD (Office of Population Research at

Princeton University). He is considered one of the top (if not the top)

authority on contraceptive effectiveness. The " typical effectiveness " rates he

provides are essentially from data that he gathers from the (1995) National

Survey of Family Growth and corrects for the under-reporting of abortion. Most

of the users of " periodic abstinence " in that survey are from users of some type

of rhythm formula. His " perfect use " rates (for periodic abstinence) are

essentially from the WHO study of the ovulation method and re-analyzed by him.

I am not sure if he trusts the results on efficacy from NFP providers or

developers of NFP methods. He probably would be suspect that they are biased.

Furthermore - most studies are more clinically controlled studies and not " true "

typical effectiveness studies. See:

Trussell, J. Contraceptive failure in the United States. Contraception,

2004;70:89-96.

#4

I believe that the effect of the hormonal pill on the aging of the cervix is

from the work of Odeblad. I do not believe that his data (on the aging of the

cervix) has been published in a peer reviewed scientific journal. You can find

his work in the Bulletin of the Ovulation Method and Reference Centre of

Australia. However, there is no evidence, that I am aware of, that use of the

pill delays or causes infertility. The one year Time to pregnancy rates after

the pill are similar or better than a comparable population of non-pill users.

There is evidence that there is variability of the length of the menstrual cycle

(for up to 9 cycles) post pill use compared to non-pill nuse women.

Odeblad, E. (1994). The discovery of different types of cervical mucus and the

Billings Ovulation Method. Bulletin of the Natural Family Planning Council of

, 21(3), 3-34.

Odeblad, E., (1997). Cervical mucus and their functions. Journal of the Irish

Colleges of Physicians and Surgeons, 26(1), 27-32.

Gnoth, C., -Hermann, P., & Schmoll, A., et al.. Cycle characteristics

after discontinuation of oral contraceptives. Gynecological Endocrinology.

2002;16:307-317. (174 pill users vs 284 non-pill users)

The results showed that the post pill group had significantly longer cycles than

the control group for up to 9 cycles and had significantly more long cycles (>

35 days) for up to 6 cycles.

See: Farrow, A et al. Prolongeduse of oral contraception before a planed

pregnancy with a decreased risk of delayed conception. Human Reproduction.

2002;17:2754-2761.

I wish you well with you research.

J. Fehring

Professor of Nursing

Marquette University

science and contraception questions

(I am re-trying this message, I don't think it went out...my apologies

if it is a repeat)

I have a few scientific questions for the group. I am currently doing

content analysis on medical textbooks as part of a larger effort to

figure out, sociologically, why/how contraception is taken for granted.

1. Some of the most compelling arguments in these texts for

contraception are all " health benefits " they describe such as: decreased

risk of ovarian and endometrial cancer, decreased risk of benign breast

disease and symptmatic plevic inflammatory disease. Questions: Are

these true? What are they not saying? Does anyone have citations for

research that disputes these finding? How would you critique these?

2. A quote from one: " higher-dose COCs should be reserved for patients

currently on medications that may interfere with contraceptive

effectiveness or for the short-term treatment of certain menstrual

disorders "

Question: Is it FDA approved for treatment of menstrual

" disorders " ? How do I go about finding out such info?

3. Most of the tables in the books describe the " typical use " of

" periodic abstinence " as 25% failure rate (no distinction of which

method, including rhythm), and " perfect use " : calendar = 9%, ovulation

method = 3%, symptothermal = 2%, postovulation = 1% failure rates.

Questions: Is any of you out there familiar with the research that

produces these numbers? These perfect use numbers are higher than

research I've read by some of you. Why the distinction? How do they

get these numbers and why don't they draw on your research (probably the

million dollar question, right)?

4. Finally, a while back a friend of mine said that her midwife was at a

conference and a presenter discussed research on the effect of the pill

on the cervix -- I think the findings suggested that the reason some

women experience infertility after using the pill is because it destroys

cervical cells - and then the mucus doesn't function well. And I think

she said that pregnancy rejuvenates the cells.

Do any of you happen to know of this research or does it sound at

all familiar?

Thanks for any help you could provide!

Bertotti Metoyer, Ph.D.

Assistant Professor of Sociology

n College

Indianapolis, IN

May 23, 2005

I'll try to answer some of your queries in the text, am sure some on the list may have more specifics. I do have to disagree with Dr. Fehring on a minor point. Odeblad's work in the Irish Journals etc. is peer reviewed. Mucus patterns of return to fertility when coming off the pill show wide variety. While an aggregate number of time to conception may not show divergences, those of us who see individual women who are coming off the pill see a range from immediate return to normal to months of anovulation, and the occasional dry cycle in spite of a thermal shift which would point to ovulation and burned out cervical crypts. Odeblad has shown that the normal aging of the S crypts in the cervix is retarded by pregnancies.

See below.

Hanna Klaus, M.D.

Natural Family Planning Center of Washington, D.C. and Teen STAR Program

8514 Bradmoor Drive

Bethesda, MD 20817-3810

Tel. , Fax

hannaklaus@...

http://www.teenstar.org

Why Wait? Move to EarthLink.

science and contraception questions

(I am re-trying this message, I don't think it went out...my apologies if it is a repeat)I have a few scientific questions for the group. I am currently doing content analysis on medical textbooks as part of a larger effort to figure out, sociologically, why/how contraception is taken for granted.1. Some of the most compelling arguments in these texts for contraception are all "health benefits" they describe such as: decreased risk of ovarian and endometrial cancer, decreased risk of benign breast disease and symptomatic pelvic inflammatory disease. Questions: Are these true? What are they not saying? Does anyone have citations for research that disputes these finding? How would you critique these?

While the incidence of ovarian and endometrial carcinoma is lower in women who have used oral contraception for some time, this is balanced by a much higher incidence of cervical carcinoma most probably mediated by HPV.

If you send me your email address, I'll send you a copy of an article with references.

2. A quote from one: "higher-dose COCs should be reserved for patients currently on medications that may interfere with contraceptive effectiveness or for the short-term treatment of certain menstrual disorders" Question: Is it FDA approved for treatment of menstrual "disorders"? How do I go about finding out such info? Any menstrual disorder 'cured by the pill' is not cured, but over-ridden by suppression of the hypothalamic center which regulates FSH and LH. At times, shutting everything down and then allowing spontaneous start up works, like my computer...

3. Most of the tables in the books describe the "typical use" of "periodic abstinence" as 25% failure rate (no distinction of which method, including rhythm), and "perfect use" : calendar = 9%, ovulation method = 3%, symptothermal = 2%, postovulation = 1% failure rates. Questions: Is any of you out there familiar with the research that produces these numbers? These perfect use numbers are higher than research I've read by some of you. Why the distinction? How do they get these numbers and why don't they draw on your research (probably the million dollar question, right)?4. Finally, a while back a friend of mine said that her midwife was at a conference and a presenter discussed research on the effect of the pill on the cervix -- I think the findings suggested that the reason some women experience infertility after using the pill is because it destroys cervical cells - and then the mucus doesn't function well. And I think she said that pregnancy rejuvenates the cells. Do any of you happen to know of this research or does it sound at all familiar?Thanks for any help you could provide! Bertotti Metoyer, Ph.D.Assistant Professor of Sociologyn CollegeIndianapolis, IN

May 23, 2005

Dr. Klaus (Hanna):

The peer reviewed part of my message referred

to the “aging of the cervix” data. I don’t recall that being

a part of the Irish Journal article. However, I have not read that article recently.

But thanks for keeping me on my toes!

Looking forward to your presentation in Ann Arbor!

RE:

science and contraception questions

I'll try to answer some of

your queries in the text, am sure some on the list may have more

specifics. I do have to disagree with Dr. Fehring on a minor point.

Odeblad's work in the Irish Journals etc. is peer reviewed. Mucus

patterns of return to fertility when coming off the pill show wide

variety. While an aggregate number of time to conception may not show

divergences, those of us who see individual women who are coming off the

pill see a range from immediate return to normal to months of anovulation, and

the occasional dry cycle in spite of a thermal shift which would point to

ovulation and burned out cervical crypts. Odeblad has shown that the

normal aging of the S crypts in the cervix is retarded by pregnancies.

See below.

Hanna Klaus, M.D.

Natural Family Planning

Center of Washington, D.C. and Teen STAR Program

8514 Bradmoor Drive

Bethesda, MD 20817-3810

Tel. , Fax

hannaklaus@...

http://www.teenstar.org

Why Wait? Move to

EarthLink.

science and contraception questions

(I am re-trying this message, I don't think it went

out...my apologies

if it is a repeat)

I have a few scientific questions for the

group. I am currently doing

content analysis on medical textbooks as part of a

larger effort to

figure out, sociologically, why/how contraception

is taken for granted.

1. Some of the most compelling arguments in

these texts for

contraception are all " health benefits "

they describe such as: decreased

risk of ovarian and endometrial cancer, decreased

risk of benign breast

disease and symptomatic pelvic inflammatory

disease. Questions: Are

these true? What are they not saying?

Does anyone have citations for

research that disputes these finding? How

would you critique these?

While the incidence of ovarian and endometrial

carcinoma is lower in women who have used oral contraception for some

time, this is balanced by a much higher incidence of cervical

carcinoma most probably mediated by HPV.

If

you send me your email address, I'll send you a copy of an article with

references.

2. A quote from one: " higher-dose COCs should be reserved for

patients

currently on medications that may interfere with contraceptive

effectiveness or for the short-term treatment of certain menstrual

disorders "

Question: Is it FDA approved for treatment of menstrual

" disorders " ? How do I go about finding out such info?

Any menstrual disorder 'cured by the pill' is not cured, but

over-ridden by suppression of the hypothalamic center which regulates FSH and

LH. At times, shutting everything down and then allowing spontaneous

start up works, like my computer...

3. Most of the tables in the books describe the " typical

use " of

" periodic abstinence " as 25% failure rate (no distinction of which

method, including rhythm), and " perfect use " : calendar = 9%, ovulation

method = 3%, symptothermal = 2%, postovulation = 1% failure

rates.

Questions: Is any of you out there familiar with the research that

produces these numbers? These perfect use numbers are higher than

research I've read by some of you. Why the distinction? How do they

get these numbers and why don't they draw on your research (probably the

million dollar question, right)?

4. Finally, a while back a friend of mine said that her midwife was at a

conference and a presenter discussed research on the effect of the pill

on the cervix -- I think the findings suggested that the reason some

women experience infertility after using the pill is because it destroys

cervical cells - and then the mucus doesn't function well. And I think

she said that pregnancy rejuvenates the cells.

Do any of you happen to know of this research or does it

sound at

all familiar?

Thanks for any help you could provide!

Bertotti Metoyer, Ph.D.

Assistant Professor of Sociology

n College

Indianapolis, IN

May 24, 2005

Dr. B,

Allow me to suggest that you obtain and study " Breast Cancer: Its Link

to Abortion and the Birth Control Pill " by Kahlenborn, MD. (2000). K

addresses your questions dealing with ovarian and endometrial cancer. He

also addresses the link between breastfeeding and the reduction of ovarian

cancer (15% reduction per child nursed in one study, 70% reduction for five

in another). Importantly, he shows that the increase in breast cancer

related to the OCPs overshadows any reduction in the other cancers.

-- Kippley

www.NFPandmore.org

science and contraception questions

> (I am re-trying this message, I don't think it went out...my apologies

> if it is a repeat)

>

> I have a few scientific questions for the group. I am currently doing

> content analysis on medical textbooks as part of a larger effort to

> figure out, sociologically, why/how contraception is taken for granted.

>

> 1. Some of the most compelling arguments in these texts for

> contraception are all " health benefits " they describe such as: decreased

> risk of ovarian and endometrial cancer, decreased risk of benign breast

> disease and symptmatic plevic inflammatory disease. Questions: Are

> these true? What are they not saying? Does anyone have citations for

> research that disputes these finding? How would you critique these?

>

> 2. A quote from one: " higher-dose COCs should be reserved for patients

> currently on medications that may interfere with contraceptive

> effectiveness or for the short-term treatment of certain menstrual

> disorders "

> Question: Is it FDA approved for treatment of menstrual

> " disorders " ? How do I go about finding out such info?

>

> 3. Most of the tables in the books describe the " typical use " of

> " periodic abstinence " as 25% failure rate (no distinction of which

> method, including rhythm), and " perfect use " : calendar = 9%, ovulation

> method = 3%, symptothermal = 2%, postovulation = 1% failure rates.

> Questions: Is any of you out there familiar with the research that

> produces these numbers? These perfect use numbers are higher than

> research I've read by some of you. Why the distinction? How do they

> get these numbers and why don't they draw on your research (probably the

> million dollar question, right)?

>

> 4. Finally, a while back a friend of mine said that her midwife was at a

> conference and a presenter discussed research on the effect of the pill

> on the cervix -- I think the findings suggested that the reason some

> women experience infertility after using the pill is because it destroys

> cervical cells - and then the mucus doesn't function well. And I think

> she said that pregnancy rejuvenates the cells.

> Do any of you happen to know of this research or does it sound at

> all familiar?

>

> Thanks for any help you could provide!

>

> Bertotti Metoyer, Ph.D.

> Assistant Professor of Sociology

> n College

> Indianapolis, IN

>

May 25, 2005

Dear Dr. Bertotti Metoyer,

your questions would require a book to fully answer them, but you

have had some good responses.

I will add one answer about the FDA approval.

Oral contraceptives are FDA approved for two things

contraception

acne

(one specific brand of OCP only)

However, because a drug is not FDA approved for a specific

indication does not necessarily mean it doesn't work for that

indication. The drug approval process for a specific condition

is very expensive, and drug companies only pursue it when they think

it will improve their profits. So if doctors come to believe

that a drug that is previously on the market for something else works

for a different condition, drug companies are happy to have doctors

prescribe it " off label " for that condition and not bother

to get formal approval from the FDA, which would cost them a lot more

time and money. Whether what the doctors believe is based on

good scientific evidence is another question. Most doctors treat

almost any menstrual disorder with birth control pills. There is

scant published evidence that they work for any of them- although they

may suppress some symptoms (such as excessive vaginal bleeding).

Hope that helps.

Joe Stafnord

2. A quote from one:

" higher-dose COCs should be reserved for patients

currently on medications that may interfere with contraceptive

effectiveness or for the short-term treatment of certain menstrual

disorders "

Question: Is it FDA approved for treatment of

menstrual

" disorders " ? How do I

go about finding out such info?

--

______________________________

ph B. Stanford, MD, MSPH

Health Research Center

Dept. Family & Prev. Med.

University of Utah

jstanford@...

June 2, 2005

> 3. Most of the tables in the books describe the "typical use" of> "periodic abstinence" as 25% failure rate (no distinction of which> method, including rhythm), and "perfect use" : calendar = 9%, ovulation> method = 3%, symptothermal = 2%, postovulation = 1% failure rates.> Questions: Is any of you out there familiar with the research that> produces these numbers? These perfect use numbers are higher than> research I've read by some of you. Why the distinction? How do they> get these numbers and why don't they draw on your research (probably the> million dollar question, right)?>

Trussel did not discriminate between "Ovulation Method" and the various NFP methods based on the work of the Doctors Billings, Brown, Odeblad and others when he cited the lowest expected percent of women with pregnancy. While I cannot comment specifically on Creighton model or Family of Americas data, the 0.5% pregnancy rate currently being promulgated by the Billings Ovulation Method is Chinese National Health Center data for 4 million couple users. Chinese women must report their menstrual cycles to public health nurses in the workplace. Regardless of the arguments for/against the one-child policy, and the criticism of adherents to other methods, the Chinese government promotes BOM as an effective alternative to IUD and OCPs

> 4. Finally, a while back a friend of mine said that her midwife was at a> conference and a presenter discussed research on the effect of the pill> on the cervix -- I think the findings suggested that the reason some> women experience infertility after using the pill is because it destroys> cervical cells - and then the mucus doesn't function well. And I think> she said that pregnancy rejuvenates the cells.> Do any of you happen to know of this research or does it sound at> all familiar?>

Dr. Odeblad has studied the cervix with nuclear magnetic resonance and electron microscopy with various collaborators for 50 years. His publications range from Acta Obst. et Gynec. Scandinav, Journal of the Irish Colleges of Physicians and Surgeons, ls of the New York Academy of Science, Obsterik och Gynekologi, International Review of Natural Family Planning and Proceedings 6th World Congr. Obst. Gyn. New York. Other investigators, including Gipson, Pilar Vigil, Pinkerton and Linn have published on the relationship between cervical mucus and OCP in the following journals: JAMA, Hum. Reprod. Med. J. Aust., Biol Reprod. and J Clinical Endocrinology and Metabolism.

Odeblad's explanation is that the mucus-producing cells become atrophic under the influence of chemical contraceptives, much as the same cells atrophy in perimenopause. Further, there is squamous metaplasia which transforms the columnar epithelium of the endocervix, decreasing the mucus production permanently.

Should you wish for specific reference citations please contact me off-list.

W. , M.D., FACOG

> Thanks for any help you could provide!>> Bertotti Metoyer, Ph.D.> Assistant Professor of Sociology> n College> Indianapolis, IN>>>>

June 2, 2005

> 4. Finally, a while back a friend of mine said that her midwife was at a> conference and a presenter discussed research on the effect of the pill> on the cervix -- I think the findings suggested that the reason some> women experience infertility after using the pill is because it destroys> cervical cells - and then the mucus doesn't function well. And I think> she said that pregnancy rejuvenates the cells.> Do any of you happen to know of this research or does it sound at> all familiar?

I forgot to add that Dr. Odeblad was once part of the oral contraceptive pill research team at Schering Pharmaceuticals. That collaboration did not end on a friendly basis. Dr. Brown, the other major scientific contributor to the Billings Ovulation Method, was once a collaborator of Pincus and Rock, who introduced OCP's to the United States.

mm

June 2, 2005

The data for NFP are old. Calendar data come from Laing's study in the Philippines, the OM from the WHO study, actually 2.9, which, as we now know included 2 sites where condoms were sometimes used during fertile times, the S-T figures came from the same source, post-ovulation from Barrett and Marshall. See my review article for references.

Hanna Klaus, M.D.

Natural Family Planning Center of Washington, D.C. and Teen STAR Program

8514 Bradmoor Drive

Bethesda, MD 20817-3810

Tel. , Fax

hannaklaus@...

http://www.teenstar.org

Why Wait? Move to EarthLink.

Re: science and contraception questions

> 3. Most of the tables in the books describe the "typical use" of> "periodic abstinence" as 25% failure rate (no distinction of which> method, including rhythm), and "perfect use" : calendar = 9%, ovulation> method = 3%, symptothermal = 2%, postovulation = 1% failure rates.> Questions: Is any of you out there familiar with the research that> produces these numbers? These perfect use numbers are higher than> research I've read by some of you. Why the distinction? How do they> get these numbers and why don't they draw on your research (probably the> million dollar question, right)?>

Trussel did not discriminate between "Ovulation Method" and the various NFP methods based on the work of the Doctors Billings, Brown, Odeblad and others when he cited the lowest expected percent of women with pregnancy. While I cannot comment specifically on Creighton model or Family of Americas data, the 0.5% pregnancy rate currently being promulgated by the Billings Ovulation Method is Chinese National Health Center data for 4 million couple users. Chinese women must report their menstrual cycles to public health nurses in the workplace. Regardless of the arguments for/against the one-child policy, and the criticism of adherents to other methods, the Chinese government promotes BOM as an effective alternative to IUD and OCPs

> 4. Finally, a while back a friend of mine said that her midwife was at a> conference and a presenter discussed research on the effect of the pill> on the cervix -- I think the findings suggested that the reason some> women experience infertility after using the pill is because it destroys> cervical cells - and then the mucus doesn't function well. And I think> she said that pregnancy rejuvenates the cells.> Do any of you happen to know of this research or does it sound at> all familiar?>

Dr. Odeblad has studied the cervix with nuclear magnetic resonance and electron microscopy with various collaborators for 50 years. His publications range from Acta Obst. et Gynec. Scandinav, Journal of the Irish Colleges of Physicians and Surgeons, ls of the New York Academy of Science, Obsterik och Gynekologi, International Review of Natural Family Planning and Proceedings 6th World Congr. Obst. Gyn. New York. Other investigators, including Gipson, Pilar Vigil, Pinkerton and Linn have published on the relationship between cervical mucus and OCP in the following journals: JAMA, Hum. Reprod. Med. J. Aust., Biol Reprod. and J Clinical Endocrinology and Metabolism.

Odeblad's explanation is that the mucus-producing cells become atrophic under the influence of chemical contraceptives, much as the same cells atrophy in perimenopause. Further, there is squamous metaplasia which transforms the columnar epithelium of the endocervix, decreasing the mucus production permanently.

Should you wish for specific reference citations please contact me off-list.

W. , M.D., FACOG

> Thanks for any help you could provide!>> Bertotti Metoyer, Ph.D.> Assistant Professor of Sociology> n College> Indianapolis, IN>>>>

June 2, 2005

Dear ,

What you included below sounds familiar. Please look on the

following two URLs:

Effects of the Pill

http://www.billings-ovulation-method.org.au/act/pill.html

Ageing of the Cervix

http://www.billings-ovulation-method.org.au/act/cervix/ageing.shtml

Audrey

www.woomb.org

-----------------------------------

At 09:50 AM 2/06/05 -0400, you wrote:

In a message

dated 5/24/2005 3:09:28 P.M. Central Standard Time,

jfkippley@... writes:

> 4. Finally, a while back a friend of mine said that her midwife

was at a

> conference and a presenter discussed research on the effect of

the pill

> on the cervix -- I think the findings suggested that the reason

some

> women experience infertility after using the pill is because it

destroys

> cervical cells - and then the mucus doesn't function well. And

I think

> she said that pregnancy rejuvenates the cells.

> Do any of you happen to know of this research or does it

sound at

> all familiar?

I forgot to add that Dr. Odeblad was once part of the oral

contraceptive pill research team at Schering Pharmaceuticals. That

collaboration did not end on a friendly basis. Dr. Brown, the other

major scientific contributor to the Billings Ovulation Method, was once a

collaborator of Pincus and Rock, who introduced OCP's to the

United States.

mm

June 6, 2005

Aside from health issues - socialogically -

I've heard that various books used in medical schools are written by

pharmaceutical companies. If this is true of books you are checking,

they are going to be promoting contraceptives as a normal aspect of life.

They have mucho $$$$$ invested in these products and the promotion of them.

Barb H