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Royal College of General Practitioners Pill study reports three times more deaths in young contraceptive pill users

13 March 2010

Ellen CG Grant,

Physician and medical gynaecologist

Kingston-upon-Thames, KT2 7JU

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Re: Royal College of General Practitioners Pill study reports three times more deaths in young contraceptive pill users

My colleagues and I have contributed many publications since 1962 describing and explaining the harmful effects of oral contraceptives. These include 14 electronic responses at www.bmj.com which point out numerous deep flaws in the large �observational� Royal College of General Practitioners Pill study such as very large drop out rates and losses. As usual Hannaford and colleagues make unsubstantiated claims of benefit.1 It would need a Magic Pill and not a Bitter Pill to confer benefit up to 40 years later after an average �observed� use of 44 months!

The genuine proof from the randomised controlled Women�s Health Initiative Study, that progestogen and oestrogen hormones (given as combined HRT) increase cancers and vascular diseases and mortality from lung cancer, is apparently disregarded.2 Combined HRT is the same biochemically and physiologically as the Pill. Although most deaths in this RCGP Pill study were in women over age 49, whether or not they were taking HRT is largely unknown.

It is remarkable that Hannaford is unable to explain the increased risk of violent and accidental deaths among users of oral contraceptives. Has he not read our 1968 proof that progesterone dominant oral contraceptives raise endometrial monoamine oxidase levels and increase depressive mood changes and loss of libido?3 This study was quoted in the

RCGP 1974 publication which reported observations in the Pill study from 1968 to 1972. By then the RCGP study found increases among Pill users in about 60 conditions including mental illnesses and marriage break ups. 4

We also noted in our 1968 paper that increased violent events were seen with a dose combination which particularly increased both vascular arteriolar development and dilatation of sinusoids. Now the immediate progesterone stimulated increase in Vascular Endothelial Growth Factor is thought to be a contributory cause of increases in metastatic breast, lung

and ovarian cancers as well as vascular diseases.2,5

Even if the results are taken at face value, it is absurd to claim a net benefit if nearly three times more women in the main pill taking age group, younger than age 30, are likely to die (RR 2.85). CNS and pituitary tumours increased with over 3 years of Pill use. Also Pill ever takers under age 45 had a 1.76 increased risk of cancer and vascular death

5 -9 years after stopping use. This is enough time to find the increase in breast cancer mortality but after this risk estimates would be meaningless due to widespread HRT taking. These hormones in the form of HRT are the main cause of premature cancer death in menopausal women whether or not they took the hormones as the Pill at the beginning of this

or any other study 40 years ago.

It is now surely inconceivable that any medical scientist who has some understanding of basic mechanisms could believe that widespread hormone use, especially of progesterones, is not a major health problem.

1 Hannaford PC, Iverson L, MacFarlane TV, et al. Mortality among contraceptive pill users: cohort evidence from Royal College of General Practitioners� oral contraception study. BMJ 2010:340:c927.

2 Chlebowski RT, Schwartz AG, Wakelee H, GL, Stefanick ML, Manson JE, Rodabough RJ, Chien JW, Wactawski-Wende J, Gass M, Kotchen JM, KC, O'Sullivan MJ, Ockene JK, Chen C, Hubbell FA; Women's Health Initiative Investigators. Oestrogen plus progestin and lung cancer in postmenopausal women (Women's Health Initiative trial): a post-hoc analysis of a randomised controlled trial. Lancet. 2009 Oct 10;374(9697):1243-51

3 Grant ECG, Pryse-Davies J. Effect of oral contraceptives on depressive mood changes and on endometrial monoamine oxidase and phosphatases. BMJ 1968;3:777-80.

4 The Royal College of General Practitioners. Oral Contraceptives and

Health 1974 Pitman Medical, New York.

5 Grant ECG. Lung cancer and hormone replacement therapy. Lancet 2010; 375:117; author reply 118-9.

Competing interests: None declared

Sincerely yours,

Dominic M. Pedulla MD, FACC, CNFPMC, ABVM, ACPh

Interventional Cardiologist, Endovascular Diplomate, Varicose Vein Specialist, Noncontraceptive Family Planning Consultant, Family Planning Researcher

Medical Director, The Oklahoma Vein and Endovascular Center (www.noveinok.com, varicoseveins1@...)

Executive Director, The Edith Stein Foundation (www.theedithsteinfoundation.com)

(office)

(cell)

pedullad@...

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