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.