From an early age most children will be told that drugs are bad. This will be reinforced again and again, usually by a recovering crack addict, who for some reason gets to preach to school assemblies about how to live one’s life. But I digress.
The usual culprits we’re all urged to avoid are substances like heroin, cocaine and methamphetamines. Now imagine if I told you there was a drug which millions of people take legally every day which can cause nausea, vomiting, stomach ulceration, severe bleeding and even death without warning. In fairness I’m lying about the warning part because the drug in question is Aspirin and the above information is available in the package insert and from any suitably qualified healthcare provider. The fact that the overwhelming majority of people who take Aspirin, often on a daily basis, will never suffer from any of these side effects is obviously of little comfort to those who take to making mountains out of mole hills using nothing but their stupidity and Facebook accounts.
This brings me to an article published by Australian Marie Claire in April of 2013 which has recently gone viral on social media networks across South Africa. The offending piece from the overrated penal colony claims that your oral contraception is a ticking time bomb which could go off at any moment rendering you anything from depressed to paralysed or even dead. As I’ve already illustrated with Aspirin, every single drug ever created has potential side effects. The important word here is ‘potential’ and the even more relevant concept is ‘risk versus benefit’. The use of any medicine should always be carefully considered for the risk it may pose to a particular patient and the benefit which they may gain from taking it. Some drugs which reduce blood pressure can cause kidney failure, but their benefit in preventing cardiovascular disease due to to high blood pressure most often outweighs the very small risk of causing kidney problems in a subset of patients which we can usually identify.
There are several issues with the Marie Claire article which raises most of its concerns with Yasmin and Yaz, third generation oral contraceptives taken daily by millions of women worldwide. The article selectively chooses to publish evidence about the number of adverse events and even law suits related to these drosperinone containing contraceptives. At no time does it provide any meaningful figures choosing instead to manipulate data so as to make the drug sound far more dangerous than it actually is.
For example if the occurrence of an adverse event in the normal population is 1 in 1 000 000 and in a population taking a drug this increases to 2 in 1 000 000, the best way to report this for effect would be to say that the drug causes a 100% increase in the adverse event. The fact that this is still very unlikely to happen is completely lost and is a common method used by those who wish to distort data to make their point (see Wikipedia for the definition of news media).
We, the medical fraternity, are acutely aware of the risks oral contraceptives. They’re banged into us, excuse the pun, from early on in our training. These include an increase in risk of venous thromboembolism (VTE) or ‘clots’, emotional lability and weight gain, amongst others. It is however important to remember that risk is the chance that something may happen but not a guarantee that it will.
In the case of oral contraceptives the increased incidence of VTE is 3 to 10 events per 10 000 life years on such an agent versus 1 to 5 events per 10 000 life years not taking the drug. Indeed that is as many as 10 times more events but in the overall scheme of things not actually significant enough to flush your pill down the toilet tomorrow morning (this is a euphemism, please don’t poison all of us and the fish with your birth control). Further studies analyzing the increase in relative risk show similar findings with an obviously increased risk of VTE of as much as 4 times in those on oral birth control, however this should be placed in context because pregnancy in itself increases the risk of VTE by up to 20 times and it is still a relatively rare occurrence.
That said it is for this reason that such drugs are only available on prescription from your doctor, who should inform you of the potential risks and complicating factors. I am baffled as to how Professor Kerryn Phelps, who claims to have taken Yasmin at the age of 46 and suffered a complication, could not have known that women over the age of 35 are at considerably higher risk of VTE. The risk in such patients usually outweighs any potential benefits and those of us with a non Australian medical education know this.
Lastly, and perhaps most importantly, is that all patients should be aware of changes to their mental and physical well-being which may be caused by the initiation or cessation of a drug. Such changes should not be ignored as several of the anecdotal case examples in the Marie Claire article seem to indicate. With that said if you’re choosing to get your health advice from any periodical they sell in the queue at your grocery store then you may have more mental health issues than any kind of contraceptive will cause. If you still disagree based on such anecdotal evidence then please find another suitable contraceptive because it’d probably be best for all of us if you didn’t breed.
(For more on interpreting erroneously reported scientific data please read this.)