The Dangers of Depo [Podcast]

“Every woman should understand the short and long-term side effects, risks, and recovery. Otherwise, that isn’t informed consent.”

-Dr. Poppy Daniels

The Depo shot is a widely prescribed hormonal birth control which comes with a litany of possible life altering side effects that are not typically explained to patients before they begin taking the drug. One of my favorite podcast guests, Dr. Poppy, returns to explain the dangers as outlined in her book, The Dangers of Depo: The World’s Most Dangerous Birth Control. Even if you’re not on or considering Depo, listen in to learn more about the risks of Depo and gain a better understanding of hormonal birth control and other options.

Did you know?

• Depo increases risk of: HIV, bone loss, immune system suppression, decreased estrogen, increased testosterone, worsened insulin resistance, hypertension, depression, and breast cancer
• Depo is a steroid and carries all of the steroid side effects

Mentioned Links:

The Dangers of Depo: The World’s Most Dangerous Birth Control

The Progesterone & PCOS Connection [Podcast]

DangersofDepo.ca

DrPoppy.com

All PCOS Diva podcasts are now

Dr. Poppy Daniels was born in Boston and raised in Missouri. She attended undergraduate and medical school at the University of Missouri-Columbia.  She completed a residency in Obstetrics and Gynecology at Drexel University in Philadelphia, PA.  She worked for a short time for Drexel University Division of Infectious Diseases & HIV Medicine, on a project to institute rapid HIV testing for women presenting in labor with poor prenatal care. She and her husband, Dr. Dennis Daniels who is a Pulmonary/Critical Care/Sleep Medicine specialist, moved to Missouri where she has been in private practice since 2003.  They have 5 sons and one daughter, enjoying football, family time, gardening and raising chickens. Dr. Poppy, as she is known to her patients and social media followers, has a wide variety of special interests including: Physician-Midwifery Collaboration, Functional Obstetrics, Bioidentical Hormone Therapy, Progesterone Support in Pregnancy, Recurrent Pregnancy Loss, Infertility, Polycystic Ovarian Syndrome, Clotting Disorders, and Vaginal Birth After Cesarean (VBAC).

Full transcript:

Amy:                                   How many of us take prescriptions the doctor hands us, without reservation, without understanding short and long-term side effects and risks? I know I have, and I write about this in my book that will be coming out next year. I was given … One of the prescriptions I was given was Actos, off-label, to help with insulin-resistance. Little did I know that it can cause congestive heart failure, which, now, it has a black box warning on that drug for congestive heart failure, and has also been linked with bladder cancer. Thank goodness, I only took that short-term, but did so without any idea of the risk factors for that medication, that drug. I think a lot of women with PCOS have done the same thing.

I’m really here today, with my wonderful podcast guest that is returning to the PCOS Diva podcast, Dr. Poppy Daniels, to kind of raise, sort of, a warning flag for women with PCOS, who are given the birth control pill as therapy, and other drugs as therapy. As Dr. Poppy says, “Every woman should understand the short and long-term side effects, risks, and recovery, otherwise, that isn’t informed consent.” Welcome back to the PCOS Diva podcast, Dr. Poppy.

Dr. Poppy Danie:              Thank you for having me again.

Amy:                                   I just wanted to point listeners in the direction of the podcast that we did earlier this year. It was podcast 62, and we talked about pregnancy and the importance of progesterone replacement therapy for many women with PCOS, so check that podcast out. Super informative.

I just want to give listeners a quick overview of what your expertise is. You are known to your patients and social media followers as an OB/GYN, and you have a wide variety of special interest, including physician midwifery collaboration, functional obstetrics, bioidentical hormone therapy, progesterone support in pregnancy, recurrent pregnancy loss, infertility, PCOS, clotting disorders, and vaginal birth after cesarean. You’re also an author of a book that I just read last night, and it’s really interesting but horrifying at the same time. “THE DANGERS OF DEPO: The World’s Most Dangerous Birth Control Pill,” and you wrote that with Traci Johnstone.

Today, I really wanted to talk about that topic of making sure that you understand the risks, long-term and short-term, of any type of medications that you’re given. I think that your book, and this idea of how really dangerous the Depo shot is, is really a great example. Maybe you could just give us some background as to how you wrote that book, and your experience working with Traci, and what her experience was with that shot.

Dr. Poppy Danie:              Sure. Well, I guess it would probably go back to when I was a resident. OB/GYN resident. I did my training in Philadelphia, and large metro urban hospital. That was back in the days of Norplant. If some of you aren’t familiar with Norplant, that was when you would have six rods implanted into your arm. With mainly a black, urban population that I was involved with, I would really see that Norplant and Depo were both, sort of, emphasized to that patient population.

It always bothered me because I knew that a lot of the underlying, unspoken reason was that these women shouldn’t be reproducing. Nobody would say that out loud, but it was just this, sort of, feeling that you would get. That these were the ones that we really need to try to get them on because they’re long-term and they don’t require someone to remember to take a pill every day. I would see lots of side effects from these two contraceptives. Lots of irregular, heavy bleeding. Lots of weight gain. Lots of mood problems. I did not like them. I didn’t like them for the side effects.

Norplant was shortly taken off the market because there was a lot of consumer anger about this medication. It was felt to be targeted toward women of color and lower socioeconomic class. There were a lot of law suits, a lot of watchdog groups and it was taken off the market. Depo, of course, was not taken off the market. It’s still on the market. It has a very long controversial past. Most people don’t know that it took a really long time for it to be approved as a birth control medication in the United States. One of the things that was noticed about Depo was the weight gain. There was sort of a tremendously higher amount of weight gain with Depo shot than there were with regular birth control pills. Nobody could ever explain it.

It was interesting, because, in doing the research for this book, I have a lot of regular, mainstream gynecology text books. I just was going through all of them to see, you know, what is the opinion for why this happens? Would you believe the majority of time the women are blamed in these gynecology textbooks? Various wording, but a lot of it is sort of like, “Women are going to gain weight, anyway.” Acknowledging that a lot of the women who are prescribed this medication are African-American or Hispanic and that they’re more likely to gain weight anyway. It’s more reflective of food choices than it is the drug. Basically blaming women, which is highly offensive on almost every level.

It’s interesting because of that, you may have fewer PCOS patients prescribed it because they are often already struggling with weight gain, and so you may not have as many PCOS patients who are prescribed it as they are birth control pills. They still are prescribed it in some way and a lot of women who have endometriosis are prescribed Depo and I see a lot of women who have both endometriosis and PCOS, that’s very common. You still have quite a few women and women who have PCOS who have very heavy periods. They’re often recommended to be taking these things to stop their period so they’re not bleeding out all the time.

In the United States, though, it’s a very unpopular contraceptive because of the side effects. It’s interesting because if you look at the percentages, and I list them in the book, the percentages of white women who take Depo-Provera is way outpaced by birth control pills. The vast majority of hormonal contraceptives taken by white women are oral contraceptives and less than 5% for the Depo shot. In women of color, African-American women are prescribed Depo three and a half times more than white women and Hispanic women about double what white women are prescribed.

There’s lots of things in the book that we don’t have time to get into in terms of population control and all of these things, which are, I mean, there’s no denying it when you look at the history. There just isn’t. If you focus just on how women do on this medication, they do poorly. They don’t do well in the vast majority of cases. One thing that I have, and I think we may have talked about this on the last show, but many times when women bring their complaints about birth control to the doctor, the doctor does not want to blame the birth control. The doctor wants to blame this, that or the other thing. Often the woman, herself. It’s a very weird thing that happens where, you know, women will come in and in your audience, more typically, it would be birth control pills. If they come in and they’re prescribed birth control pills and they’re having mood swings or they’re having still irregular bleeding even on birth control. I mean, there’s so many times that women are sort of not listened to when it comes to what they’re experiencing or they’re prescribed another drug, like an anti-depressant.

Amy:                                   Low libido. I think a lot of women have no idea that the birth control pill is actually suppressing their libido. I think it’s that sense … I know what I experienced was, like there was just no joie de vivre. I just felt very flat and life was very flat. I remember mentioning that to the doctor and that’s exactly what his response was. “Well, you know, we could prescribe you something for that.”

Dr. Poppy Danie:              Exactly. We have a pill for every ill.

Amy:                                   Right.

Dr. Poppy Danie:              I really did not prescribe Depo very much in my own private practice after I got out of training. There would be women that would come in on it, you know, they were already on it and I would sort of, you know, if they were doing okay on it continue it, but I would never start someone on Depo because I just never liked the results that the women would complain of. Through the years I’m always, you know, I’m very tuned in to any research that comes out about hormones and contraceptives. What happened was we started to see, or those of us paying attention. Mainstream, this is not really obvious, but in the academic world there started to be papers being published about Depo and HIV, which is, interesting. Why would that be connected? Why would that be an issue?

What you have to understand is that Depo is greatly pushed in the developing world. It is, actually, one of the most popular, depending on who you were asking, certainly popular with donor agencies and family planning organizations. It’s very much pushed on the developing world. In particular, Africa. The idea is that you want to get these women on a long-term birth control because there’s limited health resources and limited exposure to health care providers. We need to get them on a long-term agent. You’re working in Africa in lots of areas of high rates of HIV. We don’t have that in this developed world because have HIV medications. While there is HIV in this country, it’s not that there isn’t, but we have much more access to medications and treatment than they do in the developing world. It’s much more of an epidemic in Africa.

When you’re studying these things you obviously are going to get better data from places where this is happening more. Back in the ’90s, all the way back in the ’90s they were starting to see this association of increased risk for HIV acquisition in women who used hormonal contraception. As I mentioned, most women in Africa are not taking birth control pills. Some of them are, but it’s much more likely to be Depo. People started to theorize why this was happening. One of the things that happens with Depo is that it is one of the most effective hormonal contraceptives, of turning off your hormones completely. The first thing it does is it turns off your progesterone production because it’s a progestin. It occupies the receptors so you’re not making progesterone and you can’t respond to progesterone and you’re not ovulating from it.

At the very beginning, women have tremendous heavy bleeding because they still have estrogen going on. Estrogen is a growth hormone, progesterone is a balancing hormone. You take away the balancing hormone and all you get is the stimulation effect from estrogen. The vast majority of women bleed, bleed, bleed, bleed, bleed when they first go on Depo, which is horrible. I mean, you’ll hear women say, “I was on my period for three straight months.” The doctor will be like, “That’s normal. That’s normal, just put up with it.”

After you’ve been on Depo for a while, then what happens is your estrogen levels start to drop. When your estrogen levels drop then you can exhibit symptoms of low estrogen which includes thinning of your vaginal tissue. Just like in menopause, women who go through menopause experience vaginal dryness and your vaginal tissue becomes easily irritated and susceptible to infection. The supposition was that as the vaginal tissue was thinning out it was becoming more likely for the HIV virus to penetrate into the vaginal tissue and more likely for a woman to become HIV positive if exposed. That’s sort of the theory that everyone was saying.

However, as things continue to progress with research, a lot of people started to say, “There seems to be more evidence of the HIV virus in women on Depo in their vaginal secretions. Is there some kind of innate immune system issue going on here?” There’s lots of theories and research, but finally in 2013 two different labs, one in South Africa and one in the United States in Birmingham, Alabama, proved that Depo was affecting the innate immune system. Specifically, it was suppressing T-cell production. Your T-cells are your main weapon against HIV. Once you get exposed to HIV, your immune system is activated to fight this threat, but if your first line of defense is suppressed, then you’re much more likely to actually acquire the HIV virus if you’re exposed to it.

Women at high risk for HIV, this would be women in high areas of endemic HIV, women who are sex workers, women who have other immune system issues and women who are discordant, meaning their partner is HIV positive and they’re HIV negative. These women are at much higher risk for acquiring HIV. These papers were published and honestly, the only people really paying attention to it would be people in the academic world. There were a few articles that were published in mainstream publications, but if you don’t have someone to translate all this stuff to a lay person it’s going to go like this. They’re not going to understand what all this means.

There were people who understood what it means and that is WHO, World Health Organization. They were really dragging their feet in response to this information. For many, many years there were no restrictions on the prescription of HIV to women at high risk for HIV. When this information started being published and these were journal articles in very highly respected journals, like the Lancet Infectious Disease. 2011 huge paper published showing a 50% increased risk for HIV in women who use Depo and were a high risk for HIV. Published by Renee Heffron in the Lancet Infectious Diseases. It created a buzz in the academic world.

What started to happen was people went into spin doctor mode, because we don’t want to take this drug out of Africa, and who’s drug is that the favorite drug of? Melinda Gates. Melinda Gates loves Depo. Also, in 2012 was her London Family Planning Summit where she sort of rolled out this grand plan to increase contraception access to the developing world under the guise of empowering women. Her drug of choice was Depo. This was just starting to come out that Depo was a problem. Before it really started to be exposed, she was sort of jumping out ahead of it to say, “This is what we’re doing. We’re helping women. We’re putting all this money into it and we’re really pushing Depo into the developing world.”

They also unrolled a Depo version called Sayana Press. Sayana Press is Depo that can be self-injected. They’re putting even more layers of distance between a woman and her healthcare provider because now they’ll just give the drug out and a woman can give it to herself at home, and they will likely give her plenty of these so she doesn’t have to come back in. There’s nobody monitoring her, there’s no one she can really talk to if she’s having side effects. She’s obviously given very little information up front about the risks, even though they tell you, “Oh, we give all the information about all the side effects.”

I think that if you actually came out and said, “Hey, you’re in Africa where there’s high rates of HIV. This drug right here might increase your risk by 50%.” Most women would probably say, “I’m not sure if I want that.”

Amy:                                   Right, right. You know what is so surprising to me? I hear from women here in the US that they are on Depo and they talk about how their PCOS symptoms have increased. Reading your book last night, many of the side effects mimic a lot of the PCOS symptoms. The other thing that I think is interesting is that when you come off of Depo, maybe you could speak to this, and I mean, just even birth control in general. I know Dr. Lara Briden talks about it in her Period Repair Manual that there’s, she believes that there’s sort of this post pill form of PCOS. Coming off the Depo, it affects women in different ways, as I read in your book. Some women can start to have increased testosterone so it sort of brings about PCOS just from the withdraw of the Depo, which I think is fascinating. It really makes sense what I’m hearing from women the way that you explained it in your book.

Dr. Poppy Danie:              Right, so what happened with that basic research was that the basic scientists that were looking at the immune system. They proved that Depo is a glucocorticoid medication. In common language, a glucocorticoid is a steroid. Most of us are familiar with steroids being used in medicine for various problems. Autoimmune disease, respiratory illnesses, asthma, infections, things like that where steroids are given. Most people also know that steroids, the most common one that people have heard of, is Prednisone, cause a lot of side effects that are also seen with Depo. Weight gain, mood swings, fluid retention and over time, suppression of the immune system. It’s interesting that the weight gain that’s associated with Depo is a very specific pattern of weight gain that is also seen with another condition called Cushing’s Syndrome. Cushing’s Syndrome comes from over production of cortisol. Cortisol is your ultimate glucocorticoid hormone that’s made inside the body.

If you have a tumor that’s overproducing cortisol or if you just have hyperplasia of your adrenal glands overproducing cortisol, then you will gain weight in a very specific distribution pattern and that is abdominal weight gain, so you have a lot of belly fat. Protruberant abdomen. Women will get a lot of edema and weight gain in their face. That’s called a moon face and often get a double chin and very round face. Then they can get fat pad on the back of the top of the spine, it’s called a buffalo hump. You see that exact same fat distribution pattern as someone that has Cushing’s Syndrome. The reason for that is that Depo is a steroid that is very similar to cortisol and to Prednisone, other steroids, and nobody really understood that.

Well, here’s the other piece of the puzzle that comes into play with Depo and that is bone loss. Depo, really it took until 1992 to be passed as a drug with the FDA, even though it had been around since the 1960s. It took that long to get approved for various reasons that I go into in the book. By 2004, there was already a black box warning for bone loss. Again, a lot of people said, “Oh, this has to be because the estrogen levels are dropping because where do we see bone loss? In menopausal women.” The problem was they were seeing this bone loss that was persistent, meaning it didn’t turn right around as soon as you got off of Depo. In fact, in adolescents, which was the most concerning and which actually lead to the black box being put in there, in adolescents they had not regained their bone density in five years from going off of Depo. This is a huge problem because those women, most of them have not attained their full bone strength already because of their 16, 17, 18 getting a Depo shot. That black box warning was in place for bone loss since 2004.

Well, if you look at steroid patients, patients who are on long-term steroids, what’s the main problem that they have with their bones is development of osteoporosis. That’s because steroids affect your ability to grow new bone. Osteoporosis is a risk of long-term steroid use. Well, now that we know that Depo is a steroid, or a glucocorticoid medication, the bone loss makes complete sense because it’s having the same effect as someone who is taking Prednisone. You’re putting all these pieces together with this new research. You’re saying the weight gain, the bone loss, the immuno suppression, Depo is a steroid. You have all of these women on steroids. They’re all wondering why they’re gaining weight. Now, not everyone gains weight universally with Depo, but it’s a huge percentage of women who do. Not everyone who takes Prednisone gains weight, either, but it’s sort of like one of the more common reasons people stop taking it because they are tired of gaining weight.

That can lead to worsening of insulin resistance and diabetes. As far as the metabolic side of PCOS, absolutely, it’s going to worsen the metabolic side of PCOS, which is insulin resistance. It can cause fluid retention which can increase your risk for hypertension. These are problems that PCOS patients already have. In many cases, Depo could absolutely make everything worse.

Amy:                                   I was just going to interject. I hear from so many women that have that anxiety is so debilitating. That is part of that mood disorder. I think birth control bills and Depo can exacerbate.

Dr. Poppy Danie:              I think we talked the last time about the study that came out last year in Scandinavia that was done with looking at the risk for depression with all hormonal contraceptives and they were all found to increase the risk for depression. This was a huge study because, as we had said, so many women are told their mood problems are not from the birth control. This study proved that all hormonal contraceptives increase the relative risk for depression. The other reason it affects mood is when you do not make progesterone. Progesterone production is completely turned off. Progesterone is a mood stabilizing hormone because it has calming effects on the brain and it also has metabolites that are calming to the brain. Well, synthetic progestins don’t have that, so you’re not making the calming hormones so you have lots of anxiety, you have lots of mood swings.

Estrogen is also important in mood, too because you need estrogen for cognition, for thinking, for concentration. Basically, your female hormones are being completely turned off and then you have the steroid effect of Depo causing you to have all these metabolic problems. Then, when you go off of it, it sometimes gets worse. Why does it get worse? It gets worse because if you take something that is a steroid and then you stop that steroid immediately and don’t ween off of it, then you will have adrenal suppression and that’s why all people are told to ween off of steroids when they’re on steroids unless you’re taking them for like five days. If you’re just taking it in a short-term burst you don’t have to ween off of it. If you’re on long-term steroids, you have to gradually ween off of them or else your adrenals, which have been dependent on that glucocorticoid, will completely crash.

That’s what happened to Traci, who is my co-author of this book. Number one, she had almost an immediate effect on her immune system because she started getting all kinds of infections, which ultimately lead to her hysterectomy. It took her fertility away from her, it took her ability to have a strong immune system away from her, and now, even after she’s been off of it for several years, she’s still dealing with the adrenal withdrawal and adrenal suppression that comes. Now, this is not something that hardly anybody recognizes as an adrenal problem because most people don’t realize it’s a steroid. If you don’t know it’s a steroid, you don’t know to look at the adrenals. I’ll be honest with you, the vast majority of doctors are not good at the adrenals, anyway. They usually ignore them. Even endocrinologists, it’s not on their radar like it should be in this kind of a setting because they don’t know that this drug, up until now, that this drug is a steroid.

You often have women who are doing okay on Depo, and then when they stop Depo they go really downhill. They get worse. They get worse, and so they think, “Oh my God, I got to get the Depo back.” The truth is, it was the withdrawal of the steroid. That’s why they’re having all these problems, but people can’t recognize it for what it is, so all of these women are miserable. If you go to Traci’s social media pages, especially on Twitter, you have a long litany of women literally cursing out the Depo shot for how horrible they feel. We’ve included a lot of that in the book where we’ve just listed people’s comments about Depo. Over and over, I mean you will not see things like, “Oh, I didn’t really like it or I didn’t tolerate it,” you know, some of the things that you might hear with regular birth control pills. You will hear, “This drug ruined my life. This drug is the devil. I hate the Depo more than … I would rather be pregnant than be on this medication. This is horrible.”

Women aren’t doing well on it, and the fact that it now has the potential to have such life altering effects on your hormones, on your adrenal system, on your immune system, the other risk with it is breast cancer. Breast cancer, this is even more of a risk with Depo than it is with birth control pills. We know that most of the risk of breast cancer with birth control comes with long-term use of birth control pills, or with starting it at a very young age and using it, you know, if you’re using it for 10 years continuously your risk for breast cancer is increased on birth control pills.

With Depo-Provera, the problem with Depo is that it has been shown to be causing breast cancer for many years. That was one of the barriers to its approval in the United States as a contraceptive because even the World Health Organization’s data showed an increased risk for breast cancer, which they sort of swept under the rug and said, “Oh, this is small and this is just in younger women.” Then, what happened was we had a big hormone study in 2002, which was the women’s health initiative study. That was done with the hormone replacement drugs, Premarin and Prempro. Prempro is Premarin plus Provera. Provera is the same thing as Depo-Provera. They are the same drug. That study showed that women who took Prempro had a 26% increased risk for invasive breast cancer. This was a randomized controlled trial, so this was proof that it increased the risk for breast cancer.

Whereas, women who just took Premarin they did not have an increased risk for breast cancer, so that pointed the finger at Provera. Now, Provera is a very low dose of Medroxyprogesterone acetate, which is the actual drug. It’s about five to 10 milligrams. Whereas, in a Depo shot that’s 150 milligrams.

Amy:                                   Oh my gosh. Wow.

Dr. Poppy Danie:              Another study finally came out in 2012 showing that women who took Depo had a 2.2% increased risk for breast cancer and that was women who only took it for a year. They already had a double, a two-fold increased risk for breast cancer. You have probably a direct effect on the breast, but also an immunosuppressive effect on the breast. As you may know, if you suppress the immune system, your risk for cancer goes up. Not only are you at risk for infectious problems, but you’re at risk for cancer because your immune system can’t fight the cancer cells. It’s a very bad drug. You know, you see these commercials on TV, 1-800-BAD-DRUG. I actually haven’t seen very much, I should contact some of these lawyers and say, “How come you’re not advertising about Depo? I mean you could have some major lawsuits with Depo.” This drug, it has immediate short-term side effects, it has long-term side effects. I’m going to tell you what most women hear when they go for counseling for birth control.  “What kind of birth control do you want? Do you want to take a pill every day? Do you want a shot? Do you want a ring? Do you want a patch? Do you want a rod implanted in your arm? Which would you like? What would you be more likely to be consistent in taking?”

Then, there might be a few, “I’ll tell you what happens with Depo. This could affect your bones, so be sure and take calcium.” That’s it. The counseling that women are receiving when they go in for birth control, and you know this from hearing about the birth control pill in PCOS patients. Very little counseling. Very little discussion of short-term or long-term side effects. It’s mostly with the PCOS patient. Do you want to get pregnant? Do you not want to get pregnant? If you don’t want to get pregnant let’s put you on birth control, because that will fix your periods.

Amy:                                   Yeah, and it’s the therapy that’s offered. It’s going to fix your hormones. The other thing that I just wanted to, I always try to point out when we’re talking about birth control. Although it’s still a small risk, but the risk is increased for blood clots. I can’t tell you, when I post about that how many young women in their 20s and 30s have posted, “Yes, this happened to me. I’ve gone for a life-threatening blood clot to the emergency room and never in a million years thought that would happen to me, or it was even a possibility because I was never told that I was at a two times increased risk for blood clots.”

Dr. Poppy Danie:              Yeah. Absolutely. You can die from that, so there are women who have not come back from that. There is also clotting risk with the Depo shot. A lot of people prescribe Depo because it doesn’t have estrogen in it. They assume that this is safe for women who are at higher risk for blood clot. When the truth is, is that the actual research shows that you’re still at risk for blood clots with the Depo shot. Some of that is probably mediated through the steroid effect on the body, so it leads to weight gain, fluid retention and that increases your risk for clotting if you’re overweight or obese. It’s contributing to that risk.

Certainly, you still have a clotting risk with the Depo shot just like you do with birth control pills. Some of that has to do with the generation of progestin that you’re taking in the birth control. Some of the newer progestins in birth control pills. What birth control was most commonly prescribed to PCOS women for years? Yaz. Yasmin, that version. That was a fourth-generation progestin that was actually found to have almost triple or quadruple the risk for blood clots. You’re taking a population of people that are probably already at higher risk because of their tendency to have obesity or insulin resistance and you’re putting them on the most risky birth control pill because why? Oh, it helps your acne.

Amy:                                   Right.

Dr. Poppy Danie:              Well, why? Because it has an effect similar to spironolactone, which is a drug that many PCOS patients are given to lower their male hormone levels. This was thought to be the miracle drug for PCOS. Yes! Because, it fixes your period, and it helps your acne, and it lowers your male hormones. It’s great, it’s wonderful. Except that, if you get a blood clot that’s not such a great thing. If you get worsening insulin resistance from being on birth control pills, that’s not a good thing. We know that birth control increases your risk for insulin resistance from a metabolic standpoint. These are not healthy things for PCOS women to be dealing with.

You’re right, this is portrayed as a treatment for PCOS, which it does not do. It does not treat PCOS. It does nothing to address the underlying hormonal imbalance and it may actually worsen it in cases like I mentioned.

Amy:                                   Dr. Poppy, when you see your patients with PCOS, how do you … I know every woman is a unique individual case, but if you’re not prescribing birth control as therapy, what are you counseling women to do? What are her alternatives to managing her PCOS?

Dr. Poppy Danie:              It’s usually multi-factorial because it has to be, right? We have to address a lot of elements with PCOS. The cornerstone of PCOS therapy is giving women back the hormone that they are not making, which is progesterone. Progesterone is made from the ovulated eggs, so if you’re not ovulating, you’re not making progesterone and most of these women are what we call estrogen dominant. They have a lot of estrogen and that’s often why they’re having either heavy periods when they do have them, very heavy periods. Often why they’re dealing with ovarian cysts. They’re dealing with often endometriosis, uterine hyperplasia, they’re at risk for endometrial cancer. Those are all estrogen dominant conditions. Progesterone, as I mentioned before, is the balancing hormone. It’s the hormone you don’t make when you don’t ovulate.

You have to give women that hormone back and cycling them with natural Progesterone will greatly increase their return to more of a regular bleeding cycle. Then of course, as you know, and as you’re working with, you have to address the metabolic side of it by addressing diet, doing nutrient supplementation, supplements that help them. Inositol, Omega-3 and all of these healthy supplements that we use in PCOS patients. The dietary component, as you know, is critical because most of these women are insulin resistant or insulin sensitive so they need to have very healthy, more protein oriented diet in general. Mediterranean diet, Paleo, there’s a lot of different ways to get there. There’s no one right way. Most of the time you have to get rid of processed food. Too much sugar, too many carbs, because that’s the bane of PCOS patient’s existence. It makes everything worse in them.

It’s a holistic approach. I do use medications. I do use Metformin. I do use spironolactone. I use natural hormones because we’ve got to address the root of the hormonal imbalance and we have to work with the hormonal system to get it to do what it’s supposed to do.

Amy:                                   The other thing that I wanted you to address, too is okay, if we don’t want to be on hormonal birth control but we’re not looking to get pregnant, what can we do? I’ve been very open in sharing my … I was actually diagnosed with PCOS through using the Creighton Model of Natural Family Planning. I mean, it took me 15 years to get that diagnosis and really understanding my cycle at that sort of level of looking at it every single day was really the only way that I sort of gained the knowledge that there was something awry and it was PCOS. Tell us, and I know you’re an advocate of Dr. Hilger’s work and he is associated with that Natural Family Planning, the NaPro Technology and the Creighton Model. Just would love for you to share a little bit more with listeners about that.

Dr. Poppy Danie:              Sure. There’s a renaissance going on with these methods, which can be referred to as Natural Family Planning or Fertility Awareness Methods. These involve charting your cycles using various methods. Some temperature, some cervical mucous symptoms such as breast tenderness or mood swings, and really, trying to identify what’s happening with your cycle. This is critical. This is very critical also for diagnosis and treatment. The vast majority of gynecologists know nothing about charting. Unfortunately, unless they’re Catholic or unless they’re really tuned into this stuff and holistic, you’re unlikely to be even suggested to chart your cycle so it becomes hard to find someone to teach you. A lot of women teach themselves by getting the book Taking Charge of Your Fertility by Toni Weschler, which teaches you how to chart, which is a great way of getting in touch with your body, your hormones, your cycles, what’s going on here.

A lot of women who have PCOS still have fairly regular bleeding cycles and they’re even harder to diagnose because the doctor thinks you don’t have PCOS if you’re still having your cycle. If you’re having 35-day cycles, a lot of these cycles are likely anovulatory and they’re not necessarily normal, but you wouldn’t know that unless you’re charting, right? Now, obviously if someone is definitely not wanting to get pregnant, you have condoms, which is probably one of the most commonly used nonprescription forms of contraception. Diaphragms, cervical cup caps can actually be ordered online without being fitted. There’s a diaphragm called Caya, C-a-y-a, that can be ordered online that you don’t have to be fitted for. I do fit patients for diaphragms so there are some of us still old school people out there fitting people for diaphragms.

Some women choose the copper IUD, which is intrauterine device that does not contain hormones. It’s not my favorite, I don’t put those in, but some women choose them. It’s called the PARAGARD because it doesn’t contain any hormones. If you are someone who has had children or knows for sure that you don’t want to have children ever, no way, no how, then some women also choose permanent sterilization. Tubal ligation or vasectomy if they know for sure that they don’t want to have any children.

Amy:                                   I do want to just make a note about that. There’s an excellent article on PCOS Diva about a woman with PCOS who had tubal ligation. It’s kind of similar to the work that you’ve been doing with the Depo where she had some horrible side effects, started a community and we’re hearing more and more people that have tubal ligation syndrome. Lots of issues after tubal ligation. That’s another, there are some women who’ve had negative experiences through that.

Dr. Poppy Danie:              Yes, and I would say I see a lot of those women. I’d say I see probably more so than other doctors just because I’m a hormone doctor I tend to see problem patients more than I just seen happy go lucky. I’m happy with my birth control patients. There’s no one right answer for everyone. Everyone has to step back and analyze their situation and sometimes you have to kind of take things that you wouldn’t like because of your situation. You have to discuss with your partner what makes sense for your lives. There’s not going to be, there’s women who say, “I can’t chart my cycles. I’m too busy, I don’t pay attention to that stuff. There’s no way I would stay on top of it. It’s not a good choice for me.”

I would also say that there’s been a lot of technology that has arisen to help women with charting their cycles, so lots of apps, lots of thermometers that are very fancy. There’s OvaCue, there’s Daysy, there’s all kinds of gadgets that have greatly increased the use of technology in order to help women who want to do fertility awareness or natural family planning. It’s not going to be the answer for everyone. I’ve even had women who said, you know, let’s just try me on low dose birth control because I don’t want to get pregnant right now. Let’s just see how I do. I’m not opposed to that. It’s all about informed consent. I strongly counsel them. I say, “Look, I need you and your family to be aware of your mood, and if it’s changing and you’re not yourself and you’re definitely dealing with mood problems after we start this medication, I need you to let me know.” We engage with one another in order to have communication about their response to the medication. That’s the way it should be, but many women that’s not their experience.

Amy:                                   Well, I really appreciate the time that you took with us today, Dr. Poppy, and giving us that information so that we can have the informed consent. I encourage listeners to continue educating themselves beyond this podcast and certainly check out your new book and maybe you could just give us the title for that and where we could find it.

Dr. Poppy Danie:              Yes, it’s called The Dangers of Depo; The World’s Most Dangerous Birth Control. It’s on Amazon, so if you go to Amazon you can either get it on Kindle or you can get a paperback. If you go to Dangers of Depo.ca, there’s a website there that has lots and lots of information about Traci’s journey. I met her online. She contacted me when she heard one of my shows on Depo and that’s how we came together to write this book together, because I’ve actually never met her in person, only online. It’s because she’s in Canada, so the website is Canadian. That’s the dot ca instead of dot com. If you go there you can also follow Dangers of Depo on Facebook and Twitter. You can follow me on Facebook and Twitter, Dr. Poppy on Facebook, and Dr. Poppy BHRT on Twitter. I also have a website, Dr. Poppy.com. I have a license in Missouri and Pennsylvania so I can take patients from Missouri or Pennsylvania. I can do Skype consults for patients in those states.

There’s lots more holistic practitioners. I know you talk about a lot of them. I talk about a lot of them in my book. I have a list of resources in my books, blogs, Facebook, Twitter pages of people doing more natural holistic hormone balancing so there’s tons of resources like that in this book. Even if you’re not on Depo or don’t want to take Depo, this is a very good book for understand hormones, understanding hormonal birth control.

Amy:                                   Mm-hmm (affirmative), and just to give another little plug. You have a great section in the back about how to recover from hormonal birth control if you’re having some of these symptoms that we talked about. You kind of have a little, you know, you go into how to do that. Another great reason to pick up a copy of the book.

Thank you again. I hope to have you on the podcast again, soon. You’re one of my favorite guests.

Dr. Poppy Danie:              Well, thank you so much. I’d love to be back and I can’t wait to read your book that’s coming out.

Amy:                                   Oh, yay. I know, I’m really excited about that. Well, I just want to thank everyone listening. Thank you so much for joining us on today’s PCOS Diva podcast. If you like this episode don’t forget to subscribe to PCOS Diva on iTunes or wherever else you may be listening to the show. If you have a minute, please leave me a quick review on iTunes. I read every one of them, and I’d really love to hear from you. Please, don’t forget to sign up for my free newsletter. It goes out every Thursday with some really interesting piece of related content to PCOS. You can get instant access for that at PCOSDiva.com. This is Amy Medling wishing you good health. Look forward to being with you again, soon. Bye, bye.