By Eleanor Francis
You might assume that the recommendations by the World Health Organization, as well as a variety of studies done in England, the Netherlands, and Denmark, might give pause to the German-owned Bayer company in its promotion of their newest incarnation of the hormonal birth control pill Yasmin, which contains an estrogen compound called and Ethinyl estradiol (“World”). The third generation birth control pill, Yasmin, also contains the progesterone drospirenone, which contains potassium, linked to the increased occurrence of blood clotting (Bederman, Kientz). Bayer has faced sanctions and had to pull ads aimed at teens that claim benefits such as preventing acne and PMS, and the FDA strengthened warnings for the Yasmin pill (Meredith, “Birth”). Given the many lawsuits against Bayer’s Yasmin, many might question whether this has gone far enough (“Health”). Since environmental health affects human health indirectly, the hormonal pill should be banned as an environmental hazard or required to be sold with a warning label containing a simple and direct message because not only the environment but women and teenage girls in particular face risks equal to if not greater than the lung cancer risk faced by a smoker.
Why is a drug that has been classified as a group 1 carcinogen (carcinogenic to humans) by the World Health Organization treated as a standard for women’s health and featured in ads targeting young teen aged women? The synthetic estrogen hormones are not eliminated by water treatment plants (AP). High concentrations of these hormones can and do affect wildlife and humans generally — not just the women taking the hormonal birth control pill. According to Luke Dery, “estrogen has been tied to changing the endocrine function and harming the brain of both animals and human beings” (Dery). Because Yasmin is the highest profit producing-drug that Bayer makes, they appear to be able to afford a strategy of marketing, followed by restrictions and penalties resulting from lawsuit settlements (Feeley, “Research,” “Contraceptives”).
World Health Organization. Pharmaceuticals: A Review of Human Carcinogens IARC International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans. http://monographs.iarc.fr/ENG/Classification/ClassificationsGroupOrder.pdf
In a chart provided by the WHO, oral contraceptives are clearly listed as group one carcinogens (the 1 beside the chemical indicates it is included with other Group 1 carcinogens). This means that estrogen is known, without a doubt, to cause cancer.
Even if Bayer faced further restrictions, such as paying to pollute waterways, the fact remains that the hormonal contraceptive pill is known to be harmful to the environment and humans. According to a website by the Watershed Institute at the University of Wisconsin Eau-Claire: “Overexposure to estrogens have been correlated with increased rates of breast, uterine, and prostate cancer; heart disease; and stroke; as well as decreased muscle mass, sperm count, and sex drive in humans” (“Estrogen”). Although the hormonal contraceptive pill is curiously not listed among the sources of estrogen on the university website, it is implicated in a video produced as a public service advisory (“Estrogen”).
Effects of estrogen, as seen in a graphic from a University of Wisconsin Eau-Claire film called “Estrogen and Estrogen Mimics.” Pedal and Paddle Pollution Video Tour, Part 9, Lower Chippewa River. YouTube. 3 Feb 2011. http://www.youtube.com/watch?v=pcBDXdNsbTY
When environmentalists hear about the water pollution resulting from hormonal contraceptives, they are quick to point out other sources of synthetic estrogen deriving from pesticides such as atrazine, cattle raising practices, and plastics, such as BPA Bisphenol A, found in a wide range of products (“Can,” McGuire). This is a valid point. Yet, no one has claimed the birth control pill–essentially a steroid—as the sole source of estrogen contamination in water. Ignoring this fact, environmentalists generally invoke the precautionary principle except when hormonal contraceptives are involved. Increasingly, however, it is becoming clear even to environmentalists as well as those inside the pharmaceutical industry that dangers exist for the environment, specifically for animals and humans. Mary Buzby, the director of environmental technology for drug maker Merck & Co. Inc., said: “There’s no doubt about it, pharmaceuticals are being detected in the environment and there is genuine concern that these compounds, in the small concentrations that they’re at, could be causing impacts to human health or to aquatic organisms” (qtd in AP). Hormonal contraceptives are designed to operate at the micro scale for the sole purpose of interfering with female fertility within the endocrine system. They do not disappear when taken but are released later when a toilet is flushed. The fact that these steroids are endocrine disrupting compounds means they are particularly dangerous when present even in trace amounts.
“Estrogen and Estrogen Mimics.” Pedal and Paddle Pollution Video Tour, Part 9, Lower Chippewa River. University of Wisconsin Eau-Claire. YouTube. 3 Feb 2011. http://www.youtube.com/watch?v=pcBDXdNsbTY
As the University of Wisconsin Eau-Claire video notes, America’s plumbing infrastructure was built at a time when people were not aware of the dangers of estrogen and estrogen mimics. Projected costs to revamp sewer systems are huge (McKie, “Water”). Reverse osmosis, for instance, is capable of removing pharmaceuticals; however, it is extremely expensive and produces several gallons of polluted water for every drinkable gallon (AP). Currently, there is no required testing or established federal limits for trace amounts of drugs such as contraceptives in the drinking water, and regulations do not address trace pharmaceuticals.
Perhaps the biggest problem with the newest oral contraceptives is the extensive marketing to teens (Alley, “Bayer’s,” “Birth,” “EU”). Like cigarette advertising of the past, which played on a young person’s desire to belong and to behave in mature, cool ways, the Yasmin ad depicts high school age girls in cliques or pairs, who seem to be in on a secret. The girls in the ad huddle together, leaning in to find out what the others know, giggling together excitedly or looking off in the distance, as if having an “ahah” moment. The ad implies that Yasmin provides entry to a secret club, and what young woman doesn’t want to be part of the girl group that’s in the know? The ad makes it appear as though casual sex is on a par with a sporting activity in which one takes proper precautions and then can go ahead.
Yasmin Commercial. YouTube. April 2008 http://www.youtube.com/watch?v=NoKSL8eBrW0
In reality, however, casual sex leaves casualties. Sexually transmitted diseases, unwanted pregnancies, abortion, being used, degraded, left broken hearted: contraceptive use often leaves women devastated. Young women are especially vulnerable to sexual assault, heartache, mood swings, and depression. Steroids put women at risk for a long list of side effects, among which is high blood pressure and blood clots because the blood is thickened (Balinski). This makes the heart work harder. In an article called “Hormonal Contraceptive Use Among Adolescent Girls in Germany in Relation to Health Behavior and Biological Cardiovascular Risk Factors,” scientists found that teenage girls on hormonal contraceptives experienced an increased risk of cardiovascular problems (Du). Apparently, women with higher than normal levels of estrogen are at higher than normal risk for strokes and heart disease. These are serious health risks, and youth does not minimize the risk.
More long-lasting consequences include infertility and interference with the selection of a husband, something most teens probably have not considered. Taking the pill for a long time can interfere with the woman’s menstruation so that she fails to return to a regular cycle when she stops taking the steroid. In some cases, women never regain their fertility. Equally disturbing are the studies showing how the pill affects the choice of mate in humans (Phillips). The interference is caused because the way a hormonal pill works is by mimicking pregnancy. This affects the man looking for a mate, because a pregnant woman is not in her fertile time and thus is not attractive as a mate. Steroid use, in a sense, makes the woman less attractive.
This is not just a matter of dating selection either. Because the best immune system protection and expectation of fertility is derived when the man and woman provide divergent genes, a woman traditionally was attracted to men who smelled different from her relatives. Humans have receptors below the eyes that perceive the pheromones through smell. Some theorize that a woman on steroids is seeking a male with the instincts of a pregnant woman, who seeks brotherly or fatherly protection. Moreover, the researchers found women on steroids no longer show a preference for males with distinctive facial or vocal features that are traditional cues of masculinity (“Unnatural”).
To avoid the problems found, for instance, in the Russian royal line’s propensity for hemophilia, humans have a system for screening potential mates that prefers diverse genes. The best choice of mate, it turns out, is one with divergent genetic qualities, yet women on the pill tend to go with the pheromones that resemble a relative’s. Women traditionally gravitated toward men displaying masculine qualities; not so on the pill (Wenner). Less immunity from diseases may be one of the long term results in the offspring of women on steroids (Roberts). The pill confuses the process of attraction and disrupts the normal patterns of interaction between men and women.
A woman on steroids overlooks or dismisses men that were once at the top of her list. According to the studies, her body thinks she’s pregnant, so the woman on steroids is not interested in men in the same way. Although still dating in the hopes of finding a lifelong partner, the woman is less likely to attract the man best suited to her genetically (Phillips). Teens are trying to fit into their adult roles, and many want to find a lifelong mate. By offering the hormonal pill to teenagers, we are disrupting normal dating patterns and putting them at great risk of cardiovascular problems because adolescents are already experiencing an influx of hormones and the pill may put them at a greater risk of blood clots.
The teen brain is not totally finished developing. Even those not altogether opposed to contraceptives question whether teens should ever be prescribed hormonal birth control. As Katie Clancy points out, girls as young as twelve are often placed on steroids to “regulate” their periods, yet healthy menstruation is characterized, especially at first, by its irregularity. Clancy questions whether hormonal contraceptives will damage what is actually very sensitive human biology. Further, Clancy highlights the fact that accumulated or lifetime exposure to estrogen is a known risk factor for cancer. For these reasons, she specifically cautions against prescribing steroids to adolescent girls (Clancy). Jacking up the estrogen levels in a teen may permanently mess up the brain’s own regulation orchestrated by the hypothalamus and pituitary gland.
If the concern is unwanted pregnancies, surely it is wise to look at a method that has been shown to be effective in reducing out of wedlock pregnancies among teens. Many commentators have noted the low success rate of teen contraceptive use, often referred to as a high discontinuation rate. In contrast, researchers at the University of Pennsylvania found that teaching abstinence reduced the number of unwanted pregnancies. Contrary to the expectation voiced by former President Bill Clinton and others, those taught about the benefits of abstinence did not lead them to behaviors that would allow them to get AIDS later (Ertelt “Study”). The teens were actually able to refrain from sex until a later age than those not provided with abstinence education. The study concluded that abstinence programs encourage teens to take a long view, teaching them to consider their long-term goals of education and career or having a family. By comparison, the safe sex program was less successful (Ertelt “Women”). Clearly, there is a better alternative to pushing steroids and emergency contraception on young girls.
Do patients routinely read all the fine print provided with a prescription? Most scan the pages briefly and assume the doctor evaluates the risk for them. The small print is often overwhelming, and the tendency of a healthy person is to suppose the doctor would not prescribe it if the risk was too great. However, as has been argued here, the chemical hormone estrogen is a known carcinogen and should not be used as a routine medication ever. According to the World Health Organization, estrogen causes cancer in humans. Because of the insistence on what has come to be known as reproductive rights, physicians apparently prefer to take a hands-off approach, accepting the feminist charge that steroid drugs are required for women’s health. Given the increasing research on the detriments to the environment as well as health concerns and unwarranted risks for women and adolescent girls, steroids should be banned outright — or at least sold with a simply-stated warning label in bold type face on the outside of the package:
The World Health Organization has declared estrogen a Class 1 known carcinogen. This means that the International Agency on Research for Cancer that is part of the WHO has determined estrogen causes cancer. In addition, teens on oral contraceptives are at additional risk for Cardiovascular Risk, STDs, and unwanted pregnancy.
A more complete warning could be placed at the top of the page of medication information:
Risk of developing blood clots: Blood clots and blockage of blood vessels are one of the most serious side effects of taking oral contraceptives and can cause death or serious disability. In particular, a clot in the leg can cause thrombophlebitis and a clot that travels to the lungs can cause a sudden blockage of the vessel carrying blood to the lungs. The risks of these side effects may be greater with drospirenone-containing oral contraceptives, such as [brand name of drug] (drospirenone and ethinyl estradiol), than with certain other low-dose pills. Rarely, clots occur in the blood vessels of the eye and may cause blindness, double vision, or impaired vision.*
*Adapted from “Petition to Ban Third Generation Oral Contraceptives Containing Desogestrel.” Public Citizen. 6 Feb. 2007. http://www.citizen.org/notmypill
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World Health Organization. Pharmaceuticals: A Review of Human Carcinogens IARC International Agency for Research on Cancer Monographs on the Evaluation of Carcinogenic Risks to Humans. 2012. http://monographs.iarc.fr/ENG/Monographs/vol100A/mono100A.pdf
Yaz TV Commercial. You Tube. Aug. 2007. http://www.youtube.com/watch?v=vfQqzPl5EGg