Archive
Birth Control Pills and Depression
This week a study was published in JAMA Psychology drawing a connection between the use of birth control pills and depression. This was picked up in the popular press, and briefly we were hearing about it in the news and radio. I first heard about on my way to work listening to NPR. The message I got was that a study was just published that showed a link between the use of birth control pills and the development of new depression.
Today I read the actual paper that led to this media frenzy, and not surprisingly the media got it at least partially wrong.
Skovlund et al reported the following
“A total of 1 061 997 women (mean [SD] age, 24.4 [0.001] years; mean [SD] follow-up, 6.4 [0.004] years) were included in the analysis. Compared with nonusers, users of combined oral contraceptives had an RR of first use of an antidepressant of 1.23 (95% CI, 1.22-1.25). Users of progestogen-only pills had an RR for first use of an antidepressant of 1.34 (95% CI, 1.27-1.40); users of a patch (norgestrolmin), 2.0 (95% CI, 1.76-2.18); users of a vaginal ring (etonogestrel), 1.6 (95% CI, 1.55-1.69); and users of a levonorgestrel intrauterine system, 1.4 (95% CI, 1.31-1.42). For depression diagnoses, similar or slightly lower estimates were found. The relative risks generally decreased with increasing age. Adolescents (age range, 15-19 years) using combined oral contraceptives had an RR of a first use of an antidepressant of 1.8 (95% CI, 1.75-1.84) and those using progestin-only pills, 2.2 (95% CI, 1.99-2.52). Six months after starting use of hormonal contraceptives, the RR of antidepressant use peaked at 1.4 (95% CI, 1.34-1.46). When the reference group was changed to those who never used hormonal contraception, the RR estimates for users of combined oral contraceptives increased to 1.7 (95% CI, 1.66-1.71).”
In summary, women who used birth control pills were more likely to also use antidepressants. They concluded that women who use birth control use antidepressants more often, and thus they may be more likely to be depressed.
Here’s what I think about this.
Why Pro-Choice is Losing
Lately I’ve been troubled by how badly the pro-choice movement has been doing. Here in South Carolina we are continuously dealing with legislation to limit access to abortion. This year a 24 hour waiting period law was passed, and the state legislature is almost ready to sign in a law that prevents state funding for any abortion, even in 
cases of maternal jeopardy, rape and incest. Nationwide, abortion is under attack in many states, and in some cases progress is being made to limit access.
One of the things that bothers me is that I don’t see this trend improving, at least not until some major changes are made in the pro-choice movement. Right now, anti-choice is wiping the floor with pro-choice. Pro-choice is always on the defensive, and never on the offensive. Prochoice is tending goal and Prolife is always taking shots. This can only go on so long before one gets in the net, and we’ve been seeing that happen lately.
Read more…
D and C Workshop
This is a rerecording of a recent workshop on D and C procedure that I did with my residents. Enjoy!
If you would like to use this prezi for your residents, let me know and I can send you the file. All I ask is a mention of the blog in your presentation!
Enjoy!
Ortho Evra and Venous Thromboembolism Risk – Why You Need to Read More Than Abstracts
When Ortho Evra, the contraceptive patch came on the market, physicians were happy that women had a new and novel contraceptive method that significantly expanded options over what was already available. Since that time, hundreds of thousands of women worldwide have safely used Ortho Evra for birth control.
As the transdermal patch was a new delivery method for birth control, several new pharmacokinetic studies were done postmarketing, in addition to those done prior to FDA approval. One of these studies demonstrated that patients using Ortho Evra had on average 60% higher estrogen blood levels than patients on oral contraceptives, despite lower peak levels (1). Given that estrogen somewhat increases the risk of venous thromboembolism(VTE), this data raised the concern that Ortho Evra might confer a greater attributable risk than traditional oral contraceptives.
I got published this month! Yahoo!
Nothing like getting in press. This project started over two years ago and now has made it to press. Man this stuff takes a long time. Congrats to my wife who was primary investigator on this!
Bottom line – using a paracervical block during second trimester abortion done under general anesthesia does not affect postoperative pain scores.
Evidence Based Use of Misoprostol in Second Trimester Induction
I was recently on call and we had 2 patients on our board having second trimester inductions, one for ruptured membranes at 17 weeks and another for fetal anomaly. Both patients were being treated with what seemed like a strange regimen of misoprostol, 400 mcg miso vaginally _and_ 400 mcg orally, every 4 hours. I had never heard of this regimen, and was wondering where it came from. None of the residents seemed to know, only that it had been passed down through some route to them.
It struck me as odd that people are using misoprostol in all kinds of different ways, despite the large amount of available evidence in the literature. In fact, it may be one of the most thoroughly studied topics in obstetrics, having been the subject of many randomized trials, a standard of research rarely achieved in our field. Studies have included both pharmacokinetic and clinical data. For better or for worse, abortion is the single most common procedure performed for women worldwide, and the patient population tends to be appreciative and willing to participate in research. Sadly, the mammoth amount of data available seems overlooked by the majority of practicing obstetricians, given the wide variation in practice I have observed. As such, I want to review a few of the major articles here.
Academic OB/GYN 