Population Matters-USA – Page 7 – working for a sustainable world

There are many mysteries in medicine. One of the mysteries that has plagued me for years may now have a solution.

When I was in medical school I learned about Stein-Leventhal syndrome. Women with this condition tend to be overweight and have excess body hair. Their ovaries have lots of little cysts, and don’t seem to function normally because the women have irregular periods, or no bleeding at all. Although this may seem to be just an annoyance, it is really more serious. Lack of periods may lead to endometrial cancer. Often the best treatment for this syndrome is oral contraception, because the hormones help regulate periods and reduce the risk of developing this cancer. However, often the reason a woman with this syndrome will seek medical care is because of infertility, and The Pill won’t help with that!

Through the years the name changed to “sclero-cystic ovary syndrome” and now it goes by “Poly-Cystic Ovary Syndrome” (PCOS). I used to think that the cause of PCOS was obesity; indeed, some women who are obese will have symptoms similar to women with PCOS, but their ovaries are normal. In the past experts said that PCOS was caused by an increase in the level of Luteinizing Hormone. LH is made by the pituitary gland; this hormone helps control ovarian function. Usually it spikes before ovulation, but people with PCOS have relatively constant, high levels. What causes the LH to be elevated? No one seemed to know. This seemed to be more of a finding than a solution to the mystery.

Now there appears to be a solution to the mystery of PCOS’s cause, and I should have guessed it years ago. I first became interested in endocrine disrupting chemicals when I had a chance discussion with a professor of chemistry over 20 years ago. These chemicals are everywhere, and in essentially every person’s body who has been tested. The latest ones to grab media attention are the omnipresent “forever chemicals”, PFAS. They have been found in drinking water supplies all over the USA in miniscule amounts. You might be thankful that they are not more concentrated, but the reality is that many endocrine disruptors are more troublesome when very dilute. A tiny pinch of an endocrine disruptor in an Olympic-sized swimming pool can be enough to cause serious problems!

Many modern chemicals are endocrine disruptors—they interfere with our hormonal systems. Bisphenyl A (BPA) is added to plastics to make them flexible; it was one of the first chemicals to be recognized as harmful. Perhaps you have a water bottle that claims it is “BPA free”. Don’t celebrate too much, because the chemicals that replace BPA, such as BPF, are often equally harmful.

More than 90% of people in the USA carry BPA in our bodies, and women with PCOS have higher levels of BPA than women without PCOS. This strongly suggests that BPA causes some cases of PCOS. As a result of this endocrine disruption, many also have increased levels of male hormones, and thus their increased body hair.

As bad as BPA and other endocrine disruptors are on adults, their effect on a developing fetus may be both worse and more insidious. Fetal exposure to BPA may be associated with several problems affecting both females and males—but it is too early to know with certainty.

My goal is for people to be able to have control over their own fertility. Dangerous chemicals such as BPA may reduce fertility involuntarily. I look forward to more testing of chemicals that may affect endocrine systems, and better regulation should they be found dangerous.

©Richard Grossman MD, 2024

There are three pieces of good news about birth control methods. One is very old, but never really studied, one is brand new and one futuristic.

I spent some time in Paris studying French when I was in college. I also learned about a male method of birth control from a research assistant for Dr. John Rock. Rock is best known for his work in developing “The Pill”, but he was also interested in other means of limiting fertility. He tested an idea based on the fact that testicles work best if they are cooler than core body temperature. His idea, which was never marketed, was an insulated athletic supporter. It was nicknamed the “Rock Strap”, of course.

Fast forward 60 years and researchers are still working on this idea. The physiology is clearly effective, but the long-term safety of heating testicles hasn’t been studied. Furthermore, persuading men to wear a warming codpiece doesn’t seem too practical.

Many governments have recognized that it is safer for women to take “The Pill” than to not use contraception. The relative safety is especially true in places with high maternal mortality—because preventing pregnancy also prevents maternal mortality. Oral contraceptives are available without prescription in over 100 countries—and, thanks to OPill®, now the USA is one of them! The FDA has finally recognized the safety of oral contraceptives.

The manufacturer and nonprofits that worked to make birth control pills available over the counter had several wishes that went along with the approval. The pill should be available to teens, it should not be too expensive, and that insurance should cover the medication even though it is available over-the-counter. After 20 years of work, they finally got their wishes! The FDA has very strict requirements. One of them is that the pills come with instructions on their proper usage that almost anyone can understand.

OPill® is a Progestin-Only Pill (POP). Unlike the majority of hormonal contraceptives, it does not have any estrogen. Blood clots, the most serious problems caused by birth control pills, are caused by estrogen; that is one reason the FDA finally gave their approval. There are minor problems with POPs, however, such spotting and needing to take OPill® at the same time of day, every day. Also, the unintended pregnancy rate may be a little higher than pills with estrogen.

Although I knew that sperm didn’t like heat, I didn’t know that they don’t like iron. An innovative contraceptive that is now the subject of research makes use of that fact. Ovaprene® is a diaphragm-like vaginal insert with a central mesh that is impregnated with an iron compound. Because it is a mesh, it is permeable to blood and cervical mucus, but the iron makes it lethal to sperm. The woman places it in her vagina as her period ends, being careful that her cervix is covered. The insert is left in place until her next period starts. It has the theoretical advantage of being nonhormonal, and providing month-long protection against pregnancy.

Ovaprene® appears to be ready for human testing. However, it is still years away from commercial availability, so don’t expect to find it in your pharmacy any time soon.

This brings up the challenges of developing a new family planning method. There are many contraceptive ideas that seem great at the start, but wind up in the trash. I know from personal experience. My idea for a rip-stop condom earned a patent (#4,881,553), but lost me a lot of money since no company was interested in buying the idea. This winnowing process explains, in part, why new methods are usually expensive.