Question 140

 I have just come back from my doctor’s visit and he told me that I should no
longer continue my hormone replacement therapy (HRT). I had been using Prempro for years, but he told me another study just recently came out that confirmed that estrogen and progesterone in HRT causes an increased risk of breast cancer. My married daughter is on estrogen and progesterone in her birth control pill. Should she stop too?

Catholic and Confused on Contraceptives

Dear Catholic and Confused on Contraceptives,

There are many ways to answer your question. As a woman physician who has used birth control herself, and now practices in a NFP-only, contraceptive-free practice, I do have much to say on this matter. First of all, from a Catholic perspective, our
Catechism clearly states that “every action which, whether in anticipation of the conjugal act, or in its accomplishment…whether as an end or as a means to render procreation impossible is intrinsically evil” (CCC 2370).

As a physician who helps couples manage and live with their fertility through teaching and encouraging NFP (Natural Family Planning), I am always amazed at the striking difference between NFP couples and contracepting couples. It seems that spiritually, there are marked differences between couples that use NFP and couples that contracept.

Contracepting couples seem to have far more marital problems, increased rates of substance abuse, alcohol abuse, pornography addiction, infidelity and increased divorce rates. My experience has been documented in a large study by Mercedes Wilson showing that NFP couples have divorce rates of 1%, in contrast to our national average, which is about 50%. So clearly, spiritually, there is something different going on in the NFP couples.

Regarding the medical safety of contraceptives, we in the medical community have long known of the harms and risks of oral contraceptives (OCPs). The NSFG (National Survey of Family Growth) indicates that the number of women continuing on OCPs is only 68% after one year. This shows that despite the apparent ease of just taking one pill per day to suppress the woman’s fertility, there are many side effects that cause her not to want to continue. However, there are many serious risks of the pill that are not routinely discussed in doctors’ offices or mentioned in the main street media.

There are hundreds of research articles that show serious risks of oral contraceptives regarding increased cardiovascular risks, increased risks of breast and cervical cancers, and increased risk of liver tumors. In women who are older, who smoke, or have one of many possible silent gene mutations (like Factor V Leiden, for example), these women are all at  increased risk of cardiovascular events, up to 10 times the risk of noncontracepting women.

Recently, since 2002, there have been 3 major randomized control studies showing that the estrogen and progesterone in postmenopausal women’s hormones cause an increased risk of breast cancer. The IARC (International Agency for Research on Carcinogens) declared estrogen and progesterone Class 1 carcinogens in 2005.

There are many studies that show the same risks for younger women who take birth control pills for extended periods of time. Dr. Chris Kahlenborn, M.D. was one of the first physicians to show the increased risk of breast cancer, through his meta-analysis published in the Mayo Clinical Proceedings. His article reviewed more than 34 case-control studies and found that the use of OCPs was associated with an increase in PREmenopausal breast cancer, and especially in young women who used OCPS before their first full term pregnancy, and also for women who had used OCPs for more than 4 years.

Why are we, the medical community, warning older women of the risks of hormones, but not routinely cautioning younger women of these same risks? Some young women start OCPs in their teens, while their breast tissue is highly susceptible to the effects of carcinogens. According to Dr. Angela Lafranchi, M.D., breast surgeon, the breast goes through a series of phases whereby tissue matures and develops.

It is not until the woman has her first full term pregnancy and her milk develops, that those breast cells become fully matured. After the breast cells have matured to this level, they are “protected” to some extent against carcinogenic influences. Therefore, exposing young womens’ breasts to years of carcinogenic hormones, before they have their babies, is VERY harmful.

As a Catholic physician, I am always amazed to see how God displays his wisdom through natural law. When we engage in activities that are against His moral law, we can see that the effects of these practices are not going to be good for human beings. Nowhere can that be seen more clearly than regarding oral contraceptives.

Theologically, spiritually, and medically, contraceptives are harmful to the individual women that use them. There may be a very small percentage of women who have to use OCPs to alleviate certain medical conditions, but these women should represent a small minority of the total population. Oral contraceptives are the number one choice of family planning in the regular population AND Catholic population. Clearly, we have to educate all women on the risks of OCPs and look for alternative ways to live with and manage our God-given gift of fertility. NFP and abstinence are two ways that our Catholic faith has given us. Don’t they deserve another look?

A full list of over 60 research articles documenting the increased risks of OCPs
can be obtained by emailing Dr. Rebecca Peck, M.D. at rbamer2@yahoo.com