Published Jan 23, 2008 in the North Island Weekender 

Jill, age 33, came into my office asking my opinion about birth control. She had 2 children and she did not want any more so her and her husband were discussing a vasectomy. I told her that I don’t recommend vasectomies based on the wise counsel of the late Dr. Robert Mendelson, M.D a medical heretic of his day! He was against unnecessary medical procedures in general as he was against vasectomy. There is no substantive evidence that vasectomies cause any pathology of the prostate gland in men, but clinically I am concerned and counsel men against it. Therefore if Jill wants permanent birth control I recommended to her to have a tubal ligation, where the tube is clipped so that the egg that her ovaries produce every month cannot be fertilized.

Having said this I also cautioned her. In my practice I have observed an increase in menstrual bleeding problems within 10 years, in up to half of the women who have had a tubal ligation. My reasoning for this is that the microcirculation to the ovaries is disturbed upsetting the health of the uterus causing the uterus to enlarge and develop fibroids. I reassured her that these fibroids are rarely cancerous, but when they get big enough they start to cause heavier menstrual bleeding, they can press on the bowel and or bladder causing problems and can contribute to cramping and discomfort.

Naturopathic medicine does provide treatments for uterine fibroids that may be effective if they are treated in the early stages. However once a woman has large fibroids causing heavy bleeding what is normally done is support the woman until she gets to menopause. During menopause uterine fibroids can shrink as the hormone levels change but this doesn’t happen in every case. These women are often very anemic so I am also following their blood work to get their ferritin iron stores to the 30-50 range.

I also told Jill that if she wanted to avoid a tubal ligation that the cervical cap was another option. This is a barrier method similar to the diaphragm or condom where it needs to be used 100% correctly 100% of the time for it to be 96% effective. The huge benefit of the cervical cap over the diaphragm is the comfort level and the fact it can stay in place for up to 36 hours without causing any trauma to the cervix. A trained health care provider fits the woman, (some naturopathic physicians do this as do I) and during the fitting procedure the woman is trained on how to insert and remove the device. They learn to make sure the cap is properly positioned with adequate suction and instructed to keep it in place at least 24 hours after intercourse. The only draw back is it is not used during the menstrual cycle as the flow of blood interferes with the suction of the device. The cervical cap is made of latex and comes in various sizes, the best size determined during the fitting. They are made in Great Britain and have been on the market for over 30 years. One of the reasons the medical profession may not be offering this method is the one hour over two visits it takes to fit the woman. During the fitting the woman practices several times inserting and removing the device before going home with it to practice. On the follow up visit the woman returns wearing the device for a final evaluation. The device may last up to 4 years if carefully taken care of and is much cheaper than the cost of birth control pills.

Susan, a 50 year old, asked me recently if the hysterectomy she had had in her early 40’s was possibly due to the tubal ligation she had had 10 years prior to that? I said that it might have and so Susan asked me how she could counsel her two daughters? I encourage women to get off the birth control pill after 5 years of use. I am concerned about the B vitamin deficiencies they can cause including folic acid, the deficiency of which is well known to cause some birth defects. Although there is conflicting evidence, I am also concerned about putting exogenous estrogens into anyone’s body and the cancer causing effects this may cause in the long run. The other main concern with birth control pills is blood clotting and circulation problems that are greatly enhanced if the young woman also smokes! There is a case of a young woman losing the sight of one eye because of it. It is important to know if there is a family history of factor V Leiden and, if so, estrogen based birth control pills need to be avoided.

This means that Susan’s daughters, who are in their twenties, should be looking at alternatives for birth control other than prescription hormones. Hormones given by injection every three months are known to increase the incidence of osteoporosis, or thinning of the bones. Given the number of soft drink trucks driving around town, young people by the time they are in their late thirties are going to have soft bones from all the soft drinks they drink, let alone adding hormones to the mix! 

Condoms of course should be used by all couples until there is assurance that there is no AIDS virus present or if people are having multiple sexual partners.

This topic is a very delicate and multifaceted one so it is important to be candid with your health care provider in finding the best solution for you. Jill and Susan left with a lot of information to help them and their families make their decisions. As always an informed patient is a healthy patient!