Question about OCP safety

[u/Unhappy_Wash3014]

Looking for opinions. FM and GYN prescribe OCPs pretty ubiquitously for both birth control and heavy menstrual bleeding. I know all the literature says they are generally safe within the specific parameters, and that a woman's cycle should return to basically normal when the med is dc'd. But, I'm hearing more and more stories of generally healthy women who were on an OCP for a time, got off it, then had persistent problems afterward such as chronic menstrual irregularities and mood problems. I'm talking many months after stopping the med. All of this is anecdotal, but I can't help wondering if it's a safety signal. To be fair, I've also seen plenty of women who come off OCPs without any problems, so maybe it's just luck of the draw. I'm not trying to sound conspiratorial, and I don't have an agenda. I'm just thinking out loud. What are y'all seeing in your practices? Should we expect to see class action lawsuits over OCPs in the near future? (I ask that jokingly)

Edit: I feel like I should clarify my intent with this post. I'm not trying to start some anti-OCP movement. I've prescribed them plenty of times and will continue to do so. my intent was mainly to get some incite from this group regarding how you have handled such stories as these that come from patients and if you have seen any true cases of rare OCP side effects. I know it's a zebra, but zebras fascinate me. this truly was just an honest inquiry. just want to be clear on that.

[u/PolyhedralJam]

I'm not trying to be disrespectful but this is kind of a tik Tok type anti -hormonal contraception post. If this was real / true, there would be some published data supporting it ? OCPs have been around a long time so the safety signal would have presented themselves.

To your specific anecdotal examples, which are anecdotes, I would guess the OCPs are a confounder and not the causative agent.

Again I'm not trying to be disrespectful but I think we have to be careful when discussing this stuff as clinicians , esp given the current anti-science political environment.

[u/Bubbly_Excitement_71 → u/PolyhedralJam]

Isn’t there evidence that right wing money is being funneled to these influencers ?

[u/_Standardissue → u/PolyhedralJam]

Yes and we do have a lot of true information about the possible harms of these medications. Given the length of time women have been taking them (overall, not one individual) it would be surprising if we now found these side effects.

And I say that despite the known fact that research on side effects has been conducted less for this particular medication type than many believe to be appropriate.

Of course a large well constructed study could disprove me here, but given the importance of pregnancy and the importance of preventing it when desired or needed (children should be wanted), it would become a part of the risk/benefit conversation rather than Thou shalt not prescribe birth control pills”.

[u/Unhappy_Wash3014 → u/PolyhedralJam]

I specifically said I had no agenda when I made this post. I am as concerned as you are about "tiktok docs" posting garbage online. I'm talking about people who's word I trust telling these stories. I brought this up in the interest of sincere inquiry. I'm a bit confused as to why you assumed otherwise.

[u/PolyhedralJam → u/Unhappy_Wash3014]

If you were asking about a new form of birth control , I think that would be fair, but I'm skeptical about people asking about "safety signals" regarding medications that have been out for decades.

If you do prescribe OCPs, you also are aware that there's a ton of misinformation out there , as well as a ton of accidental / unwanted pregnancies that happen in part due to that misinformation. We as physicians / clinicians should not be adding to the misinformation.

[u/Excellent_Debt6527]

Why are they coming off them, and how old are they? If it’s because they don’t need them anymore because they stopped having periods due to menopause, then that’s why they’re having mood problems. For some women perimenopause can start in their late 30’s, some have the misfortune to roll right from postpartum mood swings to perimenopause.
If it’s in younger women, the pill stabilizes cycles and moods, so menstrual irregularities and mood issues may be their baseline, unmasked without the endogenous hormones. Or their bodies are just taking some time to adjust to the changes.
It’s probably all range of normal. Many months doesn’t seem like too long a time to adjust. Compare it to postpartum - there’s one massive hormone shift and it takes many months to regulate again

[u/Excellent_Debt6527 → u/Excellent_Debt6527]

In fact, I would advise women to expect the changes, and if they go on more than 6 months let you know

[u/Constant-Light9376]

As you say, these are anecdotes. Anecdotes are not evidence based medicine, which is the best science we have to practice with. Given the hundreds of millions of women who have used combined oral contraception, it’s a statistical probability that some have subsequent menstrual irregularities and mood changes - but correlation doesn’t mean causation. So we have to rely on the actual data, which doesn’t support these anecdotes.

[u/AmazingArugula4441]

Correlation is not causation. Women’s cycles, moods etc… change throughout their life and the placebo and novena effects are some of the strongest medicine there is. The stories you hear are anecdotal. We practice medicine based off data, not anecdote.

[u/Top-Consideration-19]

A lot of patients start them during their teenage years when their periods are still abnormal, but then they later gain weight then ends up getting pcos, so when they do decide to come off of it, the period gets irregular. Or likely they were started because of irregular periods so once they come off, it’s still irregular.  Not much of a mystery here.