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Shiny

Research on Testing with Birth Control

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Please keep in mind that this is a pretty old paper, so the doses of estrogen in the birth control pills are a lot higher than in modern birth control pills. According to Wikipedia, one of the most common types of birth control pills, regular Ortho Tri-cyclen (Trinessa), only has 35 ug (0.035 mg) estrogen in each pill. The lowest dose of estrogen shown in this paper is 0.050 mg, and it does not increase 9 am serum cortisol over the normal range (Figure 3). They don't show the 24 hr UFC for the 0.050 mg dose by itself, so it is hard to tell if this dose has any effect on a 24 hr UFC. So, it seems like the birth control pills that most of us would be on wouldn't have much effect on our cortisol tests. Here's another paper on birth control and cortisol: Paper. This paper shows a 2-4 ug/dl increase in afternoon serum cortisol for birth control users (estrogen <0.050 mg) vs. control women, depending on phase of menstrual cycle. They also found that stress can increase serum cortisol 3-5 ug/dl.

Edited by Dana2

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That was pretty much my point - birth control doesn't raise cortisol that much (just like it doesn't cause more then like 3 pounds of weight gain, if that!). I've been researching it because I don't want my doctors to explain away high cortisol because I'm on bc.

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Oh, OK. I can sympathize with that. I've had to defend my high prolactin levels because estrogen can increase prolactin (but I haven't found anything that says by how much). Of course, they've just dismissed my high serum cortisol because it's "not diagnostic" and haven't had to use the bc excuse. And I had one tell me that my IGF-1 was just low because of my fat (and not the other way around, like is shown in all the literature).

 

You're right. I think the old high-dose bc could cause weight gain (maybe) but bc pills don't typically do that today. I actually lost weight when I first went on bc pills (about 30 lbs in 6 months). Funny thing was, I wasn't even trying to loose weight, I just wasn't hungry at all and hardly ate. I wonder if the bc pills induced a low cortisol cycle, because I also felt like crap (kept getting sick, very fatigued, abdominal pain, GI problems, aches and pains).

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That's interesting, because all my health problems seem to have started around the same time I started on bc (my last year of college). Can't really remember which came first anymore, though... plus, then, I didn't realize the weight gain was a problem. I had lost a little weight a year or so previously (I was working out more), so I figured I was just gaining a little back since I wasn't working out as much. When it didn't stop, and I developed more and more symptoms, we knew there was something wrong, but it's been hard to trace everything back now. Interestingly, I had a few of my symptoms in a very mild form during high school, but I don't think I would say with any confidence that it had started then. But, I don't know... this whole thing has been weird to figure out.

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I think I had it at least the last 2 years of high school because of the 60-70 lb weight gain then, but maybe I had it much earlier. Then I lost the 30 lbs freshman to sophomore year of college after I started the bc pills, but have since gained another 60-70 lbs (over 9 years). But I didn't realize something was systematically wrong until the last few years, when I started getting all the other symptoms and going downhill quickly. Before that, it was just weight gain, GI problems, irritability, edema, mild joint pain, and generally feeling crappy, all of which could be explained by other things. Many times I felt pretty good, and in high school I was very active and played a lot of sports. Oddly enough, going off bc recently seems to have caused my weight to just shift to my belly (or maybe it is just bloated), but I have only gained a couple lbs if that.

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Interesting. Because I actually credit the Birth Control from keeping my Cushings from getting worse/showing for so long. When they finally discovered it in 2007 (when I was 29) they believed I had it since I was 15. But because I was on birth control from Junior year in High School (Cause oddly enough I wasn't having my monthly gift regularly or at all, should have been a hint to doctors... but don't you know i will 'grow out of it') through college I actually lost weight while I was on it, stopped having acne,stopped the facial hair growth, and didn't have all the problems that came back once I stopped taking them when I was 26. Then it came back full force.

 

It's the one reason I refuse to get off of it even though it's back, because I think it's keeping it from getting worse this second time.

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Interesting. Because I actually credit the Birth Control from keeping my Cushings from getting worse/showing for so long. When they finally discovered it in 2007 (when I was 29) they believed I had it since I was 15. But because I was on birth control from Junior year in High School (Cause oddly enough I wasn't having my monthly gift regularly or at all, should have been a hint to doctors... but don't you know i will 'grow out of it') through college I actually lost weight while I was on it, stopped having acne,stopped the facial hair growth, and didn't have all the problems that came back once I stopped taking them when I was 26. Then it came back full force.

 

It's the one reason I refuse to get off of it even though it's back, because I think it's keeping it from getting worse this second time.

 

I feel the same way. Both times I've stopped taking the pill my Cushing's symptoms became worse. It wasn't a good thing for me though because it was masking the symptoms for so long that I was in denial of recurrence. I finally had to stop taking it because I was having mini strokes (TIA's) and it was putting me at a high risk for a permanently debilitating stroke.

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Weird. Guess bc affects everyone differently. :P I did notice a huge improvement with cramping pain when I added progesterone cream to the mix, but I quit that when my nurse practitioner changed my bc for me (higher progesterone - I asked her for one that would be gentler on my system). The pain got a bit better, but still not great (also, progesterone at night makes me sleeeeepy, which was just plain awesome). Not being able to take ibuprofen when on the dexamethasone this time around was HELL.

 

I'm very close to looking into how much insurance covers for an implant bc - progesterone only. I would imagine that not having any extra estrogen could only help. The progesterone only pill is really twitchy about being taken them same time every night, which is not good when my brain is seriously shot these days.

 

Heather, that sucks that they wanted you to just "grow out of it." Geez... :yeahrite:

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I think the "grow out of it" approach is common with doctors. I started on birth control at 19 because my periods were very irregular. Basically any sort of stress, like a big test or illness, would really delay my period. Freshman year of college, I didn't have a period for about 5 months because I had an infected pilonidal cyst and surgery to remove it. My gyno's solution was just to put me on bc pills, instead of trying to figure out why my periods had never been regular (even after 8 years of getting them). In high school, my dermatologist told me that my acne wouldn't clear up until my periods were regular (and I grew out of it). After I went on bc the acne got much better (although not perfect). The doctors just seem to treat the symptoms and not be very curious about the cause of any of the symptoms, and they assume most to the symptoms are unrelated to one another. I'm actually a little angry, because I suspect that I have had Cushing's (or some other hormone problems) since adolescence, but my doctors never investigated anything. Recently, it has taken a lot of personal research and being extremely pushy just to get some basic tests done.

 

There is some research on the effect of estrogen and progesterone on ACTH or cortisol. It seems that estrogen suppresses the increase in ACTH and cortisol in response to stress. There is still some stress response, but it is blunted with estrogen treatment ( link ). So, it is possible that the estrogen in bc pills is actually decreasing ACTH and cortisol levels, thus decreasing Cushing's symptoms. This would be consistent with my own experience, because I lost weight when I first went on bc pills and have gained some weight and a bit of abdominal fat since going off of bc pills (plus all the other symptoms have gotten worse). I also gained weight quickly when I went from regular dose to low dose bc pills, although I only stabilized in weight when I went back to the regular dose. I think bc can decrease Cushing's symptoms but does not completely block the disease (although everyone reacts differently because this system is very complicated). Thus, I still gained weight and had symptoms developing while on bc, but it is just worse when I am off bc.

Edited by Dana2

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Thanks for the link! The idea it could lower cortisol is very interesting... I'll have to look into this more. I wonder if they've done research on triphasic bc and cortisol...

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Most of what I have seen is just with constant doses of estrogen (not triphasic bc), but I have just started looking at this. It seems to be easier if you search for "estrogen and ACTH". I was on triphasic bc (ortho tri-cylen regular and lo) when I saw these effects.

 

This link describes how estrogen decreases ACTH and cortisol in studies in human women, but in mouse and non-human primate studies, estrogen increases ACTH. So, there are differences in estrogen response between species, and I bet that different study conditions, populations of women (genetics), and types of bc may give different results in humans.

Edited by Dana2

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Shiny - Oh yeah I heard I'd grow out of it, from the time I was 15 until I was 27. When the last doctor told me that when I was 27 I wanted to Hit her. I immediatelly then started to keep going to new doctors until finally some one took me seriously. And I had to take 3 or 4 different possible diagnosises with me. I finally found a doctor that used a wireless lap top so she was able to go online and figure out tests I needed. However... they stopped looking once they found cysts in my overies (something they probably should have looked for back when I was say... 15!). They told me I had PCOS and tried to treat me with all kinds of stuff for PCOS... but surpisingly nothing worked. Took a Kidney stone to finally get a CT scan where they found the growth on my 1 addrenal. (Was never so happy for a kidney stone in my life.) Which then finally got my cortisol tests done. And then a year after they took the adrenal, the cysts went away, my monthly gift became normal, etc. etc. (I still think most PCOS is caused by Cushings.) But now I'm back on birth control because my issues are back and I don't want kids till I get this all figured out (and it's looking like the other adrenal will need to come out).

 

Sometimes I think doctors should just be Shot for just assuming things. Oh you'll grow out of it. Oh you just need to exercise more. Oh you just need to eat less. Oh you just need to wash your face better. Oh you just need to sit up straighter (for the buffalo hump). No... maybe you need to run a Cortisol test! ARG.

 

Dana - Ahhh that is interesting. And might explain why I seemed to get a better time before than I am now while on BC. I'm on a different type and low dose.

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I've been looking for a more recent study, and I found this. They did still find an increase in blood cortisol levels, but saliva is completely fine to test on birth control.

 

Link here

 

Definitely printing this off to put in my "emergency" journal article stash... ;)

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That's a useful paper. It is similar to the paper I had a link to in my first post in this thread (My link), except your paper showed that serum cortisol almost doubles with birth control pills, while the one I had showed a moderate 2-4 ug/dl increase (not enough to put it out of the normal range and similar to the effect of moderate stress). Maybe it is a difference in methods, because your paper tested the same women before and after 3 months of bc, while my paper compared different women not on bc or on bc for at least 6 months. So it could be the length of time on bc, or maybe the type of bc used in each group of women. It is possible that long-term bc use over years would have a different effect or no effect at all. And then the other two papers I linked to above said that estrogen actually suppresses the increase in ACTH and cortisol in response to stress. One paper (My link) shows that the estrogen/ACTH relationship was related to a woman's waist-to-hip ratio (abdominal obesity), but this was in postmenopausal women. So, I think it all depends on study conditions (woman's age, weight, genetics, type of bc, etc.) and there is probably no way to predict how an individual woman will respond to bc and estrogen.

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I think the difference with the one I posted might be because of the amount of ACTH injected (1?g vs 0.25mg). I don't understand ACTH well enough yet to be able to speculate on that, though. I did find the saliva part incredibly useful, though (and I would assume it would hold true for urine, as well). I got my good high on saliva (not that my endo thought it meant anything, but that's beside the point). <_<

 

This article is about too little cortisol, but it says that free serum cortisol is better to measure than total serum cortisol, and the free serum cortisol was not affected significantly in the study I posted. So, I wouldn't say blood testing is out of the question with birth control!

 

I'm really hoping to not be taken off if I ever find a good endo, partially because I'm on it for some very good reasons, and partially because I'm afraid of messing with my hormones even more right now. :wacko: If it comes to that, though, I figure I'll ask for the progesterone only pills. Thought about implanon, but I'm not sure I want to try something with potentially funfunfun side effects right now. I can't take any side effects. :crazyeyes:

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This article doesn't even touch on cortisol binding globulin, it strictly uses the UFC as its base of measurement which is just plain old faulty science.

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