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Everything posted by Dana2

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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).
  6. 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.
  7. Dopamine is the primary inhibitor of prolactin production from the lactotrophs in the pituitary (and lactotroph growth). So low dopamine coming from the hypothalamus to the pituitary would result in increased growth of lactotrophs and hyperprolactinemia (or a prolactinoma), and the dopamine agonist cabergoline is used to treat it. This paper (Dopamine and ACTH) states that blocking dopamine signaling (by knocking down one of the dopamine receptors) increases ACTH production and causes Cushing's-like symptoms in mice. So, dopamine has multiple effects on the pituitary. Cabergoline is generally considered safe, although it has side effects like nausea (and hallucinations at very high doses).
  8. Yes, this is why I wish they had passed a single-payer system (i.e. expanded Medicaid/Medicare to all), like there is in Europe and Canada. I've had to fight with even good insurance plans for basic coverage, let alone the expensive things. I'm sure many of you have had similar experiences. When I was 19, my mom had to argue at length to get our insurance to cover my birth control pills, because they were medically necessary (I was getting about 4-6 periods per year, and the gyno was concerned about my long-term fertility). My husband had an ingrown toenail not covered because it was considered "surgery" even though it took 10 minutes to treat. When my husband started seeing an Endo, he had a limited benefit plan from Cigna (it was the only thing his company offered, even to their managers, and my school wouldn't allow spouses on the student plan). So Cigna first argued that the blood tests were unnecessary, then said that it was a pre-existing condition (it wasn't). Cigna managed to delay paying anything for 6 months and required many letters and phone calls to get anything covered, and we ended up owing $2000 out of pocket. To top it off, his employer asked for everyone to fill out health insurance forms because they were switching plans and to send the forms to HR. He put down the hypothyroidism and pituitary disease (that was a mistake). He was fired in under a week for very flimsy reasons, only a few months after being promoted. We should have sued them for wrongful termination, but we couldn't afford a lawyer, it would have been difficult to prove anything, and I'm sure they had already destroyed the evidence. Even our current "cadillac" plan (although it is an HMO) has had their fingers in many medical decisions, like whether he needed a MRI, and then where he could go to get it (I wonder if they picked a cheap place that never finds anything wrong). And apparently we can see most doctors in our city, but we couldn't travel to another city for surgery, which would be wonderful in the case of pituitary surgery. So, it is hard to believe that the government could possibly be any worse than private insurance companies. Also, maybe this sort of thing is really why it is so difficult to convince some doctors to test for Cushing's.
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