Helen Pensanti, M.D.

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Dr. Helen Pensanti Discussion

Why I don’t like Birth Control Pills

By, Helen Pensanti M.D.

Since the beginning of my private practice in 1985, I was always very wary of writing prescriptions for Birth Control Pills. There was just a “gut” reaction that someday I was going to learn the truth . However, I did write the prescriptions and I did hand them to my patients ( but, with a heavy heart.) I made my patients come in every 6 months for a Pap Smear and Breast Check so that I could be on top of any change that was going on in their bodies.

This is a review of what we know now about Birth Control Pills:

There is something called SHBG Sex hormone binding globulin

I would like us to look at this:

  • Transport of sex hormones
    Sex hormones circulate in the bloodstream, bound mostly to SHBG and to some degree bound to albumin. Only a small fraction is unbound, or "free," and thus biologically active and able to enter a cell and activate its receptor. The SHBG inhibits the function of these hormones. Thus bio availability of sex hormones is influenced by the level of SHBG.

  • Production of SHBG
    SHBG is produced by the liver cells and released into the bloodstream. Other sites that produce SHBG are the brain, uterus, and placenta. In addition SHBG is produced by the testis; testis-produced SHBG is also called androgen-binding protein. The gene for SHBG is located on chromosome 17.

  • Control of SHBG
    SHBG levels appear to be controlled by a delicate balance of enhancing and inhibiting factors. Its level is decreased by high levels of insulin and insulin-like growth factor-I (IGF-I). Also, high androgen levels decrease SHBG, while high estrogen and thyroxine levels increase it.

  • Conditions with high or low levels
    Conditions with low SHBG include polycystic ovary syndrome, diabetes, and hypothyroidism. Conditions with high SHBG include pregnancy, hyperthyroidism, and anorexia nervosa.

  • Measurement of sex hormones
    When determining levels of circulating estradiol or testosterone, either a total measurement could be done that includes the "free" and the bound fractions, or only the "free" hormone could be measured.

A study was published in the Journal of Sexual Medicine: which showed that women using Birth Control Pills have 4 times the levels of SHBF then women who never used Birth Control Pills. The conclusion is that Chronis elevations of SHBG may have long term effects of women. For instance sexual, metabolic, and mental status.

So to make a long story short…..I would prefer that my patients not go the way of Birth Control Pills but rather choose another way for Birth Control.

Cordially, Dr Helen Pensanit, MD

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