Diane-35: Reconsidering the risks

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Publication Date: 
Thu, 2013-08-01

A study conducted at the University of Virginia School of Medicine and published by the Canadian Medical Association Journal in 2012 found that for women with PCOS taking any birth control pill could double their risk of deep vein thrombosis. So, potentially, women with PCOS are facing the heightened risk caused by their condition plus that caused by oral contraceptives generally, as well as the risk specific to Diane-35 if that is what they are prescribed for their symptomatic severe acne. At least one study suggests as many as 83 per cent of women with severe acne have underlying PCOS, although it often goes undiagnosed.

Amy Medling is the founder of online community PCOS Diva. She used the birth control pill for 10 years to suppress PCOS symptoms. “When I came off to have my children I realized I had just been slapping a band-aid over my symptoms. I now take a holistic approach with a low carbohydrate, nutrient-rich, whole foods diet and doing the right kinds of exercise to stay fit and lower stress hormones. On the pill I had extreme moodiness and irritability with no libido. I felt like the drug had hijacked my body. The nutritional deficiency and negative metabolic impact aggravated my PCOS. I share my own treatment methods on my website and they appear to work for the majority of women.”

Another route of treatment

Dr. Jerilynn Prior is director of the Centre for Menstruation and Ovulation Research within the University of British Columbia. On the CEMCOR website Prior addresses the use of Diane-35 to treat acne in the “Ask Jerilynn” patient Q&A section. Prior recommends that instead of this drug someone suffering with acne as a result of PCOS—which Prior prefers to call “anovulatory androgen excess” to be specific about its physiological root—should try a combination therapy of oral bioidentical progesterone taken during the second half of the monthly cycle and spironolactone, which is similar to the anti-androgen in Diane-35 but, she believes, does not have the adverse effects of blood clotting and liver damage.

“I have treated somewhere between 100 and 200 women with that combination and it has worked very well for them. It brings their own hypothalamus, pituitary glands, and ovaries into balance and drops the male hormones that cause acne. The imbalance isn’t an irreversible issue. You can break the cycle and restore normal health. Suppressing your own system with Diane-35 or any birth control pill is not a good thing; it is suppressing the production of hormones that are essential to life,” says Prior.

“There’s a lot of stigma around acne and women get desperate enough that they will use a harmful drug to get relief. If they get relief from Diane-35 they won’t want to go back to the acne and will want to stay on it. They aren’t made aware of the other options,” she says.  Prior suggests that in addition to the bioidentical progesterone and spironolactone for even quicker skin-clearing results it is possible to add to the routine a highly effective topical medication containing retinoic acid and Stievamycin.

The term bioidentical is much disputed with some believing it to be a relatively meaningless description as there is no way to reproduce a synthetic version of women’s hormones that are exactly the same as those produced by the body. On a molecular level they are the same as the body’s hormones and the body responds to them as though they were the same, but little is known as to how they are changed once metabolized.

Prior believes that some doctors, once aware of the risks of Diane-35, may opt to swap their patients to Yaz or Yasmin. These two birth control brands contain the synthetic progestin drospirenone but a lower amount of synthetic estrogen and are approved for the treatment of moderate acne. Yaz or Yasmin, also produced by drug company Bayer, are at the centre of a large civil law suit in the United States with hundreds of Canadian women recently taking the same action with the support of law firm Siskinds LLP. Yaz and Yasmin also hold a higher risk of causing blood clots, around three times higher than other birth control pills.

Drospirenone and depression

Shannon Tessier was switched to Yaz on the recommendation of her doctor after years of taking Diane-35. In line with the anecdotal evidence provided by women who have gone online to share the negative psychological and emotional effects of this drug, Shannon describes her experience, “I just didn’t feel ‘right.’ I felt uncomfortable in my own skin. So, I booked another appointment and asked to be put back on Diane-35. Now though, I can see we are over-reliant on the pill as the answer and this prevents us from accessing other treatments.”

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