Displaying items by tag: medical

That Your Joy May Be Complete

by Brooke Myrick BSN, RN, LAS

As the Father has loved me, so have I loved you. Abide in my love. If you keep my commandments, you will abide in my love, just as I have kept my Father’s commandments and abide in his love. These things I have spoken to you, that my joy may be in you, and that your joy may be full.

John 15:9-11 ESV

As Nurses within the pregnancy help setting, often we are blessed with experiences that fill us with abundant happiness and thankfulness. In comparison, we can also find ourselves experiencing feelings of utter sadness that can bring us to our knees.  The service offered to women and families within the pregnancy help role is a unique service, unimaginable and unrelatable to many, unless they are also united in the same service. Many times, the nursing care offered is concerning a life-or-death decision. As love, care and support are shared, to reach and rescue as many lives as possible, there are times when the woman’s decisions may not be as we had earnestly prayed and hoped. In addition, the conversations had, and relationships built, each distinctly demands an immense amount of physical, emotional, and spiritual support from the nurse. Appointment after appointment, nurses proceed to offer all we can, with all that we have, as we pray for God to guide our words and actions, in efforts to save lives today and for eternity future.

Despite circumstances, how can your joy be made full and complete?

Though you have not seen him, you love him. Though you do not see him, you believe in him and rejoice with joy that is inexpressible and filled with glory…

1 Peter 1:8

The joy described in 1 Peter is an inexpressible joy. A joy unable to be given an explanation. This joy is independent of circumstantial surroundings, adversity, and attacks. It is a constant joy independent of the current life challenges. This joy is a byproduct of the love given us by remaining in Him, as referenced in John 15.

In Hebrews 12:2 we read that Jesus endured the cross, for the joy set before him, to become our Savior and sit at the right hand of God. He can identify with our struggles. With every act of service offered and with every sacrifice made, may you also be filled with joy.

With the utmost gratitude, we thank you for your endless hours of acts of service to those entering your pregnancy help center doors. Thank you for your continued prayers for the families you serve and their situations long after their care at your center is complete. You care. You care deeply for those you serve, and this is worthy of commending and admirable.

Your service does not go unnoticed and is making a difference, one life at a time, every single day.

This Nurses Week we are praying you remain in the love of our Father, that his joy may be in you, and that your joy may be complete.

Meet the Medical Impact Team: Bryan Williams MHA, RT(R), RDMS, RVT, RDCS

MeetBryanFamilyThis month we are highlighting Bryan Williams, one of our Ultrasound Consultants. Bryan brings wisdom, humor, and encouragement to our team. As he teaches medical professionals in the pregnancy help setting, they benefit greatly as they gain knowledge and inspiration. Bryan has a desire to help others learn the skill of imaging life so they can in turn show life to those they encounter in their pregnancy help center.

Where did you grow up and go to school?

I grew up in Mtn Grove MO. A small town near Springfield, MO. I went to a hospital based x-ray and ultrasound school at CoxHealth in Springfield, MO. I completed my business degree from Evangel University. I completed my MHA at Webster University in St. Louis, MO.

Share with us about your family.

I have been married to my wife Lindsay for 18 years. We have two daughters. Addy is 12, and Izzy is 6.

Tell us about what brought you to Heartbeat International.

I was brought to HB because of my desire to train. The story is long, but I met Cindi Boston at the center in Springfield, MO when I volunteered and trained nurses there. She offered our names up when HB began to think about starting their own training.

What do you enjoy most about your role as Ultrasound Consultant for Heartbeat International?

I get so much joy when I get to teach at trainings. My cup gets filled at each training event. This literally gives me the energy I need to go back to my other job at the hospital with joy and renewed efforts.

What do you love most about ultrasound?

The ability to see life and make an impact in people’s lives.

Tell us about sharing your love of ultrasound with new nurses in the pregnancy help setting.

OB is not something that I really wanted to do. It is something that God pushed me to do. I really enjoy the ability to train others so they can be equipped to do the work God has called them to do.

Where else do you work and what is your role in that setting?

I work at CoxHealth in Springfield MO. I’m the Administrative Director of Neuro and Cardiovascular Services.

What are your favorite things to do?

Spend time with my family, fish, and run.

What else would you like to share?

I’m extremely humbled by the people who do this job every day. I get to play a role part-time, but the people who do this on a regular basis are doing the real work. They are dedicating their lives to serve the ones that cannot speak for themselves.

Meet the Medical Impact Team: Tammy Stearns MS, RDMS, RVT, RT(R), FSDMS, LAS

TammyFamily.jpg

This month we are highlighting Tammy Stearns, one of our Ultrasound Consultants. Tammy brings love and encouragement to our team, as well as to the many pregnancy help medical professionals she teaches the skill of ultrasound. Tammy and her family have a heart for the world and for all to come to know and love Jesus! It is a blessing to us all to witness the many ways God uses Tammy to bring light to the darkness.

Where did you grow up and go to school?

I grew up in a tiny town called Pontiac, Missouri located on Bull Shoals Lake. I went to college, Radiology and Ultrasound School in Columbia, MO and Springfield, MO. I have a Master’s in Administrative Studies with an emphasis in Communication, along with being credentialed in Radiologic Technology, and Abdominal, Obstetrics and Gynecology, Vascular Technology, Pediatrics and Neurosonography.

Share with us about your family.

I married my high school sweetheart 32 years ago. We have four children. A son who is 30. He and his wife live in Houston TX. Our daughter, Taellor, passed away in 2014 at the age of 19 in the mission field with us. Our two younger boys are Antonio (14) and Slaton (13) who both serve on the mission field with us in Nicaragua. 

Tell us about what brought you to Heartbeat International.

I had the privilege to work with Cindi Boston at her Pregnancy Center in Springfield, MO launching her medical mobile unit. While there, I also helped train some of the nurses given that my background is a Diagnostic Medical Sonographer Educator. When Cindi came to work for HBI, the opportunity presented itself for me to join the team to develop a Limited Obstetrical Educational Program for nurses.

What ministries are you involved in?

My family and I serve as full-time missionaries in Nicaragua. We moved there in 2012 to serve with Project HOPE. I am the Director of Women’s Ministries with a feeding center in the city dump called Center of Hope, UnShackled. This is a place that offers restoration and redemption to ladies coming out of prostitution along with serving women in the jails and hospitals. I also perform ultrasound exams with our ministry’s physician. 

What do you enjoy most about your role as Ultrasound Consultant for Heartbeat International?

I love being part of something so much bigger than myself! God has put together an incredible team whose focus is to share life through imagery. I love being able to come alongside those trying to learn ultrasound to image life and getting to be an encourager in their journey. 

What do you love most about ultrasound?

I love when mom sees her baby for the very first time. Each and every time there is a sense of wonder when we see what God is knitting in the mother’s womb. I never get tired of that! 

Tell us about sharing your love of ultrasound with new nurses in the Pregnancy Help setting.

I love when it begins to make sense. You can tell when someone is worried or concerned about not understanding it. We then find a different way to explain and teach the method or technique and watch the moment of awareness that every teacher teaches for. For some, it clicks faster than others and that is okay as we each have our own journey and our own process. God always equips who He calls. 

What are your favorite things to do?

I love to serve. I love to play with the kids at the city dump or hang out with the ladies from our outreaches. I love spending time with my family exploring the world. In my quiet time, I love to read and write.

What else would you like to share?

It is such a privilege to be able to do ultrasounds. I’m thankful for the technology and the resources that allow us to image life literally bringing Light to the darkness.

Nursing CEUs at the 2022 Annual Conference!

Nursing continuing education contact hours coming to YOU through Medical Professionals at the 2022 Annual Heartbeat International Conference! Come grow your skills in pregnancy help!


Attention Medical Professionals working in pregnancy help medical clinics:
an opportunity to advance your knowledge in pregnancy help, provided by Medical Professionals that are experts in their field, is available to you through the Medical Advancement tracks! The workshops this year offer education spanning a variety of topics with the most recent and updated information to strengthen your pregnancy help medical services.

Pre-Conference (Tuesday, March 29):

  • Adding STI Testing and Treatment Services:

    Instructor: Karolyn Schrage, Life Choices

  • Chemical Abortion Today & Saving Lives with Abortion Pill Rescue Network:

    Instructors: Dr. Brent Boles, Medical Director of APRN, Heartbeat International
                       Christa Brown, Director of Medical Impact, Heartbeat International
                       Dr. George Delgado, Steno Institute
                       Medical Impact Team, Heartbeat International

  • Sexual Risk Avoidance Training: 

    Instructor: Tracey Pike, Ascend

Conference (Wednesday, March 30th- Friday, April 1st)

In person and virtual tracks available to provide education for the pregnancy help community. The workshop topics this year include incorporating STI testing to reach the next generation, tough abortion questions, safety considerations of medical abortion, caring for your ultrasound equipment, the LOVE approach method to scanning, incorporating medical services, chemical abortion in 2022 and much more!

Heartbeat International will offer continuing education nursing contact hour credit for nurses (approved by Heartbeat International). Provider approved by the California Board of Registered Nursing. Provider Number 16061 for 1.00 contact hour for each qualifying medical workshop and 6.00 contact hours for each In-Depth Day. Medical Professionals ~ please bring your license number if applying for CEUs. Trainings that are approved are marked with an asterisk (*) in the Conference Schedule.

NURSES: To receive continuing education credit, please remember to fill in the appropriate boxes in the registration form online and bring your license number with you to conference!

All courses are also eligible for Life-Affirming Specialist credit hours.

We look forward to seeing you soon in Jacksonville, Florida!

Meet the Medical Impact Team: Darcy Noltemeyer

DarcyThis month we are highlighting Darcy Noltemeyer, one of our Medical Impact Office Assistants. Darcy brings joy and encouragement as she provides organization and assistance to our team in many ways. She is a blessing to us all as she serves with a smile and a servant’s heart in all she does. We are so thankful for Darcy and all she brings to our team!

Where did you grow up and go to school?

I grew up in Grove City, a small town just outside of Columbus, Ohio.  For college I attended The Ohio State University for Health and Rehabilitation Sciences.

Share with us about your family.

I have been blessed with such a close family despite being so spread out across different states. My dad passed away when I was a senior in high school, so I am thankful to still have my wonderful mom to hug. I am the youngest of four children, and have six adorable nieces and nephews. I started dating my high school sweetheart when we were 16. We have now been married for almost 3 years, with two rescue Pomeranians, Bingley and Evee.

Tell us about what brought you to Heartbeat International.

Growing up as the daughter of a pastor, I understood from an early age the struggles that many people faced in their lives. I could see for myself how much expressing and sharing God’s love could change the hearts of people and help them when they needed it most. My heart has always been designed to help and serve others, and I never felt like I was accomplishing that fully in the beginning of my adult career. By God’s grace I stumbled upon a job listing for Heartbeat International and I was instantly intrigued. After researching the company, delving deeper into its founding, learning of the current works they were involved in, and their vision for the future; I knew God was calling me to place roots in the good ground they had cultivated. My desire was to be a part of an organization that aligned with my beliefs that would allow me to work wholeheartedly towards advancing their mission. I am thankful to have found that with Heartbeat. 

What do you enjoy most about your work as Office Assistant for the Medical Impact?

Every day is new and varies in what I get to do! I enjoy a job that gives room for growth in ideas and responsibilities. I am very detail oriented, and love being given statistical tasks or projects that allow for me to be creative in presentation. It is so encouraging to be able to share with people all across the world the new hope we can give women, and to receive so much intrigue, excitement, and willingness in response. Overall, I am thankful for the trust that has been placed on me to support the Medical Impact Team.

Tell us about working on the Medical Impact Team.

Working with the Medical Impact Team is so unique! We are spread across two countries and still remain well connected. The trust that is shared amongst each other is nothing short of extraordinary. I have always been so impressed with how valued everyone’s ideas, thoughts, and questions have been with the team as a whole. Since I started here at Heartbeat, I have seen the passion Medical Impact has for the unborn, the commitment to the women, and the sincere heart for the people they interact with daily. They really do keep such a positive and loving atmosphere no matter what the team faces. I have only felt acceptance since I joined, and I love being a part of it!

What are your favorite things to do outside of work?

I enjoy the outdoors! Many of my past times include hiking, kayaking, fishing, and walking my dogs with my husband and friends. I am a certified scuba diver, but I don’t get to do that as often as I would like to outside of Ohio. If it involves tea, I’m in! I spend time going to local tea shops as I travel, and enjoy a nice cup or glass of tea when relaxing at home. I have always loved being an aunt, and spend a lot of time playing with them as well.

What else would you like to share?

Joining Heartbeat International has been such a wonderful experience, and I am proud to be a part of an organization that is moving forward to do great and impactful things in the world.

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Meet the Medical Impact Team: Maria Beigel

MariaFamilyThis month we are highlighting Maria Beigel, one of our Medical Impact Office Assistants. Maria brings joy and encouragement as she provides organization and assistance to our team in many ways. She is a blessing to us all as she serves with a smile and a servant’s heart in all she does. We are so thankful for Maria and all she brings to our team!

Where did you grow up and go to school?

I grew up in a very small farming community called Coldwater, Ohio and attended Wright State Lake Campus for my associates degree in Business Administration. I graduated with that degree in 2015.

Share with us about your family.

I’ve been so blessed by my family and I’m so thankful to have the relationship that I do with my parents and my siblings. I am the fifth of six children and all of my older siblings are married with children now, so I have a lot of nieces and nephews to love on! 14 to be exact. I’ve been married to my husband, Austin, for four years this past December and we have two children - a 2-year-old daughter named Vera and a 5-month-old son named Graham. We also have a very spoiled ragdoll cat named Shapiro (Ro for short).

Tell us about what brought you to Heartbeat International.

When I moved to Columbus and I was looking for a job, my former pastor at my parent’s church, Michael Spencer (who now works for Project LifeVoice), recommended I look into Heartbeat International. As I was growing up, Michael played a big role in developing my passion for the unborn and I was eager to take his advice and I’m so glad I did!

Tell us about your experience sharing APR with others.

It’s always very interesting to tell people what I do for work, because most of them previously had no idea that it is even possible to reverse the effects of a chemical abortion. I love spreading the word about Abortion Pill Reversal!

What do you enjoy most about your work?

Hands down, the best part of my job is reaching out to former APRN clients to see how their experience with Abortion Pill Reversal was and how they’re doing now. The responses that I’ve gotten have brought me to tears. I get to see photos of ultrasounds and born children who wouldn’t have had a chance at life without the APRN, and I get to hear the testimonies of their moms, who are so thankful and moved that there was someone who could help them, even when there were others pressuring them to continue their abortions.

Tell us about working on the Medical Impact Team.

I couldn’t have asked for a better group of women to work with. From the day that I started working with the Medical Impact Team, I’ve felt welcomed and loved and appreciated. This team has faced many spiritual battles and continues to overcome and manages to stay positive in spite of everything. We are a unique team, in that only one of us is actually in office in Columbus. The rest are remote and working all over the country (and one in Canada), which presents a unique dynamic. Because of this, it’s extremely special when I do get to see others on the Medical Impact Team in person and I look forward to our weekly Tuesday meetings where we get to see a glimpse into each other’s lives.

What are your favorite things to do outside of work?

I really enjoy visiting my hometown and my parents and taking my kids to the places I went as I was growing up. I stay at home with my children and love being a mom to them and getting to watch them grow up. I also enjoy reading, doing puzzles, playing tennis, playing board games, listening to podcasts, and going on date nights with my husband.

What else would you like to share?

I’m very thankful to be part of the Medical Impact team! I can see that we are making a difference and I’m so excited to see how God uses us in 2022.

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Hope and Support

by Brooke Myrick, BSN, RN, LASAPRBabyPicture
Healthcare Team Manager, Heartbeat International

Pressure, stress, lack of support, and limited finances. Women with unplanned pregnancies often find themselves facing most or all of these challenges. Often it is not a matter of the pregnancy being unwanted. The external factors surrounding the pregnancy make it seem impossible. Women are looking for a plan, a solution to their circumstances, hope, and support. When women choose abortion as a solution to their situation, many experience immediate regret. Statistics show that more than 2,500 lives have been saved (and counting) as women successfully stop their chemical abortions and save their children through the Abortion Pill Rescue Network.

What is the success rate of Abortion Pill Reversal?

  • Oral Protocol 68% Reversal Rate
  • Injection Protocols 64% Reversal Rate1

Using the APR protocol to reverse the effects of mifepristone roughly triples the chances of a live birth. The data that APRNetwork has been collecting and continues to collect supports the conclusion that the effects of mifepristone can be stopped by the administration of progesterone.


1. Delgado, G. M.D.,Condly, S. Ph.D., Davenport, M.M.D., M.S., Tinnakornsrisuphap, T. Ph.D., Mack, J. Ph.D., NP, RN, Khauv, J. B.S., and Zhou P., A

Case Series Detailing the Successful Reversal of the Effects of Mifepristone Using Progesterone. Issues in Law & Medicine, Volume 33, Number 1, 2018.

To receive an APR Provider Kit, updated APR Protocol or for additional information, email This email address is being protected from spambots. You need JavaScript enabled to view it..

A Life Saved by Choice

by Brooke Myrick, BSN, RNJulian
Healthcare Team Manager, Heartbeat International

“I'm so glad I picked up my phone that day and looked for help, who knows what the outcome would have been? All I know is it was by the grace of God! Thank you all again for your help. I'm blessed and thankful every day. I could not imagine my life without my baby boy.” -Ashley

The pressures and stressors women are facing at the time of an unplanned pregnancy are often played on for them to believe a chemical abortion is their only choice. Women are often looking for support, a solution, and a plan for their situation. Chemical abortion is sold to them as a private option to be completed in the comfort of their own homes with sometimes even with the convenience of mail delivery. Many women are not prepared for the severity of the bleeding, the severity of the pain, or potentially seeing the body of their lifeless child. An informed decision is the best decision. Women deserve to know the truth, medical facts, receive proper medical care, and a second chance at choosing life for their unborn child. Abortion Pill Reversal empowers women with choices.

Is it too late to reverse the abortion pill?

For those seeking to reverse a chemical abortion, the goal is to start the protocol within the first 24 hours of taking the first abortion pill, mifepristone, also known as RU-486. However, there have been many successful reversals when treatment was started within 72 hours of taking the first abortion pill. Even if 72 hours have passed, it may not be too late. Initial studies of APR have shown that APR has a 64-68% success rate.

To receive an APR Provider Kit or for additional information, email This email address is being protected from spambots. You need JavaScript enabled to view it.

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Exciting News about Heartbeat's Online Ultrasound Training!

UltrasoundTraining

Our completely updated training will be available in early March for medical professionals offering Limited Obstetric Diagnostic Ultrasound in Pregnancy Help Clinics. We are thrilled to offer ten new modules on topics such as ultrasound physics, first trimester scanning, legal and ethical questions, knobology, and more.

We invite imagers around the world that perform limited obstetric diagnostic ultrasounds to our updated Online Ultrasound Training. The purpose of scanning in the Pregnancy Help Clinics is to shed His Light on the reality of life by showing a mom the first image of her baby. Designed with the medical professional in Pregnancy Help Clinics in mind, this training is rooted in the LOVE Approach for all who serve and all who are served in Pregnancy Help Clinics.

Available to you:

  • Preparation for the imager for the front lines  
  • Image review by sonographer trainers for one full year
  • Community calls with sonographer trainers and other students
  • Handouts for all training modules
  • Self-paced training for the busy nurse
  • Video training and demonstration
  • Clinical component completed in your own center
  • Access to the didactic training for six full months
  • Nursing and ARDMS CEUs
    (SDMS does not require continuing education credits)

Training topics includes:

  • Legal and Ethical issues of Limited Obstetric Diagnostic Ultrasound
  • Nursing Professional Practice Guidelines
  • Patient Assessment and Education
  • Ultrasound Instrumentation & Imaging Techniques
  • Typical and Atypical Findings
  • Doppler and the Fetal Heart
  • Policies, Procedures, and Protocol
  • Ultrasound and the Abortion Pill Reversal Client
  • Obstetrics and Prenatal Health
  • Ergodynamics
  • The Physics of Ultrasound
  • Fetal biometry in Limited Obstetric Ultrasound
  • And more!

Who are the instructors of this course?

You will not walk the journey alone but rather will be guided by those of us who have walked the journey before you. Each member of the Medical Impact team has been a part of creating this training and providing support for you as you learn.  

Gathered from around the world, we are dedicated to assisting and encouraging while you learn not only the technique of performing a Limited Obstetric Ultrasound Diagnostic Exam but also as you forge through the spiritual warfare that will accompany it.  

Our team is composed of sonographers that are multicredentialed to include RDMS(OB/GYN) and recognized nationally for their accomplishments and Registered Nurses that have performed ultrasounds in Pregnancy Help Clinics throughout the nation. You will also hear from Heartbeat International General Counsel, HBI President Jor-El Godsey, Vice-President of Ministry Services Betty McDowell, and Vice-President of Development Cindi Boston-Bilotta and others from the HBI team. Each member of this team brings with them experiences that will enhance your learning experience. 

Who is this course designed for?

This course was created for medical professionals who are called to perform ultrasound in Pregnancy Help Clinics. It is not essential for you to obtain the RDMS credential to effectively perform Limited Obstetric Diagnostic Ultrasound.  It is essential that you become competent.  This course is designed with you in mind.  We fully believe that God equips who He calls!  

What is the pace of the course?

This training is self-paced and can fit in any schedule. Participants complete modules when convenient to their them. There are no required log-in times but we would expect the course to completed within six months from start date. Recognizing that each person will progress at his or her own time frame, the clinical section of this course can be completed while one is completing the didactic portion of the program or may be completed following the completion of the program.

What topics are included?

Module I The Power of Seeing
This module explores a basic overview of the history of Ultrasound and its unique utilization in Pregnancy Care Centers.

Module II: Limited Obstetrical Ultrasound for the Registered Nurse
These presentations provide guidance on patient assessment & education, documentation, and nursing professional practical guidelines for those that scan in Pregnancy Help Clinics. 

Module III: The Physics of Ultrasound
These presentations will help you become more familiar with you machine along with teaching basic physics principles that will enhance your scanning effectiveness. 

Module IV: Pelvic and Obstetrical Anatomy
This module will briefly review basic embryology along with the female reproductive system and basic first trimeter obstetrical anatomy in order to prepare the participant for First Trimester Obstetrical Ultrasound.  

Module V: Obstetrical Ultrasound
These presentations focus on the basics of scanning in the first trimester starting from basic transducer manipulation to basic measurements along with presentation techniques. 

Module VI: Normal Variants and Atypical Findings
These presentations focus on scanning beyond the typical first trimester scan concentrating on the second and third trimester basic measurements, presentation techniques, commonly encountered first trimester abnormalities and scanning multiple gestations. 

Module VII: Abortion Pill Reversal and Ultrasound
These presentations will help you to care for the abortion pill reversal client in your clinic.

Module VIII: Legal and Ethical Issues
This module concentrates on quality analysis of exams along with legal and ethical issues.

Module IX: Self-Care and the Imager
This presentation explores the personal role of the imager and the care that is involved in those who serve on the front lines.

Module X: Clinical Competencies
The clinical component of your training includes two elements, an experience log and competency evaluation. Clinical portion of training is completed in your clinic under the supervision of a qualified RDMS OB/GYN Sonographer, qualified RN who has completed ultrasound training, or a Physician of your choice.

What is included in these modules?

Each module of this course consists of presentations, discussion questions, and assignments. This course is designed to be completed in its entirety with each section developed to specifically prepare students for the task ahead. After each section, a small quiz assesses understanding of the topic. Questions are encouraged in the discussion forum or in email to our ultrasound instructors.

What is the cost?

Cost is $495 for non-affiliates/$395 with HBI affiliate discount.

Assistance is available to centers who qualify through the Option Ultrasound Program (OUP) which provides grants to qualifying pregnancy medical clinics for 80% of the cost of an ultrasound machine or sonography training for medical personnel.


We are excited for those that will join us on this endeavor to image life. We can assure you, this will be a life changing experiencing for you and those for who you scan!  

For more information:

Contact our Medical Impact Team at This email address is being protected from spambots. You need JavaScript enabled to view it.
We are thankful to all that heed the call of obedience and using your medical background for the unborn child. 

Provider approved by the California Board of Registered Nursing, Provider Number CEP 16061 for eight contact hours.

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How Female Hormones are Used Against Women

by Leontine Bakermans MSc PharmDHormonesPills.jpg
Coordinator One of Us, Netherlands

Introduction

The birth control pill came on the market in the middle of the last century as a new remedy for menstrual disorders, such as painful or irregular periods, and it is still prescribed for these indications, usually for a short time. But what was first described as a side effect ("you can become infertile") quickly became the main indication.

The pill is now used by millions of women around the world. In the field of family planning, the pill is also presented as the instrument par excellence for the emancipation of women. Its use is promoted at all levels, such as the proposal of the Council of Europe with the resolution 'Strengthening women: promoting access to contraception in Europe' (1) and the UN population fund (UNFPA) (2).

However, there seems to be a turnaround, the number of women taking the pill is decreasing. This is because there are also negative sides of pill use, about which more and more is known.

Types of pills

There are different types of oral contraceptive pills. The most commonly used pills are the so-called combination pills and the pill with progestogen only, or the mini pill. This article is limited to the combination pill, which is most commonly used. At the end the morning-after pill and abortion pill will be discussed. The combination pill contains two artificial sex hormones: an estrogen and a progestogen. The pills can be further distinguished into so-called 2nd and 3rd generation pills. The 2nd generation pills contain levonorgestrel and norgestimate as progestogen and the 3rd generation pills contain e.g desogestrel. The estrogen is almost always ethinylestradiol.

The pill is swallowed for 21 days, after which nothing or seven placebo pills are taken for seven days During these seven days, what is called a “withdrawal bleed” occurs; it is not a real period. Because of these monthly hemorrhages, it seems as if there is a normal cycle, but this is a fake cycle.

The normal cycle

What happens during a normal cycle is summarized in the figure below:

NormalCycle.jpg

Figure 1

The sex hormones oestradiol and progesterone are regulated from the brain (hypothalamus and pituitary) and via the ovaries:

  • The brain measures the amount of sex hormones circulating in the blood.
  • The pituitary gland uses this to produce the hormones LH and FSH, which, in turn, send messages to the ovaries to produce the sex hormones (3).

Because of this:

  • Due to the increase in progesterone, the endometrium becomes thicker and is well blooded. This is necessary to allow any fertilized egg to implant. If no egg is fertilized, no implantation takes place and the thick endometrium is rejected: menstruation. After this, another egg matures in the ovary and the whole cycle starts again (if a pregnancy takes place, the amount of progesterone remains high, as this is necessary to maintain the pregnancy).
  • The mucus in the cervix becomes thinner, which makes it easier for sperm to progress. This is also one of the symptoms used by natural birth control methods, as this phenomenon is usually easy to detect yourself.
  • But female sex hormones also influence emotions like attraction to the opposite sex, stress, hunger, behavior, friendships, aggression and how you feel (4).

Mechanism action of the pill

The effect of the pill is based on the same principles as the hormones in the normal cycle, but in the opposite direction (5). The artificial hormones in the pill weaken the signal given by the brain and this stops the natural cycle. The body itself no longer produces natural estradiol and progesterone, with the result that

  • No more egg cells mature and no more eggs are released. This is the intended main effect of the pill, because it prevents fertilization and pregnancy
  • The uterine lining does not thicken and is therefore unsuitable for the implantation of a fertilized egg
  • Cervical mucus becomes more difficult for sperm to penetrate

Side effects

Abortifacient effect?

To reduce side effects, the dosage of estrogens and progestogens in the pill has been reduced. The decreasing dosage of the pill has a direct effect on the effectivity and of course, a minimal amount of active ingredient is needed for a drug to have an effect. As a result, the main effect may no longer be 100% and egg ripening and ovulation are not always stopped. An egg can then still be released that could be fertilized. If this fertilized egg is implanted in the uterus despite the fact that the pill makes implantation more difficult, we have an ongoing pregnancy, despite taking the pill. But it is also possible that the fertilized egg cannot implant in the uterus, because the pill has not made the uterine mucosa suitable for it. The fertilized egg is then destroyed and the pill works as an abortifacient.

In practice there are a number of factors that reduce the efficacy of the pill. There are situations in which too little of the active substance from the tablet becomes available in the body, for example due to certain interactions with other medicines or diarrhea, or because a number of women have difficulty taking the pill consequently every day. Certain genes may also cause increased degradation. How often does an early abortion occur? There are no exact numbers, we can only say that it cannot be excluded that it happens (6,7).

Cancer

Because research shows that some types of cancer depend on naturally occurring hormones for their development and growth, a lot of research has been done into the relationship between hormones in the pill and cancer. A study showed that taking the pill for more than 8 years showed an increased risk of cancer (8). By the way, the pill has a protective effect against cancer of the lining of the uterus and ovaries, but these types of cancer are very rare by nature and an improvement of a very small amount is still very small. The U.S. government has therefore added estrogens contained in the pill to the official list of carcinogens (9) and the WHO has also classified the pill as a group 1 (the heaviest type) carcinogen for breast, cervical and liver cancer (10). This is the same category as for tobacco and asbestos.

Breast cancer

The risk for a woman to get breast cancer depends on several factors, including a link with pill use, because estrogens affect breast tissue. The risk increases from 1.1 times higher with 1 year of pill use to 1.6 times higher with 10 years of use. Further, this risk is higher if you start taking the pill at a young age, because when breast cell proliferative activity is high, there is more chance for mutations in DNA, so the susceptibility to genetic damage in breast epithelial cells becomes higher. Women who have an abnormality in one of the breast cancer genes even have a greatly increased risk of developing breast cancer (11,12,13).

Liver tumors

"At the beginning of 2014, for a change, I went to see the doctor again, because I was still very tired. My liver values were always a bit higher than normal rates, but now they were even higher. "It is probably nothing, but just go to the gastrointestinal liver doctor" said my family doctor. When I got there, I heard "I'm sure it's nothing, but we are going to make an ultrasound of the liver". While I looked on the screen, I saw it immediately. A huge thing in my liver!" (14).

 

The pill plays a key role in the development of liver cell adenoma (benign tumor), usually after use for more than 5 years, but sometimes an adenoma develops as early as after 6 months of pill use. It occurs in about 3 out of every 100,000 pill users (15, 16).

Cervical cancer

Cervical cancer is the second most common type of cancer in females worldwide.

Human papillomavirus (HPV) is a group of viruses that are extremely common. Two HPV types (16 and 18) cause 70% of cervical cancers and pre-cancerous cervical lesions. HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity. A condom gives insufficient protection because the virus is available in a broad zone around the sex organs. OC users might have more sex, with more partners higher chance of infection. Changes to cervical fluid caused by OC use may compromise one’s immunity higher susceptibility to HPV infection.

Women who take the pill for more than 5 years are twice likely to get cervical cancer. After 10 years, this can increase to a 3 times higher risk (17,18).

Osteoporosis

The amount of bone tissue in skeleton is known as bone mass and can keep growing until age 30. At that point, bones have reached their maximum strength known as peak bone mass (PBM). The PBM relates to lifetime fracture risk. Natural estrogen, plays an essential role in bone growth. By suppressing estrogen, as in OC-use, there is

a detrimental effect on the bone. In later life it increases the risk of brittle bones (osteoporosis) and therefore a rise in bone fractures (19).

Heart and blood vessels

Oral contraceptive hormones have an impact on the lipid and carbohydrate metabolism. They significantly affect plasma lipoprotein metabolism, which can raise the levels of plasma triglycerides, low-density lipoprotein, and high-density lipoprotein.

Taking the pill therefore increases the risk of thrombosis (the formation of a blood clot,

Thrombosis.png

in a vein of the legs, lungs, heart (heart attack) or brain (stroke) 2 to 4 times (23, 24). The third-generation pills even give a 4 to 7 times higher risk of thrombosis (reason why they are now much less prescribed).

Myocardial infarction

Suppose, you're at work and suddenly you feel dizzy. You try to go outside for fresh air, but you don't feel your legs. You can only hang to one side and start vomiting. It turns out to be a brain attack.

 

Studies show that in young women taking the contraceptive pill more or less doubles the risk of having a stroke (20.21). Women who take both the pill and carry the variant of a certain coagulation factor gene are 20 times more likely to have a brain attack (22).

Lung embolism

"I was 21 and very tired and flustered for a while. I worked in preschool, so at first, I thought it was from the kids. But it got worse and worse. It felt like my heart was bothering me. I could hardly breathe. The next day it turned out I had a pulmonary embolism. After extensive examination doctors established that she was hypersensitive to the hormones from the pill. My pulmonary artery was pinched off by a blood clot. I really couldn't breathe, I was in mortal danger" (25).

In rare cases, a venous thrombosis or pulmonary embolism is fatal (26).

The risk of thrombosis when taking the pill is also greatly increased by the presence of risk factors such as smoking, age and obesity.

 

Psychological effects

In addition to effects on the ovaries, the sex hormones also influence emotional things like attraction, stress, hunger, behaviour, friendships, aggression and how you feel (4). Effects on this by suppressing the sex hormones through pill use is therefore inevitable, but only recently more clarity has become available. It appears that also the Hypothalamic-Pituitary-Adrenal axis (HPA axis) is involved. This axis also acts via the hypothalamus and pituitary gland, but with the adrenal glands as target organ. Via this axis, the renal glands release cortisol. Cortisol reacts to stress and regulates many body processes including, mood, emotions and sexuality. Sex steroids exert profound control over the HPA axis. Suppressing this system with artificial hormones, has an effect upon all the processes this axis regulates. The HPA axis continues to develop until after puberty.

A 2016 Danish study of women between the ages of 15 and 34 showed that among those who used hormonal contraceptives, there was a forty percent higher risk of taking antidepressants. Especially women between 15 and 19 years had a higher risk of becoming depressed (28). 

"When I was seventeen, I went on the pill. It was obvious when you were dating. Man, I thought it was exciting and mature. But after a month I cried all the time, for nothing, and wanted nothing more than to sit on my father's lap. At school I became very uncomfortable, which caused me to distance myself from my friends, who I thought were blaming me for that, so I made even less of a rapprochement, and I came home crying again. It was an incredibly unpleasant time" (27).

A link between pill use in young women and the risk of depression in adulthood has also been shown. This suggests that adolescence can be a sensitive period during which pill use can increase a woman's risk of depression, even years after use of the pill was stopped (29).

The Dutch researcher Estrella Montoya states: "It is almost certain that the pill has an effect on the brain, in areas that are important for mood, anxiety and pleasure (30).

In her book 'Your brain on the pill' (4), Sarah Hill, professor of psychology, describes new research on the effect on the brain and psychological influence of pill use. She came to the conclusion that by suppressing the natural hormone profile through pill use you can start to feel like a totally different person. This goes as far that, although the research is still in its very recent, this suggests that the pill could have an influence on who you find attractive (through pill use you could fall for a different type of man as without pill), on the dynamics of your relationships (pill extinguishes feelings of lust), how you react to the face of your partner, on your chances of ever getting divorced, etc.

MRI scans have recently shown that the size of certain parts of the brain, including the hypothalamus, was considerably smaller in women taking the pill than in women not taking it (31). And the hypothalamus is the organ from which the hormones are controlled. What effect this has in the longer term is still unknown.

Women under 19 years of age

The influence of sex hormones plays an enormous role in all gender-specific developments during puberty and adolescence, not only in the visible parts of the body, but also on the brain. Girls who are just menstruating are still busy with their brain development. Brain development is usually not finished until we are 20-25 years old. Sarah Hill advises against influencing your hormone balance with the pill before the age of nineteen or twenty and recommends more scientific research into the effects of the pill. Animal studies have found that hormones, especially when the brain is still developing, can irreversibly influence behavior. Adolescent girls have in addition a higher chance of getting breast cancer and reach a lower peak bone density with higher risk of fractures.

The morning-after pill

There are 2 types of morning-after pill available. One consists of the same progestogen as most commonly used in the pill: levonorgestrel. It can be taken up to 72 hours after unprotected sexual intercourse. Later, another one is added EllaOne® (ulipristal acetate). This is even effective up to 120 hours (5 days) after unprotected sexual intercourse. They are sold about 300,000 times a year in the Netherlands in a population of 17 million people (32).

The effect of the morning-after pill is partly based on ovulation inhibition, but if the pill is taken from the day before ovulation, i.e. in the most fertile period, ovulation can no longer be inhibited. If ovulation has already occurred, it can of course no longer be inhibited as well. In these cases, the efficacy is based on preventing implantation, an abortifacient effect (33).

The abortion pill

Despite contraception, many women get unplanned pregnancies. 60-70% of women who come for an abortion indicate that the unwanted pregnancy occurred despite the use of contraception (34).

At first, I didn't feel anything, after three hours my bowels started to rumble a bit and after that it got much worse very quickly. I couldn't get off the toilet for three hours, I emptied on all sides. I felt so miserable. I cursed myself, I cursed the contraceptive pill that hadn't worked. For three hours I sat on the toilet with a bucket (because in the meantime I also had to vomit) groaning, crying and shivering. I had never had so much abdominal pain in my life and didn't know how to sit or stand anymore'. (35)

The abortion pill is a series of 2 types of pills, to be taken 2 days in a row. The first pill to be taken, mifepristone, is an antiprogesterone drug, which suppresses the natural progesterone needed to maintain a pregnancy.  It loosens the baby. After 2 days another medicine has to be taken, prostaglandin, which causes the uterus to contract and expels the baby. This can be done up to ten weeks after the last menstruation in the U.S.

"She saw that there were still a lot of remains in my womb. She therefore decided that a curettage was still necessary. This would be the only way to stop the severe bleeding, and remove the remains'.

The abortion pill is not a simple and innocent remedy. It ends human life and it's not without risk. The leaflet therefore states that it is important to have access to appropriate medical care if an emergency situation arises and the patient must remain close to the treatment center (36). In addition, an ectopic pregnancy must first be excluded, because in that case the abortion pill does not work and medical intervention is required. Enormous cramps and heavy blood loss are common. Prolonged vaginal bleeding may occur. In some cases, severe bleeding may require surgical removal of the uterus. Rarely, the uterus may rupture or a fatal shock syndrome may result from a particular bacterium. Bleeding is in no way proof that the pregnancy has ended, because bleeding also usually occurs if the treatment fails. The non-negligible risk of failure (4.5 to 7.8% of cases) makes a control visit mandatory to check that the abortion has been completed. In case of an incomplete abortion, a curettage is still required to achieve complete abortion. A so-called "do it yourself abortion", which means that the pills are taken without medical supervision, can therefore have terrible consequences.

Abortion Pill Reversal

What if there is regret after the abortion pill? After taking the abortion pill, some women have regret and realize that they do want to keep their baby. If they have only taken the first pill, but have not yet started the medication for the following days, they are still eligible for the abortion pill reversal.

The abortion pill reversal consists of the drug progesterone because the woman’s body had stopped producing it naturally when the first abortion pill was taken.This was switched off by taking the first pill of the abortion pill. By not taking the second day's pills and taking the abortion pill stopper as soon as possible (at least within 72 hours) and continuing this until the 14th week of pregnancy, the baby can be saved up to 65% of cases (37).

Women pay a high price for controlling fertility

We are concerned about artificial sex hormones that men use in the gym because of all the effects they have on their bodies. But at the same time, healthy women are routinely prescribed female sex hormones and swallow them for years, despite the increased risk of cancer and thrombosis, sometimes with fatalities and severe emotional disturbances.

Influence on the environment

The hormones in the pill are excreted again and reach the water purification system via the sewer. The sewage treatment system does not succeed in breaking down all the female hormones in the wastewater, causing estrogens to re-enter the environment. Synthetic hormones can be active even at very low concentrations. Estrogens from the pill, for example, are ten times more active than the natural female estrogen (38). Hormone-disrupting effects in the aquatic environment have been clearly and frequently demonstrated. For example, feminization was found to occur in male fish.

What this means for humans and the environment is still unknown (39-43).

No pill, but what else?

There is an alternative to taking the pill. This alternative requires the cooperation of both partners, especially in the field of self-control, but it has no side effects: natural fertility management, also called 'Natural Family Planning' (NFP). NFP is based on the knowledge that, on the one hand, sperm cells only survive in the fallopian tubes for a maximum of five days and, on the other hand, an egg cell can only be fertilized for a few hours. A woman is therefore fertile for a week before ovulation until about a day after it. If one does not have intercourse during this period, pregnancy is impossible. To determine when the fertile period falls, there are several possibilities.

The Billings method makes use of the fact that around ovulation the mucus in the cervix is thinner. It is possible to draw 'threads' from it, as with the white of a raw egg. This is easy to determine yourself. You can even determine when a woman becomes fertile again after a pregnancy.

The sympto-thermal method, such as Sensiplan, is also based on the observations in the cervix mucus, but also uses the woman's body temperature: after ovulation the body temperature rises by about half a degree (five dashes). By taking the temperature daily, one has an extra control on ovulation.

Information about Sensiplan: www.sensiplan.nl

 

Sensiplan.jpg

References

  1. Council of Europe, Parlementairy Assemblee, Empowering women: promoting access to contraception in Europe. http://assembly.coe.int/nw/xml/XRef/Xref-XML2HTML-EN.asp?fileid=25012&lang=en and https://www.unfpa.org/family-planning
  2. The Rights to Contraceptive Information and Services for Women and Adolescents https://www.unfpa.org/resources/rights-contraceptive-information-and-services-women-and-adolescents
  3. Wat doen de hypofyse en hypothalamus met je hormoonhuishouding (https://www.cyberpoli.nl/craniofaryngeoom/faq/1333
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  10. WHO- IARC Monographs on the Evaluation of Carcinogenic Risks to Humans Volume 91
  11. Collaborative Group on Hormonal Factors in Breast Cancer. Breast cancer and hormonal contraceptives, Lancet 1996; 347: 1713-27
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  15. TJM Teeuwen, T.J.M. Ruers, Th. Wobbes, Het leverceladenoom, een tumor bij veelal jonge vrouwen, NTVG 17-06-2007
  16. AW Hsing AW, RN Hoover, JK McLaughlin et al. Oral contraceptives and primary liver cancer among young women. Cancer Causes Control 1992;3:43-48
  17. Green et al. Cervical cancer and hormonal contraceptives: collaborative reanalysis of individual data for 16573 women with cervical cancer and 35509 women without cervical cancer from 24 epidemiological studies. Lancet 2007; 370:1609-21
  18. Smith et al. Cervical cancer and use of hormonal contraceptives: a systematic review. Lancet 2003; 361: 1159-67
  19. Jamie A Ruffing et al. The influence of lifestyle, menstrual function and oral contraceptive use on bone mass and size in female military cadets. Nutrition & Metabolism 2007, 4:17
  20. nl – Emma kreeg herseninfarct door de pil -6 november 2018 https://www.linda.nl/nieuws/interview/herseninfarct-emma-schuldgevoel/
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  22. De pil vergroot kans op hartinfarct met stollingsfactor gen 20x. Gezondheid.be. Aug 2019. https://www.gezondheid.be/index.cfm?fuseaction=art&art_id=5095
  23. Stichting anticonceptie Nederland, https://www.anticonceptie-online.nl/pil.htm overzicht tromboserisico
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  26. Nooit mee aan de pil -Ik was er bijna niet meer geweest. RTL nieuws 29 maart 2018 https://www.rtlnieuws.nl/magazine/artikel/4132041/nooit-meer-aan-de-pil-ik-was-er-bijna-niet-meer-geweest
  27. https://www.elle.com/nl/beauty-health/health/a30269840/anticonceptie-pil-sarah-hill/
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  31. RSNA Press Release Study Finds Key Brain Region Smaller in Birth Control Pill Users Released: December 4, 2019 https://press.rsna.org/timssnet/media/pressreleases/14_pr_target.cfm?ID=2136
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