Estrogen / BCP / Pancreatitis

[Guest guest]

Jen,

You wrote, " .if you know of research done on the affect of the birth control

pill on the pancreas? "

I did a rather difficult search to learn more about the exact reason Estrogen

is listed as a medication known to cause pancreatitis. I say difficult

because most of them are all quoting the same source, which simply accounts fro

their association. It is important to understand the relationship and principle

of

interaction that estrogen has on the body. What is the pathophysiology

resulting in pancreatitis? Knowing more than I really will ever need, I will

share

what I can.

Estrogens causes pancreatitis in different ways. Estrogen, by itself, has

been shown to increase triglyceride levels. The estrogen component of oral

contraceptives is thought to increase production of VLDL and elevate

triglyceride

levels. Pancreatitis has been reported with the use of estrogen used for

patients with familial types I, IV, and V hyperlipoproteinemia. These patients

also

have elevated cholesterol, chylomicron, and VLDL levels and decreased HDL

levels.

An important factor to remember when evaluating the risk probability of

estrogen induced pancreatitis is to monitor the triglycerides closely.

Triglyceride

levels >1000 mg/dL predispose to the development of pancreatic inflammation.

You also mentioned, " Others have said that it isn't making a difference since

I've been on it for 10 years and only started having pancreatic attacks a

year ago.

That statement has merit, based on literature I read. It states that

estrogen-induced pancreatitis usually occurs during the initial months of

therapy.

Isotretinoin-induced pancreatitis results from dose-related hypertriglyceridemia

and usually occurs within the first month of therapy. (Isotretinoin is an

estrogen based acne medication. There are extremely severe side effects,

especially if you are pregnant.) Individuals who are obese and glucose

intolerant are

at increased risk.

You also asked, " Should I discontinue it? "

The literature states that discontinuance of the inciting medications will

result in a decrease in triglyceride levels and a decrease in the risk for

pancreatitis. The potential adverse reactions of estrogen therapy are important

issues for physicians to consider in the management of all women, especially

women with hyperlipidemia. These patients are noted to have resolution of

symptoms once the oral contraceptive has been discontinued.

Some investigators have advocated that oral contraceptives be relatively

contraindicated in patients with known hyperlipoproteinemia. Estrogen-containing

oral contraceptives should be avoided in women with preexisting

hypertriglyceridemia. Estrogen replacement therapy has been reported to induce

pancreatitis

in women with familial type V hyperlipoproteinemia. It is suggested that

pancreatitis in these cases is secondary to the combined effects of estrogens on

triglyceride-clearing enzymes, carbohydrate metabolism, and triglyceride

production, which is increased.

It has been recommended that estrogen replacement therapy be relatively

contraindicated in women with triglyceride levels >300 mg/dL and absolutely

contraindicated in women with triglyceride levels >750 mg/dL, to prevent

triglyceride-induced pancreatitis. Evaluation of fasting triglyceride levels may

be

considered before postmenopausal estrogen replacement therapy is initiated. It

is

suggested that women with baseline elevated triglyceride levels are poor

candidates for both oral contraceptives and estrogen replacement therapy.

You also said, " I've been on it for 10 years and only started having

pancreatic attacks a year ago. "

This may be an important fact. Literature states that familial

hypertriglyceridemia should be investigated in patients who develop pancreatitis

while they

are taking estrogen compounds.

Anyone considering adjusting their medication should do so only under the

collaboration with their health care professional.

Karyn E. , RN

Executive Director, PAI

http://www.pancassociation.org

Pancreatitis Association International