If you live in the Dallas-Fort Worth area, sign up for the Eric Genuis performance September 28th. It promises to be an inspirational afternoon.

​Bring a friend because all donations go towards the BOMA medical student education initiative and Eric’s prison ministry.

                Their blog says “the Mirena crash is real and affecting countless women.” They even quote a woman saying she felt “smothered with severe despair.” The website for Dolman Law Group in Clearwater, FL, may have mastered the SEO for the term “Mirena Crash,” but what does the term mean and is it real? Unfortunately, when I reached out to this law group (and holder of the first position on Google search) for additional information, their response was “we are unable to assist with the matter.” So then I went to the scientific literature, thinking surely there must be some published evidence for this condition. But that failed to produce any definitive results specifically related to the Mirena device. Finally, I thought that with the existence of so many blogs containing comments from women, clearly articulating similar symptoms and side effects after IUD removal, it must be a well-described side effect listed on the product insert. Once again, nothing about side effects after removal and not even a mention of depressive symptoms. So what can I tell you about this mysterious, apparently well-known but curiously undocumented side effect to removal of the Mirena IUD? Let me try to piece together the evidence and use a little scientific deductive reasoning.

What Is Mirena?

                Mirena is a progestin-releasing intrauterine device (IUD). It releases a progestin called levonorgestrel and is indicated for contraception lasting for up to 5 years or for treatment of heavy menstrual bleeding. After 5 years, the implant can be removed and a new device reinserted, providing another 5 years of “no compliance required” contraception. It is considered a long acting, reversible contraception (LARC) and is a progestin-only form of contraception. There are several published studies indicating that Mirena is safe and effective, but they do not address symptoms after removal. The device is supported by the published literature and the American College of Obstetricians and Gynecologists (ACOG). Stoddard et al. (2011) concluded that LARC, including the Mirena implant, “should be offered as the first-line contraception for most women.” An ACOG committee opinion states that complications of IUDs are rare and LARC is safe for adult and adolescent women. It goes on to say that offering it is essential to reproductive justice and equitable health care (ACOG 2018). The mechanism of action is stated to be multifactorial but mostly prevention of fertilization by thickening the cervical mucus and inhibiting sperm motility and capacitation (Stoddard et al., 2011). Those of us who have studied reproduction know that the term “multifactorial” means that it can also work by inhibiting implantation or disrupting development of an embryo (aka abortion). The implant contains 52 mg of levonorgestrel, which is released at a rate of 20 mcg/day. At this dose, some women will have ovarian activity with cyclic menstrual bleeding, some will have variable ovarian activity and irregular bleeding, and some will have complete suppression of ovarian activity (ESHRE Capri Workshop Group, 2001). The only data I could find about removal was a pilot study examining fertility after removal of IUDs. The study reported that pregnancy rates for former IUD and non-IUD users were no different, except for African American women, who experienced reduced fertility after removal (Stoddard et al., 2015).

Hormonal Effects on the Brain

                It is unfortunate that I could not find any scientific or medical documentation of mood or emotional symptoms after removal of the Mirena implant, while reporting of it is so prevalent on the internet. Nevertheless, there is evidence that hormonal contraception is associated with depression, and a recent review by Del Rio, et al. (2018) discusses how the lack of hormonal balance can affect a women’s brain. In a study of over 1 million women followed for 6.4 years in Denmark, all forms of contraception were associated with a higher incidence of first-time diagnosis of depression. Regarding Mirena users specifically, women actively using the implant had a 40% increased risk of being diagnosed with depression (Skovlund et al., 2016). The same authors published additional work in 2018 reporting on a half million women followed for over 8 years (Scovlund et al., 2018). The authors found that women who used hormonal contraception had a relative risk of 1.97 for suicide attempt and 3.08 for committing suicide compared to women who never used hormonal contraception. That’s a 97% greater risk of attempting suicide and 208% greater risk of committing suicide! Clearly something is going on here. Another study published in 2018 indicates that users of progestin-only contraception may have a greater risk of depression than estrogen-progestin combined contraception. Using reduced levels of the protein marker Beta-Arrestin 1 as a diagnostic indicator of depression, progestin-only contraception led to more mood disorder pathophysiology than either combined hormonal contraception or no contraception (Smith et al., 2018).
                The paper published by Del Rio et al. (2018) was previously summarized on our [HT1] blog by Santiago Molina, but it is particularly pertinent for understanding how both the administration and withdrawal of hormonal contraception can result in mood disorders. Steroid hormones organize and activate different actions on the central nervous system. They can modulate the activity of neurotransmitters, regulate neuron survival and proliferation, alter cell metabolism, or influence nerve impulse transmission. Collectively these actions determine how the brain functions. Furthermore, normal cyclic fluctuations in estrogen and progesterone cooperate to produce the physiological response appropriate for the proper stage of the women’s ovarian continuum.  The Mirena implant would alter this physiology in the following ways:

1. Normal fluctuations in hormones would no longer exist. As pointed out earlier, women have variable levels of ovarian activity when on the implant, making some women more susceptible to pathophysiology.
2. Synthetic progestins are slightly different in potency than natural progesterone and they are being administered at much higher doses than normal circulating levels of the hormone.
3. While on the implant, progestin levels remain constant for a prolonged period, and the body adjusts. When the levels are suddenly removed, the women’s body will not recover normal function for weeks or even months, leaving her in a state of hormonal deficiency. Since steroids also act on the nervous system, this is not unlike other drug withdrawal physiology, especially drugs that alter the central nervous system.

Nutritional Deficiency—Another Plausible Explanation?

                Oral contraception is known to depress levels of B vitamins (B6, B12, and folate), vitamin C, and zinc and to elevate levels of vitamin K, copper, and iron (Webb, 1980). While nutritional studies may not have been conducted specifically on women using the Mirena implant, it is likely that a similar alteration in nutritional status would occur. The B vitamin pyridoxine (B6) is responsible for converting the essential amino acid tryptophan into serotonin and is involved in the formation of GABA. Both serotonin and GABA are vital for normal functioning of the central nervous system. Furthermore, vitamin B6 deficiency is known to cause central nervous system abnormalities. Therefore, in addition to the effects listed above, if the woman has not been taking adequate B-vitamin supplementation while on hormonal contraception, a deficiency in vitamin B6 would exacerbate her symptoms because she would already have a shortage of neurotransmitters, resulting in anxiety and a loss of well-being.

Conclusion

                Taken together, the anecdotal and published evidence support the existence of a neurological condition called the “Mirena Crash.” It can severely reduce a women’s quality of life at best, and it can be life threatening at worst. It is hard to imagine why any women would want to take this risk, given the existence of an alternative method that is both effective and totally free of any side effects. The Billings Ovulation Method® does take some effort to learn and practice compared to the Mirena, but the effort is rewarded with a lifetime of body literacy that leads to a cleaner, healthier, and happier life.
 
References
​
ACOG (2018) Adolescents and Long-Acting Reversible Contraception: Implants and Intrauterine Devices. ACOG Committee Opinion. Number 735, May.
Del Rio et al., (2018) Steroid Hormones and Their Action in Women’s Brains: The Importance of Hormonal Balance. Frontiers in Public Health. Vol 6, 141.
ESHRE Capri Workshop Group, (2001) Ovarian and Endometrial Function during Hormonal Contraception. Human Reprod. Vol 16, 7.  
Scovlund et al., (2018) Association of Hormonal Contraception with Suicide Attempts and Suicides. Am J Psychiatry. Vol 175, 4.
Skovlund et al., (2016) Association of Hormonal Contraception with Depression. JAMA Psychiatry. Vol 73, 11.  
Smith et al., (2018) Do Progestin-Only Contraceptives Contribute to the Risk of Developing Depression as Implied by Beta-Arrestin 1 Levels in Leukocytes? A Pilot Study. Int J. Environ. Res Public Health. Vol 15, 1966.
Stoddard et al., (2015) Fertility after Intrauterine Device Removal: A Pilot Study. Eur J. Contracept Reprod Health Care. Vol 20, 3.
Stoddard et al., (2011) Efficacy and Safety of Long Acting Reversable Contraception. Drugs. Vol 78, 8.
Webb (1980) Nutritional Effects of Oral Contraceptive Use: A Review. J. Reprod Med. Vol 25, 4.

​Dear fellow teachers and Billings Ovulation Method® practitioners and fans,
 
Now that school is back in session and the dizzying heat will soon subside, allowing our brains to reorient and our schedules to find a nice groove again, I want to write you a letter of encouragement. You are truly making the world a better place by continuing to share this incredible knowledge that was gifted to us by God through the work of Drs. John & Evelyn Billings.
 
Last year I was lucky enough to participate in the making and release of the film by Springtime Productions Sexual Revolution: 50 Years Since Humanae Vitae. The team travelled all the way to Australia and New Zealand to meet the adult children of John and Evelyn Billings. And we also interviewed Marian Corkill, Gillian Barker, and the enduring disciples of the groundbreaking scientists that gave us modern NFP. Also in the film are Abby Johnson, Mary Eberstadt, Steven Mosher, and Professors Janet Smith, Peter Kreeft, Robert P. George, Mark Regnerus, Helen Alvaré, Angela Franks, and Brad Wilcox. Drs. Marguerite Duane from FACTS, Pilar Vigil, Joe Santamaria, Day Gardner, and Fr. Tad Pacholczyk from the National Catholic Bioethics Center all make appearances, as well as Mother Teresa’s former assistant Sr. Hannah, MC.
 
In short, Sexual Revolution has achieved something very special by collecting and immortalizing the voices of the most important thought leaders in the counter revolution to the 1960s’ failed experiment that was thrust upon us by Margaret Sanger and her horrible Pill.
 
Many of you are aware of the predictions that Pope Paul VI made when he wrote his prophetic encyclical Humanae Vitae. He described a world in which men lost all respect for women—and today we are all aware of the #MeToo Movement and crimes like those committed by Jeffrey Epstein. We now live in a world where so few have self-control regarding their sexuality that somehow human slavery has become justifiable in the minds of many.
 
But we have the antidote. It’s called Natural Family Planning, and we’re not afraid to use it!
 
We believe that where sin abounds, grace abounds all the more, which is what drove us to make the film in the first place. Experts interviewed in the film describe the now-confirmed predictions of Paul VI in significant detail.  You need to hear what Steven Mosher from the Population Research Institute has to say about his work in China and the one child policy there. John Billings also describes the horrors he witnessed in India during their forced sterilization programs in his personal diary, which we were granted exclusive access for inclusion in the film.
 
Sexual Revolution is a strong tool for Billings Ovulation Method® instructors specifically. Many of you might not know that all modern FABMs are based on the research of John & Evelyn Billings and that we teach the original NFP method as perfected by the Billingses. Sexual Revolution profiles John & Evelyn’s journey, contrasted with profiles of Margaret Sanger and Dr. Gregory Pincus who gave us the Pill.
 
If you want a tool that will help you pull in new students, or something that will demonstrate without a doubt why NFP is important and why the Pill is evil and broken, we have done all the hard work for you in this beautiful documentary. All you need to do is hand your pastor a DVD or organize a screening of the film in your community. DVDs are now for sale right here on the BOMA-USA website. All proceeds support BOMA and administrative efforts. Email screenings@sexualrevolutionmovie.com if you’re interested in organizing a public screening. A license is not only very affordable; it can boost your visibility as an NFP teacher and community resource on this topic significantly.
 
I want to thank BOMA for their endorsement of the film. I know that many of us have come to be passionate about this method because we’ve witnessed firsthand the destruction caused by the sexual revolution of the 1960s—myself included—and I am so proud of you for showing up and trying your hardest to do something about it. The work you do is valuable. The work you do calls forth new eternal souls destined for sainthood. The work you do heals wounds, both relational and clinical, and even though I may not know you personally, you have my full admiration for continuing the legacy of Popes John Paul II and Paul VI and Drs. John & Evelyn Billings. May God bless you as you continue to fulfill your calling.

​Alana Newman
Narrator, Sexual Revolution: 50 Years Since Humanae Vitae
Founder, AnonymousUs.org and DealingwithDonorConception.com
Billings Ovulation Method® Instructor

​Erica and Kevin Jacobi with their four handsome boys

In this month’s spotlight we are featuring incoming board president, Erica Jacobi. We find Erica to have a very positive, upbeat personality and a can-do attitude!

Q.  First of all, congratulations on your new role as president of BOMA-USA!  What do you see as our opportunities and challenges in the next couple of years?

Thank you! Our previous board leadership has done so much to grow BOMA and develop us into a more polished organization, ready to support our network and grow the future of the Billings Ovulation Method® in the United States. Our opportunities and challenges going forward are one in the same. BOMA has a treasure to offer this country, but only if we can show that treasure to potential users. It is vital to make the Billings Method one of the methods that come to mind first when people think of natural, sustainable, and loving options for fertility awareness.

Q. Have you always been personally associated with Billings, or did you learn another method prior to Billings?

No, as a young woman I leaned a sympto-thermal method through my own research (aka Google!) and used that early in our marriage. Then after the birth of our first son, we struggled with accurate temperatures and ecological breastfeeding, which led us to Creighton. The Creighton Model quickly taught us how valuable having an NFP instructor is. The and the instructor’s support and willingness to answer detailed personal questions left us feeling far more confident than when we were self-taught. I’m a millennial, so Google is my go-to when learning something new. But I quickly learned the difference in success with having an instructor. That experience told me I wanted to be able to share that same confidence and become a teacher myself. My Creighton instructor encouraged me to investigate the Billings Method. After we saw its effectiveness, ease, and fit with modern day life, I was hooked.

Q.  What has your experience been like teaching Billings?

Teaching Billings has led me into new friendships. Making friends after the school-age years can be challenging! The small talk and looking for common interests are hard. How often do you meet somebody new and only talk about the surface-level topics? Talking about Billings requires deeper conversations about life and relationships. In a few meetings you share of your own life and theirs in topics you might not share as readily when meeting somebody new. Secondarily, as a teacher I get a front row seat to sharing in the joys and challenges in the lives of my clients, like navigating the struggles of delay in much wanted conceptions or sharing in the familiarization with the body’s changes postpartum and in times of change. Or conversely, there have been many times when I’m the first to hear about a positive pregnancy test or get to share in conversations about life with a newborn.  Teaching Billings allows me to hold the hands of my fellow women as we journey through life.

Q.  What words of encouragement would you give to someone who is thinking about becoming a teacher?

So many of us are already talking about birth control, spacing babies, breastfeeding, and fertility in casual conversations. Why not do it with the authority of a certified instructor? Again, I thought I knew what I was doing when I was self-taught, but teacher training changed so much.

Q. What is your “real job” outside of volunteering with BOMA-USA? Tell us about your family. 

Oh my, which job do you want to hear about? I’m a wife to Kevin, and we’re parents to 4 boys under the age of ten. I also have a job I enjoy at Tyson Foods. I love that working with food is something that impacts the world on so many levels and is always relatable. From the farmers to families, everybody is impacted by our food system.
We're a busy family of 6 living in northwest Arkansas. We work our way through the same challenges other Christian families face, trying to support each other's winding journey to sainthood. It's often everyday stuff. Sometimes, it means sticky messes and budgeting at home; other times, it takes the form of hiking or fishing in the beautiful outdoors. That support can even come from valuable alone time.

Q.  Looking forward, is there anything our teachers and/or general members can to do help us?

Participate! BOMA is offering a network for learning and fellowship, but I would love to see more participants join webinars, engage with BOMA on social media, and ask questions. You can start today by liking and sharing our Facebook page at https://www.facebook.com/billingsusa/ and forwarding this newsletter to your clients, friends, and family.

​After six years of dedicated service, Kristin Putnam, Eileen Wood, and Dr. John Worden are ending their terms on the BOMA board. These legacy members have been integral to shaping and maturing BOMA into the organization we know today. They’ve given us an invigorated, structured, passionate organization that the board and BOMA personnel are committed to continuing to cultivate. 
 
To help us continue the BOMA mission, we're excited to announce that two new board members, Christina Brown and Dr. Danielle Koestner, were nominated and, subsequently, appointed to the Board.
 
Christina (Christy) Brown and her husband, Paul, have been teaching the Billings Ovulation Method® since 2010. In describing her journey, Christy stated, “We liked how the method could stand on science alone. Billings is a strong witness to those coming to NFP from the natural/science side of things. We also believe it can open the door to the students thinking about the moral aspects of NFP and encourage them to grow in their faith.” Among her many talents, she is interested in supporting BOMA and finding ways to grow our teacher support network.
 
Dr. Danielle Koestner and her husband, Kyle, have been teaching Billings together for the last 6 years. She is a family doctor, which includes a lot of gynecological care. She brings a valuable physician perspective to the board and has a passion for making sure patients have easy access to fertility knowledge and charting support. She has taken the medical management seminars and has fully integrated FABMs into her medical practice for all women from menarche to menopause.
 
Please join us in celebrating those who have served and those who are just beginning to serve in a new capacity.