Joanne symptoms and conditions

Can Statins Cause Chronic Low-Grade Myopathy?
Statins (hydroxymethyl glutaryl coenzyme A reductase
inhibitors) are highly effective drugs for reducing serum
cholesterol and low-density lipoprotein cholesterol levels.
Clinical trials have shown that they also reduce risk for
coronary heart disease events, coronary procedures, and
stroke by about one third (1). Millions of people in the
United States and worldwide are being treated with statins.
In clinical trials and in clinical practice, statins have proved
to be remarkably safe.
The one notable side effect of statin therapy is myopathy.
A small fraction of patients who are treated with
statins will develop severe myopathy (2). In the worst cases,
severe myoglobinuria, acute renal failure, and even death
can occur. The incidence of severe myopathy is low, perhaps
1 in 1000 patients (2). Predisposing factors for severe
myopathy appear to include advanced age, relatively low
body weight, female sex, certain medications, use of multiple
medications, multisystem disease, and acute illnesses
or major surgery (3). If statins were avoided or used in low
doses in these circumstances, it is likely that the incidence
of severe myopathy could be greatly reduced.
Less severe forms of myopathy undoubtedly occur. In
some patients, fatigue and muscle pain and weakness develop
with moderately high serum creatine kinase levels
but not acute renal failure. In these cases, the myopathy
resolves when statin therapy is discontinued.
Still more patients report various muscle symptoms—
fatigue, pain, and muscle weakness—but have normal creatine
kinase levels. These symptoms probably are unrelated
to statin therapy in many patients. In middle-aged and
older people, muscle, joint, and tendon symptoms are very
common. Naturally, if a patient takes a medication that is
believed to produce muscle problems, symptoms are often
attributed to the medication. On the other hand, the major
controlled clinical trials have not detected a higher prevalence
of muscle symptoms during statin therapy versus placebo
(1). This failure of detection has generally led clinical
trialists to conclude that statin-associated myopathy with
normal creatine kinase levels essentially does not exist or
that, if it does exist, it cannot be detected above the “background
noise” of muscle symptoms in the general clinicaltrial
population.
Many physicians in clinical practice nonetheless believe
that they can identify a subset of statin-treated patients
who have a unique set of statin-related muscle symptoms.
Some patients clearly relate the onset of muscle
symptoms to initiation of statin therapy. These symptoms
may abate after discontinuation of therapy, only to reappear
when statin therapy is restarted. The number of such
patients is not large, and thus it may have been impossible
to identify them in large clinical trials.
In this issue, Phillips and colleagues (4) report on a set
of studies in four patients who had muscle symptoms during
statin therapy that resolved during placebo use. Quantitatively
measured muscle weakness also resolved during
placebo use. Muscle biopsies were performed in three patients
during statin therapy and then during placebo use.
Several pathologic changes were seen on biopsy specimens
obtained during statin therapy: increased lipid content of
mitochondria, fibers that did not stain for cytochrome oxidase
activity, and ragged red fibers. The authors suggest
that these patients had statin-associated myopathy with
normal serum creatine kinase levels.
Despite the study’s small size, we cannot dismiss these
observations as random variation in muscle structure.
However, these highly suggestive results are clearly preliminary.
The number of patients was small, and all appropriate
controls were not used. Nonetheless, this study is novel
because it used quantitative measures of muscle strength
and muscle biopsy to address the question of myopathy
with normal creatine kinase levels during statin therapy.
To be confirmed, the current data would have to be
extended to many more patients in whom muscle symptoms
are closely correlated with statin use. Reproducibility
of symptoms during therapy and symptom resolution after
discontinuation of statin therapy would be necessary. A
definitive study would have to be carefully designed and
executed. It would need to be double-blinded and placebocontrolled
and include sufficient numbers of patients to
provide a valid statistical comparison. In addition, investigators
would have to carefully consider the appropriate
selection of patients. The development of a registry of candidate
patients at multiple sites could facilitate a multicenter
study.
Is a carefully controlled, sizable study of this type
worth the investment of time and effort? To date, no evidence
indicates that prolonged statin therapy leads to permanent
muscle damage or progressive myopathy in patients
with normal creatine kinase levels. Controlled
clinical trials attest to the general safety of statins, and
symptomatic side effects appear to be limited to a relatively
small proportion of treated patients. In addition, no therapy
prevents or treats statin-induced myopathy, short of
withholding the drug. On the other hand, statins are being
prescribed to millions of people, and are usually continued
throughout the patient’s lifetime. It is certain that statins
cause myopathy in some patients. For these reasons, a valid
argument can be made for a more extensive study of lowgrade
myopathy in patients treated with statins.
In the meantime, physicians should recognize the great
benefit of statin therapy in high-risk patients and their
documented safety for most patients. For high-risk persons,
the proven efficacy for preventing cardiovascular disease
outweighs the unlikely possibility of permanent muscle
damage. Phillips and colleagues’ preliminary results
certainly do not provide adequate information on the spec-
Editorial
www.annals.org 1 October 2002 Annals of Internal Medicine Volume 137 • Number 7 617
trum, scope, or prognosis of myopathy with normal creatine
kinase levels during statin therapy. For these reasons,
prescription of statins for eligible patients should continue
despite the current results. Moreover, before discontinuing
therapy, physicians should carefully evaluate any patient
receiving statins who reports muscle symptoms. In most
cases, the symptoms will be found not to be consistent
with chronic myopathy, and often they will not be related
temporally to statin treatment. High-risk patients in particular
should not be deprived of major cardiovascular risk
reduction just because they display symptoms not clearly
documented to be closely related to statin therapy.
Despite these comments, the actions of statin on muscle
metabolism and structure deserve further investigation
to clarify the confusing area of low-grade myopathy apparently
associated with statin use in a few patients.
Scott M. Grundy, MD, PhD
University of Texas Southwestern Medical Center at Dallas
Dallas, TX 75390-9052
Current Author Address: Scott M. Grundy, MD, PhD, Center for
Human Nutrition and the Departments of Clinical Nutrition and Internal
Medicine, University of Texas Southwestern Medical Center at Dallas,
5323 Harry Hines Boulevard, Y3.206, Dallas, TX 75390-9052.
Potential Financial Conflicts of Interest: Honoraria (from Merck &
Co.; Pfizer, Inc.; Bristol-Myers Squibb; and Bayer); Grants (from Merck
& Co. and Pfizer, Inc.)
Ann Intern Med. 2002;137:617-618.
References
1. Executive Summary of The Third Report of The National Cholesterol Education
Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment
of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;
285:2486-97.
2. Staffa JA, Chang J, Green L. Cerivastatin and reports of fatal rhabdomyolysis
. N Engl J Med. 2002;346:539-40.
3. Pasternak RC, Smith SC, Bairey-Merz CN, Grundy SM, Cleeman JI, Lenfant
C. ACC/AHA/NHLBI clinical advisory on the use and safety of statins (1)
(2). J Am Coll Cardiol. 2002;40:567-72.
4. Phillips PS, Haas RH, Bannykh S, Hathaway S, Gray NL, Kimura BJ, et al.
Statin-associated myopathy with normal creatine kinase levels. The Scripps Mercy
Clinical Research Center. Ann Intern Med. 2002;137:581-5.
© 2002 American College of Physicians–American Society of Internal
Medicine
Editorial Statins and Low-Grade Myopathy
618 1 October 2002 Annals of Internal Medicine Volume 137 • Number 7 www.annals.org

I'm so glad I googled side effects of Yasmin and found this site. All of the sudden my mood swings for the past almost YEAR make sense. I started out fine. The pill was great, and I haven't had to worry about acne at all. Of course I gained a few pounds, but not too much. However, I'm a pre medical student trying to study for the MCAT this summer. I've been SO tired and drained and majorly depressed that I just can't seem to concentrate. I feel like I'm always crying over the stupidest stuff (AKA: no reason at ALL), and my grades are starting to suffer. Hopefully now that I've read this, I can stop taking this pill and see an improvement. It's just not worth the depression. I'm 22 right now, and until recently had never had a suicidal thought. I was starting to panic, because I couldn't identify the cause of my depression. I'm a good student, have lots of friends, and have the most amazing boyfriend and family. Life is good, I shouldn't feel this bad. Now that I have a clue as to what this may be, I can fix it.

I have a six year old son who has asthma. He has been taking singulair and Flovent every day for 4 years. He also has a lot of the side effects that I see listed on this site. I was wondering if anyone with children taking Singulair have more cavities than their other children. My son with astham is the youngest of four child and last week we found out he had four cavities. One was so bad he needed root canal. Fortunately, these were all baby teeth. My destist said it is because he does not floss since the cavities started between teeth. Most moms I spoke to said their kids do not floss and never had a cavity! I'm just wondering if there is a connection between cavities and Singulair
Joanne

I started Aromasin 3 months ago - only one side effect- significant loss of hair.

Gwen
My boobs also grew a cup size possibly more, I have now been of the pill for 5 months and unfortunately they have dissappeared again, its not done them much good with growing bigger and now shrinking though, its quite depressing.
Stay of Yasmin, we can put things in our bras, we go through hell and back to get rid of these horrible side effects, its not worth it.

Joanne.

UPDATE

Hi ladies just thought I would give you an update. I have just received my ct scan results and they are fine.
I have been of Yasmin for 5 months and I have to say I am getting better yipeee, I never thought the day would come.
I had dizzeyness, heart palps, BAD anxiety (thought I had a brain tumour), numbness in left hand and arm, persistant headaches, shakes,
I know yasmin is coming out of my system because my PMT has returned, my boobs have shrunk and my spots have returned, but who cares I can handle all those over the HORRIBLE yasmin side effects.
I do get a LITTLE headache, and anxiety around ovulation and when I am having a period but it is NOTHING like what it was.

This HORRIBLE thing does work its way out of our bodies, hang in there.
Joanne.

Cristy

Keep a diary of them I found they were worse around ovulation and when I was due a period, you may notice a pattern.

Joanne.

To Cristy

I stopped Yasmin 5 months ago, 2 months ago I started to get headaches every day, I was very concerned I had a tumour, my headaches were in the back of my eyes and on the left and right back of my head like a tight band, I have since seen a neurosurgeon and he has assured me there is nothing wrong, I had a scan done and I am still waiting for the results. The only advice I can give to you is read up about anxiety and headaches, I found my headaches were through anxiety (tension headaches) and nothing I took for them worked, after weeks of persistent headaches they are finally easing. I worried about them every day and made things worse but the anxiety kept them there, when your anxiety eases you will notice your headches ease as well.

You will get better, the ladies on this site have told me I would get better and I am, it is slow but I am getting there and so will you.

Joanne.

Hormone tests

Hi ladies I had my testosterone, estradiol, DHEA and estrogene levels checked, my results have come back and the doctor said they are fine, how can I find out if this is true? I am picking the results up tomorrow.
I am also having a CT scan tomorrow so hopefully put an end to my paranoia of brain tumours and the anxiety will ease.

Joanne.

Hey ladies, Silke, Joanne and all of you out there suffering,

I recently went to a top notch endocrinologist after my gyne denied everything I complained about the yasmin. I asked him what he knows about yasmin. His answer " another form of bc out the the 35 brands available." I told him of my symptoms and he said it all makes sense. each body reacts differently and that it takes 6 months at least to get back in balance. I'm almost 5 months off yasmin. 1 natural period. My most severe side effects is weight gain and plummeting libido. Sometimes I feel the water retention will drive me mad. However some days are better than other which gives me some hope that I might still creep out of this unscathed in the future. Cheer up and keep your chin up everyone. There are better days ahead. Let's just support each other . As they say " all good things come to those who wait."
Sherry

Joanne,
I understand completely what you are going through. I have been off Yasmin for 6 mos and I thought I was going crazy for 5 months after stopping Yasmin in February. It was so bad, that I also told my family I felt like I had a brain tumor. Fortunately, women on this website helped me to see that it was the Yasmin that was causing my anxiety, panic, depression, mood swings, and feeling of being totally out of my mind at times. If you want to be sure you are healthy, you can always get a workup done with your internist, but I honestly think you're just suffering from a bad case of Yasmin. Hang in there because it does get better. I'm 6 mos Yasmin free and still have anxiety the week of my period, but it is way more tolerable and I am back to my normal life.
Take care and God Bless

joanne!!!
u do not have a brain tumour!! believe me i know what your feeling.... i was only on yasmin for a month and the anxiety started about 6 weeks after i stopped taking it. i went to hospital twice thinking i was having a heart atack but everything was fine. all you have to do is train yourself and your mind not to get nervous when u feel the anxiety coming on... at the start it is hard ur right but you will get better at it and eventually you will forget it altogether.
it will go away i promise you.... ive been off yasmin for almost 3 months now and it has improved alot. now that i know wat it is i can control it. just remember to breathe in deep when u feel it and try to keep your mind occupied so ur not always thinking about it....
i havnt taken any medication either and i feel better each day.... trust me its going to be alright you just need to give yourself time and keep telling urself its only yasmin thats doing it ....
it will be out of ur system eventually and life will go back to normal i promise...
take care and good luck xoxoxo

Need your help!

I have already left a few messages but I have had enough now. I stopped taking yasmin after 9 months and 7 weeks after stopping I started to get heart palpatations, panic attacks and anxiety. After finding this site I felt so much better as I found the reason why I didnt feel right, but the anxiety is driving me mad I am convinced I have a brain tumour silly as it sounds and I cant get the thought out of my head I keep telling myselve I dont feel right because of yasmin but it dont work, as I said before I do not want to go on mediacation as I have two children and next week I am going back to college, I really have had enough now I kept going to the gp and he said he would refer me to a neourologist but the appointment is not until 29th nov, I need to get this thought out of my head as it is really getting me down, any advice ladies??

Thankyou
Joanne.

To Joanne, and all the ladies,

Regarding the panic/anxiety attacks. im 22 and I was on yasmin for 1 month only and ive been off it for about 6 weeks.... i have had two anxiety attacks and ive been fully checked out by doctors who say medically im fine. Just wanted to let you know it will get easier as the days pass... i know you didnt want medication and i am NOT on anything either - i preferred to do this on my own..
when you feel anxious just try taking a big deep breath in and hold it for about 3 seconds and just let it out slowly.... just concentrate on ur breathing and you'll get through it. i find that keeping busy takes my mind off it..
and remember that one day everything will be back to normal, you just gotta give ur body a chance to get your hormones back into wack.
take care...hugs to every1 xoxox
chrissy xox

THANKYOU

Just wanted to let you all know how much better I feel from reading your posts, I feel better knowing that I am not alone and not going mad, the anxiety is driving me up the wall but I now know that I will get better.
To the lady who said how anxiety makes her feel about her little girl, I understand I am the same and it is a shame because I cant even let the kids play normally I keep thinking they will have an accident, I have a little pool out and watch them like a hawk incase they drown bear in mind it is not even up to my sons knees and he has been going swimming for over two years now, well hopefully we will all get better soon.

Thankyou
Joanne.

I left a message on sat 27th Aug about anxiety/panic attacks, I now realise that this is due to me stopping Yasmin, I was fine on this pill but 7 weeks after stopping I got these problems.
Is there any advice for me to help my anxiety as I have two children aged 6 and 8 and I do not want to go on medication and is there anything out there to help us get a little back to normal???

Joanne.