Stephanie Vaz still finds it hard to recall the moment when she was first diagnosed with 22 liver tumors. The 34-year-old refers to what followed her tense wait for MRI results as a "complete and utter blur."
"Everything happened really fast," she told Newsweek. "I was told I had hepatic adenomas but I had no idea what that was, I had a look online and saw that it's something to do with the pill."
The doctors who examined Vaz suspected her condition arose from her long stint on the contraceptive pill, which she began taking at 18 and continued to for 16 years, after suffering from painful periods.
"I now have multiple tumors in my liver, 22 to be precise" Vaz said.
"I think that around one in a million people on the contraceptive pill develop these liver lesions, which are called hepatic adenomas. Then only 10 percent or so of those people go on to get multiple adenomas, which is what I have. I'm not in favor of taking the pill lightly anymore," she added.
Vaz, who is British and works as a trustee at a charity in London, was first diagnosed with "multiple hepatic adenomas" in December 2018. She now lives with the risk of each one of the tumors shifting from benign to malignant.
"There is a chance of these tumors becoming cancerous and I've got 22 of them. It takes only one, which is so scary," she explained.
Hepatic adenomas are benign tumors of the liver, according to Richard Semelka, a radiology consultant and former professor who now heads a medical consultancy firm in North Carolina. Adenomas are either monitored in the long term through scans, to ensure that they don't change or grow, or in more extreme cases surgically removed.
The medical consultant told Newsweek that hormonal birth control, the best known of which is the contraceptive pill, has been long linked to the formation of adenomas. "This is because it's widely assumed that adenomas are female hormone-induced tumors," Semelka said.
Indeed, Vaz believes her diagnosis "makes total sense," as more than 90 percent of adenoma sufferers are women and she had been on the combined contraceptive pill for so long.
Despite the connection made in hindsight, Vaz's adenomas turned out to be an accidental finding, after she was rushed to the hospital with appendix pain.
Doctors performed a CT scan on Vaz to determine the cause of her pain and were surprised to catch sight of a healthy appendix but 22 tumors in her liver. The diagnosis of "potential multiple hepatic adenomas" left the charity trustee's head spinning.
She was soon called into an oncology ward to meet with a specialist, who greeted her with a smile, and reiterated that the "good news" is that the tumors spotted in the scan did not appear to be cancerous.
However, their origins and impact on Vaz's health have had a profound effect on her ever since. The sheer number of adenomas in her liver have also stripped her of her eligibility for a resection, which is the surgical removal of the tumor.
Her consultants are now tasked with checking each of her tumors every four months for signs of malignant growth.
Her doctors are debating whether she could potentially undergo a liver transplant in the future after they've monitored the adenomas further for signs of shrinkage. Vaz herself is still undecided on the best cause of action.
Can the Pill Ease Painful Periods?
Vaz told Newsweek that she'd initially been placed on the combined contraceptive pill as an antidote to excruciatingly painful periods. Endometriosis was later found to have been the cause.
A biopsy of her tumors, in 2021, confirmed that the lesions in her liver were in fact adenomas and not cancer. She was swiftly advised to come off and stay off any sort of hormonal contraception.
There is a chance of these tumors becoming cancerous and I've got 22 of them. It takes only one, which is so scary."
Vaz has been torn over whether she should hold out hope for a liver transplant, or just live with the alternative hope that her adenomas won't increase in size.
"If these adenomas do not shrink, they could turn into cancer. When I met with a consultant last June, he told me that because it's been nearly five years since my initial diagnosis and I've not been taking the pill for a while, we should be seeing some shrinkage in the tumors," she said.
Vaz's tumors did not reduce in size which has concerned her doctors. They haven't grown either, which helps the 34-year-old stay positive that they could one day fade away.
"It was really scary and shocking to hear this because I'd been focusing on the fact that the tumors being stable is a good thing," she added.
Is the Pill Safe to Take?
It's not new for the effectiveness and safety of the contraceptive pill to be called into question. In March, researchers at the University of Oxford established a link between the progestogen-only pill and breast cancer, after this mode of the pill was long thought to be at little to no risk of triggering the disease. Links between the combined contraceptive pill (oestrogen and progestogen) and breast cancer predate the 2023 findings.
The National Cancer Institute (NCI) states that "an analysis of data from more than 150,000 women" who had participated in 54 studies showed that women who had used oral contraceptives had a 7 percent increased—described as "slight"—risk of breast cancer than those who had never used it. Women who were currently using oral contraceptives had a 24 percent higher risk.
This risk ratio declines once the user stops taking the pill. "No risk increase was evident by 10 years after use had stopped," according to the institute.
The NCI also points out that, "the risks of endometrial, ovarian and colorectal cancers are reduced" in women taking the birth control pill.
Dr. Semiya Aziz, a general practitioner in London, previously told Newsweek that most of the studies on cancer risk are observational and "unable to definitively establish the fact that exposure to the oral contraceptive may cause or prevent cancer."
The hepatic adenoma risk is, according to Semelka, much easier to ascertain.
"Stoppage of birth control pills is the general recommendation when diagnosed with an adenoma, which seems to result in arresting growth, but I have not observed regression of tumors with this approach," the medical consultant said.
Semelka continues to vouch for a connection between contraceptive pills and adenomas because, in his experience, he's only ever seen these tumors regress at the time of menopause which can indicate that they are directly influenced by female hormones.
While adenomas start off benign they can take a more sinister turn over time if any one of the tumors grows to surpass 5 centimeters (nearly 2 inches)—because that creates an increase in rupture and malignant transformation—which can lead to cancer.
A Closer Look at Hepatic Adenomas
Dr. Shoshana Ungerleider is a board-certified internal medicine physician and the Host of TED Health. She holds particular expertise in reproductive health and tumors.
"Hepatic adenomas are rare, benign liver tumors that primarily occur in women of childbearing age," she told Newsweek, adding that patients with glycogen storage disease or obesity were at a higher risk of developing them.
"When they occur, they are often associated with the use of oral contraceptive pills. The exact process of how oral contraceptive pills lead to the development of hepatic adenomas is complex, but it is believed to be related to their estrogenic or hormonal effects.
"The liver plays a key role in hormone metabolism, and increased exposure to estrogen or similar substances over a prolonged period can alter normal liver cell activity. This hormonal alteration can trigger increased cellular proliferation and abnormal growth patterns, eventually leading to the formation of an adenoma," she added.
According to the San Francisco-based doctor, the risk of developing hepatic adenomas increases with the duration of oral contraceptive use and the dosage of estrogen in the pills.
This would put someone like Stephanie Vaz, who'd been taking her prescribed pill for over 10 years, at a greater risk of developing hepatic adenomas than an individual who'd only been on the pill for one year.
"It's also worth noting that these adenomas can potentially lead to serious complications, such as hemorrhage or malignant transformation, although these are rare," Dr. Ungerleider said.
What Are the Risks of Taking the Pill?
The adenomas' likely emergence due to the pill has haunted Vaz ever since she first became aware of it back in 2018.
"No general practitioner ever told me that this could be a side effect of the pill. It's just not spoken about at all," she said.
"The answer for everything seems to be: 'we'll just put you on the pill.' Even my sister who suffers from acne was offered the pill," she added.
Vaz told Newsweek that when her sister responded to the prescribing doctor that her sister who'd been a long-term user of the pill was suffering from adenomas, they brushed her concerns off by saying that adenomas are "very rare."
Between 2015 and 2017, 64.9 percent of the 72.2 million women aged between 15 and 49 in the U.S. reported being on contraception, the National Survey of Family Growth found. During that period, the pill was one of the most common contraceptive methods used, with slightly over 12 percent of women taking it.
The U.S. Office on Women's Health states that the combined pill, first approved in 1960, can have side effects including headaches, upset stomachs, sore breasts, period changes, mood changes, weight gain and high blood pressure. "Less common but serious risks include blood clots, stroke and heart attack; the risk is higher in smokers and women older than 35," it adds.
Its newer iteration, the progesterone-only tablet, can have side effects including irregular, weight gain, sore breasts, headaches and nausea, according to the office, which is part of the Department of Health and Human Services.
"It's something that needs to be monitored," Vaz added. "Sadly, I think that it's very easy for doctors to just throw medicine at women but not care about the side effects that we may go through."
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Uncommon Knowledge
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Newsweek is committed to challenging conventional wisdom and finding connections in the search for common ground.
About the writer
Melissa Fleur Afshar is a Newsweek Life and Trends Reporter based in London, United Kingdom.
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