The power of placebo: woman manages to stop bleeding between periods

UPDATED: Lead researcher in study weighs in on results, as patient says she used the power of her mind to stop the side effects of the contraceptive implant, Implanon.

Smiling woman looking away while waiting at bus stop

Smiling woman looking away while waiting at bus stop Source: AAP

Within days of Michelle Wallace having the contraceptive implant, , medically inserted into her upper arm, the bleeding started.  

Spotting between periods is a common side effect of the implant, which progressively releases a progestin hormone as a method of birth control.

For Michelle, she found she was bleeding an unbearable 20 days out of 30 during her usual cycle.

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“I definitely wanted to take it out, straight away,” she says, but her doctor recommended she keep it in for 3 months to allow her body to acclimatise to the implant and resume its normal cycles.

After 4 months of almost continuous bleeding, she was unconvinced and made plans to see her doctor again for its removal.

“It was all just too much trouble.”

 
Insight guest Michelle Wallace
Insight guest Michelle Wallace Source: SBS


Before she could, a friend told her of  being run by a research collective, made up of doctors working in hospitals and universities  across Australia, including the University of Sydney, the Royal Women’s Hospital in Melbourne, the Sydney Centre for Reproductive Health Research and King Edward Memorial Hospital in Perth.

The trial would test drug treatments for episodes of bleeding between periods in women using Implanon.

It was a trial that would eventually stop Michelle’s side effects completely for two years.

No thanks to the drugs, however.

Michelle was given a placebo. 

Mind over matter

“For the first six months, it was actually quite hard for me,” says Michelle, as she kept a daily menstrual diary to create a history of what she was normally experiencing. “I had to just keep bleeding in the same way, for 20 of 30 days – for the next six months.”

She was then started on a series of one of five drugs over the following three months, taking them for five days of each month. The monitoring continued and the bleeding stopped.

Michelle was ecstatic.

“I’d gone back to having a regular period every 28 days, like every other normal person, with no spot bleeding in between.”

After another 18 months or so, she received a hard copy of her results in the mail.

She’d been on placebo drugs the whole time: simple pills of gelatin and starch.

“I was just blown away,” she says. “I knew there was a possibility that I could have been on a placebo … so I wasn’t totally shocked. I probably felt a little bit tricked.”

Mostly, she just marvelled at the results, “fascinated by how the mind works.”

And then, just 3 days later, the spot bleeding started again.

Michelle wasn’t having any of it.

“I guess I thought about it for about a week and thought, well, if the placebo worked on me I should be able to stop my bleeding as well. I kind of just told myself, ‘you don't need to bleed, you don't need to spot bleed, it's inconvenient’.”

I just told myself: you don't need to bleed.
“And it stopped again. Intermittently, but mostly stopped … It was really the power of my mind that stopped it to start with, I should be able to stop it again,” she says.

When asked by Insight’s Jenny Brockie, she said she hadn’t tried the method with anything else and attributes the results largely to her very positive attitude towards the trial in the first place.

into antidepressants and the placebo effect has shown that initial optimistic attitudes towards a study or medication can increase the likelihood of positive results when taken off the placebo.  

 

'Not uncommon to see improvements with placebo': experts

“At a bigger level, we now understand that the thing driving placebo effects is expectancy,” Ben Colagiuri, a University of Sydney researcher specialising in placebo, told Insight’s Jenny Brockie.

“Certainly we know in double blind randomised control trials where people get an active treatment or get a placebo, which is done all around the world all the time, the placebo group often substantial improvement.”

“It's not uncommon at all to see improvement in placebo arms of clinical trials.”



Insight contacted the  – the research arm of NSW Family Planning – and they confirmed Michelle’s involvement in the trial.

They were unable to confirm whether she had been given a placebo, as the nature of a double blind randomised study means the patient's file cannot be unsealed unless they are experiencing severe adverse side effects.

Lead researcher, Associate Professor Edith Weisberg, noted that the results of the study indicated Michelle's experience was more likely one where the bleeding stopped naturally. 

The study showed that there was little difference in the reduction of bleeding between the group of patients who were given the placebos, and those given active drugs. 

"Certainly some people will get better on placebo, and 17.7% of the women in the study had a reduction in bleeding while on placebos ... but their bleeding would have settled down naturally," said Weisberg.

"I don't think her mind would have done that."

I don't think her mind would have done that.
Weisberg said that the whole point of the placebo was to show whether the bleeding would have stopped anyway without treatment, and that this was most likely the case with Michelle.  

"It was a coincident, because certainly we didn't find any treatment better than placebo." 

However, she acknowledged more information was needed about a variety of other factors in Michelle's life - particularly after she finished the trial and was told about her results - to fully account for her experience. 

Dr. Sarah McKay, also on the program, noted that Michelle’s case was “amazing”, but that it was hard to reconcile with existing knowledge about placebos – that they work better in subjective, emotional conditions rather than in more objective and measurable situations like Michelle’s.

“I guess there's so much we don't know about our brains,” she qualified. “Our knowledge of our mind and our brain is where astronomy was in the 17th century."

“We're only just starting to think about the neurobiology of the placebo and how fascinating it is and what we can do to harness that rather than dismissing it as an annoying part of a clinical trial.” 

 

Insight: | Repeated Wednesdays, 3:30pm, SBS or

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6 min read
Published 19 February 2016 at 5:47pm
By Madeleine King