Blood Clots, Birth Control and Being Aware

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Whether it is arsenic in your apple juice, or blood clots from taking birth control pills, it is always disconcerting to hear that something you thought was safe may in fact be risky. The drospirenone clot issue first came to light in May 2011 when two studies suggested that drospirenone, one of the hormones in Yaz, Yasmine, BeYaz and generic equivalents, might increase the risk of a life-threatening venous thromboembolism, a clot that forms in blood vessels and then breaks off and travels to other parts of the circulatory system, potentially causing a stroke or heart attack. Many other studies did not show such an association, which is why the FDA decided to review all the data and determine if there was reason for concern.

An FDA committee met and decided that drospirenone may have a slight increase in risk over other pills, but the data was not conclusive enough to tell women to stop taking drospirenone products or to pull them off the market.

All hormonal contraceptives with estrogen will increase the risk of blood clots, particularly in women who are smokers or who are obese. Additional risk factors include a genetic predisposition to blood clots, recent surgery, cancer and/or prolonged immobilization. Fortunately, blood clots in young women are very rare, which is why knowing the actual numbers helps to keep things in perspective.

  • The likelihood of a blood clot if not on birth control pills is two to three for every 10,000 women
  • The likelihood of a blood clot when taking birth control pills is three to nine for every 10,000 women
  • The likelihood of a blood clot during pregnancy is 5-20 for every 10,000 women
  • The likelihood of a blood clot post partum is 40-65 for every 10,000 women

Clearly, anyone can develop a blood clot, but it is far more likely during pregnancy or after delivery than while taking contraception. Also, most clots occur in the first few months of pill use, so women who have been on pills for years are at significantly lower risk.

Ultimately, the FDA concluded that the benefits outweigh the risk and since the data is not conclusive, the FDA is not currently recommending that women stop taking drospirenone products. The only outcome of the meeting is that, in a move similar to the European counterpart to the FDA, product inserts will now reflect the concern.

When No Period Is No Problem

 

By Lauren Streicher, MD

 

When the pill was first released for use as a contraceptive in 1960, it was prescribed to include a hormone-free week in order to ensure a normal menstrual period. The scientists that invented the pill felt that in spite of the nuisance factor, maintaining a normal menstrual cycle would make women comfortable taking this new form of contraception. The truth is, there is no medical benefit to that week off, and there are a number of advantages (beyond wearing white pants without fear) to skipping the pill-free days and instead take an active pill up to 365 days a year.

The obvious benefit is that no period means no cramps, no menstrual headaches,  and no making a midnight run to buy tampons! Women who are anemic from heavy periods may particularly benefit. Eliminating the hormone-free week also dramatically decreases the chance of an inadvertent pregnancy that can occur if a new pack of pills is started late. The idea of eliminating periods by taking pills continuously is not a new concept. For over 20 years gynecologists have recommended continuous rather than cyclic use of birth control pills to eliminate painful menses in women with endometriosis. What’s new is the notion that menstrual suppression is an option driven by patient preference and convenience rather than medical indication.

Many women, when asked, think it is unnatural and unsafe to not bleed monthly, which is why the majority of women who use hormonal contraception take three weeks of hormones followed by four to seven hormone free days to bring on a menstrual period. While a monthly period may seem “natural,” what nature really intended was for women to be pregnant or nursing as much as possible and have relatively few periods. Consider that prehistoric women experienced only 50 menstrual cycles in a lifetime (due to shorter lifetime and increased rate of pregnancy) as opposed to the approximately 450 menstrual periods experienced by most women today.

With the average woman spending over 2,000 days of her life bleeding, it’s no surprise that according to a Harris poll, a majority of women would eliminate or decrease the number of their menstrual periods if safe to do so.

Currently, many new forms of hormonal contraception are packaged this way, and the expectation is that this trend will continue. I predict our granddaughters will want to hear about the “olden days” when women who were not trying to get pregnant still got a period.

So if you take birth control pills, try skipping the hormone-free days. People who use a NuvaRing may also be able to skip the ring-free week and replace one ring with another after 3-4 weeks.

Buying those extra couple of packs every year can be expensive, but you can more than make up for it in the money saved in pads, tampons and pain medication!

Origianlly published Jan, 2014 DoctorOz.com