Birth Control: What You Need to Know

According to the CDC, over 9 million women in the United States are currenty taking birth control pills. That means that over 9 million women are at risk for a blood clot, but may not know it.

Birth control is a powerful medication that many people benefit from. It prevents unwanted pregnancy, treats polycystic ovary syndrome, lowers the risk of some cancers, and more. However, women who are prescribed hormone-based contraceptives often aren’t educated properly about their risk of blood clots.

According to Dr. Gregory Piazza, a cardiovascular medicine specialist at Brigham and Women’s Hospital, this missing knowledge stems from misconceptions among the doctors who often prescribe birth control.

“When you think of lack of knowledge, you think ‘patients.’ It’s true, patients probably don’t know. But, it’s actually providers who don’t often times associate the risk of the birth control pill with blood clots because patients are so young,” he explained. “There’s that lack of knowledge and, if the doctors don’t teach patients, then patients don’t know either.”

Why is birth control a risk?

The estrogen in birth control is what interacts the body and increases the risk of blood clots occurring. Estrogen can be found in many different forms of birth control including the patch, the ring, and the pill.

“The birth control usually has estrogen in it. Most women take birth control in the form of a combination pill that has estrogen and a form of synthetic progesterone. The progesterone component helps with acne and moods. The estrogen is what takes control of the menstrual cycle and keeps it regular, but also is what keeps you from getting pregnant when it’s taken in a systematic fashion with the progesterone,” explained Dr. Piazza.

“To really control the menstrual cycle, you need doses [of estrogen] that are a bit higher than what your body usually makes,” he said. “There’s something about that higher dose or type of estrogen that increases the risk of making blood clots. Estrogen itself increases the risk of making blood clots, even when women are pregnant. If you look at lifetime risk of blood clots, it goes up at puberty and stays up until a woman goes through menopause. For men, it’s flat until 35 or 40.”

How can you lower your risk?

If you’re on birth control, you can minimize your risk for a blood clot by avoiding other risk factors. Some risk factors, such as being overweight and smoking, are within your control.

“When people are obese and use birth control, or they smoke and use birth control, they’re adding not just one risk factor, the birth control, but they’re adding it on top of these other risks,” Dr. Piazza explained. “Don’t smoke. If you’re overweight or obese, try to achieve a healthier body weight.”

If you are on birth control and you need surgery, it’s important that your doctors know about your blood clot risk.

“If you’re going through surgery, or you’re going to be on bed rest for something, or you have a trauma, make sure people know you’re on the birth control pill,” advised Dr. Piazza.

If you do have uncontrollable risks for a blood clot, such as genetic risk, you may want to avoid estrogen-based birth control methods all together.

“Some people have genetic tendencies towards blood clots that would never cause them to have a blood clot, until they do one thing to tip themselves over and the birth control pill could be that thing,” he explained. Alternatives to estrogen-based birth control include the progestin and copper IUDs and progestin-only pills. They may be a good option for you, if you’re at risk for a blood clot.

Some patients, Dr. Piazza advised, shouldn’t be on any form of estrogen treatment if they have a history of clotting.

“If you’ve had a blood clot before, you probably shouldn’t be on an estrogen-based contraceptive” he explained. “If you’ve got a strong family history, you’d want to think twice and possibly use something that’s not estrogen. If you have a known clotting disorder…you’d want to at least have a conversation about alternatives to estrogen.”

Each patient has different risk factors for blood clots. You should speak with your doctor to decide what treatment is right for you.

Jess’ Story

Jess Roland was only 23 when her experience with DVT and PE began. She first developed blood clots in her leg. Then, while waiting for treatment, two of the clots broke off and moved to her lungs.

At the time, she was on birth control and had recently had surgery on her knee cap.

“They never really said anything to me about blood clots being a possibility,” Jess said, describing the situation. “I didn’t even know what a blood clot was.”

The day after her surgery, she started to feel pain in her leg but believed it was normal post-operative pain. She had her father, an infectious disease specialist, check her knee, but she had no physical symptoms of a blood clot. Then, several days later, Jess’ foot turned purple.

“I went to get in the shower. I looked down, took my sock off, and my foot was purple,” she explained. “My dad came over and said, ‘You probably have a blood clot.’”

“It was probably the most excruciating pain I’ve felt in my entire life. I really hope childbirth is less than that,” Jess joked. “It feels like someone is just squeezing everything in your leg as tight as they can. You have no feeling.”

While waiting to see a hematologist, Jess started to have difficulty breathing. At first, she thought she was experiencing a panic attack, but it was actually the development of her PE.

“I couldn’t breathe. I could not catch my breath,” she explained. The doctor she was waiting to see immediately recognized her symptoms and wanted to call an ambulance. However, Jess didn’t comprehend the serious nature of her condition and wanted to drive to the hospital.

“No, no,” she protested. “That’s too much drama for me.”

It wasn’t until she almost passed out that Jess let them call the ambulance for her.

Jess received anticoagulation treatment for six months after her experience.

Today, Jess is 29 years old and has not been on birth control since. She shares her story with those around her in order to raise awareness about DVT and PE.

Looking back at her experience, Jess sees her blood clots as a blessing.

“I really don’t see it as ‘I’m a victim,’” she explained, emphasizing how lucky she feels to have survived her experience. “All of my doctors after pulled me aside and said, ‘You really shouldn’t be here.’”

“I’ve got an angel watching out for me,” she said. “It really opened my eyes to the person I always wanted to be. I was so young, not sure of myself and who I was and what I was going to be in life. It propelled me into who I am, and I really like who I am as a person.”

“I’ve chosen to never see myself as a victim, but more of a champion of my story,” Jess remarked.

Jess shared her whole story with in order to raise awareness among other young women.

Birth Control May Be a Clotting Risk, But So Is Pregnancy

While it’s important to know that birth control causes an increased risk for developing blood clots, it’s also important to acknowledge how beneficial it can be. Birth control is used to treat unpredictable menstrual cycles, migraines, bad acne, endometriosis, and more. It can also reduce a patient’s risk of developing ovarian cancer.

“Millions and millions of women use birth control with estrogen successfully and never have a problem,” stressed Dr. Piazza. “The point of talking about this is not to scare women out of birth control. It’s to help them understand a risk that, while tangible, should not prevent women from using something that has a lot of health benefits.”

For many women, the alternative to birth control can be pregnancy. Pregnancy itself carries a much higher risk of blood clots developing than birth control does.

By knowing the risks that birth control carries, patients can empower themselves to make the best health decisions possible for their own unique circumstances.

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