Blot clot in leg


What Every Woman Needs to Know About Blood Clots

by Varci Vartanian – Reproduced with Permission – Originally Published in the Daily Muse April 8, 2012

Kate, a 28-year-old development professional, was uploading snapshots of Mai Tais and Maui sunsets from her Hawaiian honeymoon when she noticed a pain in her calf that felt like a pulled muscle. At night, the pain was so intense that it woke her up, so she went to an orthopedic surgeon who ordered a scan.

The test didn’t show any issues, so she forgot about it, until seven months later, when the newlyweds hopped a plane to San Francisco. On the return layover, Kate exited the plane, felt dizzy, and passed out in the terminal. The alarmed couple rented a car and drove back home to North Carolina, where she saw a doctor again. He chalked it up to dehydration.

Then Kate started experiencing something new on her daily five-mile walks: “I was kind of short of breath. Since it was my first summer in North Carolina, I thought it was allergies or maybe that I was out of shape—so I would go extra hard on the elliptical machine.” She didn’t share her symptom with anyone and soon became preoccupied with packing for a family trip to Alaska and Seattle.

As she waved hello to Starbucks’ stomping grounds from the Space Needle, Kate was completely unaware of the killer in her right calf. A massive blood clot, or deep vein thrombosis (DVT), had formed in her lower right leg and was releasing smaller clots that were traveling to her lungs.

These blood clots in the lungs, called pulmonary emboli (PE), “can be life-threatening and in 10-15% of cases, cause sudden death,” says Dr. Jack Ansell, MD, hematologist and member of the National Blood Clot Alliance’s Medical & Scientific Advisory Board. “The first sign of a PE can be death.”

As the trip progressed, Kate had an increasingly difficult time catching her breath. She couldn’t shake the feeling “that something was wrong,” but boarded the plane with a pack of M&M’s and told herself everything would be OK.

Mid-flight, she got up to use the bathroom and collapsed in the middle of the aisle. A group of firemen on board gave her oxygen, and upon landing, an ambulance whisked her to an Atlanta ER where she was diagnosed with dehydration and vasovagal reaction (a fainting episode). She immediately flew back to North Carolina and scheduled an urgent doctor visit. As she prepped for her appointment, she collapsed again after climbing the stairs.

“I called 911, and the didn’t think anything major had happened,” she recalls. “They said, ‘wait until your husband gets home and he can take you to the doctor.’”

Luckily for Kate, a mother’s instinct was on her side. Her mom (a nurse) suggested that a blood clot might explain Kate’s mystery malady. Her doctor ordered a V-Q scan (a specialized lung test), and found multiple PEs in both lungs. Kate—a healthy young woman whose only risk factors were a series of flights longer than five hours and the daily birth control pill she popped—was in danger of having a heart attack.

Although Dr. Ansell states that the actual frequency of DVTs is low in young people, he emphasizes that it’s essential to know about the risk. “This should not be called an epidemic, but about 100,000 people die each year as a result and there are upwards of 500,000-600,000 cases per year.”

Take a lesson from Kate’s story, and read on for what you need to know.

Acquaint Yourself With the Symptoms

Kate was lucky to escape with her life, but knowing the warning signs could have gotten her more immediate medical attention. Shortness of breath, chest pain (particularly with deep breathing), coughing up blood, persistent leg pain, or redness, swelling, or warmth in your lower legs (usually one-sided) can all be indications of a blood clot in the legs or lungs, and should never be ignored.

And, give yourself a break already. “Women tend to beat themselves up about losing weight,” she says. “But, if you’re short of breath, it may not mean you’re out of shape. Know the signs and symptoms—you are your own best advocate.”

Get to Know Your Meds (and Your Family History)

Using estrogen-based birth control (pills, patches, and rings) comes with a risk of blood clots, though it’s relatively small. “The overwhelming majority of women on birth control pills do not have problems,” says Ansell.

But, it’s important to note that smoking, being obese, or having a family history of clotting disorders while you’re taking estrogen can all increase the risk.

Check your family tree for clotting disorders before your next appointment for hormonal birth control—and communicate the findings with your doctor. The most common inherited disorder leading to blood clots is Factor V Leiden, which is typically suspected in “individuals who develop blood clots at a young age, who are white with European ancestry, have a family history of clots, or have blood clots in unusual sites,” says Ansell.

If you’re already on estrogen-based birth control, burn the list of DVT and PE symptoms into your brain. And if you feel strongly that something is amiss—trust your instincts and see your doctor.

Wiggle Your Way Across the Ocean

Those warnings you see in the back of airline magazines? They do warrant a few seconds of your attention. “Individuals who undertake long distance air travel (greater than five hours) and are relatively immobile have a slightly greater chance of developing a clot,” says Ansell. And, the possibility of travel-related DVT is amplified somewhat with pre-existing factors (like taking estrogen-containing birth control, pregnancy, or obesity)—however, it’s important to note that the overall risk of clotting with air travel still remains small.

Even so, if you’re traveling internationally or cross-country, it’s imperative to get out of your seat every hour and move. “Get in the habit of fidgeting when you’re sitting,” says Ansell. Point your toes downward and upward, make circles, and heck, even try spelling out the alphabet. The key is to keep the blood flowing.

And, although being well-hydrated (a.k.a. asking the kind flight attendant for ice water instead of extra ice for your vodka cranberry) is never a bad idea—there is no definitive evidence to show that dehydration increases DVT risk. Pushing fluids might, however, push you to get up more frequently to use the facilities, and reduce your risk that way.

While you don’t need to be overwhelmingly alarmed about your blood clot risk, you should definitely be aware. The bad news is that we’re talking about 100,000 deaths per year from blood clots, but the good news is that most of them can be prevented.

About the Author

Varci Vartanian is a jack (er, Jill) of all trades. After a successful career in healthcare, she traded her lab coat for her current position as chief temper tantrum tamer/play date consultant for her two-year-old. She also enjoys writing short stories, freelance magazine work, and carbohydrates.

Top things to know:

  • Blood clots aid in the healing process. Proteins in your bloodstream activate to form a makeshift plug—called a blood clot or thrombus—over an injury or hole.
  • Blood clots in veins and arteries can be dangerous, because they can partially or completely block the flow of blood.
  • Sometimes, clotting occurs in areas it’s not supposed to, and can cause damage. This is what happens in the case of Deep venous thrombosis (DVT).
  • People who use hormonal birth control methods have a higher risk of blood clots compared to people who don’t use them.

Hormonal birth control and blood clots

Hormonal birth control, like the pill, increases your risk of blood clots. If you’re interested in using hormonal birth control, it’s important to understand your personal risk. Your risk changes with age and with the development of certain medical conditions, but most premenopausal people have a low underlying risk of developing clots.

What your healthcare provider might say

People who use hormonal birth control methods that contain estrogen have higher risk of blood clots in comparison to people who do not use hormonal methods, but the overall risk is still very low among most people using hormonal methods. Types of birth control that contain estrogen are called combined hormonal contraceptives and include the combined-hormonal pill, the ring, and the patch.

Birth control methods that only contain a progestin (synthetic progesterone) probably do not increase a person’s risk of blood clots, but this may depend on the method.

Blood clots are very rare among people who are not pregnant and are under 45 years old—even among those who use estrogen-containing birth control. The risk of blood clots is comparatively very high among pregnant people and people who have recently given birth. It’s important to balance the risk of blood clots and other negative side effects with the benefits of estrogen-containing birth control.

Here’s why it’s tricky

The amount of estrogen and the type of progestin in a form of birth control probably affects the risk of blood clots. There have been many formulations of the combined-hormonal pill since it was developed in the 1970s, and so studies done at different time points and among different populations have found different results. They generally all find an increase in risk, but the size of the risk differs among studies and among the different types of pills.

The patch, ring, and progestin-only forms of contraception, like the contraceptive shot and hormonal intrauterine device (IUD), have not been studied as much as the combined-hormone pill. It is thought the patch and ring increase the risk of clots, but more research is needed.

Most forms of progestin-only contraception are not associated with increased risk of blood clots. The contraceptive injectable or “the shot” may be associated with increased risk of blood clots, but more studies are needed.

Here’s what the research says about each birth control type

What are blood clots, anyway?

Blood is transported throughout the body through a series of tubes known as blood vessels. When blood is moving away from the heart, these vessels are called arteries, which bring oxygen-rich blood from the lungs (via the heart) to the entire body. Once this blood has reached its destination, gas exchange occurs across blood vessels (known as capillaries) with the surrounding tissue, and the now de-oxygenated blood returns to the heart through blood vessels known as veins.

In a healthy body, blood stays within this vast network of blood vessels, and is not free flowing under your skin. It’s a very controlled system. If any injury or breakage occurs to a blood vessel, there is a safety system in place to patch any holes up quickly and effectively—this is called clotting. Think about when you get a cut: you don’t bleed indefinitely. Within minutes blood flow will slow and stop from your cut—this is thanks to clotting. Proteins in your bloodstream activate to form a makeshift plug—called a blood clot or thrombus—over the injury or hole. Blood clots can occur in both arteries and veins.

Sometimes, clotting occurs in areas it’s not supposed to, and can cause damage. Types of dangerous blood clots include:

  • Deep venous thrombosis (DVT): clots that form in the muscles, often in the leg
  • Pulmonary embolism: blockages in the arteries of the lungs caused by clots, often ones that started as a DVT

DVT and pulmonary embolism both fall into a category of conditions that are known as venous thombroembolism (VTE) (1).

Blood clots that travel to the brain or the heart can cause strokes or heart attacks, respectively.

(If you want more information on the types of blood clots and how frequently they happen, see the bottom of the article.)

Combined oral contraceptives (the pill)

Combined oral contraceptives (the pill) contain a form of estrogen and a synthetic progesterone (called a progestin). Premenopausal people using the pill are more likely to experience a VTE than premenopausal people not using hormonal birth control (2,3), but the overall risk is still small.

The estimates of the risk of VTE vary, but researchers think that premenopausal people using the pill age 15-44 are 1.5 to 7 times more likely to experience a VTE than premenopausal people not using hormonal contraception (2-6). People using the pill are also about 1.3 to 2.5 times more likely to experience a stroke or heart attack than those not using the pill (7,8). Some combinations of estrogen and progestin may carry a higher risk for stroke or heart attack (7,8), but more studies are needed.

Although this is a large relative increase, the number of people affected is still small. For example, in a large study using Danish health registry systems, the rate of VTE was about 4 in every 10,000 premenopausal people age 15-44 not using any form of hormonal contraception per year. In comparison, the rate among pill users of the same age group was about 4 to 16 per 10,000 per year (5), depending on the type of pill.

The amount and type of hormones in pills have higher risk of blood clots than others. As the amount of estrogen in a pill increases, so does the risk of all types of blood clot (3-7).

The risk of blood clot may also depend on the the type of progestin. Pills that contain the progestin levonorgestrel tend to have lower risk of VTE as compared to pills that have the progestins desogestrel, gestodene, drospirenone, or cyproterone acetate (3,6).

The patch, the ring, the shot, the IUD, and other forms of contraception

The contraceptive patch and vaginal ring are combined hormonal contraceptives, meaning they have both an estrogen and a progestin. Similar to combined hormonal pills, these forms of birth control may increase the risk of VTE and potentially stroke (7,9). The risks associated with this forms of birth control also may be higher than the risks for pills. A recent literature review found that those using the patch or ring may be at higher risk of VTE as compared to those using combined hormone pills, but there needs to be more research to understand if this is true (9).

Progestin-only contraception are birth control options that contain only a progestin, so it doesn’t contain estrogen. Progestin-only methods include the contraceptive shot (such as DMPA or Depo), the hormonal intrauterine device (IUD), the contraceptive implant, and progestin-only pills.

Less is know about the risk of VTE among users of progestin-only methods. It is currently thought that progestin-only pills, the implant, and the hormonal IUD generally do not increase a person’s risk of any type of blood clot or stroke (5,7,8,10).

In comparison to the other forms of progestin-only contraception, the contraceptive shot may increase risk of blood clots, particularly VTE; however, there have only been a few studies and not all of the findings agree on this association (10,11). More research is needed to see if these results are true or if they are due to another factor. For example, it’s possible that people who are advised not to use combined-hormonal methods due to their increased risk of blood clots may chose to use the shot (10).

Balancing the risks and benefits of hormonal birth control

Hormonal birth control has many benefits. For people having penis-in-vagina sex, one of the most important benefits is that it greatly reduces the risk of unintended pregnancy as compared to not using any form of contraception.

Pregnancy and the postpartum period (ie. the 12 weeks after delivering a baby) come with many risks, including increased risk for blood clots (12). For example, the risk of VTE among postpartum people is about 40 to 65 out of every 10,000 postpartum people per year (13). This risk is more than two times greater than the risk of VTE among pill users.

Some people are at increased risk of blood clots when using combined hormonal contraceptives. People who have multiple risk factors for clots, strokes and/or heart attack should avoid using combined hormonal contraceptives. These risk factors include having recently given birth, superficial venous thrombosis, hypertension, vascular diseases, migraines with aura, and previous DVT (14,15). People older than 35 and who smoke 15 or more cigarettes per day are also advised not to use combined hormonal contraceptives (14,15). Your healthcare provider will be able to tell you if combined hormonal contraceptives are safe for you to use.

It’s important for you to understand the risks and benefits of using hormonal birth control. You can use Clue to track changes to your body when using hormonal birth control to see if the benefits of using your method outweigh any concerns you have. More information on blood clots A blood clot can be superficial, which means the clot is in veins or arteries close to the skin surface, or deep, where the clot forms in veins and arteries in the muscles (1).

Blood clots in veins and arteries can be dangerous. They can partially or completely block the flow of blood. This is called ischemia. If a clot blocks the flow of blood to a major organ, like the lungs or heart, this can cause death. Clots and death due to clots are very rare among people younger than 45 years old.

Deep vein clots and clots in the lung

When clots form in the deep veins, it is called deep venous thrombosis (DVT). DVT often form in the legs, but they can form in other parts of the body too (1). Not everyone with a DVT will show symptoms, but the classic presentation is sudden pain in one leg or calf, pain on walking or standing, swelling, redness, and warmth in the area (1).

DVT can cause serious injury to the lungs if a piece of a clot breaks off from the DVT and becomes free to flow in the bloodstream. This is called an thromboembolus. If an thromboembolus continues to flow downstream of a vein, it’s path will be eventually stopped by the small blood vessels of the lungs and can block blood flow to that area. This is called a pulmonary (lung) embolism (blockage) and can cause symptoms of chest pain and trouble breathing, and can be life-threatening (1). DVT and pulmonary embolism both fall into a category of conditions that are known as venous (vein) thombroembolism (clot-blockage) (VTE).

VTE and serious complications from are very rare among premenopausal people age 15-44 (2). It is estimated that about 4 to 10 in 10,000 premenopausal people age 15-44 who are not using hormonal birth control experience a VTE in one year (16,17). The risk of VTE increases with age (5,16).

Strokes and heart attack from blood clots

Blood clots in the brain can cause a stroke. Blood clots in the heart can cause myocardial (heart) ischemia (decreased blood flow), which can cause a heart attack, also known as myocardial infarction. Blood clots in the brain and the heart are more rare than VTE events among premenopausal people. Less than 5 in 10,000 premenopausal people age 15-44 experience a stroke or a heart attack each year (7.16).

to track your health

Media hype blood clot risk of birth control pills

“Deadly risk of pill used by 1m women: Every GP in Britain told to warn about threat from popular contraceptive,” reports the Mail Online.

Combined hormonal contraceptives (or “the pill”) are in the news after letters were sent to doctors to tell them about the latest evidence on the risk of thromboembolism (blood clots) associated with combined contraceptives.

Unfortunately, most of the UK media overhyped the potential risk in their reporting. The Mail’s panic-maximising implication that 1 million women could be at risk doesn’t reflect the reality that only around 12 women per 10,000 taking combined contraceptives are thought to be at risk of having a blood clot in any given year.

The review reinforces the importance that women using combined contraceptives get clear, up-to-date information on the risks and benefits. Importantly, the review found that the benefits of any combined contraceptives far outweigh the risk of serious side effects, and that women who have been using them without any problems do not need to stop.

As Dr Sarah Branch of the MHRA, said: “Women should continue to take their contraceptive pill. These are very safe, highly effective medicines for preventing unintended pregnancy and the benefits associated with their use far outweigh the risk of blood clots in veins or arteries.

What is the latest information about the risk of blood clots?

No important new information on the safety of combined hormonal contraceptives has become available as a result of the recent review. The risk of blood clots with combined contraceptives has been known for many years.

Combined contraceptives contain synthetic versions of the hormones oestrogen and progesterone. It is the oestrogen hormone that is associated with the risk of blood clots, though the type of synthetic progesterone hormone used in the combined contraceptive can influence the risk to a certain extent.

The review found that:

  • the risk of blood clots with all combined contraceptives is small
  • there is good evidence that the risk of blood clots may vary between products, depending on the type of progestogen (synthetic progesterone hormone) they contain
  • combined contraceptives containing levonorgestrel, norethisterone or norgestimate (types of progestogen) have the lowest risk of blood clots
  • the benefits of any combined contraceptives far outweigh the risk of serious side effects
  • prescribers and women should be aware of the major risk factors for blood clots (such as older age, obesity, prolonged immobilisation, surgery, personal history of blood clots, smoking), and be aware of the key signs and symptoms

Symptoms can vary depending on where in the body a clot develops. A clot that develops inside the leg (deep vein thrombosis) can cause a cramping pain, a heavy ache and swelling of the affecting limb. A clot that develops in the blood vessels connecting the heart to the lungs (pulmonary embolism) can cause chest pain, sudden breathlessness and faintness.

What is the risk of blood clots from contraceptives?

The risk of blood clots in the veins varies between combined contraceptives, depending on the type of progestogen they contain, and ranges from five to 12 cases of blood clots per 10,000 women who use them for a year. This compares with two cases of blood clots in the veins each year per 10,000 women who are not using combined contraceptives.

  • combined contraceptives containing levonorgestrel, norethisterone or norgestimate were associated with between five and seven cases of blood clots per 10,000 women who use them for a year
  • combined contraceptives containing etonogestrel or norelgestromin were associated with between six and 12 cases of blood clots per 10,000 women who use them for a year
  • combined contraceptives containing drospirenone, gestodene or desogestrel were associated with between nine and 12 cases of blood clots per 10,000 women who use them for a year
  • the risk associated with combined contraceptives containing chlormadinone, dienogest or nomegestrol is not yet known

However, there are other factors that can increase your risk of a clot, such as age, body mass index and smoking history, and these may change over time.

In which situations is the risk of a blood clot highest?

  • in the first year of combined contraceptive use
  • if you are overweight
  • if you are older than 35 years
  • if you have a close family member who has had a blood clot at a relatively young age
  • if you have given birth in the previous few weeks

If you smoke and are over 35 years old, you are strongly advised to stop smoking or use a non-hormonal method of contraception.

Your risk of a blood clot is increased if you travel for extended periods (for example during long haul flights) or if you have been off your feet for a long time (for example due to injury or illness).

How accurate is the media reporting?

Generally, the UK media’s reporting of this issue is both poor and puzzling. The fact that hormonal contraceptive use can lead to a very small increase in blood clots has been known for decades. Also, this latest advice was actually released in October 2013 by the MHRA and European Medicines Agency. Although the Department of Health has just sent the letters to doctors to tell them about the latest evidence on the risk of thromboembolism.

Importantly, the review reports that women who have been using a combined contraceptive without any problems do not need to stop using it, and that the benefits of any combined contraceptive far outweigh the risk of serious side effects.

To put the risk in context, you are far more likely to develop a blood clot in pregnancy than by using a combined contraceptive.

However, it should be noted there are various groups of women for whom the combined contraceptive is contraindicated (including those who have had a previous blood clot), and those who should use the contraceptive with caution (including those with risk factors for vascular disease such as diabetes). For these groups of women, doctors often suggest alternative hormonal methods (such as the progesterone only pill), or non-hormonal methods of contraception, such as a condom.

How does the new information affect me?

All combined contraceptives increase the rare, but important, risk of having a blood clot. The overall risk of a blood clot is small but clots can be serious and may in very rare cases even be fatal. As said, if you have characteristics that suggest you may be at increased risk of a blood clot, your doctor is likely to suggest an alternative method of contraception.

If you have concerns, you should discuss them with your contraceptive provider at the next routine appointment, but should keep taking your combined contraceptives until you have done so. Suddenly stopping a combined contraceptive may result in accidental pregnancy.

It is important that you recognise when you might be at greater risk of a blood clot, what signs and symptoms you need to look out for and what action you need to take.

Dr Sarah Branch, Deputy Director of the MHRA’s Vigilance and Risk Management of Medicines Division, said:

“Women should continue to take their contraceptive pill. These are very safe, highly effective medicines for preventing unintended pregnancy and the benefits associated with their use far outweigh the risk of blood clots in veins or arteries.

“No important new evidence has emerged – this review simply confirms what we already know, that the risk of blood clots with all combined hormonal contraceptives is small.

“If women have questions, they should discuss them with their GP or contraceptive provider at their next routine appointment but should keep taking their contraceptive until they have done so.”

Analysis by Bazian
Edited by NHS Website

Links to the headlines

Deadly risk of pill used by 1m women: Every GP in Britain told to warn about threat from popular contraceptive

Mail Online, 2 February 2014

Birth control pills could increase chance of getting blood clots

Metro, 2 February 2014

GPs warn 1m women of deadly blood clot risk

The Times, 2 February 2014

Blood clot warning for 1m contraceptive pill users

The Daily Telegraph, 2 February 2014

Pill poses risk of blood clots, GPs warned

The Guardian, 2 February 2014

Blood clot risked doubled for some new contraceptive pills

Daily Mirror, 2 February 2014

Women warned of contraceptive pill blood clot fears

ITV News, 2 February 2014

Links to the science


Press statement: MHRA responds to European Medicines Agency recommendation following review on combined hormonal contraceptives

October 2013

European Medicines Agency.

Benefits of combined hormonal contraceptives (CHCs) continue to outweigh risks – CHMP endorses PRAC recommendation

November 2013

“I think women really need to talk with their doctors before they start a birth control pill, and doctors should try to choose ones that have lower risks,” Wu says. “I wouldn’t start with these riskier oral contraceptives as first-line, first-start pills.”

Because so many women take birth control pills, even small risks can have significant public health consequences.

“You have to consider that 200 million women, every day, worldwide take such a pill. So even if it’s only one in 500 per year who get the thrombosis if they are on a fourth-generation pill and are 30 years old, then you actually get a relatively high number of complications,” says researcher Ojvind Lidegaard, MD, professor of obstetrics and gynecology, Rigshospitalet at the University of Copenhagen, in Denmark. “And you could actually halve that number just by changing the pill from a fourth- to a second-generation pill.”

But experts say switching to an older pill may not be the best option for every woman.

“It is important to have a range of different oral contraceptives available because some women tolerate one preparation better than another,” Philip C. Hannaford, MD, who is the Grampian Health Board chair of primary care at the University of Aberdeen, in Scotland, says in an email to WebMD.

Some women prefer one kind of pill over another, Hannaford says, because they experience less nausea, acne, or weight gain.

“This means that clinicians and women often chose to use combined oral contraceptives which do not contain levonorgestrel, and this seems a pragmatic and sensible thing to do given that the background risk of DVT is very low,” says Hannaford, who was not involved in the research but wrote an editorial on the study.

Smoking, being overweight, family history, and age also increase the risk of blood clots.

Those risks should be discussed with a doctor before starting or switching any kind of hormonal contraception.

Women who are on birth control pills should also be aware of the symptoms of blood clots. Symptoms of a blood clot in the leg can include pain in the calves from walking and one leg swelling larger than the other.

“One of the symptoms patients really need to look out for is shortness of breath because one of the huge risks with DVT is that the clot can travel to the lungs, and that can kill people,” Wu says. “Even though the risk overall is low, I think that the possible consequences are pretty dire. Patients on these riskier birth control pills should know the symptoms to look for.”

The Blood Clot and Birth Control Pill Link

Oral contraception, or the pill, is a popular form of birth control and is also used to treat a number of conditions, such as irregular menstruation and hormone imbalances or acne. But, like all drugs, the birth control pill is not without risks. Certain types of hormonal birth control may increase a woman’s risk of developing a condition called deep vein thrombosis (DVT), a dangerous type of blood clot that usually forms in the legs. The most serious possible complication of DVT is the possibility that a clot can travel to a lung, resulting in a pulmonary embolism — a blockage of an artery in the lung — which can cause death.

Blood Clot Risk Factors

While just about anyone has the potential to develop DVT, some people are at higher risk than others. Women have an added risk if they’re pregnant or if they take certain types of birth control or hormone replacement therapy (HRT), particularly if they have any of the following risk factors:

  • Are overweight
  • Are sedentary or bed-ridden
  • Have injured a leg
  • Have recently had surgery
  • Smoke
  • Have a family history of blood clots, among other things

Douglas Schuerer, MD, director of trauma at Barnes-Jewish Hospital and assistant professor of surgery at Washington University in St. Louis, Ill., says these risk factors “make the patient’s blood ‘hypercoagulable,’ or easy to clot.”

Blood Clots and Birth Control Pills

Although some newer birth control pills contain only a synthetic form of the hormone progesterone, called progestin, most birth control pills contain both estrogen and progestin. These hormones affect a woman’s ovulation cycle (release of the egg from the ovary) and the lining of the uterus, when taken to prevent pregnancy. When used as hormone replacement therapy, they balance out a woman’s natural hormone levels.

The estrogen found in hormonal contraception is what is thought to increase the risk of blood clots — not by forming the clots themselves, but by making the blood more likely to clot. Any type of hormone therapy that contains estrogen, including oral contraceptives, HRT, or hormone patches, carries a risk for hypercoagulability.

Without a doubt, the birth control pill is a convenient and effective way to prevent pregnancy or to replace lost hormones, but how are you to know if the pill is safe for you?

While all medications have risks, it’s often possible to reduce risk factors by taking certain steps. Before starting hormone pills, discuss your individual level of risk for DVT with your doctor. You may be at increased risk if you:

  • Are a smoker
  • Are overweight
  • Travel frequently, particularly in cramped situations (like flying)
  • Have a personal or family history of blood clots, heart disease, heart defects, or stroke
  • Have high blood pressure over 160/100 mmHG
  • Suffer from severe migraines

Blood Clot Warning Signs

If you do take birth control pills, the best way to protect yourself from blood clots, other than reducing the risk factors you have control over, is to know the signs and symptoms of DVT. If you experience any of these symptoms, contact your doctor immediately:

  • Red, painful areas on a leg
  • Temperature differences in your legs (a leg with a clot may be warmer to the touch)
  • Swelling in one area or on one leg
  • Pain or tenderness in your leg
  • Shortness of breath
  • Chest pain
  • Numbness or weakness that is unusual for you

By asking questions and discussing your risks with your doctor before starting hormone therapy or birth control pills, together you can decide what’s right for you and feel good about your decision.

Key Facts

  • Birth control pills are used to treat irregular periods, cramps, acne, PCOS, endometriosis, and other conditions.
  • Taking birth control pills does not change a woman’s fertility as ovulation returns to normal when the Pill is stopped.
  • It’s safe for teens to take birth control pills for years without taking a break.

If your daughter has recently started taking birth control pills or is thinking about taking them, you probably have some questions and worries of your own. Adolescent girls and young women are frequently prescribed birth control pills (also called oral contraceptive pills, hormonal pills, or simply “the Pill”) for irregular or heavy menstrual periods, menstrual cramps, acne, PMS, Primary Ovarian Insufficiency (POI), endometriosis, and hormone replacement therapy. For example, girls diagnosed with Polycystic Ovary Syndrome (PCOS) – a hormone imbalance which causes irregular menstrual periods, acne, and excess hair growth, are prescribed birth control pills to lower their hormone levels (to the normal range) and regulate menstrual periods. Girls with acne that are not responding to simple measures are often prescribed birth control pills. Girls whose ovaries are not producing enough estrogen (due to the effects of radiation or chemotherapy, a genetic condition such as Turner Syndrome, or stress) may take birth control pills to replace estrogen. If the lack of periods are caused by low weight or an eating disorder, the best treatment is healthy nutrition to restore a normal weight. Girls with endometriosis are also often prescribed birth control pills, in cycles or continuously, to suppress the condition. Normal estrogen levels and healthy weight are important for healthy bones. Last but not least, birth control pills are used for birth control.

Does the birth control pill have health benefits?

Yes. The Pill has many health benefits, such as:

  • Regulation of menstrual periods
  • Decreased menstrual cramps
  • Treatment for acne
  • Treatment for polycystic ovary syndrome (PCOS)
  • Lowered risk of anemia
  • Lowered risk for cancers such as ovarian and uterus cancer

Are there any serious side effects from the Pill?

Most young women who take birth control pills have few or no problems. However, birth control pills with estrogen cause a slight increase in the risk of developing blood clots in the legs, eyes, and lungs. If your daughter develops any of the following problems, call her health care provider right away or take her to the closest emergency room:

  • Abdominal or stomach pain (severe)
  • Chest pain (severe), cough, shortness of breath
  • Headache (severe), dizziness, weakness, or numbness
  • Eye problems (vision loss or blurring), speech problems
  • Severe leg pain (calf or thigh)

Remember: ACHES

Does the birth control pill cause blood clots?

There is a very slight risk of developing blood clots in the legs, but much less than the risk during pregnancy. Among adolescent girls who do not take the Pill, 1-10 in 100,000 will develop blood clots each year. Among girls who take combined oral contraceptive pills, the risk increases 3-5 fold or to 5-50 per 100,000 per year. For women who are pregnant, the risk of developing blood clots is twice as high as Pill users and 4-10 fold compared to nonusers.

Is there any way my daughter can lower her risk of getting blood clots while taking the Pill?

Make sure you let your daughter know (and her health care providers) if any of her blood relatives have had blood clots, especially when they were young (in their 20s, 30s, or 40s). There are other factors that can contribute to the likelihood of whether a teen or adult woman develops blood clots such as a diagnosis of Factor V Leiden, trauma, or surgery, being overweight and smoking.

If your daughter smokes, encourage her to quit. If she is planning a flight or long car ride (especially if 6-8 hours or longer), remind her to get up and walk around and drink lots of fluids to lessen the risk of blood clots. If she is having surgery (and will be immobilized and on bed rest for a period of time), talk to her health care provider about whether she should go off the Pill 3-4 weeks before the surgery.

Does the birth control pill cause heart attacks or strokes?

There is no increase in the risk of heart attack or stroke in healthy young women who take birth control pills and don’t smoke. If your daughter is a smoker, encourage her to quit smoking. She can still take the Pill if she smokes, but if she quits smoking, she’ll be healthier for life and her risks from taking the Pill will be less.

Does the birth control pill cause cancer?

The truth is that the Pill actually protects against cancer of the ovaries and cancer of the lining of the uterus. A woman is half as likely to get cancer of the uterus or ovaries if she has taken birth control pills. Most experts believe that taking the Pill does not cause any increased risk of getting breast cancer. Even girls with a family history of breast cancer can take the Pill.

Does the birth control pill cause birth defects?

Birth control pills do not cause birth defects or affect the health of future children.

Is there any trouble getting pregnant after using the birth control pill?

There is no change in fertility with using the birth control pill. Regular periods and ovulation usually start up again right away. However, girls who were very irregular before starting the pill may be irregular after they stop the pill. Girls who have PCOS or lose weight on the pill are particularly likely to be irregular, not because of the Pill, but because of their medical condition.

If your daughter was using the Pill for birth control, she should use another birth control method right away if she doesn’t want to get pregnant. She should talk to her health care provider before she actually stops taking the birth control pill.

How long is it safe for my daughter to be on birth control pills?

It’s safe for your daughter to be on the Pill for years, whether she’s on it to regulate her menstrual cycles, cramps, hormone replacement, or if she’s simply using it for birth control.

Does my daughter need to take a break from the Pill?

There is no medical reason that your daughter would need to take a “break” from the Pill. There are no medical benefits from taking a break. If your daughter were to stop taking the Pill and then go on it again, she could have the same side effects that she already experienced during the first few months of pill use. Also, your daughter would not experience the many medical (non-contraceptive) benefits that the Pill offers.

Will my daughter gain weight from taking birth control pills?

It’s unlikely that your daughter will gain weight on the Pill. Research studies have not shown a connection between birth control pills and weight gain. Some teens gain weight, some lose weight, but most teens stay exactly the same weight when they are taking the birth control pill. Sometimes a young woman thinks she has gained 5-10 pounds, but when weight is actually measured, there’s no change. If your daughter thinks she may have gained weight due to the Pill, she should see her health care provider and get her weight measured. Encourage your daughter to eat a healthy diet. Suggest that she eat 5-7 servings of fruits and vegetables a day, eat normal portion sizes, avoid fast foods and simple carbohydrates such as cookies, cake, sugary cereal, etc. Also, encourage her to be active and exercise or take part in an activity that she enjoys.

Will the birth control pill have any negative effects on my daughter’s growth?

No, the birth control pill will not affect or hinder your daughter’s growth if she has already started her period. By the time she has her first period, she is already at 95% of her final height. A girl grows about 2 inches in the 2 years after her first menstrual period.

Will the Pill make my daughter’s cramps better?

For girls who experience severe menstrual cramps and over-the-counter medications do not help, birth control pills may be the solution. Birth control pills can help to decrease menstrual cramps. Because the combined birth control pills prevent ovulation, they also get rid of pain that your daughter may experience with ovulation in the middle of her menstrual cycle.

Will the Pill make my daughter’s menstrual periods more regular?

For girls whose menstrual periods are irregular (too often or too late), birth control pills can help to regulate the menstrual cycle to every 28 days. Birth control pills can also reduce the amount and length of menstrual bleeding.

What if my daughter’s period is very light while she’s taking birth control pills?

Your daughter’s period may be so light when she is taking birth control pills that she may only have a brown smudge on a tampon, pad, panty shield, or her underwear. The hormone doses in birth control pills are very low. This means that the lining of your daughter’s uterus doesn’t become very thick, so very little blood needs to come out each month.

Will the birth control pill make my daughter’s acne better?

Birth control pills usually improve acne. For moderate to severe acne, which over-the-counter and prescription medications haven’t cured, birth control pills may be prescribed. The hormones in the birth control pill can help stop acne from forming. It doesn’t usually matter which type of birth control pills your daughter takes, since most of them can be used to treat acne. Encourage your daughter to be patient though, since it may take several months to see a difference with her acne.

What if my daughter has PCOS? How do birth control pills help?

If your daughter has PCOS, you’re probably already aware that PCOS can cause irregular menstrual cycles, excess hair growth, and acne. One of the treatments prescribed for PCOS are birth control pills (oral contraceptives), because the hormones (estrogen and progestin) in the pill regulate menstrual cycles. Birth control pills allow the endometrial lining to be shed every four weeks so your daughter’s menstrual period will be regular. Because birth control pills cause women to menstruate regularly and shed the endometrial lining on time, they reduce the risk of endometrial cancer. Birth control pills also improve acne and lessen excess hair growth, which is another reason they are used to treat PCOS.

What if my daughter has endometriosis? How do birth control pills help?

Hormonal treatment such as birth control pills either taken in cycles or continuously are felt to relieve symptoms associated with endometriosis in 8 out of 10 patients. The Pill does not cure endometriosis, but when prescribed continuously, it will stop your daughter’s period along with the pain that is often associated with it and lessen the chance of the endometriosis growing.

Will my daughter start having sex if she goes on birth control pills for acne or any other medical reason?

Your daughter will most likely not start having sex if she goes on the Pill for reasons other than birth control. If she goes on the Pill for one of the medical reasons, she is probably just thinking about treating whatever the problem is. Her decision to have sex will likely be completely independent from her decision to go on the Pill at this time. Your daughter will choose to start having sex when she is ready, which involves much more than just when birth control is available.

What other medical benefits does the pill have?

Because there is less menstrual bleeding with the use of birth control pills, your daughter is less likely to get anemia (low number of red blood cells, which carry oxygen from the lungs to the tissues). Birth control pills also decrease the chance of getting endometrial (lining of the uterus) cancer, ovarian cancer, and ovarian cysts.

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