Blood Clot Risk Linked to Some Non-Pill Contraceptives

THURSDAY, May 10 (HealthDay News) — Some women using hormonal
contraceptives other than birth control pills may have an increased risk
for serious blood clots, Danish researchers report.

These alternate hormone-releasing birth control methods include skin
patches, implants and vaginal rings. To reduce the risk, women who use
these should consider switching to the pill, the researchers said.

Deep vein thrombosis is a kind of clot that typically originates in the
legs and can travel to the lungs, where it becomes an often deadly
pulmonary embolism. Both types of clots combined are called venous
thrombosis, according to the study. Symptoms include leg pain, chest pain
or sudden shortness of breath.

“The transdermal patch and vaginal ring confer at least a sixfold
increased risk of venous thrombosis as combined pills with desogestrel or
drospirenone, a risk which is about twice the risk among women using
second-generation pills with levonorgestrel,” said lead researcher Dr.
Ojvind Lidegaard, a professor of obstetrics and gynecology at the
University of Copenhagen.

However, hormone-releasing intrauterine devices (IUDs) do not increase
the risk of venous thrombosis, he said.

“Women should be informed about these risks in order to be able to
choose the most appropriate hormonal contraceptive product,” Lidegaard
said. “There are hormonal contraceptive alternatives which confer less or
no risk of venous thrombosis.”

Common implants include Implanon and the newer Nexplanon; Ortho Evra is
the patch and the ring is NuvaRing. These products gradually release
hormones into the body to prevent pregnancy.

Methods like the sponge (Today Sponge), which uses a spermicide rather
than hormones, were not addressed in the study.

The findings were published May 10 in the online edition of the
BMJ.

For the study, Lidegaard’s team collected data on incidents of venous
thrombosis in Danish women using methods of birth control other than the
pill. All the women were aged 15 to 49, and none were pregnant.

The researchers found that between 2000 and 2010 there were more than
3,400 diagnoses of venous thrombosis.

For women who did not use any type of hormonal contraceptive, two women
developed clots for every 10,000 (combined) years they used
contraceptives.

For women taking the pill containing the hormone levonorgestrel, the
risk for a clot was three times higher, or 6.2 clots for every 10,000
years they took the pill, the researchers found.

The risk to women who used a skin patch was about eight times higher,
or 9.7 clots per 10,000 exposure years.

Women who used a vaginal ring had a 6.5 times higher risk, or 7.8
events per 10,000 exposure years).

For women who used an implant that contained only progestogen, the
increased risk for clots was very small. There was no risk for women using
a progesterone-only IUD and it may have has a protective effect, the
researchers noted.

There was no reduction in risk with the long-term use of a patch or
vaginal ring, they added.

“For the majority of young women, the recommendation is
second-generation combined pill with levonorgestrel, and for women who
have given birth, that a hormone-releasing intrauterine device is an
attractive option, because it at the same time does not increase the risk
of venous thrombosis, perhaps even protects against them, and reduces
menstrual complaints,” Lidegaard said.

To cut the number of women who develop clots from these riskier birth
control methods, the authors advised that more women choose the pill.

Dr. Elizabeth Poynor, a gynecologist and pelvic surgeon at Lenox Hill
Hospital in New York City, commented that “over the past years, newer
versions of combined hormonal contraception have been developed.”

“While these types of transdermal hormonal contraceptives may be more
convenient for some women and lead to better compliance with appropriate
use, they have their own set of medical side effects and concerns,” she
said.

“This highlights the importance of reviewing the risks, benefits and
alternatives among differing types of medications within the same broad
category,” Poynor added.

For some women, these types of medications are extremely useful, but
their potentially elevated risk of thrombosis should be reviewed before
prescribing them, Poynor stressed.

More information

To learn more about contraceptives, visit the Planned Parenthood.

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