Increased risk of blood clots with newer contraceptive pills
The contraceptive pill has been a trusted method of contraception for Australian women for over 50 years but it has also been found to increase the risk of developing dangerous blood clots. Ellen Patterson speaks to women with their own experience of deep vein thrombosis.
Hannah Paskal has to inject herself with three needles on long-distance flights: one 24 hours before departure, one directly before and a third not long after landing. It is one confronting way to overcome a fear of needles but Hannah is amused by the irony. “It’s funny because I’ve always been the type of person who can just get on a plane and sleep,” she says. “I slept for ten hours on the way back from South America, woke up and it was breakfast! Now I have to set my alarm every hour, get up and walk around and give myself all of these injections.”
The three needles are a precaution against Deep Vein Thrombosis (DVT) or a blood clot, which develops in the veins of the leg. Hannah developed DVT last December from being on the contraceptive pill and had to cancel a trip to Cambodia at a week’s notice. She lives in Bondi, has almost finished a Masters of Arts at the University of New South Wales, along with a sociology-legal degree from the University of Sydney, and has backpacked throughout Asia and South America. Her love of travelling, yet not having travelled for two years, makes it even more ironic that an active, healthy 23- year-old with no family history of blood clots recently had a serious scare.
The US Food & Drug Administration (FDA) announced in recent times that birth control pills containing drospirenone, a type of progestogen hormone would be labelled with a higher blood clot risk. These are known as ‘third generation’, or newer pills including Yaz, Yasmin, Safyral and Ocella. To put this into perspective, the FDA says that, “The risk of blood clots is higher when using any birth control pills than not using them, but still remains lower than the risk of developing blood clots in pregnancy and in the [post-natal] period.”
Hannah had been on the contraceptive pill Estelle for three years without suffering any negative side effects when she discovered a blood clot in her calf. Approximately 30 per cent of women in Australia take an oral contraceptive pill and, according to the FDA, third generation combined oral contraceptives have a higher clotting risk. Although the original drug, introduced to Australia in 1961, contained more hormones than today’s version, there remains the risk of developing a blood clot.
Pharmacist Gail Bell, 61, has worked in hospital and retail pharmacy her entire life and has witnessed the evolution of the pill in Australia. “What I think [pharmaceutical companies] have done is they have tweaked the molecules a bit, quite a bit,” Gail says. “Such that what we had 30 or 40 years ago was a blunter tool, now we’ve got a sharper tool.” She points out that the combinations are slightly different and that DVT is now monitored more often today. “Well I looked up one of my old uni text books from many years ago and found instances of women dying from DVTs back then from taking the pill I was on.” Gail remembers going on Lyndiol in 1968, which contained 2.5 milligrams of oestrogen, “So my generation were taking some pretty heavy amounts of hormones, but you know we’re still standing.”
While the risk is low, DVT is potentially fatal if it is not detected and treated in time. It generally develops in the leg and if the blockage builds up for long enough, part can break away shooting off to the brain, heart or lungs causing a stroke, heart attack or pulmonary embolism- when the lungs collapse. When Hannah’s clot was detected, it was at a volatile stage. “It was quite warm, but just looked like a really swollen calf, kind of bruised and hard and there was a throbbing pain whenever I was still,” she says. Her doctor immediately advised her to stop taking the pill and begin treatment that was inconclusive. “The tests didn’t prove whether the pill was a contributing factor or whether it wasn’t, which is kind of annoying,” Hannah says. Hannah was not immediately aware of her condition. She mistook the blood clot for a calf muscle injury and rubbing tiger balm into her muscle, with heat and pressure aggravating the clot.
Medical Director of NSW Family Planning, Dr Deborah Bateson, explains that you cannot actually test whether the pill leads to DVT. “You obviously test to diagnose a blood clot,” she says, “but unfortunately you’re not always able to pinpoint what the cause is.” It then comes down to a process of elimination. “You have to be very careful that you try to exclude other causes such as obesity, smoking, recent flying and often it’s a very mixed pattern and some people will have a genetic tendency to blood clots as well,” Dr Bateson says.
On average between five to 15 out of 100,000 women who are not taking the contraceptive pill will get a blood clot. Dr Bateson says, “Now there is some variation and this could be that for some pills this increases up to 25 or 30 more, but then again,” she says,” these are still very low numbers.” Dr Bateson stresses that it is a matter of putting things into perspective, “The pill will slightly increase the risk of blood clots, but because the baseline risk is so low that additional risk is very low indeed for most women.”
Renee Chapman of Coffs Harbour had a pulmonary embolism when she was 26 from being on the pill and like Hannah, did not realise the risk of developing DVT. After suffering asthmatic symptoms she took herself to hospital and there she could read the expressions of the medical staff before getting any results. “You know that look that says, ‘We aren’t going to say anything but there is something very wrong’”. Renee was placed under observation for four days in case a blood clot travelled from her lung to her heart, which would have caused a heart attack. The experience has caused post-traumatic stress for Renee who still gets anxious when she has to travel for work. “I wish women knew about what blood clots really are. I hear of so many young women being placed on [the pill] without any knowledge of what could occur,” she says, “much like I was.”
Pharmacist Gail Bell believes there is an issue of complacency surrounding the pill and cannot remember the last time anyone with a first time prescription for the pill asked her for advice. “It doesn’t happen. I mean if it was some rare antibiotic or some new drug on the market, people usually ask, “Ooh what is this?” But you know, everyone is on the pill, it’s been around for sixty years and all their friends are on it.”
Hannah has been off the pill for four months now and doesn’t feel comfortable going back on it for now. Considering other forms of contraception, she says, “I would much prefer just to take a pill every day. It’s convenient, it’s just a habit and it’s not gross. It’s kind of just the easy option.” I guess this is the philosophy of many young women in thinking that nothing will go wrong; it’s just a little pill after all. Pharmacists and doctors ultimately cannot make up a person’s mind; everyone makes their own life decisions. Even though the likelihood of developing DVT from the pill is rare, sometimes like Hannah, you are just unlucky so it is imperative to be aware of the risks.