Dear Anne, I just read that birth control pills can cause blood clots and cardiovascular problems. Should I stop taking mine? -- J.S.
Since their inception in the 1960s, oral contraceptive pills have revolutionized the way we have sex. For millions of women then and today, these tiny hormone tablets are more than a mixture of synthetic estrogen and progesterone: They're a symbol of sexual and social autonomy. Oral contraceptives are ubiquitous, tucked in the purses and medicine cabinets of many U.Va. undergraduate women and 16 million women in the United States. Indeed, of all the medicines we take, this is the one that has earned the moniker "the pill."
In addition to helping take the procreation out of fornication, birth control pills have been linked to a number of health benefits. Most compellingly, studies have found that a woman who takes oral contraceptives for at least five years has about a 50 percent decrease in her lifetime risk of developing ovarian and endometrial cancer. Many women are prescribed birth control pills for their ability to regulate menstrual cycles, while others find they help curb PMS symptoms.
Despite their benefits, oral contraceptive pills come with real risks and are not right for everyone. The most dangerous complication of estrogen-containing birth control pill use is the development of blood clots, and the risk of such an event rises exponentially when combined with smoking. Migraine headaches associated with visual symptoms also bump up the likelihood that pills will precipitate a clot, as does any disorder that makes blood more prone to coagulate.
Typically clots first show up on legs, forming the dreaded "DVT" or deep-vein thrombosis. The affected limb usually becomes reddened, swollen and painful. Although nobody likes a big red leg, the real danger in a DVT lies in its ability to break off and head for the lungs. This condition, known as a pulmonary embolism, can present a minor shortness of breath or, in severe cases, sudden death. Bear in mind that, for a healthy non-smoker, the risk of developing a blood clot while on the pill is still far less than the likelihood of developing dangerous complications with pregnancy.
Other rare problems associated with OCPs include high blood pressure and, infrequently, a benign liver tumor that can sometimes rupture, causing acute blood loss manifesting itself with abdominal pain. Perhaps most concerning, recent research reported at the American Heart Association meeting Nov. 6 revealed hormonal contraceptives caused a significant increase in atherosclerosis. The study, performed last year at the University of Ghent in Belgium, used ultrasound to investigate the arteries of 1,300 healthy women and found a 20- to 30-percent increase in plaques for every 10 years of oral contraceptive use. It's not clear what this new data means for us, since the OCPs taken by the women in the study had much more estrogen than the pills we pop today, and we can be somewhat reassured that other studies haven't yet found an increase in heart attack with hormonal contraceptive use. Nevertheless, for a country that produced "Fast Food Nation" and boasts a greater than 30-percent obesity rate, learning about yet another factor that might raise our risk of cardiovascular disease should also raise some serious red flags.
Fortunately, there are ways you can work to decrease your risks while on birth control pills, which remain a safe, reliable method of pregnancy protection in most women. Most importantly, if you smoke, stop. Consider using a lower-estrogen preparation of OCP, although bear in mind that if you weigh more than 175 pounds you're not going to get full pregnancy protection from this option. You can also think about the so-called "mini-pills," which don't have any estrogen and thus aren't associated with clotting risk. Avoid the patch, which releases much more estrogen than modern preparations of oral contraceptive. Realize that contraceptive rings such as NuvaRing have the same risks -- and benefits -- as oral-combined hormone preparations; they're merely a different method of delivery. Be skeptical of advertising campaigns for new, brand-name birth control pills, which often tout their product's ability to treat everything from bloating to the plague. Often they contain newer synthetic hormone preparations that haven't been around long enough to be well-studied, so we don't know much about their cardiovascular risk profiles.
Anne Mills is a Cavalier Daily Health & Sexuality Columnist. She can be reached at mills@cavalierdaily.com or through the Sex & Balances submission page at cavalierdaily.com/sex.asp. This column should be used for educational purposes only and is not meant to substitute advice from your doctor.
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