Contraceptive Conundrum

Whether it is arsenic in your apple juice, or blood clots from taking birth control pills, it is always disconcerting to hear that something you thought was safe may in fact be risky.

Posted on | Lauren Streicher, MD | Comments ()

Whether it is arsenic in your apple juice, or blood clots from taking birth control pills, it is always disconcerting to hear that something you thought was safe may in fact be risky.

The drospironone clot issue first came to light in May 2011 when two studies suggested that drosperinone, one of the hormones in Yaz ™, Yasmine, ™ BeYaz™ and generic equivalents, might increase the risk of a life-threatening venous thromboembolism, a clot that forms in blood vessels and then breaks off and travels to other parts of the circulatory system, potentially causing a stroke or heart attack. Many other studies did not show such an association, which is why the FDA decided to review all the data and determine if there was reason for concern.

On December 8, an FDA committee met and decided that drospironone may have a slight increase in risk over other pills, but the data was not conclusive enough to tell women to stop taking drospirinone products or to pull them off the market.

Keep in mind that all hormonal contraceptives with estrogen will increase the risk of blood clots, particularly in women who are smokers or who are obese. Additional risk factors include a genetic predisposition to blood clots, recent surgery, cancer, and/or prolonged immobilization. Fortunately, blood clots in young women are very rare events, which is why knowing the actual numbers helps to keep things in perspective. 

  • The likelihood of a blood clot if not on birth control pills is 2-3 for every 10,000 women
  • The likelihood of a blood clot when taking birth control pills is 3-9 for every 10,000 women
  • The likelihood of a blood clot during pregnancy is 5-20 for every 10,000 women
  • The likelihood of a blood clot post partum is 40-65 for every 10,000 women 

Clearly, anyone can develop a blood clot, but it is far more likely during pregnancy or after delivery than while taking contraception. Also, most clots occur in the first few months of pill use, so women who have been on pills for years are at significantly lower risk.

Ultimately, the FDA concluded that the benefits outweigh the risk and since the data is not conclusive, the FDA is not currently recommending that women stop taking drospirinone products. The only outcome of the meeting is that, in a move similar to the European counterpart to the FDA, product inserts will now reflect the concern.

My recommendation? There are lots of hormonal contraceptive options out there and, if you are more comfortable taking a non-drospironone product, call your doctor and ask to switch to a pill containing levonorgestrol, another progestin.  On the other hand, if you have no other risk factors and your current drosperinone pill is the only pill that controls your acne, PMS and doesn’t cause breakthrough bleeding, it’s fine to keep taking it. 

Blog written by Lauren Streicher, MD
Dr. Lauren Streicher is an Assistant Clinical Professor of Obstetrics and Gynecology at Northwestern University’s medical...